Podcast: Considerations for Behavioral Euthanasia in Dogs with Dr. Pachel

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In this episode, host Alyssa Watson, DVM, welcomes Christopher Pachel, DVM, DACVB, CABC, to discuss his recent Clinician’s Brief article, “Considerations for Behavioral Euthanasia in Dogs.” Dr. Pachel explores the challenging factors surrounding these cases, both leading up to the euthanasia decision and following it. He also shares practices and resources that can help patients, clients, and providers alike.

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Episode Transcript

This podcast recording represents the opinions of Dr. Watson and Dr. Pachel. Content, including the transcript, is presented for discussion purposes and should not be taken as medical advice. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast. The transcript—which was prepared with the assistance of artificial intelligence—is provided as a service to our audience.

Dr. Watson [00:00:11] Hi, everyone. Welcome back to Clinician's Brief: The Podcast, where we give you a backstage pass to the conversations behind all of your favorite Clinician's Brief content. I'm the host of the show, Dr. Alyssa Watson, and today, I am really thrilled to welcome our guest. He is a board-certified veterinary behaviorist, Dr. Chris Pachel, and with his extensive experience as the owner as well as the lead clinician at Animal Behavior Clinic in Portland, Oregon. Dr. Pachel is well-equipped to help us tackle a crucial and often challenging topic. We're going to be talking about considerations for behavioral euthanasia in dogs today. And so we know this topic can really evoke deep emotions, not just for our clients, but also for, you know, all the veterinary staff, you know, the veterinarian, our support staff. And this topic can really lead to some considerable work-related stress. So, I'm really eager to hear some of these insights and perspectives and really some practical considerations that are going to help us navigate this sensitive topic in our profession. So thank you so much for sitting down with us today. I'm sure everyone is going to really get a lot of value out of this discussion. Before we start to talk about some of these things, though, I would love it if you could just take this opportunity to introduce yourself to our audience and give us a little about your background.

Dr. Pachel [00:01:35] Certainly. Certainly. So, first of all, thanks for having me on this. This conversation is one that's near and dear to my heart. And so the opportunity to engage the conversation today is really a special opportunity. So first of all, thank you for that. I am the owner and lead clinician of the Animal Behavior Clinic here in Portland. As you mentioned, we are a five-doctor practice dedicated specifically and only to the behavioral needs of our canine and feline patients. The clinic itself has been around since 1997. I've been the owner of the practice since 2011. And together with my clinicians, we lead a team of just an incredible team of technicians and support staff. And we work collaboratively with the rest of my team at Instinct Dog Behavior and Training in Portland, where we've got a team of behavior consultants and trainers and support staff, offering both training services as well as boarding services. And board and train using a positive-reinforcement model. So, lots of different options and lots of different conversations that really do inform this particular topic today.

Dr. Watson [00:02:43] That's wonderful. Thank you. We're going to start at just the very beginning. You wrote an incredible article for Clinician's Brief. It's only been out for about a month, but we have gotten just wonderful feedback about it. Everybody loves it. And in that article, you really do emphasize the importance of approaching these behavior cases like any other patient evaluation, you know. We need to start with a really good history. We need to start with a good physical exam. But that's really challenging, especially when our patients are fearful or reactive in the clinic. So give us a few strategies that we can employ so that we can conduct this evaluation safely.

Dr. Pachel [00:03:27] Yeah, it's such a great question, especially when I recognize that many of our practitioners are in busy practices. So not only are you strapped for time, you've got a patient that may require a slightly different skill set for you when we're dealing with significant fear, anxiety, or safety concerns like aggression. So I think the first thing is, you know, as you're as you're getting your history information, really being mindful of what information is going to help you make your recommendations and then trying to be as efficient as possible. And I suspect we'll get into a few more of those details within the conversation. So I'll mention a couple of other things now. And, the next one is really being mindful of what you can gain from an observational, hands-off examination first, looking at the way in which the animal is responding to the physical environment, the social environment, looking for movement patterns or attention to particular body parts that may give you a better sense of is this animal experiencing any degree of discomfort or changes in sensory perception that we may need to evaluate further to see whether or not that's relative to the behavior concerns or perhaps, you know, any sort of musculoskeletal or gait changes, anything like that, even something as simple as, you know, if we're doing some food tosses for example, how easy is it for that animal to ambulate throughout the space if they're turning tightly to the left but not to the right, does that tell us something even before we get to a point of a hands-on examination exactly what's going on. Where are we really localizing and focusing our efforts? And then lastly, I think really being mindful of when is a sedated exam the right option and really being mindful of of, you know, not only our injectable sedation protocols, which are fantastic, don't get me wrong, and some of our previous pharmaceutical protocols love them. And when we need a full hands-on physical in a patient that's going to struggle, can we leverage some of our oral transmucosal protocols, or even perhaps some of our ingestible protocols that can provide us with a profound level of sedation in a way that really minimizes patient stress and maximizes clinician input? All of these things are available.

