[00:00:00] Micaela: So I, I think in general, you know, prescribing the pain medications isn’t always the most influential part of it, as is helping them to see how much it’s a factor because they can build an enrichment program that doesn’t include anything that flares that up. And we don’t need to go necessarily to heavy doses of pain medications just so that they can chase the ball. We can use enrichment as pain control.

[00:00:24] Allie: Welcome to Enrichment for the Real World, the podcast devoted to improving the quality of life of pets and their people through enrichment. We are your hosts, Allie Bender…

[00:00:42] Emily: …and I’m Emily Strong…

[00:00:44] Allie: …and we are here to challenge and expand your view of what enrichment is, what enrichment can be and what enrichment can do for you and the animals in your lives. Let’s get started.

 Thank you for joining us for today’s episode of Enrichment for the Real World, and I want to thank you for rating, reviewing, and subscribing wherever you listen to podcasts.

The voice you heard at the beginning of today’s episode was Dr. Micaela Young. Dr. Micaela Young is a veterinarian and a certified professional dog trainer, knowledge assessed. She started her career in a community practice in Germany, and shortly thereafter entered the training world when an accident with her mom left them in need of a hearing alert service dog.

Preparing for veterinary school while at West Virginia University, she met a life-changing dog called Patty, a 14-year-old heeler who had been living in the kennel area of the vet clinic for over a year. Patty joined Micaela at veterinary school in Davis, California and taught her about living with severe separation anxiety as well as resource guarding, cognitive dysfunction, and senior dog enrichment.

Deeply inspired by Dr. Sophia Yin and egged on by Patty, Micaela pushed to take advantage of every available behavior related learning opportunity in veterinary school. While in California, Micaela started Happy Lead, first, a basic training company, and today an ambulatory service veterinary practice.

Micaela now lives in Seattle, Washington, offering services at home via Happy Lead and in a local clinic. She can be reached at HL home vet at gmail.com and you will not find her on social media. Good for you, Micaela. I have been hearing about Micaela and how awesome she is for a while from both Emily and Ellen since Micaela sees their pets. I’m so jealous that they live in an area where Micaela serves. And now that I’ve heard this interview, I am jumping right on that admiration bandwagon with them. This is absolutely one where I’m going to listen a few times through to make sure I don’t miss anything. I was hooked.

In this episode, you’re going to hear Emily and Micaela talk about, do you know how to identify chronic pain or only acute pain? Micaela’s list of how to identify less obvious signs of pain, the gut-brain, skin axis and the new four-letter F word. Alright, here it is, today’s episode, Dr. Micaela Young, When Medical Problems Become Behavioral Problems.

[00:03:16] Emily: Okay, so tell us your name, your pronouns, and your pets.

[00:03:21] Micaela: I am Micaela Young, uh, she her, and right now I have two, I have a pair of dogs. Um, so my first dog is Echo. She is my mom’s dropout hearing alert service dog because she is as I call, recovering reactive, um, and did not appreciate the 12 grandkids. So, she’s with me and then her dog is Curie, who is a lab husky that I brought home, mid vet school, who was my spay lab dog. So, I saw her interactions with the other dogs and I said, that’s my dog’s dog. So, they are best friends, and despite me thinking I was going to have old dogs for a long time. I ended up with two young ones.

[00:04:02] Emily: So, she’s the other dog’s emotional support dog?

[00:04:05] Micaela: Yes, yep. Exactly. Slash co-conspirator.

[00:04:10] Emily: Yeah. Yeah. It, it’s like, how, how is it emotional support if they’re like getting each other riled up?

[00:04:17] Micaela: And she says, “Hey, hey Curie. I can’t reach this. Come over here and get this off the counter for me.”

[00:04:21] Emily: Yeah. That’s pretty cute. Uh, so tell us your story and how you got to where you are.

[00:04:26] Micaela: I, I thought a lot about this, because it’s not a linear story and it’s not a typical, “I’ve wanted to be a vet my whole life” story either. I actually had to call my mom earlier to clarify something. So, I grew up on a military base and when I was a kid, my mom told me that kids weren’t allowed in the vet clinic and in my adulthood, I’ve been thinking back, I’m like, “Was that a clever lie she told so that she didn’t have to deal with pets and kids in the clinic?” So, I called her earlier. No, that was real. Um, and that was because the community vet clinic was also where they treated the military working dogs, so kids weren’t allowed to go. So, I didn’t set foot in a vet clinic until I was 17.

I basically said, “Well, let me give this a shot.” Because I had an opportunity and then ran with it. And midway through my program, uh, with that clinic, two things happened. One, I was picking up my friend from school and a dog ran behind my car as I was parked and was hit, and I spent the rest of my day counseling her owner.

Once she came out and realized, then I had to give her the news. and then some months later, my mom, who is hearing impaired was nearly run over by a semi-truck while she was sleeping in a tent and didn’t hear it. So, we kind of as a family unit did owner trained service dog for a hearing alert dog since the programs overseas aren’t really good for access.

So, we got into training together and then really ran with it from there. Then on my way to vet school, I of course, got a little bit frustrated with how much wrestling I was watching in the veterinary clinic and found Sophia Yin. Decided to go to Davis for her and didn’t make it there in time.

And on my way to vet school, brought along a 14-year-old cattle dog who’d been living in the clinic I was working in, and she was a project. So, Patty, Patty was my entrenching dog into this sector of the profession where I was darn lucky that classes were partly virtual because I could not be gone for very long without coming home to an absolute separation anxiety disaster, among other things. So, that’s how I really ended up as firmly in my camp as I am.

Then after graduating, I was in a clinic for a while and I decided I was going to leave incidentally as the pandemic was hitting, and I happened upon a doctor who’d been doing house call medicine for 26 years. And she was in her late sixties, did not want to be out mid pandemic, so I started doing her calls.

Boy, what a difference did that make. So, I fell in love with the house call side of things, and all the pieces just fit together. That house calls work really well with behavior, so now where I’m at is, um, I have a house call training company, Happy Lead, and I also do a couple of days in a clinic, a week.

So, I have the opportunity to do virtual, and I know that we’ll talk about this a little bit, my process later, but virtual coaching, in-home care and training, and in clinic care. So, I’m trying to straddle everything so that some of these dogs can have, and cats too, can have continuity of care where they receive it best.

[00:07:38] Emily: I love that. And full disclosure for everybody listening, Micaela is my vet. And so, I can attest to how much of a difference it makes for our nervous kiddos to just have that in-home care. So, I, I am really grateful that you are here and a resource, and I, my hope is that what you do becomes more common in the profession everywhere, not just here.

[00:08:04] Micaela: Me too. Me too. It feels like it’s disappearing. and nobody taught me about it in school. So, if I hadn’t happened upon Sybil Murray in Vacaville, I I probably would’ve not even thought of it as an

[00:08:18] Emily: Yeah, Yeah, I mean, I think the movement towards, you know, more technology and more virtual services, is great and important. And also, I don’t think that that’s incompatible with increasing, like in-home services. I think those two can go really well together, go hand in hand. As you are proving, right? Or demonstrating anyway. I hope that this becomes a more common phenomenon. So, let’s talk about that intersection between medicine and behavior. Cuz that’s, that is your niche. That’s where you, you firmly sit is in that intersection. And I think what’s interesting is that a lot of people know, in theory, that this is a consideration that we need to be paying attention to medical issues, uh, and how they relate to behavior and vice versa.

