Dr. Angie Krause (00:00)
Welcome back to Tails of Truth, where we tell the truth about veterinary medicine. I'm Dr. Angie, and this is my co-host and veterinary nurse extraordinaire Jojo. And today we have our very first guest on our podcast. Welcome Dr. Kenneth Pierce, who's a board certified ophthalmologist and the founder of VESPECON And today we're going to talk about eyes.

But we're also gonna talk about specialty care in general and what it means for your pet to see a board-certified cardiologist or internist or surgeon and how Dr. Pierce is making that more accessible. So welcome, thanks for hanging out.

Kenneth Pierce, DVM, MS, DACVO (00:41)
Yeah, thank you for having me. It's an honor to be here and to be your first.

Dr. Angie Krause (00:46)
Yes, I know.

JoJo (00:46)
Yes, that's exciting.

Dr. Angie Krause (00:49)
just like hoping technically we know how to do this and so hopefully there are no glitches.

Kenneth Pierce, DVM, MS, DACVO (00:52)
next time.

JoJo (00:54)
We

can have the conversation, no problem there.

Dr. Angie Krause (00:57)
Yeah, we can talk all the time, but I'm I'm so happy you're here because I have been having so many problems in the last I mean it's been several years, but I would say even in the last two months acutely I've had so many patients that need to seek specialty care whether it be an internist or a surgeon and I cannot get my patient into them and we live in a you know, the Denver metro area so I have a lot of hospitals to choose from

but it's really hard to find specialty care. have one case of a dog with pancreatitis and now maybe that pancreatitis is resolving, but now we have this fever of unknown origin and I'm out of my depth. Like I'm looking around, like someone help me. And the only way this dog can get care is for the dog to be hospitalized overnight to get into internal medicine service the next day. And the dog doesn't require hospitalization.

And here in Boulder, that would be like one to $2,000 to hospitalize a dog overnight. And so that's how much it costs for an internist to just help me.

Kenneth Pierce, DVM, MS, DACVO (02:05)
Yeah, before before you even get into testing and whatever else and procedures that may need to be done. It is part of the issue, right? With the industry as a whole, just access to getting into specialty hospitals or even just access to get an appointment is become problematic, right? There's a high demand. The number of pet population over the years has increased in.

the number of specialty hospitals and specialists will never kind of meet those needs based off of the number of veterinarians that are produced on a yearly basis. So your local vet is like your main bread and butter in the first line of defense and even, you know, general practitioners.

overwhelmed right they're dealing with a lot your dog with pancreatitis to that bird that is molting and plucking all its feathers out to the cat that you know it's got herpes virus and and it's sneezing all over the place ⁓ so they are bombarded and sometimes you know they need a lifeline and

Dr. Angie Krause (02:58)
Right.

Kenneth Pierce, DVM, MS, DACVO (03:04)
I would just tell you, know, over my career of 18 plus years of being an ophthalmologist, as well as being in every, almost every region of the United States, the only place that I have not physically lived in for a period of time is the Pacific Northwest. And that's no bias to them, just, it hasn't come to fruition yet. But living almost everywhere and giving out advice and seeing the impact that

Dr. Angie Krause (03:23)
Mm-hmm.

Kenneth Pierce, DVM, MS, DACVO (03:31)
clinical advice has not only on the veterinarian and their confidence and knowledge, but also on that patient and that parent, the outcome that we're able to kind of turn an eye around that looks like this red marble and animal's not seeing to now it's almost completely normal again and seeing.

is huge, right? And be able to deliver that locally with a personal touch is how kind of VESPECON all came about. as I mentioned, kind of been around, was in academia as well as in private practice and started my own ophthalmology practice called Veterinary Vision Center in Shreveport, Louisiana. That region of the United States has never had an ophthalmologist there on a permanent basis since

veterinary ophthalmologists began, right? So people in that region of Southern Arkansas, East Texas and Northern Louisiana have to drive three to four hours just to see an ophthalmologist, right? So setting up shop there in the pandemic was great because I filled a huge need and on a daily basis, clients or general pet owners as well as veterinarians were telling me, thank you for being here. Like we really needed you.

Dr. Angie Krause (04:25)
Wow.

