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Special Ep5 - Anesthesia Under the Microscope: The Good, The Bad and The Ugly
329 Plays2 months ago
In this episode, our trio of veterinary anesthesiologists welcomes Adam Christman, DVM, MBA to unpack public misconceptions about anesthesia. From gaps in veterinary training to communication challenges with clients, we explore what’s driving the anxiety—and how we can shift the narrative. Honest, practical, and a little provocative, this conversation tackles the confidence gap head-on.
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Transcript
Intro
00:00:40
Gianluca Bini
All right. All right.
Introduction of Dr. Adam Christman
00:00:41
Gianluca Bini
Welcome everybody. Tonight we have Dr. Adam Christman with us. He is the chief engineering officer of FetchDVM360. He's also a really good friend of mine. He's an amazing social media and public figure. And you spend more time on TV than home, right, Adam?
00:01:02
Adam Christman
Seems like it.
00:01:05
Gianluca Bini
That's awesome.
00:01:06
Adam Christman
I tell my friends, if you want to connect with me, just watch TV. You'll see, see what I've been up to.
00:01:13
Gianluca Bini
He's also an amazing Dachshund father.
00:01:16
Adam Christman
Yes.
00:01:17
Gianluca Bini
Yes.
00:01:19
Adam Christman
Yeah.
00:01:19
Gianluca Bini
He says, oh, it's four, five, four?
00:01:22
Adam Christman
Four.
00:01:22
Gianluca Bini
Four. Now you need the fifth that needs to be a golden retriever.
00:01:25
Adam Christman
I know Gianluca. I know everyone, you don't know this. I got peer pressured in such a great way by Dr. Beanie's beautiful golden retriever. So if he can undergo mitosis, I need exactly him.
00:01:39
Adam Christman
So
00:01:40
Annatasha
He's mad cute. I know it's, yeah, they both are.
00:01:43
Adam Christman
he's adorable. I stole him during one of the conferences. We did a movie night together. So I took him into my hotel room and we watched Despicable Me. So was great.
00:01:54
Gianluca Bini
Oh, we need to start renting him out for while.
00:01:56
Adam Christman
Yes.
00:01:56
Annatasha
Totally.
00:01:57
Adam Christman
Yes.
Awareness and Role of Veterinary Anesthesiologists
00:02:00
Gianluca Bini
But yeah, we wanted to, you know, welcome to the podcast. And, you know, we wanted to chat about, you know, public perception of anesthesia. You know, 10 or probably 20 years ago, having a private practice with access to an anesthesiologist was probably unheard of, at least in veterinary medicine. Nowadays, it's becoming, don't want to say common, but, you know, it's some practices are getting there, right?
00:02:30
Gianluca Bini
How do you think the public perceive veterinary anesthesiologists? Do you think they even know we exist?
00:02:38
Adam Christman
I don't think they do. I don't think they do. And the reason why is because a majority of the practices do not have a veterinary anesthesiologist or either have the veterinary technician that plays the role of the, you know, induction person, the recovery person, monitoring person, or even as we were just talking about before, Dr. Beeney, is that the veterinarian plays both of those roles while trying to do surgery and you know, giving some anesthetic recommendations. So I don't think generally speaking, don't think they know that they exist and the VTS is to exist as well for that specialty.
00:03:13
Gianluca Bini
Yeah. I mean, hope there is more, there is a little bit more awareness now, I think, right? Probably, you know, on social, I think every so often we do see some, you know, or some reels about, you know, improving anesthetic care, you know, improving pain management. I think that's a huge one.
00:03:38
Gianluca Bini
But, you know, I don't, Again, I don't think that the majority of the public does have that idea.
Public Perception of Specialty Veterinary Services
00:03:46
Adam Christman
Yeah. But it's not just, it's not even just your college.
00:03:49
Adam Christman
I think there's other colleges too. For example, just last week I was at animal dermatology clinic in Louisville and, you know, I was talking to the, my followers about that. a minute, you're going to a dermatologist?
00:04:11
Gianluca Bini
Thank you.
00:04:18
Adam Christman
And also, when I talk about this on the live shows with the pet owners, I said, how much would you willing to spend to make sure that your pet recovers?
00:04:23
Annatasha
Thank you.
00:04:27
Adam Christman
Well, they said anything, they would do anything to make sure I said, that's where a veterinarian anesthesiologist come into play or anesthetist to make sure that that from start to finish that they have a very smooth and pain free procedure.
00:04:40
Adam Christman
So I do think that there's the pendulum is swinging, you know, we just need to educate a little bit more.
00:04:46
Gianluca Bini
Yeah. Do you think it's a matter of, you know, spreading the word out there? Do you think it's a matter of, you know, lack of offering? Because if cost isn't the issue, you know, those could be, you know, the two
Challenges in Veterinary Anesthesiology
00:05:01
Gianluca Bini
reasons, right? Like, do you think it's more like an advertisement issue do you think it's more like, you know, there isn't enough people out there to do this?
00:05:11
Adam Christman
Yeah, I think it's a little bit of both. I think the advertising that they exist, that they're there, sorry. Of course I have dachshunds, I have to do this right now.
00:05:20
Gianluca Bini
You're fine.
00:05:20
Adam Christman
Hold on.
00:05:21
Gianluca Bini
You're fine. You're good.
00:05:31
Adam Christman
At the time of filming this, it's Christmas week, and of course packages have to arrive, and if a leaf changes, the dachshunds bark, let alone the package delivery.
00:05:33
Gianluca Bini
It's okay. It's okay.
00:05:39
Gianluca Bini
It makes it more real.
00:05:40
Adam Christman
Yeah, yeah, yeah. you have any anesthesia right now for them?
00:05:46
Annatasha
Gotcha.
00:05:47
Gianluca Bini
There were crowds of them.
00:05:48
Adam Christman
Right.