There’s, there seems to be some common awareness that health can impact behavior, or physical health can impact behavior. But in practice, it seems to me that it’s much less common for people to know exactly what that can and should look like. So from your perspective as a vet who’s also a trainer, what are some things that pet parents should pay attention to, and what are some things that behavior professionals should be thinking about as they’re working with, either a client’s pet or their own pet?

[00:09:35] Micaela: This is my soapbox moment.

[00:09:37] Emily: I’m giving you that moment. Go for it.

[00:09:41] Micaela: Yes. Um, I have, yes. I have so many ways to answer this. So, um, I’ll try to be kind of point by point here. So, if I am able to just ask pet parents to do a couple of things, one is to just observe. And they don’t have to be an expert in dogs in general, and they don’t have to be an expert in the way that dogs move, or the way that their bodies necessarily work. They just have to be an expert on one individual animal, or multiple if they happen to be a multi pet household. But especially so when there’s a problematic behavior that’s happening, and this goes for every age group, and I will touch on that later. Pay attention to the intensity or the frequency of the problematic behavior in relation to what activities you’ve been doing with them. And you might think there’s no relationship. But there’s a lot of cases that come to me where it isn’t until I talk with them about paying attention to this, that they realize, if not the night after the day or the day after that, once they’ve gone out and done a hike, or they’ve gone and thrown the ball a lot, um, or some other high intensity exercise opportunity, that that behavior is worse. And that’s contrary to what so many trainers are coaching owners will happen. I get, uh, I just opened up a, a, a newer book and the very first intervention was, is your dog getting enough high intensity exercise?

I’m internally screaming because we don’t wanna start there. We wanna start one step before that and say, is high intensity exercise appropriate for this dog? So just to, you know, pay attention if you’re trying to wear them out and things are getting worse, there might be something internal going on. And most owners only know how to recognize acute pain. Most owners only think that an animal is going to limp, and yelp, or whimper, maybe take on a, a little hunched posture, maybe hold their head a little bit low, when they’re in pain.

But so, so many of them are in chronic pain, and that’s a different beast. Chronic pain waxes and wanes. Chronic pain has a delay after exercise where it gets flared up. You know, usually the effects of chronic pain are behavioral and the animal has time to learn how to compensate so that limp is not going to be near as pronounced as if it had just happened. And it affects the decisions that they make, and it affects their emotional interpretation of other things that are happening around them. And none of those things fall under our typical way that we recognize pain. And so, I spend a lot of time teaching people to, to look out for those things. I have a list of obvious things that we think of with pain and, and less obvious things. So, is it okay if I share my list?

[00:12:29] Emily: Yes, please.

[00:12:30] Micaela: Okay. And I don’t claim that this is comprehensive. So on the obvious side, aversion or avoidance to handling. Especially handling that is coming from a familiar person or that has been successful in the past. For example, I have seen dogs that appear to really like to be petted, but what they do is they come over and they offer their shoulders, and then as soon as the parents go to scratch their butt, they sit down and turn around and put their shoulders back and reach.

Like I said before, taking on that hunched posture or low head carriage. I see this more in little dogs where we don’t have the same perspective of their posture as we do with the larger dogs. That bunny hopping gate is one that’s pretty typical for us to talk about that that could be a red flag for some, some pelvis issues.

Self-isolation. So especially for dogs who are usually social, or I will say generalize and say animals that are us, usually social. Cats are of course the poster child for self-isolation when they’re in pain. And then that, that hesitation or that winding up to a jump. My mom’s service dog was blowing a disc and because she was a service dog, she went everywhere in the car. And one day she said, I don’t wanna get in the car. And she looked looking away, lip licking, kind of backing up, going forward, thinking about it, and the next day her back legs didn’t work. So, it’s not always gonna progress that quickly, um, but those are definitely things to look out for.

Then going on to less obvious, and this is where trainers have an opportunity to bring up some red flags. One of the things I will do with dogs is I’ll ask them, okay, what, what are you willing to do for training? For example, you’re a two-year old dog, you should be able to put your paws up on an elevated platform and stay there with some duration. So, I’m going to, you know, play a shaping game with them and ask them to do it. Dogs with painful situations in their hind end are going to do it a couple of times, and then many of them that say, ” That’s not worth it, I don’t wanna play this game.” And they may just walk away. They may just disengage. A good amount of them that still want to interact are going to negotiate. They’re gonna say, ” Oh, what if I offer you my paw? Do you like a down?” So, I take that as feedback.

There are dogs who just have a really low threshold for hyper arousal states. Beyond what we typically see. Course we have, you know, some breed types that go into hyper arousal more easily than others, and individuals too with, you know, working line traits. But that, that’s something that I’ll circle back to, um, here when I have a case to share.

High latency with fluent skills. So, they know sit, they’ve known, sit their whole life. They’ve done sit in many contexts, and now they’re looking at you saying, ” Is this gonna be worth it? Do you really wanna sit? Like, how much do you mean this?”

Then I see, and I say this again, for the younger dogs that have difficulty maintaining a consistent speed, so you get them on a leash and they’re either walking or sprinting and there seems like there may be no in between. They don’t seem to be willing to trot. And that goes on leash and off leash. Off leash decision making is more diagnostic of how they’re really feeling inside because there’s not the influence of what they ex think we expect from them.

Same thing goes for taking stairs. I’ve met young dogs that have hind end issues that take stairs as fast as they can just to get it over with.

Noise intolerance, especially noises that cause a startle. There are absolutely dogs that are noise sensitive because the noise itself is aversive. There are a lot of dogs for which the noise is aversive because it causes a startle, and it causes them to tense around something else that’s painful.

And then altered sleep duration or quality. So, this is true, I would say more so in the older population, that you start to see them shifting more frequently, or waking up in the middle of the night. And that of course, can also be related to cognitive dysfunction, but when there’s the absence of any other signs of cognitive dysfunction, and now they’re waking up at, you know, 2:00 AM and pacing around, it’s probably because they’re not comfortable sleeping and moving painful joints helps to soothe them.

So, those, those are some of the less obvious things that, and some of these trainers can identify, some of these pet parents need to know about so that they can identify. So, if you’re, if you hear some of those things coming up in history, you don’t have to jump to the conclusion that there’s pain present, but you can jump to the conclusion that you need them to gather more data and start to investigate.

[00:17:09] Emily: Yeah, I think all of that. I mean, I was like cheering on the whole time you were talking because all of that is so important, and oftentimes overlooked. I also would like to hear your thoughts about other, illnesses and diseases that don’t necessarily cause pain, but like, for example, metabolic diseases that can, first, like the most, the first most obvious symptom is not actually a physical symptom, but of a behavioral one. And the example I’ll use is, one that we’ve discussed where I think a lot of people erroneously believe that hypothyroidism causes aggression, but it’s a lot more nuanced than that. That’s not actually what’s going on. And yet I know why people think that, because I’ve had cases where we’ve done everything, the dog has been on medication, we’ve been doing an enrichment framework, and training, and the progress is slow. The dogs on an anxiolytic, and then when they finally get diagnosed with hypothyroidism, and get the proper medication, suddenly everything is easier for them, right?

So, I understand why people believe that hypothyroidism causes aggression, but can you speak a little more about diseases that don’t necessarily cause pain? But that can influence behavior and specifically what trainers should be looking for to maybe suss that out as something where they need to actually rope in a vet.