Kenneth Pierce, DVM, MS, DACVO (04:41)
It's what you do is amazing and it shows, right? And so seeing that and hearing how vets were doing their level best to manage these conditions eye related as well as like all oncology, internal medicine related problems and.

Seeing how much advisory support can have, on the success of that case, came about with VESPECON, which is an acronym for Veterinary Specialty Consultants, where we basically just link veterinarians and hospitals with just an entire network of every specialist there is for large, small, and exotic animals, to where your local veterinarian gets that knowledge from the specialist.

Ideally at no cost to you and then can deliver that specialty care locally. So now you don't have to board your animal at a hospital for thousands of dollars before they even see the specialist. Now your veterinarian can do all that locally there and then if it gets to a point where it needs to have a specialty procedure or a specialty diagnostic that your vet can't do then we help get you into the specialty hospital a lot quicker.

JoJo (05:29)
you

Kenneth Pierce, DVM, MS, DACVO (05:50)
as well.

Dr. Angie Krause (05:51)
Okay, so for this case that I'm managing the pancreatitis and the fever of unknown origin, I would be connected to an internist and I could send them the ultrasound and everything and then we would chat on the phone. How would it work?

Kenneth Pierce, DVM, MS, DACVO (06:04)
Yeah, so you go to your vet, they...

Confirm OS pancreatitis, but they have some questions or things like that. Your veterinarian will reach out to us through our website at VESPECON.com. Either the nurse, ⁓ like your stellar nurse like Jojo would go on, fill out the information, tell us when your veterinarian is available. So everything that we do is white glove for the veterinarians and for their hospital. So your vet's not wasting time trying to wait on a specialist to get on a call or wait for a call back. Your vet or the nursing team tells our admin team,

hey my doctor is available at two o'clock on Tuesday. We need to speak with an internist as well as a cardiologist. We need two specialists on because we've got some underlying comorbidities, right? So we have the ability to have multiple specialists on at a time.

JoJo (06:47)
Mmm.

Dr. Angie Krause (06:48)
Yeah. Right.

Kenneth Pierce, DVM, MS, DACVO (06:54)
your veterinarian and team can upload all the records, pictures, videos, DICOM images, the whole shebang that's associated with the case. And then our admin team coordinates all that information, sends it to our advisor that will meet with your veterinarian. They review it all in advance of the conversation. And then the specialist or specialists and your veterinarian meet at that time. And they have a recorded virtual conversation about

the case or about the topic. It doesn't necessarily have to be about your pet particularly. And so that conversation is just an experience in itself. They learn, they can troubleshoot, they could get all the questions answered no matter what the limitations of the hospital or the veterinarian has there. So again, whether you're metropolitan or rural, we just...

Dr. Angie Krause (07:27)
Okay.

Kenneth Pierce, DVM, MS, DACVO (07:44)
kind of make an even playing field for everybody to just kind of discuss things and support each other. And then at the conclusion, your vet has that plan of action. Next steps as well as what to look out for, what preventative measures need to be taken. What do we do if...

certain scenarios happen. So the full kind of gamut more than just a report in and their out the door type of situation. And then as your veterinarian is a member with us, like I said, they have unlimited consultations. So whether it's a recheck or follow up, they got blood test results and they want to, let the specialist know and figure out the next steps from there. That's at no expense to you, right? As the pet parent, all that can happen with the membership and then

that continuity of care is just delivered to you directly through your veterinarian. And even if your veterinarian didn't become a member with us, we do provide a la carte consultation. So it's not like the membership is the only thing. It's just the main thing that is most cost effective for the parent as well as for the veterinarian or their hospital having unlimited consultations during 20 a month versus having to pay individually every time.

that individual consultation numbers is significantly reduced from the client on the budget or the veterinarian that may not offer it because of whatever reasons in the heat of the moment versus if it's readily available, it's like a no brainer.

Dr. Angie Krause (08:50)
Right.

That sounds amazing and I need this right now.

Kenneth Pierce, DVM, MS, DACVO (09:06)
Yeah.

JoJo (09:07)
I was just thinking we were just talking about

a case right before this, this recording where so beneficial where we cannot even get a vet to vet consult at this point. Where it's just like, well, what do we do? Yeah, that's just, well, and I thought about that Dr. Angie, when you were a solo practitioner, just how isolating that can be when you're a solo practitioner to have no peers to

Dr. Angie Krause (09:13)
Yeah, yeah, we have been

No!