00:05:49
Adam Christman
Yeah. No, but I do think that it's a little of the education, I think showing the day in the life. I love that these videos, there's newer videos that I'm seeing this year, I would say, where the hospital is using the camera as the dog or the cat and saying, welcome to the hospital. Let me show you what your day of a spay or neuter is going to look like. And this is Dr. Smith. He's going to be your veterinarian. This is Michelle. She's going to be your anesthetist.
00:06:14
Adam Christman
And you're waving. So you see all the key players that involved. And the comments that always come in, like, I didn't know how many people are involved with taking care of my pet. They, for some reason, just think it's either like one person or two. But there's an entire team that's involved. So I think...
00:06:28
Adam Christman
To your wonderful work at that point, I think the fact that showing what you do and showcasing how important it is, especially in the social media space, is really good.
00:06:39
Gianluca Bini
Yeah, I agree. Tasha, do you have any question for the two Chris men?
00:06:46
Annatasha
course I do. Christman, have you done any referral hospital work where, for example, you have multiple specialties and no board-certified anesthesiologist?
00:06:58
Adam Christman
Yeah, so I'm at Mount Laurel Animal Hospital. Big shout out to Bryce Dooley. Dr. Bryce Dooley is our anesthesiologist. Ooh, fun fact, everyone, too, who are tuning in, she's actually in human medical school to become a human anesthesiologist, which is amazing.
00:07:09
Gianluca Bini
Cheers.
00:07:12
Adam Christman
And we also have Tasha McNerney as well, so for a technician side of things. And what's interesting is if we can have her undergo mitosis for all of our cases, we would because it's when you're comfortable having an anesthesiologist on site, it's like, oh, my gosh, it's it's incredible.
00:07:30
Adam Christman
But
Experience at Mount Laurel Animal Hospital
00:07:31
Adam Christman
at the same token, you want to use your brain and challenge So I love when. like when I had my own docs and Connor was under anesthesia, had a first degree AV block. So Bryce says to me, what would you do?
00:07:41
Adam Christman
What are you going do? I don't know. She goes, don't become a pet parent as a veterinarian. What are we going to do here? He's going to be fine. She's like, you know, like, which is great. She's like, and so I like the fact that having them on site, you get to learn together.
00:07:55
Adam Christman
So it's wonderful.
00:07:57
Gianluca Bini
Yeah.
00:07:59
Gianluca Bini
I think that's amazing for the whole team. And I mean, you're very lucky that you had access to that, right? There isn't many hospitals out there with one of us.
00:08:03
Adam Christman
Yeah.
00:08:07
Adam Christman
No, there aren't. I mean, I go into practices when I speak on practice management, for instance, I get a little lay of the land. And I think of all the practices I've been with, not a single one has a veterinary anesthesiologist there. So I asked them, I said, what does your surgery look like? And they usually refer to the veterinary technician who's, I don't know if they're an anesthetist per se, but they're trained to do anesthesia. So I said, wouldn't it be great though, if there was something like virtual to have, you know, some sort of an anesthesiologist that can chime in to help coach along the way. And they're like, yes, we need that access. So that's where maybe safe pit anesthesia can come into play.
00:08:45
Gianluca Bini
True, true story, yeah. Yeah, we would love to help.
00:08:50
Annatasha
I mean, one of the big issues that think anesthesia as a whole bumps up against both in general and referral practices is that they don't see the value in the cost.
00:09:01
Annatasha
You know, I struggle all the time to have people, you know, feel that anesthesia is cost, you know, they want package anesthesia in a $300 for two and a half hour thoracotomy, you know, or they don't want us to charge consultation or what have you. And I just, you know,
00:09:20
Annatasha
It's lucky at this hospital that the chief medical officer happens to be an anesthesiologist. But, you know, I know that that is a massive source of dissatisfaction and frustration within the specialty.
00:09:31
Annatasha
And I just know if you had any experience either, you know, discussing from the practice management point of view like where is the cost capture why why do we have value you know and why should for example you know I am not a big fan of other specialties being paid at three or four to one versus what our specialty is being paid as I consider us to be a core service as opposed to an ancillary service so did you have any experience with that at all Adam
00:09:59
Adam Christman
I love that you said that. I mean, you know, that you are a core service on an ancillary service. That's like spot on.
00:10:05
Annatasha
Everybody comes through us. We're like the eye of the entire hospital and we get treated like an inconvenient, annoying afterthought at best.
00:10:06
Adam Christman
Great.
00:10:12
Adam Christman
Yes. I mean, that's to me, I just had an aha moment because I never really thought of it in that way. But it's it's so true. mean, it's such a necessary one to have. Yeah. What I don't like is I feel like we devalue our services so much. And I and I get it. You know, we want to do what's right for the animal, whether it be like a testicle festival or a spay day or whatever you to call it, you know. But and then there's bundling that happens. And so same thing for like,
00:10:38
Adam Christman
the disposables and the payment, either it's all like included in. So to include an anesthesiologist fee on top of it may be perceived as like, I can't afford this just because, you know, why? But at the same token, we know that our pet owners are willing to do and spend whatever it takes to keep their animals having a safe and smooth recovery. So I think there's a lack of showing the value from our perception as a general practitioner, I would say, that we're not educating our clients enough to say this is the why behind the bottom line. Similar to like when we go get a car and you see everything, you're not going to just tell you the car is $50,000. You go through everything and see the value to it. And I think that we need to do a better job as general practitioners and support staff
00:11:22
Adam Christman
educating the pet owners on the why, like, what is this an anesthesiologist fee? Or what does this look like? And then you explain to them what that means. And I feel like that wouldn't be a non negotiable people don't negotiate disposable waste fees, you know, like things that they need to have, they're not going to say, Oh, I don't want pain management for my dog or my cat, they, they need it. So I just feel like there is a disconnect. we're really are on to something that you're talking about there.
00:11:46
Annatasha
Yeah. And I, I don't disagree that, you know, I think the education is definitely part of it from a personal point of view. I always think it's weird that the areas that, that both humans, like for their own procedures and for their pets, they like to price shop the stuff where I'm like, this is where you want to go, like to the highest level you can afford.