[00:18:34] Micaela: Absolutely. I think a lot of the metabolic diseases that link in have to do with signs that are go, going to look, potentially like house soiling or gastrointestinal issues, which absolutely can link into each other. The hypothyroidism topic in general, I think is an entire conversation in itself. But just to say there are a lot of other things that can cause the thyroid levels to drop. Thyroid level drops in the face of most other conditions. So, running that by itself just because of behavior isn’t necessarily the place to leap. Especially running that test in isolation without getting the whole picture. I was just pulling up a study in 2019, it was 20 client own dogs and they supplemented with thyroid hormone and measured behavior outcomes, and while the general activity level increased, the behavior signs themselves did not change.

So, behavior research being what it is, often small sample sizes, but there’s one, uh, section of evidence. And I know that it’s, it’s a big topic on its own, but there’s other things to, to keep in mind that could be present. So, diabetes and Cushing’s disease often lead to that overeating, over drinking, peeing too much, and in a dog who is typically anxious, and panting, and pacing, might take a while to recognize that. But, then there’s also, you know, the, the Great Pretender disease, Addison’s Disease, which you, I know, have some personal experience, um, with Brie. And that is something that I talk with people semi-regularly, and that’s where I really like to have a blood work panel from the start with any dog that’s been having gastrointestinal issues along with anxiety problems, because it’s relatively easy to rule out, it’s difficult to recognize, and when it goes on too long, we can end up in a crisis state where it’s more likely to be very, very serious. So, in my opinion, it is always worth the money to rule out.

And sometimes that’s just as simple as running an electrolyte panel and checking their cortisol, and that makes us feel like we are not going to be ignoring something that down the road could be a very big deal. Along those same lines, I mean, we have so many dogs that have either gastrointestinal issues in their own right or secondary gastrointestinal issues from being anxious.

And I’m asking myself in those situations, especially where we’re using medications, we’re putting the medication into the dog’s intestinal tract, is it crossing the intestinal tract? So, there are cases where absolutely I wanna start behavior meds, but we’re not going to have the confidence that if it didn’t work, it didn’t work because it wasn’t a good fit, or it didn’t work because it wasn’t actually getting into the dog efficiently.

So, we’re gonna work out the gut first. and there are some other kind of more weird and wonderful things too, which is, you know, if a dog is losing protein into its gastrointestinal tract, and I’m giving it fluoxetine, well fluoxetine needs pro protein to travel around the body, so there can be some really interesting things with that as well.

So, in general, I’m, I’m really liking that we are starting to talk about the gut-brain skin axis. And I’m hoping for more directed research, because I, I talk about probiotics all the time, and at this point it comes with the caveat of A, I have no way of telling if this is a mechanism in your particular dog, and B, I have no way of knowing if this particular species of bacteria that we’re supplementing works in a general sense or only for some populations of animals.

So, I really see each patient like this mystery lock, and I have a whole chain of keys, and I don’t know which one goes, but some of them look like they’re more likely to fit than others. So, we’re gonna start there, and then we’re gonna take feedback and try again if we need to. I try to set that expectation really early.

[00:22:47] Emily: I love that. And I, I love that analogy. I think it’s a really helpful analogy and it’s kind of similar to, we, we talk to our clients about test and eval. Um, so if it, d- you know, if it doesn’t work, it doesn’t mean that it failed. It doesn’t mean that like all hope was lost. We we’re just trying, uh, like a series of things that are possible to kind of rule out, possible explanations for what’s going on, or possible strategies that may be more or less effective.

So, I really love the key analogy cause I think that’s a very succinct way of getting that message across. This kind of brings up something that is a little bit of a sticky subject, but I think it’s really important because on the one hand, as behavior professionals, we should be able to recognize some of these signs and, and understand that they may be playing a role in, you know, the behavior that we’re working to change, and we may need to like rope in a vet, or a specialist of some kind. On the other hand, it can be really difficult to navigate how to do that while staying in your lane, and a lot of behavior professionals, intentionally or unintentionally kind of cross that line and, and start giving medical advice that they shouldn’t.

So, can you talk a little bit about what ethical conduct looks like in behavior professionals and how we should be helping our clients to navigate these medical issues while still staying firmly in our lane and, and not overreaching?

[00:24:13] Micaela: Sure can. I talk about this with trainers I work with a lot, not in a disciplinary way, but with them just kind of asking me the question of, “Is this okay for me to recommend?” And often there’s also conversations of, “So-and-sos vet said, they’re fine. I know they’re not fine.” And fine is the worst four letter F word I know.

So, it’s also really hard to have firm strict rules when there’s only a subset of people working in the field that actually have rules that we have to follow. So, myself as a veterinarian, unlike other certified professional dog trainers, I can’t recommend anything until I have established the legal veterinary client patient relationship. And that’s something that we had a little bit more leeway with during covid with regard to virtual relationships. And now that the orders have gone away, so has our ability to do that.

And then, right, the trainers with certifications have ethical obligations, which I would say there’s, there’s probably a way for us to clarify more so on that.

And then there’s the Wild West trainers who they can say whatever they wanna say. And chances of them being charged with practicing veterinary medicine without a license are very, very slim. So, it runs the whole gamut. There are things that are so clearly not okay. For example, “Oh, you know, just give Max some Lucy’s, Gabapentin, it’ll be fine.”

Not, okay. Well then there are things that seem completely okay and could have bad consequences, like recommending an over-the-counter calming supplement that happens to have St. John’s wart in it. And if that dog is also on a serotonin enhancing drug, they can have interactions and serotonin syndrome is more likely to be able to happen. Still rare.

Or there are some calming supplements on the market that are flavored with allergens. And if a trainer is not keeping that in mind, they might recommend something that causes a skin or gut flare up. So, there are even benign things that, you know, I myself as a veterinarian, I sometimes say, “Oh, look at this.” And they say, “Oh, it can’t do that. It’s got chicken in it.” Cuz they put chicken in everything, and guess what’s the most common protein allergen. Chicken.

So, I also know trainers that I know know more about behavior meds and biomechanics of dogs than some general practitioners. And that’s really frustrating for them. So frustrating. Because they’ll say, “I know that there is something not right here.” Or, “I have a strong suspicion that this drug could help your dog.” And depends on how it’s presented to that veterinarian how they’re gonna take that. So, making sure, and this is something that you know, I’ll circle back to in a little bit, that when you have something that specific in mind that you don’t send the client to play telephone, that you ask them, “Is it okay if I send a message to your vet and meet them on their level?”

And, and don’t assume that the client can relay that information because telephone doesn’t work, there’s a reason it was a fun, silly game because we mess up the message. So, there are absolutely gonna be individuals who know that they’re right, and know that their recommendation is sound, and still, I think it’s okay to make a version of that recommendation. Just try to caveat it in some wiggle terms and also trying to speak directly with the veterinarian when that’s possible. Even if that’s just sending an email and you can CC the client on the email too. That’s fine.

[00:27:44] Emily: Yeah. And I would, I would even add to that, as somebody who spent two decades in the veterinary community, many of those years as a vet tech and now has been a behavior consultant for 15 years, it’s also important to exercise some intellectual humility and realize that even when you are absolutely sure that you’re right, you may not be right. And that has happened to me before where uh, my client’s vet was giving, medication recommendation that I had been drilled into me as a vet tech, you never, never, never, never, never combine these meds, ever. I knew exactly why. I knew the mechanisms of those drugs and why they were contraindicated. And I was absolutely sure that this was, um, malpractice, unintentional, or not, right?

I was absolutely sure that this was incorrect. And instead of saying that to my client, I spoke to the vet about it and the vet was like, ” Yes, all of your concerns are true, and this animal has this incredibly rare condition where the benefit of combining these meds outweighs the risk because x, y, z factors.” And I was like, “Whoa, whoa. I, I, yes. Now that you’re saying that and explaining to me it makes perfect sense and also that never would have occurred to me. It, it flew in the face of everything that I had been taught and believed to be true and had seen with my own eyes. And I still under, I still ha learned something today after a lifetime of being in, in both of these professions.” So, I wanna add to what you said that like, hey, fellow behavior professionals, even when you are sure that you’re right, be aware that you might not be right, that you may be missing some really critical information that the vet has that you don’t.