Kenneth Pierce, DVM, MS, DACVO (09:17)
Yeah,

well, when we get done, go on bestpacon.com and we got you.

Dr. Angie Krause (09:23)
I know, like someone help me. I'm

about.

Kenneth Pierce, DVM, MS, DACVO (09:35)
Yeah.

JoJo (09:36)
to brainstorm

with or to consult with. It just kind of leaves you less alone.

Dr. Angie Krause (09:40)
Well, at that time though, I felt like I was always calling the specialist and they would talk to me. And now I feel like that's not cool to do anymore. Like that kind of peer to peer conversation is not as encouraged or they're like, just email me. And so it is, it's kind of lonely and I need it all the time. I mean, I've been practicing for 18 years.

And I'm still asking questions. I'm still sending x-rays to the veterinary dentist. Like, should I take this tooth? What's going on here? Like that just never ends, no matter how comfortable you get. And I think it's the worst with the ophthalmologist. I think Trevor Arnold hears from me like once a week with a picture of like, is this okay? Is this okay now? And he's just like, yeah, it's fine. But you just never feel comfortable.

Kenneth Pierce, DVM, MS, DACVO (10:18)
Yeah.

Thank you.

Yeah.

Dr. Angie Krause (10:29)
And it is hard because a lot of these animals, don't want to say pack up and say, well, I'm actually not a hundred percent sure that this, you know, spec on the iris is okay, but I feel really guilty packing them up and sending them to the specialty hospital because I know it's going to be costly. know Dr. Arnold's going to be like, my gosh, it's Angie's patient again. Doesn't she know this is fine. And then, you know, then it's just more stress for that animal. so, but then I also feel.

it on the other side of that coin. It's hard because I know that he's answering all my emails and looking at my pictures free of charge. And for his time, that's hard. I can't get through all of my emails. And so, you know, this week I almost reached out to a couple of internists that I'm friends with on Facebook. Like it got desperate, but then I thought they're going to unfriend me. They're going to, they're going to unfriend me. But that's, I feel like we used to have like,

friendlier times and I'm not sure what shifted or if things have just become so unmanageable because all of our caseloads are so much higher than they used to be. But I'm really excited to hear about this service because that's exactly what we need right now.

Kenneth Pierce, DVM, MS, DACVO (11:40)
Yeah, and I think you have touched on multiple points of the human dynamic where

that fear of unknown or the feeling of being humble to want to ask, or maybe I'm asking too much so I'm not going to ask and such, or like all those things just get taken away once the playing field is even, We have this service, we've got everything that you need, the specialists are getting paid for their time, there is a fee associated with it on your end, but...

Dr. Angie Krause (11:58)
Yeah.

Kenneth Pierce, DVM, MS, DACVO (12:07)
that fee is there so that you can use and abuse us, right? It is to your benefit to not feel ashamed, to not hold back on asking the simplest question, right? Or the most complex question. It doesn't matter. A lot of it is more so of just confidence and knowing. Like you're not on that island. You can...

have that lifeline and talk to somebody and know, hey, yeah, I am doing this right. This is appropriate. Or sometimes it's just also from a legal standpoint, getting that specialist record that says, yes, this is the appropriate test. This is what's happening. Boom, we've got it. ⁓ And the basis is covered. So yeah, all those are super key factors that we just kind of remove all those barriers and all that headache.

Dr. Angie Krause (12:40)
Yeah.

Yeah.

Okay, so people, like, so if you're a pet parent listening to this, and I guess it doesn't really matter if you live in a city or in rural, Texas, it doesn't matter where you are. You could reach out to your veterinarian, tell them about this service, and they could just try this service one time. You could say, hey, I need this for my pet. I would like you to consult with, and do you guys have every specialty?

Kenneth Pierce, DVM, MS, DACVO (13:19)
We do like every everything from even like poultry medicine, nutrition, behaviorist. we are working. We have oncologists who does. Eastern medicine stuff, but we're working on a holistic veterinarian. So again, everything food animal, you got a mini pig at home, a potbelly pig. We got you.

JoJo (13:22)
You got Chinese medicine and holistic veterinarian?