00:12:06
Annatasha
And that's usually anesthesia and surgery, right? Like, If I were going to have a facelift, I wouldn't pick the cheapest surgeon, right?
00:12:12
Adam Christman
Yes.
00:12:29
Annatasha
And, you know, we also keep them alive weeks down the line. So survival to discharge, you know, two, four, six weeks out. to keep them comfortable. And you know, people are like, it's funny, because that's where, if you're going cut costs, people come straight for anesthesia first.
00:12:44
Adam Christman
And it's so fascinating that this is a thing, right, Gianluca? Like, even with nerve blocks, I've seen people cut out like the nerve blocks and that must drive you bonkers when you see that too.
00:12:48
Gianluca Bini
Yeah, it's
00:12:53
Gianluca Bini
crazy. It's crazy.
00:12:56
Annatasha
Well, there's a lot of stuff that I don't consider to be optional. So for example, you know, you know, I still see GP quotes come forward where like intubation is optional, IV catheter placement is optional. And that's, that's not how I choose to practice. So.
00:13:10
Adam Christman
Right.
00:13:11
Gianluca Bini
Yeah, I think that comes down to a couple of things, right? So one is, I think education is really important, like the awareness of why does my patient, why does my dog need to have an endotracheal tube placed during anesthesia, right? And that's our fault, like as vets, I think we need to do a better job at, you know, educating the clients on that. On the other side, think I still speak with a lot of you know, veterinarians that, you know, they strongly believe that sedation is safer than anesthesia, right?
00:13:49
Adam Christman
Yes. Yes.
00:13:52
Gianluca Bini
There is this stuff about like, you know, oh, we're just going to sedate it. And then, you know, when you go check the patient, the patient is basically indebatable, right? The hairways are not protected. But they think that because there is no tube in there, that isn't anesthesia. And I'm like, that's not how it works. Like, if your patient is asleep enough to place an endotracheal tube in, that is anesthesia, regardless of whether you put the tube in or not.
00:14:20
Adam Christman
Right.
00:14:20
Annatasha
Injectable anesthesia, right?
00:14:20
Adam Christman
Yeah.
00:14:21
Annatasha
Yeah.
00:14:23
Gianluca Bini
I think the part of the problem is that... think it
Gaps in Veterinary Education on Anesthesia
00:14:25
Gianluca Bini
starts from vet school, right? like we There is 10 business days of anesthesia.
00:14:30
Gianluca Bini
That's all they get. I teach students and I'm like...
00:14:33
Annatasha
Which is wildly inappropriate.
00:14:36
Gianluca Bini
This is a core... It's such an important piece of vet med, right? I mean, I'm not saying that others aren't. They are.
00:14:43
Annatasha
I am.
00:14:44
Gianluca Bini
But like...
00:14:46
Gianluca Bini
Let's be fair, right? They all are. But, you know, I think one where you could totally kill your patient, it's definitely important. And I think that having 10 days of it isn't enough, right?
00:14:57
Gianluca Bini
Like, you know, by the end of the rotation, the students are barely getting the hang of it, right? And so I think that's what contributes to, know, the students are not...
00:15:03
Adam Christman
Right.
00:15:09
Gianluca Bini
feeling confident when they graduate on it and then they rely on maybe somebody that has been doing it for 30 years and they they haven't maybe progressed on like how or kept up with times so
00:15:27
Annatasha
they're just bad at it. I mean some of the stuff that goes on is wildly like disconcerting. The other thing that I find really like a bit crazy is that you know at the at the veterinary technician colleges anesthesia is taught to them not by VTS technician, technician not by an anesthesiologist, but by DVM.
00:15:46
Annatasha
That's the standard right? You've got a GP DVM teaching anesthesia to the population subset that does the bulk of veterinary anesthesia, right? So the veterinary anesthetists and they're taught by a DVM, right?
00:15:57
Annatasha
And I've actually seen some of the, like the classroom documentation come out and I basically, anytime I get a brand new technician in this province, I spend the first six months untraining them from what they've been told in school to retrain them to do things that are safer and more efficient.
00:16:08
Adam Christman
Mm-hmm.
00:16:12
Annatasha
So, and it's bizarre to me, cause I'm like, 10 minutes down the road from the largest veterinary technician college in Ontario and that's their standard of education and it's just like I don't don't get it
00:16:27
Adam Christman
It seems like there's a disconnect. I'm thinking of two things. One, disconnect from the schools to practice. You know, they're assuming that they're going by experience versus education. And I think the veterinary schools and technician schools really need to hone in, make it mandatory, at least one, two semesters for anesthesia. Because remember when I took it at Iowa State, there was large animal and small animal anesthesiology. And I'd still, I mean, I felt confident enough, you know, to like, okay, I'm good, you know, I'm not great, but like good to like understand things. But then it started dwindling down a little bit, I understand from like other, you know, colleges.
00:17:02
Adam Christman
That's part one. And part two, I feel like the models of the veterinary hospital are disconnected and the public perception thinks, well, if you can get it done an affordable spay neuter clinic, why are you charging me so much money at your own hospital? And so there's this disconnect that's happening between low cost spay neuters, affordable, you know, any of those kinds of things that are happening. And so what's happening, I've seen this happen at hospital is because because they're doing it that way. I'm going to do it that way. So I can cut my costs and increase my revenue, my profit a little bit deeper from my wallet, basically for a practice. So that's concerning, too. So I didn't know your thoughts were on that.
Educating Clients on Quality Veterinary Care
00:17:39
Annatasha
I mean, I think part of the problem from the training point of view, I know this is that first of all, they're just not enough veterinary anesthesiologist actually staff full faculty at all the hospitals. And also in the last 10 years, maybe a little bit more, there's been a brain drain out of academics into private practice for a variety of different reasons. But yeah, it's hard to get full anesthesia training. So we actually start behind the curve because that's the precedent we set.
00:18:04
Gianluca Bini
Yeah.