[00:29:28] Micaela: Yeah, I love that. And that’s also a reminder, you know, I think we get subtle reminders of this every day that ego is rampant in the pet behavior or in the pet care industry. And I’m guilty of it and everybody else is too. And we have our days where we’re more humble than others, and especially when we feel that right, it’s important to communicate from our most humble place. And that goes for veterinarians too, that we feel authority and we feel like that authority gives our knowledge more weight. But evidence is evidence, no matter who found it first.

[00:30:03] Emily: Yeah. Yes. I was laughing off mic because. I deeply feel your feels, right now. Yes.

[00:30:09] Micaela: I can say it and you would feel awkward.

[00:30:12] Emily: Right. You, you can say it. You’re in a position to say it. I’m, I’m less in a position to say that, but thank you. It’s such an important conversation, cause I know that everybody has the best intention, tensions, and cares passionately about it, and also a lot of harm can happen when we, when we veer outside of our lane. So, I, it’s just a really important conversation to have.

I wanna switch topics just a little bit, because when I was a vet tech, one of my very last jobs before I just switched to doing full-time behavior work, was working for a house call vet. I have to give a shout out to Dr. Matt Bendall in Austin, Texas. Extraordinary veterinarian, loved working for him. But like working for him opened up this whole new world of possibilities for me, because I got to see what veterinary medicine can look like when we’re taking a holistic approach. We’re going into their home, we’re spending more time with them assessing their nutritional health, their behavioral health, and their physical health. And, um, just looking at the whole picture and looking at the animal in the context of their environment. And getting to work with them in the place where they feel more comfortable and calm. And that, it just blew my mind after, you know, like I said, two decades in the veterinary world, having the privilege of, of getting to be a, a vet tech for a house call vet, I I just on, on a regular basis, I was just getting mind blown.

I also learned a lot of things about animals that I didn’t know, because my con, my only context for animals up to that point had been like my own pets, pet sitting clients, and working in the veterinary clinic. And so, seeing animals in a medical context, in their home environment was also, uh, really enlightening for me. So, I would love to hear you speak more about this phenomenon of house call veterinary medicine. Talk about like, what are some of the benefits, what are some of the drawbacks? And especially, um, the ones that may not be as obvious at first blush as like the ones that people kind of naturally, as might assume would be the case.

[00:32:15] Micaela: Yeah, I guess the, the first thing to say here is that nobody in veterinary school taught me about house call medicine. That was Sybil Murray. And even I think when most veterinarians think of house call medicine, they go to euthanasia. It’s a wonderful place to do a euthanasia, and there are a lot of other things we can do better too.

So, I think the, the drawbacks are a good place to start, leaves a context for us. So, it just, the business sense you are not going to see as many clients a day. I am not going more than five places in a day, and five is a lot. You have to be very conscious of geography. So, it was a really big difference doing house calls in the valley, in California where most cities are on a grid, and then moving to Seattle where there’s usually a body of water between me and where I need to go. And that took me a minute to adjust to. I look on Google and it says, oh, it’s 15 miles away, oh, but you have to go around the lake. Okay. That I, I have learned live and learn.

There are things that we just can’t do. We’re not taking X-rays; we don’t have the ability to do surgery. Minor surgeries, take a little mass off here and there type of a thing, yes, we can do, but there’s always the potential that we use sedation or any other drug, and an animal has an anaphylactic reaction or another severe type of reaction.

And in those cases, anytime I’m gonna sedate an animal, I say, “If for some ungodly reason something happens and I’m concerned, I am getting in the car with you to go to the clinic. So, I will monitor them, and you will drive, or vice versa.” It’s never happened to me. It only happened to Sybil twice. And one of those was a known heart condition where they knew that it could be risky, but it was worth it.

Logistically, again, you’re driving around, you gotta take weather into account. I got stuck at a client’s house just a month ago when we had some deep snow. Sybil used to be on paper and maps, and I’m so thankful that I have Google maps.

And then there, there are some pets for which it’s not going to be necessarily the best idea. Territorial animals might do better not at home. Animal that are terrified of visitors might do better if the visitor is not coming in to do medical care. So, those are two kind of distinct situations where we might wanna second guess if this is just generally the best way for us to deliver their care. Let’s, let’s get them out of the context where they’re already concerned.

Kind of switching over to, to benefits and, and good fits. When we have somebody bring their pet to a clinic and we’re talking to them in a relatively sparse 10 by 10 exam room, we’re taking not just their pet, we know that their pet stress increases, but their stress increases too because they’ve gone through the stressful part of getting their pet in the door. Some of them don’t wanna come in the door, then we’re adding guilt onto it.

Some of them are already worried about how much is this gonna cost me? And that’s what’s running through the back of their mind. So not only are we putting pets in a position for their sympathetic nervous system to be stimulated, but we’re also doing it to the owners.

So, when we’re talking with them at home, they’re in their best listening place, and we’re bringing the medicine to them. We’re gonna talk to them about how much it costs usually ahead of time, because we don’t wanna drive out there just for them to say, “Oh, we can’t do anything.”

The pets are in their best place to behave normally. Works really well for looking around and seeing, okay, what does their environment look like? Do we have a 14-year-old dog with multiple joints with arthritis living on hardwood floors? We’ve gotta talk about traction. I’ve talked about traction all the time. Do we have a dog with hip dysplasia that has to take multiple sets of stairs to get where they need to go? Right? So, there are environmental factors that will also lead us to make medical decisions. I’m probably gonna start that dog on pain meds sooner than I would a dog in the same exact medical condition, living on the first floor of an apartment building that never has to do stairs. So, we get to do those, um, kind of environmental prescriptions, more applicable management conversations.

And then there’s also added benefit of, you can get a sense of how financially equipped the owners are. I’m always gonna recommend, and I always present it as, “Here is our unlimited time and money plan. Nobody has unlimited time or money, so now we’re gonna build the plan for you.”

And then this one’s a little bit, little bit funny, but when you’re at somebody’s house and you ask them, what does your dog eat? They can’t just say, “Oh, I don’t know. It’s the blue bag. We buy it from Petco.” We can go look and see what the food is, and we can actually have a nutritional conversation. So pets for whom this is particularly a good fit, is especially any animal that has travel anxiety, fear of the car, previous bad experiences. I know two dogs who are recently in a car crash and that’s really affecting them. Pets with mobility challenges of any age. Huge pets, that just makes things a lot easier. Multi pet households, we’re not trying to manage multiple pets, or we’re not asking owners to do multiple trips. And then cats, cats, cats. Cats, cats, cats, cats, cats, cats, cats. It’s so much better for them. I can watch them walking around their house. They’re not curled up in their carrier saying, “Oh, for the love of God, what are we doing here?” I can see how high they choose to jump. I can see where the litter box and the water is. Is it somewhere reasonable for their state? So, and once again, I say this is not a comprehensive list. If I sat here for another half hour, it would get twice as long.