Dr. Angie Krause (13:26)
Wow.

Okay. Yeah.

Kenneth Pierce, DVM, MS, DACVO (13:42)
And then we also

have a business advisory arm too that we've kind of rolled out this past year for again, those solo practitioners who, you everybody has their pockets of I got my CPA or I got my lawyer, but I may not have my HR specialist. I may be managing that on my own internally or a social worker, right? My team is, we've lost a doctor and my team is really struggling with that loss. How do I...

rebuild the culture or what could I do, right? Being solo or few in numbers as far as leadership, it can be very daunting, right? On top of everything else that you need to do. again, VESPECON is a company that is built to provide the industry resources, right? Provide them with those advisors where if they got questions or...

they got situations that they are looking to get some guidance on. There's a lifeline to reach out to to help steer and guide there.

Dr. Angie Krause (14:40)
All okay. That's amazing. Well, can I ask you a question that I've been wanting to ask Dr. Arnold, but I feel so bad because I email him all the time. Can I ask you now? Can we do a little consult? So this is my kitty Fiona. She's three years old and she has, I don't know, I don't know, you can't see it very well, but she has chronic herpes in one eye. And I feel like I'm doing a terrible job.

Kenneth Pierce, DVM, MS, DACVO (14:52)
Sure.

Yes.

Dr. Angie Krause (15:06)
at managing it because I'm mostly doing nothing. Because it'll get kind of watery and then she'll squint and I think, I need to do something about it. But then the next day it's fine and I forget to do anything. But I think it's uncomfortable. I don't know that I would give her, I don't know how well she'd do with oral medication. What should I be doing for her to help?

Kenneth Pierce, DVM, MS, DACVO (15:25)
Yeah. So

what is going on there is that, feline herpes virus, ⁓ as it is active and it replicates, it kills cells to get out of the cell and infect the next cell, right? And those cells are all on the surface of our cornea, our epithelium, as well as our conjunctiva. But in our conjunctiva, there's also

mucin cells, cells that produce a mucus layer to the tear foam and the tears, that mucus layer helps the tears to stick and stay on the corneal surface.

So when those cells get wiped out, they call goblet cells, when those cells get wiped out as the virus replicates, that mucus layer is gone, so the tears don't stick. So cats actually start to overproduce the amount of tears to compensate because they're not lasting on the surface. And so that tearing that you're seeing is just that eye producing more that is more than what the drainage system can handle, and it's overflowing onto the eye.

And cats will squint a little bit sometimes just to kind of reduce the amount of exposure of the cornea because again, it's not sticking. So it's kind of almost like it's evaporating or kind of washing away. And so it is a little uncomfortable. It's not painful. It's not like we need to intervene with some pain meds, but it's more of just not like a dry eye type of irritation, but there is some degree of a sensation there.

Dr. Angie Krause (16:39)
⁓

Kenneth Pierce, DVM, MS, DACVO (16:47)
Actually, one of the main ways that we address it is with a topical lubricant called like vet plus eye drop is the one that I like the most there. ⁓ It is made by I med pharma I should get a little royalty on that I med I'm just joking. But that drop given twice daily actually

Dr. Angie Krause (16:55)
⁓ let write this down.

You

Kenneth Pierce, DVM, MS, DACVO (17:08)
stabilizes and balances the tear film back to normal. And it sounds counterintuitive. My cat's overproducing tears. I'm gonna give it a lubricant. This is gonna add more water to it. But it actually, because it stabilizes it, they start to dial back how much they produce. And so once everything is back to normal, then ⁓ things will stay stable and no longer tear. Now, the other caveat of herpes virus is that sometimes it could take a month

And in the studies where they took naive cats, gave them herpes virus, and then did biopsies and evaluated the tear film, the endpoint was at 30 days. And even at 30 days, some of those cats still didn't regrow those goblet cells that got wiped out by the initial infection. So if it's been a month, that's not surprising there.

Dr. Angie Krause (17:58)
Okay.

Kenneth Pierce, DVM, MS, DACVO (17:59)
So typically with my clients I tell them to use that lubricant for at least three weeks and then stop it cold turkey after three weeks. So be consistent twice daily. In the first week you're already gonna notice ⁓ the eye is better, it's not tearing, like all is great. Continue to use it for the next two weeks.