00:18:05
Adam Christman
What about the, what about the clinics out there when you see that perception of like, Oh, well, why, you know, they only charge me 50 bucks to, you know, spay and neuter my, my dog. Why are you charging me $500 to and neuter dog?
00:18:19
Annatasha
Yeah, I mean, agree with you. I think it's just a question of education. You know, and I always find things like, know, metaphors, similes, what have you very helpful, you know, sort of saying it's sort of the difference between do you want to take a vacation to England and swim, or do you wanna fly on a Concorde? So, you know, you gotta give them some idea of what the difference of the quality and the scale of quality is. And once you do that, like most people are amenable, as you said, because most people want the best for their pets.
00:18:45
Annatasha
You know, some people simply just can't afford it, and I understand that, you know, and then you want them to get the best possible treatment they can within their budget bracket. And, you know, a lot of us are very helpful in terms of trying to support, you know, when you have, you know, cats born with congenital aortic dysplasia and they can only afford the GP spay, you know, like we'll call and consult and I make myself available on the phone and that kind of thing. But yeah, the cost differential, I think it's just like you said, it comes down to the education of the situation. And in most instances, people tend to be more amenable. I also have a number of clients who to this day still, like it doesn't matter what they're doing to their pet, they will call to have me come in and personally anesthetize that pet in a GP clinic because they were like, I only want the anesthesiologist, but that's just like a tiny like crumb off the total pie. So
00:19:34
Adam Christman
Yeah.
00:19:35
Gianluca Bini
Yeah, that's maybe the top 0.1%. I mean, I think that that's where it comes to, like, I totally agree that, like, you know, the low-cost pain with the clinics are necessary.
00:19:37
Annatasha
yeah, yeah.
00:19:47
Gianluca Bini
Like, there is a bracket of the population that does need that. They cannot afford anything else, really. think from a GP standpoint, I think it would be the only way out of it is to educate your clients on what's the difference between low-cost pay-neuter versus what you can offer them. Show them, bring them in the back.
00:20:13
Gianluca Bini
Just bring them in the back.
00:20:13
Adam Christman
Yeah.
00:20:13
Gianluca Bini
Or even with the videos, as you were mentioning, Adam, I think that's a really great idea. Show them what you can offer that's different than... And I see it with some of our practices too, right? Like, you know, we do, at Safe Path Anesthesia, we do have probably 50% of our clients are GBs, right? But they put it on the website.
00:20:34
Gianluca Bini
They tell the clients, they educate them. They're like, hey, you know, this is a service that you can use. It's not going to break the bank, right? They're not in person. They're virtual. It's not going to break the bank, but it can bridge that gap between, know, having...
00:20:50
Gianluca Bini
an in-person anesthesiologist that's expensive versus having the procedure without any support. And so I think that's why we wanted to do this. We wanted to make sure that every pet could have access to one of us without having to choose between having it or not, like they could actually afford it.
Virtual Anesthesiology and Telemedicine Benefits
00:21:12
Gianluca Bini
That's why we started this.
00:21:14
Annatasha
And it's also geographical too. It's not just costs, right? Like here in Canada, like if you live up in Moosonee, you're not going to have a board certified veterinary anesthesiologist, but you may have, you know, the willingness, the interest and the budget.
00:21:27
Annatasha
but like, I'm not driving to Moosonee.
00:21:31
Adam Christman
Yeah.
00:21:31
Annatasha
So, like a virtual option is a great way to capitalize on improving access to care and, and, you know,
00:21:39
Annatasha
as opposed to, and I know the GPs up there, they tend to have a much broader spectrum of knowledge and skill because it's them or nothing. But still, like it's a nice option to be able to phone a friend and have that support and, you know, virtual telemedicine, think unquestionably is helping to do that. So.
00:21:55
Gianluca Bini
Yeah.
00:21:58
Gianluca Bini
Do you think, so, you know, I've been speaking of Fetch for a few years, and I've seen, you know, a growing demand for, at least in the first couple of years, definitely there was a growing demand of like pain management, related CEs.
00:22:16
Gianluca Bini
You know, do you think that demand is still there?
00:22:16
Adam Christman
Mm-hmm.
00:22:19
Gianluca Bini
Do you think it's, or do you think it's something that's kind of winning off a little bit? Or what's your thought, Adam? You deal with that every day with
00:22:26
Adam Christman
Yeah, I can tell you now that we're, know, at the end of this year in 2025, the top five most popular therapeutic areas, pain management is number two.
00:22:37
Adam Christman
So and we have a lot of tracks that we put in, you know, around the country. So pain is really up there. Internal medicine is number one. And so, you know, that it gives you an idea that it's not just anesthesia, of course, it's this is including things from
00:22:52
Gianluca Bini
you
00:22:52
Adam Christman
know, pain management, post-op, non-serital anti-inflammatories, multimodal pain management is really popular now. Non-pharmacologic traditions or management of chronic pain in pets, whether it be through TPEM technology or shockwave laser, those kinds of things. So, yeah, I think it's very popular. And I think that the... the knowledge gap is definitely closing you know you can see people and i'm sure you're seeing it too both of you as educators yourselves you're seeing people a little more confidence the questions that i'm seeing when i'm sitting in on the webinars for pain management they're not just your typical questions anymore like what's an opiate what's a new agonist like it's like what if i did this with like a beta alpha whatever it is you know like those kinds of things they're i sound like a frat house all of a sudden but uh
00:23:36
Gianluca Bini
Yeah.
00:23:38
Adam Christman
I do think that the questions are definitely more technical.
00:23:43
Annatasha
Well, yeah, I love that feedback
Pain Management and Continuing Education Trends
00:23:44
Annatasha
too, right? Like, I think we've gone from basics, although I would say I bet you that's not necessarily the case if you swap over to equine and farm. So that is still, I think, a significantly bigger struggle than small animal.
00:23:56
Annatasha
Trying to get the teams to, mean, I have this problem. Now you can produce a mountain of evidence, right?