[00:37:38] Emily: Right. Yeah, I mean, I think it’s just really important to, um, raise awareness of all of the different benefits of doing this. And I want to acknowledge, because we’re very passionate about, equity and inclusivity, I acknowledge that this is a privilege that a lot of people don’t enjoy, right? I, I acknowledge that first of all, living in a city where you exist is a privilege. But secondly, it is a financial privilege, right? Because the, the cost of having somebody come to your house and spend more time with you and your animals is going to be higher than a low-cost clinic. Maybe someday this will be a common enough service that a nonprofit can start that can make this service accessible to everybody, but in the meantime, yes, it’s a privilege. And also, if you have this privilege, explore this as an option because it is, it is so profoundly impactful.

So, everybody knows, everybody who listens to our podcast knows about Brie, cuz I talk about her all the time. But, uh, she was a feral dog for the first year of her life, so she struggles with people, and she struggles with cities in general, like just not being out in the desert is, is still, a little bit of a, of a, of a challenge for her. And she and I have done a lot of care with consent training. We had a good vet in Salt Lake where I used to live who would let me stay with her while they did all their procedures, so she handled vet clinics, okay. Pretty, she, she was pretty successful in vet clinics and also, the difference in how she responded to you and, um, our ability to do like a little practice run, and then go do other things, and then come back and, do it for real with almost no restraint, very, very little, minimal restraint. And how she just quickly recovered and bounced back right away as soon as it was done, as opposed to needing a few hours to recover, was just, it was so, impactful for me as her, as her mom to, to, to see that and to experience that. You know, and it’s, it’s interesting cuz I did this all the time as a vet tech with Matt Bendall and yet it was very, the, the experience of being the client and seeing the difference that it made for my dog, was unexpectedly emotional for me. Like, I was like, I know that this is the thing, but it’s just different when it’s your own kids. Right? your own pet.

[00:39:54] Micaela: Well, you know what? You just brought up something that, I honestly, I don’t know where this necessarily fits in, but it’s a good reminder for anybody that’s working in a vet clinic. Is that the things we do every day, we begin to think of as normal. And the things we do to animals every day are not normal. And they know that. But we forget. And we forget that for clients it’s not normal either. So, if you work in a vet clinic and you’re in the habit of saying, “Oh, we’re just gonna go to the back and get a urine sample.” The client has no concept of what’s happening back there. They do not know that we’re flipping their dog for cysto. And I think a lot of them, if they knew they would ask if there’s an alternative.

Or even just predictability helps, right? When we are working with Brie, and we set up for the blood draw and we do everything except the needle poke, and then we take a break and come back later, she knows what’s about to happen and we don’t have to use heavy restraints. She’s excellent.

And, you know, uh, I will say, you know, same thing with Ellen’s dogs, right? They’re in a similar situation where, you know, they have the care with consent skills, and they still show preferences. And I say, “Okay, that’s fine. That’s your preference. I have all kinds of other information and we can work to get there.” I’m not going to ask Ellen if I can go get urine directly from her dog’s bladder, who’s standing halfway across the room from me by choice most of the time.

So, I think there are a lot of conversations and luckily they’re becoming more frequent of, okay, what do we need? And what do we want? We want a sterile urine sample. There are only some situations where we need a sterile urine sample. And I’ll take the flack for that from other vets. That’s okay.

[00:41:32] Emily: Yeah, I think that’s, and, and you know, I think the other thing too is, doing a cost benefit analysis of that. Like, you can say that the cost of, we may not technically need a sterile urine sample in this situation, however, this dog ha seems to be fine on their back, seems to be fine with handling, the risk is worth the benefit of getting a sterile urine, urine sample. And on the other hand, you have a dog who has no prior training in how to lay on their back and, and have people grab their legs and stuff, and the dog is clearly starting to escalate, we go, okay, we really don’t need the ster sample in this situation, right?

[00:42:13] Micaela: Now that’s where it’s really lovely to have a trainer’s input on care, because that trainer has a much better concept of how that dog’s going to recover.

So, when, when I get to work a case in conjunction with a trainer, I say, “Hey, I’m thinking about this. What, how do you think they’re going to handle that?” and the way I hope to set up my relationships with trainers is that they feel comfortable saying, “I don’t think that’s the way to.” That’s okay. I get to be creative. That’s one of the things that matches me well with my job.

[00:42:41] Emily: yeah. I mean, obviously I love everything that you’re saying, and I agree with it and I feel like, the conversation about learning to distinguish between what is common and what is normal is a conversation that I have on a regular basis. So, I think this is just a perfect time to remind everybody in our respective fields, in animal care fields, that there is a significant difference between something that is common and something that is normal, and this is one of those situations for sure. So, we’ve already talked about it a little bit, but can you walk us through your process in an initial in-home session?

[00:43:14] Micaela: Yes. And this is where I am gonna take a step back just to kind of give some context to the way I am doing things right now, which as demands change, I may change my process, but right now what I want from people is that we’re going to meet virtually first and we’re gonna make a plan together first, and that lets everybody be in their comfortable place.

I can sit here and take really good notes. I don’t like to be sitting on a computer when I’m in the same physical space as another human being. I don’t wanna be looking away from them typing my notes so I can take really good notes ahead of time. So, before we meet virtually, I want your previous vet records. I want videos of your dog going through normal gaiting, and I give some guidelines for that for them. If you’ve been working with a trainer and they take notes, not all trainers do, then I’d like to have those, too. And by the way, if they want to join for the appointment, I would be delighted. That lets me also say, “Okay, I’ve looked at these records. It really looks like we need to repeat some blood work. I’m gonna make an estimate for you. So, you can have that before I’m there, and you can decide if that’s something that you wanna do.” I’m not going to have the social pressure on you when I give you that number because finances is semi-private.

And then I have my version of the CBARQ where I’m getting all the relevant behavior information that I think I need. so that’s really helpful. That keeps us able to focus on what are we going to do. That gives me more time to give you more nuanced information about how we’re going to use medications, or why I think a test is important to run.

I’m not asking you for your dog’s triggers and their threshold distance, I want you to think about that beforehand and when they have the opportunity to think about that stuff beforehand, I get better quality information. Because they can kind of sit on it and say, “Oh yeah, and there’s also this thing too.”

We can, at that virtual meeting, talk through any medical factors I think are important. Is this a situation where you’ve told me that we have gastrointestinal issues? I can explain why we’re gonna try to get that solved first. If some of the triggers seem ambiguous, or there seems to be a safety issue, we’re going to make sure that you have a good handle on that before I put myself in that situation.

And then I talk through kind of my big four, um, which is management and safety. We’re gonna make sure what have you tried, what’s failed? Or what, what have you tried, what hasn’t worked for you? And what other safety factors do we need to keep in mind? What is your current enrichment habit and are there opportunities that I see just based off the history? I’m gonna give you more when I’m there in person. Is it appropriate, given everything I know about your animal so far, if I’ve watched those videos and I see something off with the gait, and your enrichment plan is going to chuck the ball for 30 minutes to an hour every day, we’re gonna go ahead and talk about that.

And then in, in no specific order, the last two are medication, and training and behavior modification. In most of the cases that I’m seeing these days, it’s trainer referrals from people that I trust. And so, a lot of the training, behavior modification education has been given to them, and it’s not taking effect because we have these emotional factors at play.

So, I take my opportunity there to A, reinforce what they’re doing right. Make sure they know that yes, this is a valid plan and here are the factors that are making it not effective for your animal. And then with medication, I can start to talk to them about what, what I am thinking is a good fit for their animal. So I set the stage a little bit. I send them the information sheets for that medication if I’m pretty darn certain that’s what we’re going to do. Gives them the opportunity to read through it and be able to ask me questions when we meet in person. And then I’m gonna talk to them about side effects. Or sometimes I even say, “Hey, I know that in the records before you guys talked about potentially using Xanax, here’s why that’s at the bottom of my list.”