Then stop at cold turkey at three weeks. If there's no more tearing, then everything is back to normal. All is good. If it starts back up and you'll know that that fourth week there, if it starts back up, then restart it for another two weeks, stop cold turkey and kind of go back on and off until it eventually stops. ⁓

Dr. Angie Krause (18:35)
Amazing.

Kenneth Pierce, DVM, MS, DACVO (18:36)
That is what

you have going on in this herpes virus is super common in the young kittens and then when they all get older when other comorbidities start to come up and their immune system gets stressed then herpes will start to ramp back up there so you you're at the cusp of the quiet time for your cat just ⁓ hang out a little bit longer it'll stop

JoJo (18:41)
Mm-hmm.

Dr. Angie Krause (18:53)
Okay, okay. Okay.

JoJo (18:54)
haha

Dr. Angie Krause (18:56)
my gosh, amazing. And this is

JoJo (18:57)
That was such

a great description of what's happening. I feel so educated right now, like going into these conversations. Thank you.

Dr. Angie Krause (19:01)
Yes!

And this is

nothing I could have ever gotten via email, which I think it kind of just, no. And now, like, so I'm going, well, herpes virus is incredibly common. And so now I have just increased my level of patient care because I got to, mean, mean, that took you like maybe five minutes, but I now have a really complete understanding. I always assumed her I was uncomfortable. Now I understand it better.

Kenneth Pierce, DVM, MS, DACVO (19:10)
Yeah, it wouldn't have been that detailed.

Dr. Angie Krause (19:30)
And now I get to apply that to all of my patients. So like the service that you're providing when I can have these conversations more readily and it's more available to me to talk to any specialty, whether I'm grading a heart murmur and trying to figure out what to do, or if I need to figure out if this knee has a cruciate tear, I think this could really like elevate, everyone's care. So as a pet parent, advocating for services like this, it's only going to help your pet.

Kenneth Pierce, DVM, MS, DACVO (19:52)
Yeah.

Dr. Angie Krause (19:58)
get better care. So this is super exciting. And Fiona thanks you. Now I know what to do.

Kenneth Pierce, DVM, MS, DACVO (20:02)
Yeah.

JoJo (20:04)
And

Dr. Angie, your confidence level is going to go up in every conversation that you have. And so I love this connectivity that you're bringing Dr. Pierce, the bridge between, you know, we do get feedback that people who live in areas that don't have access, just I really appreciate the accessibility. And when I watch Dr. Angie's, I know that that's going to come up in another consultation that she does or in an exam. So I just feel like you just made the world richer. Like, I just love that. I think that's really

Kenneth Pierce, DVM, MS, DACVO (20:08)
Yeah.

Yeah.

JoJo (20:31)
As you said, the human to human piece of it is really beautiful.

Kenneth Pierce, DVM, MS, DACVO (20:34)
And that is one of the things that we get ⁓ feedback from our members and testimonials is just how much they learn, how much it may not, in their certain situations where what they learn is n't applicable right then and there, or that case may be terminal or whatever, and they couldn't apply what they learned. But.

they've already addressed it on the next case. or they've already learned it and know what to do for the next case. So it is, it just comes out easier and such. And the human interaction, seeing and having this conversation, seeing the specialist work with a veterinarian and like see the pain, like, my God, you really going through it. I've been there, like this is how I did it. And then kind of everybody coming out on them.

The great end of it at the end is amazing. Like we all feel good after that, you know?

JoJo (21:21)
Right, that shared knowledge that we kind of have lost I just feel like we kind of lost that art. it sounds like you are building a bridge back to that.

Dr. Angie Krause (21:21)
Yeah.

Kenneth Pierce, DVM, MS, DACVO (21:27)
Yeah.

Dr. Angie Krause (21:30)
So what should people tell their veterinarian? So I mean, maybe they have an animal that needs specialty care, or they're kind of wondering if their veterinarian is doing the right thing, which it's OK to wonder that, by the way, for everyone. It's OK. And what should pet parents do? Where should they go, and what should they tell their vet?