00:24:06
Annatasha
Current evidence, and you can have people vouch for you and their needle doesn't move. They just don't budge, right? They're still giving colixbutorphanol and it's just wildly inappropriate, but it still goes on.
00:24:16
Annatasha
And like said, equine is a lot harder, but it's nice to hear that small animals moving along.
00:24:21
Adam Christman
Yeah.
00:24:21
Gianluca Bini
Yeah, and I think the majority of what that I'm seeing is probably from small animal, right?
00:24:26
Annatasha
sure, yeah.
00:24:27
Adam Christman
Yeah, definitely. Just because some of the newer drugs that are out there to alfax alone and those kinds of things, like they want to know how to use it, how to integrate it and implement it into either pain management protocols.
00:24:37
Adam Christman
So, you know, there's a great interest that's there. Just the one session that was at Fetch Long Beach, I mean, the attendance poured out of the lecture hall and it held 200.
00:24:49
Adam Christman
So, I mean, there was like, I mean, it must be 250 people that want to learn more about multimodal pain management. So, and it was a combination of, you know, GPs and technicians. So again, it lets you know that it's not just from a doctor's approach.
00:25:02
Adam Christman
I think it's from the team, you know, they want to learn, you know, how to educate and talk to the clients in exam room, as well as patient monitoring and, all those, all those things. So, yeah.
00:25:12
Annatasha
It's encouraging. Yeah. Do you find out on that anesthesia is like one of your top requested CE? Because I basically like from the conferences that I contribute to from the CE that we provide just through my hospital, from what I get personally requested, like my marketing director here will tell you in a landslide that anesthesia is the single most requested specialty for like GP level CE.
00:25:35
Gianluca Bini
Thank you.
00:25:35
Adam Christman
Without a doubt, 100%.
00:25:37
Annatasha
Okay.
00:25:37
Adam Christman
Even on the webinars, too, I would say anesthesiology and ophthalmology from a webinar component lens. Ophthalmology, I don't think they get, it's taught well. I hear this a lot from the ophthalmologists that they don't get enough of it in veterinary school and they come out not being confident enough to know, you know, what's wrong. He's like, I have so many eye pictures of people saying, like, what do I do? What do I do? So, but same thing for anesthesiology. There's just, I think a lot of it is lack of training in school, not very confident.
00:26:05
Adam Christman
And then when I help moderate those webinars, I see the questions that come through is like, oh my gosh, thank you so much for giving me peace of mind. I feel little bit better. I can do this. So, you know, it's definitely helping, but yeah, very popular.
00:26:18
Annatasha
Okay, good. Yeah, I'm glad it's consistent with my opinion on the situation,
00:26:20
Gianluca Bini
It's true.
00:26:22
Annatasha
Yeah, it's funny. I've been going through all the performance reviews with my own clinicians at the hospital at the end of the year here. Right. And, you know, for a long time, we've been honing in on the ER team, like bolstering their surgical skills. And it was funny in the performance reviews, they're like, I'm actually okay with surgery.
00:26:36
Annatasha
It's the anesthesia that's really terrifying me at two o'clock in the morning. And so now I'm totally switching tack as opposed to doing like this, you know, rolling mentorship program for my ER doctors to the surgery specialists.
00:26:39
Adam Christman
Yeah.
00:26:47
Annatasha
I'm switching it to anesthesia because that's really what the majority were saying. They were like, listen, the last time I had to do a leak check on a machine was vet school. You know, or like, they're like, I don't know what to do in the middle of the night if the patient is hypotensive and turning down the ISO and giving a fluid bolus doesn't work.
00:27:00
Annatasha
And, you know, and I'm just like, and I don't want to always be on call. So yeah, I don't know. If you call me at 3am and the answer is glycopyrrolate, you're definitely getting punched.
00:27:11
Adam Christman
That
00:27:14
Annatasha
But yeah, no, was interesting. So I have a whole new like first quarter project to review in the new year because my ER vets were like, it's not the surgery. was not the surgery. They were like, it's the anesthesia. And especially if something goes wrong or if it's really speedy, like a dystocia or really unstable, like a possible GDB, like the middle of the night ER, you know, classic cases. They were like, we'd rather transfer than have to do the anesthesia.
00:27:36
Gianluca Bini
Yeah.
00:27:36
Annatasha
And so, yeah, it's interesting.
00:27:38
Adam Christman
is interesting.
00:27:38
Gianluca Bini
Yeah. But, you know, I think it's encouraging, though, right? Like, you know, think that they usually demand that there for CEs and questions and questions.
00:27:45
Adam Christman
Yeah. Yeah.
00:28:01
Gianluca Bini
So that goes back to the 10 days of anesthesia, probably.
00:28:06
Adam Christman
And you're right too. I mean, look what you just mentioned, Tasha. You mentioned like major common things that we'll see in practice, your GDV cases, dystocia case, let alone breed predispositions for brachycephalic management and certain cats are predisposed to things. Dog breeds themselves with anesthesia, you know, are prone to these things. So you have those hurdles that we need to overcome. And then there's the public perception of anesthesia. You know, because my dog is 14, he's just too old for anesthesia. So I'm gonna let the teeth rot out of his mouth. You know, so there's a little bit of that, like my dog, my cat, or they're too old to go under.
00:28:40
Annatasha
Okay.
00:28:40
Adam Christman
I'm worried about that. And then sometimes I just think sometimes veterinarians are just so busy. They just wash their hands. Similar to asking the infamous question, what are you feeding your pet? We just dance around like, yeah, that's good. That's good. Because you just know so many have an opinion about that. And when only have like 20 to 30 minutes, you kind of choose and pick your battles of what you're going to say. But anesthesia kind of like a non-negotiable.
00:29:03
Gianluca Bini
It's, it definitely, I think it definitely is. You know, I think, I think, yeah, we, we more CE is more, more help to the GP population and different options.
00:29:17
Gianluca Bini
I think hopefully we,
00:29:17
Adam Christman
What about Gianluca, what about the lab that you did? Because remember, you did the ventilation lab.