Which doesn’t mean it’s always at the bottom of my list, don’t take that as a generalization. So, it, it gives them a chance to sit on some things in between. Then we’re gonna set up that in-person and depending on what’s going on, if our priority is a behavior outcome or a medical outcome, and usually there’s some combination in between paired with how does your animal tend to interact with strangers, we might just do some relationship building. I’ll put you on my route to another appointment and I’ll stop by for five or 10 minutes and just say, “Hey, I’m this cool person and I’m not here to do anything yet. And we’re doing practice in the meantime.”

If we gotta do a little bit of training beforehand, we know that we want to get a blood draw, they’re not so severe that we think that we need to sedate them for it, and they’re trainable so we can get them set up to understand the context, and a little bit of the restraint, we can get that going. Sometimes, I just go ahead and recommend that we start with a sedated tune-up appointment. So, it’s been a year and a half since they’ve been seen, we can’t trim their nails, they’re overgrown, they’re uncomfortable. I want blood work before we’re starting on medication, and they need an orthopedic exam because I’ve seen something off. The best thing to do in that case is we have a short interaction where I sedate them, and they don’t remember the rest, and that gives us that fresh start over that next year that we can work on consent, and we can get them go from, we’ve got 18 to 20 claws that need a trimmed, now we can start on a one claw a day or one claw a week training program without the pressure. So I do offer that for some of them.

And then there are some of them where I go, I watch them moving around and I say, ” Hey, I really think the next step is getting x-rays.” And in those cases, we’re gonna work with the general practitioner that they’ve been seeing, or they’re gonna come visit me at the clinic where I’m seeing clients. And I universally sedate for x-rays that way their muscles relax, we can get really good quality images. And part of the reason I work in a clinic some days is that I can be responsible for positioning those images. So, for an animal for whom we’re going to get one chance at this, we make sure we get exactly what a radiologist would want.

I didn’t happen to talk about how I do my greetings. So, when I arrive, I’m going to call. I’m not going to knock on your door unless you don’t answer your phone. My phone wasn’t working last time I showed up at Emily’s house and so I did have to knock.

[00:49:28] Emily: It, It, worked out fine. It was, it was funny.

[00:49:32] Micaela: yes, they recovered fine. Then, unless it’s a dog who’s already happy to see visitors, or a cat. I’m gonna have them bring their pet out front to meet me. And if that pet needs space, I’m going to determine that distance. I’m gonna let them see me where they can be calm. I’m gonna let them watch me drop food on the ground, and I’m gonna walk away. So, I am dropping scent where I’ve been standing, I’m dropping good things, where I’ve been standing, and I’m showing them that I’m not here to come after them. And I’m giving them the agency to close that distance when they feel comfortable. And it’s pretty satisfying when I get, get one that goes from concern to curiosity. And they go, ” Why is this lady here? What’s she doing here? Oh, there’s, there’s kind of cookies over here. They’re coming from her. Let’s go over there. Hey, what have you got going on?” I love that. Um, that’s a, that’s a really good way to kind of just start the interaction with them, having as much control over it as they can and set the stage of I’m here to help you earn things, and I have secret medical ulterior motives.

[00:50:33] Emily: I, I love that so much. And it is fun. It’s delightful to watch them go from, like not so sure about you to like, actually, nevermind. You’re great. Like it’s, it is, it’s wonderful to watch. Yeah. Yeah. So, what are some observable goals and actionable items that people can take away from this discussion?

[00:50:52] Micaela: I have my answer split, so for pet parents, there are a few things that you can do. Obviously, look around and see who’s doing house calls in your area, if you think that that would be helpful. If you have a smartphone, you have a really good quality, slow motion camera on your phone, so if you’re seeing anything concerning, pull that out, gather data. You can bring that with you to your appointment or if they’re coming to you, sometimes, it’s not an everyday thing and we don’t happen to come visit you on the day when it’s clear. Especially if you’re going into a clinic, bring videos because it’s so, so common for a dog to get an appointment on the schedule because they’re limping and when they’re in the building, they’re not limping anymore. And that’s because the stress responses job is to mask pain and to mask signs of illness and weakness. And it’s a really well-functioning system in most animals. So, bring that with you to show. If you are a vet and you are seeing an animal for behavior problem, either ask them to bring those videos with you, or make an effort to go somewhere with appropriate traction and watch the animal moving at a walk and at a trot, from behind and from the side.

And then you can watch too. How do they go from a stand to a sit? How do they go from a stand to a down, if that’s something they’ve been taught? Are there any signs of compensation? And then if you are another pet professional, and you’re finding yourself in positions where you want to be having a say in the way that that case is going to go when it’s in the clinic, build yourself a template that is built, assuming kindly, respectfully, that that general practitioner doesn’t have the facility to watch that pet in motion and that they don’t know behavior basics.

So, try to be specific. I observed the pet shifting weight to one side, I’m not quite sure which side, and that’s totally fine to say, I just saw them shifting weight asymmetrically when we were on this substrate at this speed. I noticed that he was not using his back left leg as much when he’s at a trot while we were working on pavement. That’s good information. useless information is, “There’s something not quite right there.” There’s no context, there’s no specifics, there’s no way to help them to localize what to look for. The other thing is if you can come up with a less than one page summary of what you’ve seen, and you send that as a written document that goes in their medical record, there is documentation of what you’ve said.

Again, we’re not asking the client to play telephone, but also if another doctor happens to pick up this case, they can go back and use that information. So, even if the first person they see doesn’t use the information, somebody in the future can. So, you’ve, you’ve set them up that if they need to switch to somebody else that has more experience, or is more open to searching for subtle things, that you’ve had your say.

[00:53:45] Emily: Yeah, I think that’s so important. Um, just being able to communicate with the medical professionals that are also on your, on your client’s team, um, is just such a, a huge part of it. And so, I appreciate you giving that advice to behavior professionals, cuz a lot of times people want to do that and they just don’t know how or what would be helpful in those situations, so yeah. That’s wonderful. All right, so next I’m gonna ask you the most popular question that we got from our Pro Campus and Mentorship Program members, and it’s kind of an amalgamation of, you know, uh, sim similar questions that a couple of people asked. So, the question is, can you share some interesting cases that have utilized all your advantages? I mean, in other words, your veterinary background, your training background, and the fact that you do in-home stuff.

[00:54:35] Micaela: Uh, yes. So, I’ll start with one and then I will shift, and we’ll do another one. So, I had referred to me, Juno, who was an 18-month-old Mastiff mix. And he had been transported from the Texas area up to the Seattle area when he was a puppy. And since that time, the owners had been really struggling with hyper arousal, especially anytime the, the social picture changed, son came downstairs, mom got up after working to go move somewhere else. And really hard biting while being mouthy and jumpy. So, the initial trainer that went out, I wanna say it was when he was about six months old, had them on the typical, ” he needs a lot of exercise to wear him out. He needs more stimulation.” And they were playing a lot of flirt pole, so trainer two steps in and I, to be honest, forget how he ended up changing hands, if it was a referral or if it was, um, client’s choice. But so, trainer two has a really good eye for movement and she sent them my direction and she told me ahead of time, something’s off here.

Well, it just so happened that Juno was in her board and train when she and I had dinner, so I met him before I met the owner, cuz I said, “Hey, while you’ve got, and let me watch.” I have to be honest, I sat with his slow-motion videos for an hour and I still wasn’t quite sure where it was coming from. It seemed to be shifting and if I were to give it a subjective descriptor, it looked like he was trying to run away from his own butt.