Dr. Watson [00:05:41] Excellent. You know, we talk a lot of us as clinicians, we're really used to talking about quality of life from the perspective of physical discomfort, you know. We're talking about how does that arthritis affect their daily life and their mobility, you know, how does their diabetes affect their quality of life? But can you talk to, you know, the impact of kind of these mental stressors on a pet's quality of life? I know sometimes when you have an animal that has needs to be kenneled due to we want to protect people in the household and things like that. Those things can really have a profound effect on that animal's mental status. Are there other examples of of interventions, you know, that that can cause mental, you know, discomfort or mental harm in our patients?

Dr. Pachel [00:06:39] Yeah, I really love this, this angle of the conversation because we have the ability to say, you know, what is going to be stressful for this particular animal. And as you mentioned, sometimes we're in treatment conflict where we may be needing to manage a particular patient in a certain way for safety issues or for other concerns, and yet, managing them in that particular way creates some problems of its own, where maybe oftentimes I find for some of my dogs who tend to be quote unquote reactive or aggressive when on leash, they don't get walked, they don't get off-property as much as they probably should because of the safety concerns, either towards other members of the community or maybe they're difficult to handle on leash with the current equipment, and so there's a danger to their handler, even with their reactions. And so as we think about some of the balance here between our strategies and some of the the implications of that, I want to be mindful of patient stress. I'm also mindful that when we think about stress, we can divide that into either acute or chronic stress. And we're all designed based on our physiology to respond to those acute in-the-moment stressors, and then have some time to take a breath, to recover, to get back to that resting baseline level of emotional and physiologic arousal. And for a lot of our patients who struggle with chronic stressors, either because of the frequency of exposure to individual stressors or the profound nature of just how stressed they are, the moment we start tipping into chronic stress, we start seeing so many of the implications that we see in people as well, with implications on gastrointestinal function or allergies or itch perception, or perhaps even the ability to sleep soundly throughout the night, which is so restorative for the stress response itself. So we start to get into this, this really pretty vicious cycle where where stress becomes a really big factor.

Dr. Watson [00:08:40] Yeah, absolutely. I can see how those things will cycle and then build on each other. We also really need to consider the quality of life of people in the home, you know, in the household. And so how do we as veterinarians, you know, we're going to talk about a little bit later in the episode about, you know, is our duty to the the client, is our duty to the patient. You know, sometimes those can actually seem like they conflict a little bit. And so, you know, I always try to approach things on from a standpoint of how can I, you know, reduce caregiver burden because I think that that will increase the chances of successful treatment, you know, with behavior issues, but also with other issues, too. You know, like I said, diabetes and things like that. You know, if if we can kind of make it a little bit easier for our clients, I think we get better compliance.

Dr. Pachel [00:09:36] Yeah. I love the fact that we're bringing the the caregiver burden into this. And again, not just from a behavior or behavioral euthanasia conversation, but in the practice of veterinary medicine. So practicing some of our listening skills, leaning into empathy, which is a huge part of the work that we do, recognizing that, you know, many of us, myself included, weren't really trained in empathy as a skill set as a part of our veterinary career. And yet it's so important. And there's some things that actually looks like empathy but are actually some empathy fails, in terms of some, some mistakes that we can make along the way. We won't have time to go into all of that. But, empathy fails. There's some really amazing research and publications out there from Brené Brown that I think are a really great resource to really help us learn how to communicate with our clients well and truly be supportive. And as we're doing that, I think one of the things that's really helpful for me is going into every conversation with clients from a place of curiosity and rather than assuming that I know what's stressful or what's not, or what's doable and what's not, either from a financial standpoint or from, you know, we might look at something and say, oh, well, it's just a quick little injection twice a day. Easy peasy. Here's your treatment plan, and this may be someone who's really going to struggle with that. Maybe it's because of their manual dexterity in their hands, because of arthritis that they haven't shared with you. Or maybe it's a fear of needles that actually makes them really uncomfortable performing even a basic skill. And so if we don't lean in with curiosity and really get a sense of what's doable for them, we may be making assumptions in a way that actually interferes with the implementation of that treatment plan for whatever the condition happens to be.