00:29:22
Gianluca Bini
yeah.
00:29:23
Adam Christman
It's like, that's a little next level, you know, on what's your experience been with attendees with that interest?
00:29:29
Gianluca Bini
Yeah, I think the attendees, they were there. They all wanted to, you know, learn more about ventilation. Some of them were already using one.
00:29:39
Gianluca Bini
Some of them were about to purchase one. You know, I think a ventilator in practice, it's...
00:29:49
Gianluca Bini
Probably of the practice we deal with, for example, probably 50% of them have a ventilator of the GP ones, especially the whole habit.
00:29:56
Adam Christman
Yeah.
00:29:57
Gianluca Bini
But the GP ones, probably it's a 50-50 split. And it's daunting, right? It's a device that usually costs between $6,000 and $8,000. And some practices don't know how to use it or they're scared of it or...
00:30:16
Gianluca Bini
Simply, they want to invest the money in it, right? But we see that with monitors too, right? I think we were chatting with the human anesthesiologist in the previous podcast, and we still have GPs out there that do not have a capnograph, right?
00:30:26
Annatasha
Just
00:30:32
Gianluca Bini
And they cannot measure CO2, which now it's in the 2025 ACVA guidelines as basic anesthesia monitoring, right? So that is a non-negotiable.
00:30:47
Gianluca Bini
If you're doing anesthesia, you do need to have one. And there is plenty practices out there that do not have one, which is very scary, to be honest with you. But then instead of spending $2,000 on the module for the studio, they spend $30,000 on digital x-rays, right?
00:31:05
Gianluca Bini
So one of them is going to kill their patient and the other one definitely doesn't.
00:31:09
Adam Christman
Mm-hmm. right.
00:31:10
Gianluca Bini
But that's the unfortunate reality. Sometimes they don't perceive the value in it. And part of it is because they don't understand how to use it.
00:31:20
Gianluca Bini
A lot of them You know, we do not, for us, when we work with a practice, we do not work with any practice that does not meet the minimum standards for ICVA guidelines.
00:31:32
Gianluca Bini
So we do not work with anybody that does not have a capnograph, ECG, SPO2, non-invasive blood pressure, all of that.
00:31:39
Adam Christman
okay. Yeah.
00:31:40
Gianluca Bini
So we vet them before working with them. And if you don't have it and you want to elevate yourself, we do help you with finding what's the right what's the right thing, right? So we don't leave you stranded. But, you know, the reality is that there is some branches that do not have it and they don't care about it.
00:32:00
Adam Christman
And that's why I asked too, because Tasha, someone like myself who works in the CE space, if you had the big ask, what would be something that you think we could do better of in the CE? Is it more hands-on labs? And if so, what does that look like? What do you think that we could do to
00:32:13
Annatasha
I find a lot of the CE these days is I'm a big believer that for any skill or specialty or expertise, you have to walk before you fly. And so much of the CE is focused on like ultrasound guided blocks and local regional anesthesia. And it's really like the peripheral like bells and whistles. And at the end of the day, it's like the fundamental like core principles that are rarely addressed, right? Like ask a lot of people, they'll well, I to learn to do an ultrasound guide to block. And I'm well, what's the mechanism of action of propofol?
00:32:43
Adam Christman
Mm-hmm.
00:32:44
Annatasha
And they can't answer that question, but my God, do they want to get their hands on that ultrasound? And I'm like, absolutely not until you know what you're doing, right? So it's, I just feel like there's so much focus on like the fancy, sexy things. And at the end of the day, most people can't answer straightforward questions on like,
00:33:01
Annatasha
what's the flow on a non-rebreathing circuit and how does us a fluorine work and what's the difference between ISO and SIBO, you know, and, and, and Nalphaxelone and propofol. And, and that's what we're missing, right? We're missing the core fundamentals of building the confidence so that people can extrapolate from those first principles when things go wrong. But I mean, guarantee you that, you know, if you had to break apart the anesthesia machine and ask them things like name three safety mechanisms associated with the machine or name three points of the most common leak,
00:33:29
Adam Christman
Yeah.
00:33:29
Annatasha
90% of that GP population can't answer those questions correctly.
00:33:29
Adam Christman
Yeah, yeah.
00:33:32
Annatasha
Like I think they would fail basic general anesthesia exam, but you know, let's talk about Librella, right? So, you know, for me, that's what it is. So like I always drive, like I like my anesthesia to talk about, you know, like what are the four big complications, right?
00:33:45
Annatasha
Low heart rate, low body temperature, low blood pressure, low ventilation, how to use your machine and understand your drugs and start there,
Building a Strong Foundation in Anesthesiology
00:33:53
Annatasha
right? Right.
00:33:53
Gianluca Bini
You know how many
00:33:55
Annatasha
And stop arguing whether you should give a fluid bolus over 15 minutes or 20 minutes. No one cares, right? Like learn how to do your job properly, you know?
00:34:04
Adam Christman
I love this.
00:34:04
Gianluca Bini
It's a matter of, this is the question I get asked all the time. After every single session, they come up and it's like, what's your safest protocol or best protocol? And the answer is, it doesn't fucking matter. In 99.9% of patients, the protocol that you want to use as long as you stay within the dose range, and I probably repeated this 200 times on this podcast, it doesn't fucking matter, right? There is no safe protocol. What's safe? There is a safe anesthetist.
00:34:31
Gianluca Bini
but there is no safe protocol. Like you need to know, the person that's doing anesthesia needs to know how does this drug work? Each one of them, the ones you're giving and what are the side effects and how to fix it if shit happens.
00:34:43
Gianluca Bini
That's how you do safe anesthesia. It's not about the protocol.
00:34:46
Annatasha
Yeah.
00:34:47
Gianluca Bini
Like if...
00:34:47
Annatasha
Like people give like 2.5 micrograms per kilogram of dexmedetomine instead of three. And I'm like, what do you honestly think you're achieving? But like, you know, you still see routinely like failure to recognize that you did not intubate.