So, I got the medical records and everything before I talked with the owner, and there was a one sentence note in his rescue records, former fractured tail. And he did, he had a, had a bit of a bald spot toward the upper third of his tail, and kind of went back and looked, and it’s a little bit thickened. So, I go further forward in his records, and there’s a mention at a puppy appointment previously had fractured tail on physical exam there’s some soft tissue swelling around that area.

I don’t remember if this is one of the ones where the only intervention was Glucosamin Chondroitin, but that’s not a pain medication. So that was at about eight months, and remember he came to me at 18 months. Nothing was done for that, so I sent them back for x-rays. At this point, he’s an 80-pound dog, and his tail was fractured, and it was clear that it was chronically fractured and there was horrible tissue swelling going on.

And that poor dog, every time he got excited was whipping around at least a pound and a half of tail on the other end of a fracture. So yes, we did some behavior meds to help him in the meantime, we did pain meds very early and that led to some resolution, not complete, but better, so we amputated his tail, and he is doing excellent.

We took away the source of the pain and the dog can think, and we, she went from seriously thinking about euthanasia, to enjoying her dog every day. So, that is one where it’s really as simple as cut off the problem. And boy, if they were all that simple. So that, that is one that is extraordinary, and will always stand out in my mind.

[00:57:39] Emily: It’s just such a good example of like, be, be aware of, of pain as a contributing factor, right?

[00:57:47] Micaela: Yeah. And if trainer number one had been coming at it from the basis of we’re going to add this enrichment and then we are going to evaluate and not a place of this enrichment absolutely is the best fit because this is a young dog, we might not have needed trainer two. Who saw that there was something wrong and immediately said, “I want you to stop all of that, and give him a naptime midday.” and that led to improvement.

[00:58:12] Emily: Yeah, that’s ba, I mean, thanks for plugging our enrichment masterclass cuz that’s basically what we are teaching people how to do in that, in that course.

[00:58:21] Micaela: Yeah, absolutely. Okay. You know, I can just go off of a, a, a general pattern that it’s pretty common for me to see. I don’t need necessarily to think of an individual patient for the, the next scenario, because it, it comes up so frequently.

And the two more common, well, three more common musculoskeletal issues, that are underlying is lumbosacral disease, hip dysplasia, or arthritis, and luxating patellas. So, it’s fairly common for me to go out and see for any number of behavior problems, usually it’s a sound sensitivity or reactivity, and this becomes a bit of a cycle. That they have something painful, they lunge on their leash, it certainly doesn’t help that underlying condition. So, whether that underlying condition is the overall cause of them developing this behavior, or a secondary happenstance that aggravates it, they still need treatment. It is pretty common for me to read a veterinary record that says the vet recognized that that was something that was going on and go ahead and start on a glucosamine chondroitin supplement. Which, I say one more time, is not a pain medication.

 The only way for us to know how much pain is affecting the behavior is to treat the pain. I have situations where owners either don’t want to, can’t afford, or honestly don’t think it’ll change what we do, MRI. And it’s clear that the animal’s uncomfortable, we’re not going to get the image, sometimes we get a normal image and there’s still something going on. Because those images are taken with an animal that’s not moving. That we’re going to see, okay, we’re gonna treat the pain, that alone, how does it affect the intensity and the frequency of the behavior? Pain is an emotion. There is an entirely separate term for the signaling that leads to pain, that’s nociception. And we can affect both. So, behavior meds can directly affect pain because they’re affecting the cognitive processing of nociception. A lot of the pain medications we use are targeting the signaling that leads to pain. So, we want to touch it in as many different places along that pathway as we can.

So unfortunately, a lot of people who come to me have an understanding that there’s something going on. Have talked to a vet about it. That person doesn’t know how intertwined these things can be, and therefore didn’t recommend something to seriously affect it. And I just come behind with a little bit of education.

I don’t need to do any diagnosing. I just talk with them about how it’s affecting the overall situation. And I say, ” Okay, here’s our pain meds. We’re gonna reevaluate.” And the vast majority of those are better when we recheck.

So, and I’ll say this, especially for the little dogs with the luxating patellas, that’s uncomfortable. Skipping a step isn’t a normal way to move. Once again, it might be common to see a dog with a luxating patella skip a step, but that’s not normal. And that means that they’re aware enough of the upcoming discomfort that they are unwilling to put weight on that leg. And that’s an indication of pain. And I think too few of these little dogs with luxating patellas are getting serious treatment for it.

[01:01:34] Emily: Yeah. As somebody who has multiple subluxating joints, including my patellas, I just gotta say it is really uncomfortable. It’s very uncomfortable. And what’s worse that I think a lot of people don’t realize is that sometimes if a joint subluxate the muscles around it can, tighten up to like grab that the errant joint, right? And that is extremely painful. And I think people don’t recognize that in animals because maybe animals aren’t as demonstrative as people, or at the very least they can’t say like, ” Gosh, I’m in a lot of pain today.” My own experiences with subluxations has given me a lot more empathy for dogs with subluxations.

[01:02:18] Micaela: And it, it’s unfortunate. I think it’s necessary and it’s just a, a factor of life that those of us who are living with chronic pain really are the ones that can help other people understand what it’s like, not just for humans, but for animals. Yes, we talk about anthropomorphizing, but we have a narrative that explains where our pain is coming from, how it’s affecting our decision making, and we can explain that.

And I think that that’s helpful in people understanding their animal’s pain. Is it, they don’t have a narrative inside, as far as we know, that says, ” Well, I’m not going to play this game with you because if I do that, I’m gonna get a twinge of nerve pain up my spine.” They either will try it and then feel that twinge of nerve pain, and get either upset, or be really off later or they’ll disengage from you and they’ll not wanna do that. And that might be all that you see.

I have a colleague, whose dog just didn’t want to do some of the things in the sport that he had been doing for a long time. And she took the dog to her general practitioner and said, “Something’s not right.” And they said, ” He’s F I N E.” And she said, “No, he’s not. I wanna go to a neurologist.” And she went to a neurologist and the neurologist said, “he’s F I N E.” And she said, “No, he is not. I want an MRI.” And the radiologist said, ” He has nerve impingement.”

So, you have to be a really good advocate, and I jumped back to earlier what I said is you have to be observant of your animal and be the expert on them. Vets are our experts on how generally bodies work in pets. You are the expert on how your pet behaves. And you need to feel the confidence that you play a significant role in the outcome here. And if you feel like something’s wrong, it’s okay to shop around a little bit.

[01:04:06] Emily: Yeah. Well, you know, that was my journey with Brie, first time around with Schmidt syndrome is I had to advocate, and I wasn’t even, I understood why the vets were making the decisions they made, so I wasn’t even shocked or scandalized. I know the system well enough to know that I had to keep pushing and keep giving very specific descriptions of what was happening before we finally got to where we needed to go. But then again, as you know, the first and only indication that I saw of Bree being in pain for a while was that when she would do her deep stretch, she would do the downward dog part and then stop herself before she would do the back leg stretching part, and that was the only indication I had of her experiencing pain.

And when I told you that you were able to take video of her and slow it down and show me, a more nuanced understanding of where the pain was coming from and why it was happening. But as a professional, the only symptom that I, I could detect was the change in her stretching behavior. That was it. So, it can sometimes be really subtle, even for people who are in the field and, and know this stuff, right?