Kenneth Pierce, DVM, MS, DACVO (21:47)
Yeah, I would. So one, you always got to be respectful and tactful, right? Because you never know how people are going to take feedback when it's given. always come from a place of just genuine concern and love for your pet

suggest, having your doctor go to VESPECON.com, spelled V-E-S-P-E-C-O-N for veterinary specialty consultants, and submit a request, whether, you want to pay for it out of your pocket or the veterinarian, calls us to do like a mock consultation or a free trial or,

become a member or uses a la carte however. But being an advocate for your pet's health is just like being an advocate for your health when you're at your primary care physician. ask for, not necessarily a second opinion, but ask for that specialist's advice, have them reach out. We are readily available 24, seven, seven days a week. ⁓ we're to help.

So, but VESPECON.com and you can look at us also on social media too on Facebook at VESPECON, Instagram at VESPECON VSC. We're also on LinkedIn as well at VESPECON.

Dr. Angie Krause (22:41)
And as a GP...

And as a GP, most of the time, our feelings are not hurt. If you're like, I want to involve a specialist. Most of the time we're like, all right. Like we're for the most part, think veterinarians are so happy to collaborate. And just like I was talking about before, like we would love the help and we want to learn. And so a lot of times we're kind of drowning in our own cases and to know that there's a specialist that knows more about that particular topic than we do is actually really comforting. So I think if...

like you said, if you can approach it tactfully, most veterinarians are going to be really receptive to it. Yeah. Because I think

Kenneth Pierce, DVM, MS, DACVO (23:26)
Yeah. And you know,

the other thing is also when on the veterinarian's time too, because the other component is sometimes we get, and we see the pushback is like, I don't have time. Just like you said, veterinarians are inundated with things. So even if it's the end of the day or first thing in the morning, right? Or on a weekend, we do consults on Saturdays and Sundays. So, yeah. So whenever, you know, whenever your veterinarian has time, just have them reach out.

Dr. Angie Krause (23:45)
you do? Okay. ⁓

And veterinarians usually work really well together. Don't you think? We're a pretty like friendly group.

Kenneth Pierce, DVM, MS, DACVO (23:55)
Yeah, yeah, yeah.

Yeah, because we all, know, in the same thing, we all are trying to, figure out what's going on in these pets that are these animals that can't talk to us, right? We all are trying to solve this puzzle off the clues that our pet parents give us and the animals give us. So we all been there. Sure.

Dr. Angie Krause (24:06)
Yeah.

Yeah.

JoJo (24:13)
a practicality question too.

Now that insurance is becoming really popular, how does that work in this situation? the vet is charging their client or the pet parent, can they use insurance?

Kenneth Pierce, DVM, MS, DACVO (24:29)
Yeah, so as an ophthalmologist myself, I'm a big advocate for pet parents to get insurance. Like it will save you long run. No matter what, if you've got that puppy and that puppy turns 10 years old, like that insurance is gonna come in at some point. So it's worth getting it

I think having your veterinarian use VESPECON and submitting a claim, I think will probably just firm up your claim that things were done appropriately and you being able to be reimbursed. I would say that's probably for the vast majority of situations there.

you know, VESPECON does do as a second deal that's not kind of client facing or for the pet parents, we do provide some advisory support to some insurance companies for appeal claims. So if there was like an appeal that came through that it was questionable if something was done right, or if this pet actually had what the diagnosis was or what have you, then we can just chime in from a clinical standpoint from a specialist.

view. But no matter what, and that's just some kind of additional services that we provide as a company for the veterinary industry. But as a pet parent, kind of going back to your point.

Having insurance is worth it. It may be a little bit more financially something to budget for or what have you, but in the long run, it will save you and save your pet too. There's a lot of pets that are still alive today because of pet insurance alone.

Dr. Angie Krause (26:01)
Absolutely. Well, thank you so much for hanging out with us. This has been really great and it's given me a lot of hope that maybe some help is coming.

Kenneth Pierce, DVM, MS, DACVO (26:09)
Yeah. Thank you. Thank you for having me. Thank you for helping me spread the word about VESPECON and all that we're trying to do for the industry.

JoJo (26:09)
Yeah.

Dr. Angie Krause (26:10)
You

Yeah, so happy to do it. See you soon.

JoJo (26:20)
Thank you, Dr. Pierce.

Kenneth Pierce, DVM, MS, DACVO (26:20)
Thank you.

Thank you.

Dr. Angie Krause (26:22)
Bye.