00:35:00
Annatasha
Right.
00:35:01
Gianluca Bini
because you don't have a fitting gap enough.
00:35:01
Annatasha
That's a good one.
00:35:03
Adam Christman
you
00:35:03
Annatasha
Failure to recognize that you have not successfully intubated is a great way to kill something in the first three minutes, right? And we're so busy fighting with people about ultrasound guided blocks. And I just, I've just given up the will to live in this capacity.
00:35:15
Annatasha
But like my CE, you know, we talk so much about pain management and great, great, great, great to the point now where we overanalyze everything to the point of comas.
00:35:15
Gianluca Bini
It's not just that.
00:35:23
Annatasha
And it's just like, you want to do like a tiny little like one centimeter biopsy and we're given like 0.5 mg per kg of methadone. And I'm like, that's a dose for a fractured femur, right?
00:35:32
Adam Christman
Yeah.
00:35:33
Annatasha
Like we've lost the scale of what's appropriate and relative because we're so worried that they're going experience pain. Now we're overdoing it. And like I said, most people can't troubleshoot things like where's this leak coming from or what happens if you drop your bottle of isofluorine?
00:35:47
Adam Christman
Oh, sorry.
00:35:48
Gianluca Bini
Yeah, fucking leave the room real fast, tell you.
00:35:49
Adam Christman
That's a good one. That's such good one.
00:35:50
Annatasha
Right?
00:35:51
Adam Christman
Yeah, it's...
00:35:52
Annatasha
And I'm like, well, what happens is I'm going home for the rest of the day. Take care. So, you know, like it's just that's what it is like. You don't get enough of the fundamentals. You don't get enough hands on experience to build confidence.
00:36:03
Annatasha
We're so focused on like the flashy, like out here in the periphery. And that's why when things go wrong, like, I mean, I've had phone calls, for example, from from other clinics where you know the patient's co2 they had co2 beat me and it was 96 and i was like well what's your title volume right and it's like a 30 kilo dog and they're driving like 100 mils and i was like you know like to me that is basic ventilation to be able to troubleshoot that and this person was in like hysterical tears and i was like just turn up the title volume and i said call me back in five minutes let me know
00:36:06
Adam Christman
Yes.
00:36:34
Annatasha
and it normalized within three minutes and she called me back and she was like, I had saved that patient's life obviously, but I was also like, what business do you have doing performing anesthesia?
00:36:44
Adam Christman
Yes.
00:36:44
Annatasha
Right? What business do you have doing anesthesia? But by God, I bet you they're arguing about ultrasound guided blocks.
00:36:50
Adam Christman
Let me ask you this. I love this chat, by the way. I'm sorry. I'm not like hog this over, but I'm getting chills and they're multiplying. What if we had like a real conversation at a conference to like keeping it like fricking for real about like, we have something called veterinary crossfire, but like, are we overdoing it on pain management in our patients?
00:37:02
Gianluca Bini
have
00:37:09
Adam Christman
Like, like some people like, Oh no, we're not like we're, we're fine.
00:37:10
Annatasha
Yeah.
00:37:13
Adam Christman
Others be like, uh, yeah, they're too deep.
00:37:15
Annatasha
We're guaranteeing everything in so much trastodone gabapentin. Like it's now a standardized thing that every pet that comes through, it's like the, I always say this, it's the famotidine of this decade.
00:37:24
Adam Christman
Yeah.
00:37:24
Annatasha
You know, like it was just, and we're, we're doing to the point where most of these things are coming in, like head hanging to the point. And I'm like, you know, and every dog that even yips once in an ER, like they're like, sedate it.
00:37:40
Adam Christman
Yeah.
00:37:43
Annatasha
And I think a large part of it is I understand its best intention, but there's a component there of fear based medicine that we're so worried that we're going to miss a tiny little bit of, you know, discomfort or pain that, you know, like I said, you know, you're you're you're dropping these highest doses of the most potent medications on earth in things like a really straightforward lipoma removal.
00:38:02
Annatasha
And I'm like, have you never heard of bupivacaine? You know, like it's just it's wild to me. But like I said, we don't have enough training and basic principles and the safety associated with the equipment that we use.
00:38:14
Annatasha
But we're hyper focused on like the fancy stuff to the point where now people can no longer problem or troubleshoot or they don't actually have the knowledge base that they should have to have any business being involved in the anesthesia whatsoever.
00:38:27
Adam Christman
Yeah. Oh my gosh. How does this not jade you?
00:38:30
Annatasha
It does. Do I not seem cranky?
00:38:32
Gianluca Bini
Would you listen to her?
00:38:37
Annatasha
Cranky, cranky fuck.
00:38:40
Gianluca Bini
She's about to have stroke.
00:38:42
Annatasha
Yeah, I think about leaving the profession at least 25 times a day and specifically this specialty because it is so aggravating. I do remember 100 years ago when I started, when I decided I was gonna do anesthesia, my mentor at the time was like,
00:38:54
Annatasha
She was like, you have the capacity do this, but she goes, you will never be thanked. You will always be undervalued and you will always be aggravated because nobody listens to you. And I was like, we'll see.
00:39:05
Annatasha
She was a hundred percent right.
00:39:07
Adam Christman
Here we are.
00:39:08
Annatasha
Here we just cranking away in this tiny little weird room next to the anesthesia and doctor waiting for a radial fracture.
00:39:19
Adam Christman
I'm obsessed with her.
00:39:21
Gianluca Bini
She's amazing.
00:39:22
Gianluca Bini
I told you. told you.
00:39:23
Adam Christman
Yes. Where have you been?
00:39:25
Annatasha
No, yeah. I've got to work on my influencing, you know. No, I've always wanted to open up an Instagram page called the grumpy vet where just me complaining.
00:39:29
Adam Christman
Yes.
00:39:36
Annatasha
Just me complaining. But yeah, no, I think, like I said, I think the CE, you know, it's just...
00:39:41
Adam Christman
Yeah.