[01:05:13] Micaela: And to bounce back with what you had said earlier about once you started doing house calls, you, you learned things about pets that you, you didn’t know, you didn’t know. And that’s the same thing for veterinarians. We have our pets and the vast majority of them know what animals look like in a veterinary clinic. And myself, in a small fraction of veterinarians who do house calls, know that those little things are big indicators. And just because once we get them into a 10 by 10 exam room, we can’t push on a spot and get a big response where they say, “Owe! That hurts.” Doesn’t mean it’s not real.

And seeing is believing. I think it’s really helpful for us to be able to use our cameras and watch it together and me to say, look at, you know, look at the height of their hips, or look how there’s their, their back always has the same shape, no matter which leg they’re putting their weight on or, or what part of their stride they’re in.

That once we have an understanding, and I say this as a person who had a chronic painful condition, it’s still there, but for 10 years I didn’t know where it was coming from, that once I had a name for my monster, it changed things and I have a better understanding and it doesn’t affect me as emotionally. And animals don’t have that privilege, but their owners can really help in the way that we manage what they’re allowed to do to make it less aggravating.

So, it’s pretty common for me to be talking with an owner of a two year old dog that has some instability about chronic pain. And they say, “Well, there’s no way she could be in pain. She runs like the wind. She runs like the wind.” When she’s running like the wind, and then tomorrow she can’t handle someone walking in front of the house.

[01:06:54] Emily: My response to that is, have you ever watched a horror film, people where people are running at full speed despite their multiple injuries, right? Like, if the adrenaline is, if the adrenaline is high enough, You can do anything without, without your pain being apparent.

[01:07:09] Micaela: Yeah. And adrenaline spikes in good and bad situations, so it happens when they’re excited about stuff too, which, you know, we have to deal with our feelings of guilt of not setting up our two-year-old dog that wants to go run for an hour but shouldn’t. And they’re, they’re going to do things they shouldn’t do all the time.

[01:07:29] Emily: All right, so at the end of every interview, I ask the same set of questions. The first one being, what is one thing you wish people knew about either this topic, your profession, or enrichment in general?

[01:07:40] Micaela: I think if I can just reiterate that pain is an emotion, and it has effects accordingly. Behavior problems arise from emotional problems, in many cases. And anxiety is your brain saying the outside world is not safe. Pain is your brain saying the inside world is not safe. And in many cases, especially where they’re still young, and we still have a good opportunity to affect the way they perceive the world, we’ve got to take action on both. And you are going to have to be your pet’s superhero because you may not happen to be in an exam room with a vet that gets it.

[01:08:17] Emily: Yeah. What is one thing you’d love to see improved in your field?

[01:08:20] Micaela: I think all of us, and I include myself even as I say this, can do a much better job at building teams without thinking of hierarchies, right? We don’t need hierarchies near as much as we’ve been led to believe. So, I want a pet’s trainer to be as influential to what we’re doing as I am, and I want their sitter to be in on things, so that they know how they can accommodate for the pet.

I mean, every person who’s taking care of that animal needs to be able to, to understand and to give feedback to the process. I think it’s all too common for a trainer to refer to a vet for behavior meds, they get the behavior meds, and then there’s no request from the prescriber for feedback on how the training process is going, and that trainer doesn’t have the confidence that if they send any feedback, anything’s gonna happen with it. So, I, I think, you know, there’s certainly pockets where this is going really well, but I would like to see at, at all levels that we can just be more respectful of each other’s experience.

[01:09:21] Emily: Yeah, I love that. What do you love about what you?

[01:09:23] Micaela: I am hesitating, not because I don’t love anything, but because there’s a lot of things that I love. I love that I’m able to help people understand what’s happening. And I get to experience that, that aha moment that we see pets experience through, you know, a shaping process where they say, ” “Oh, I think I get what’s going on here.” And doing a two-week check-in after starting pain medications and hearing a client go, ” I get it now. I can see he’s choosing to do things I didn’t know he was choosing not to do.” Just that, that light bulb moment, and I’m okay if we follow up and everything is the same because that’s feedback, that’s information. It helps us to understand where things are coming from because we can do behavioral analysis in the beginning and have a hypothesis for what the motivation is, and sometimes I think that pain is a bigger factor than it is, and sometimes I underestimate how big a factor it is.

So, I, I think in general, you know, prescribing the pain medications isn’t always the most influential part of it, as is helping them to see how much it’s a factor because they can build an enrichment program that doesn’t include anything that flares that up. And we don’t need to go necessarily to heavy doses of pain medications just so that they can chase the ball. We can use enrichment as pain control.

[01:10:41] Emily: Yeah, absolutely. I love that. What are you currently working on? If people want to work more with or learn from you where can they find.

[01:10:48] Micaela: You can email me at [email protected]. You can go on my website, happyleadvet.com. You shouldn’t even try to find me on social media. I’m not there.

I am currently thinking on how I will find a way to expand my capacity, be I am busy, busy, busy, and trying to balance helping as many people as I can and continuing to be able to help people. So, I am open to, you know, different setups. I’ve been exploring relationships with veterinary clinics. I also, if a business manager dropped from the sky, would be so delighted, and in general, I’d like to have some time for other projects. So, I’ve been thinking about building a resource to help pet parents be good veterinary advocates, and the best way to get that to people, but running between appointments, not, not having the luxury of the time to, to build that. But there’s such a high demand for behavior savvy vets in the Seattle area because it’s so, so pet dense, and in general, behavior savvy vets are lowly available. So, you pair those two things together and I have unlimited work if I wanted. So, I am just pondering the next step. And right now, just trying to, trying to do what I can for the clients that I have.

[01:12:16] Emily: Growing pains are hard. We have experienced that here at Pet Harmony as well. It is hard to figure out how to, you know, expand in a way that’s sustainable, so I feel those feels. All right. Thank you so much for spending the time to talk with me. I, I so appreciate everything that you do and I hope that you can, um, inspire other people to also do what you do.

[01:12:43] Micaela: Yes. Well, I hope that, you know, if there’s any vets thinking that house call medicine is hard. It’s not. It’s me and a few plastic containers, and there’s not as much, you know, startup costs as they would think, um, that’s something that Sybil really pushed me to do. She said, “Just do it.” And I did, and I love it.

And I appreciate you too and that I have you as a resource that I can send people so that they can continue to expand, on the way that they think of their pets as an individual, and it’s not a cookie cutter, oh, you have a border collie, go do your herding, but that we can take so much into account and help them again, to be scientists of their own animal.

[01:13:20] Emily: Yeah. I love that. Scientists of their own animal. That’s, that is a beautiful way to say that. Thank you. Thank you again.

[01:13:26] Micaela: You’re welcome. Thank you.

[01:13:27] Allie: How good was that episode? First of all, Micaela has such a soothing voice, but more importantly, this is exactly what we mean when we say that behavior doesn’t happen in a vacuum. The reason that we need to focus on enrichment first is because there can be so many other factors that go into an undesirable behavior or are the cause of it.

I’ve talked about in the past that Oso stepping onto the couch instead of jumping up onto it, is technically an undesirable behavior from my viewpoint, because it’s an indicator that he’s in pain, and I want to do everything I can to prevent that, and so I want him to be able to jump up on the couch. We need to look at our pets as a whole instead of just one or two components.

Next week we’ll be talking about phrasing feedback to a vet.

Thank you for listening. You can find us at petharmonytraining.com and @petharmonytraining on Facebook and Instagram, and also @petharmonypro on Instagram for those of you who are behavioral professionals. As always links to everything we discussed in this episode are in the show notes and a reminder to please rate, review and subscribe wherever you listen to podcasts a special thank you to Ellen Yoakum for editing this episode, our intro music is from Penguin Music on Pixabay.

Thank you for listening and happy training.