00:39:43
Adam Christman
I think love what you're saying is really bringing it back to basics. Just really bring it back to basics. understand.
00:39:48
Annatasha
Basics is how a good anesthesiologist solves problems when they don't know the answer. Right?
00:39:53
Gianluca Bini
Yeah.
00:39:53
Annatasha
Like if all of a sudden I have, mean, because everybody's had this before you do enough cases, like you'll be like a healthy dog you're doing something really straightforward, like, you know, a bog standard TPLO. And all of a sudden that, and it goes blue and it's pressure dumps.
00:40:03
Annatasha
And you're like, I don't know what's happening. And man, you better understand your first principles about hypoxemia and hypotension. You know what, if you're going to figure that out, because there's no good reason.
00:40:15
Annatasha
Like, you know, we're so, you know, good at anticipating, like you take something with, you know, renal insufficiency and for, I don't know, a foreign body, right? And like, you're like, all right, kidney, kidney, kidney, kidney.
00:40:27
Annatasha
But when things go wrong and things where it shouldn't go wrong, that's when you lose patience because those basic principles, there's no lateral ability to extrapolate. And that's not when you want to be learning what are the differentials for hypoxemia, right?
00:40:39
Annatasha
When your healthy lab goes blue, that's when you need to know your stuff.
00:40:41
Adam Christman
Yeah.
00:40:43
Annatasha
And that's where we save lives and a lot of other lives are lost. So...
00:40:47
Adam Christman
Yeah. I like, I like the main thing I found too. So good.
00:40:51
Annatasha
Adam's like making notes.
00:40:52
Adam Christman
writing this the bird book.
00:40:55
Annatasha
Tasha's very cranky.
00:40:58
Adam Christman
I would say like talk titles and to like when your healthy patient turns blue, I really liked that because yeah, you just.
00:41:03
Annatasha
happens, right?
00:41:03
Adam Christman
All
00:41:04
Annatasha
I've had things like I had something fibrillate off, cefazolin. I've had anaphylaxis from famotidine. I've had, I've for sure had an endoscopic cat have its trachea ripped because they didn't detach the circuit from the tube, right?
00:41:10
Adam Christman
right.
00:41:16
Annatasha
And all sudden I have a tension pneumothorax and tachycardic awake cat is dying. And I'm like, and that kind of stuff too. Like, you know, I've had surgeons tear through uterine stumps on healthy pets and they're like, it's going to bleed out. And I'm like, if you could put your finger back in there until we make a plan, I'd appreciate it.
00:41:29
Annatasha
But all those lives got saved because of first principles, not because I know how to do QL block, right?
00:41:34
Adam Christman
Yeah.
00:41:38
Annatasha
Like, like
00:41:40
Gianluca Bini
We're really cranky against local blocks.
00:41:42
Annatasha
lives, right? But let me tell you, understanding hypoxemia and that where my machine is faulty or where the patient is failing, that does.
00:41:50
Gianluca Bini
We love local blocks.
00:41:52
Gianluca Bini
Don't get it wrong.
00:41:52
Annatasha
I love local books. I'm published in local blocks. It's just, there's such a focus on it right now and this like tit for tat over creeping scope of practice and who should do who shouldn't do it. And I'm like, why don't you tell me about the difference between midazolam and diazepam?
00:42:08
Adam Christman
There's a letter M in midazolam a letter D in diazepam.
00:42:14
Annatasha
Yeah. I mean, Yeah, you're not allowed to anesthetize stuff at my clinic, Adam.
00:42:18
Adam Christman
Yeah.
00:42:24
Annatasha
Yeah, no, we love local regional, we're all for pain control. But at the same point, too, like I said, you have to learn how to walk before you fly. And if you don't have your fundamentals down, I don't think you have any business doing the bells and whistles. Right.
00:42:35
Adam Christman
Well said.
00:42:36
Gianluca Bini
Okay, on that note...
00:42:36
Adam Christman
Excellent.
00:42:38
Annatasha
If you were a surgeon, right, you don't start with craniectomies.
00:42:41
Adam Christman
No.
00:42:43
Adam Christman
That's true. That's good.
00:42:44
Gianluca Bini
Well, on that note, thank you so much, Adam, for here.
00:42:47
Annatasha
Thank you, Adam.
00:42:48
Adam Christman
Thank you. Thanks for having me.
00:42:49
Gianluca Bini
Thank you for listening to the rant.
00:42:50
Adam Christman
This is great.
00:42:51
Adam Christman
Yes.
00:42:53
Annatasha
I feel sorry because Bailey's not here. It's our first one without him and like we haven't even touched on hot dogs, but anyway, that's...
00:42:58
Adam Christman
Oh, sorry.
00:42:59
Gianluca Bini
What's your favorite hot dog, Adam?
00:43:02
Adam Christman
Thank you for asking me this favorite question. It's the standard wire hair dachshund.
00:43:08
Gianluca Bini
That's amazing. Okay.
00:43:09
Adam Christman
I love them.
00:43:09
Gianluca Bini
That beats it all.
00:43:11
Annatasha
So good. I also love a wire haired myself, so...
00:43:14
Adam Christman
I have three of them, you know, so they're just obsessed with them, but a lot of high maintenance, but I've had all of the dachshunds of my entire life, but I will tell you the wire hairs are the comedians of them all for sure.
00:43:26
Adam Christman
So funny, but anyway.
00:43:28
Annatasha
Nice.
00:43:28
Gianluca Bini
Amazing.
00:43:29
Adam Christman
Thank you for having me on friends. So nice to see you.
00:43:31
Annatasha
Thank you guys. I'm wishing you both happy holidays too, whatever you celebrate or don't celebrate. Every
00:43:36
Adam Christman
It's the holiday season. Hey, Hey.
00:43:38
Gianluca Bini
I love you guys.
00:43:38
Adam Christman
There you go.
00:43:39
Gianluca Bini
You
00:43:39
Annatasha
year I celebrate, don't kill my mother.
00:43:42
Gianluca Bini
guys are nuts. I'm a handed here.