Dr. Watson [00:11:27] And we're going to talk a bit about assessing risk. You know, this is really a critical component when we're making decisions in these cases. There's some things that influence risk that are just readily apparent when you walk in the room. You know, like you said, that that observation from afar, I can certainly tell a Great Dane from a Chihuahua just when I walk in the room. Right. And, those things are going to be readily apparent. But what other factors should we be asking about when we're gauging the safety of the animal in in the household?

Dr. Pachel [00:12:04] Yeah, the size of the dog, for example, or the size of the animal relative to the target, whoever is being impacted by aggression. When we're talking about safety concerns, as you said, is a really observable one that we often we often know by looking at our notes, looking at the animal itself. I look at a couple of other risk, other risk factors within that assessment. The second of which is the bite history. And I think that sometimes gets missed. If a client says, oh, my dog bit my other dog, or my dog bit my neighbor or whoever was impacted. We often jump into sort of a picture in our head of what that looked like, versus using some of the more objective scales that we have available to us to say, what was the severity of the bite? And there are scales that are specific to dog-to-human bites. There are different scales for dog-to-dog bites, based on some of the differences within tissue and the way in which those bites are likely to impact the individual species. So we can look at that and say, oh, it was a level two bite versus a level four bite versus a level one threat, for example. So we can get some additional objective information there. We can also ask questions about the exposure level. So even if someone says oh my gosh my dog bit my neighbor, does your dog actually need to interact with your neighbor, or is there a management strategy we could put into place, whether that's utilizing a fence or a leash or direct supervision or understanding what actually may be available to us to manage that level of safety. And then also thinking about the level of predictability of whatever the aggression pattern is that we're seeing. If something is reasonably predictable, even if it's not 100%, we can usually get a sense of this is a dog or a cat, for example, that is likely to aggress toward unfamiliar people. Okay, then what would our management plan look like to limit that exposure? Unless we're in the course of a treatment plan where we're creating controlled exposures to change their emotional or behavioral response. But what does management look like? And that allows me to get away from sort of that knee-jerk reaction of, oh my gosh, it's a Great Dane, so much could go wrong versus this is a Great Dane with a level two bite with a highly predictable pattern and easily managed scenario. That Great Dane may actually come out as being less risky than the Chihuahua, who may be reacting in 37 different scenarios with high degree of exposure to family members. You know, if that's the target of aggression and so on. And that little Chihuahua may be little, but they may be inflicting level three, level four bites that are more likely to be injurious versus a Great Dane who growls and lunges. So we have to be able to consider these these factors in relation to one another and what it really means about the overall level of risk.

Dr. Watson [00:15:00] Wow. So, you know, we certainly there is no formula. And it kind of sounds like there's no real way to prioritize, or we don't prioritize, factors like we don't like you just said, you know, just because we have a large dog, that doesn't mean that that's the top thing that we need to be looking at, so you really need to look at these as a whole. And all of those different risk factors that you went through and then kind of piece them together in order for us to come up with that big picture. And then obviously, you know, we want to say, you know, there's we we can't determine with absolute certainty any future risk, right? You know, like I say that to my clients all the time, you know, I can't I can't predict what's going to happen tomorrow when you walk out of the store, you know, all I can do is, is make a plan for what we have in front of me right now.

Dr. Pachel [00:15:54] Yes, you're absolutely right. And I think, you know, in those scenarios when I'm looking at those, those four factors, right, size of dog or the bite history, I think about them almost like sliding scales. So if I'm looking at that Great Dane, certain things are going to be at the kind of the highe- end risks. So size of dog, bigger dog, I need to make sure that I'm making appropriate equipment selections, that the the baby gate is perhaps a bit taller or a bit sturdier than what I might need for a chihuahua. And then I can say, is that doable, right? Same thing with the bite history. If I have an animal who's threatening but never puts teeth on skin, maybe I don't need to go down the pathway of of basket muzzle training or maintaining additional distance versus a dog who has a level three or a level four bite history that is inflicting full thickness punctures. Basket muzzle training is probably a big part of our treatment plan. So I'm looking at each of those factors kind of on this sliding scale rather than saying uh oh, uh oh red flag, red flag. It's yeah, that's riskier. And what does that mean for the management strategies that will be necessary? And then more importantly, when we think about what constitutes sort of an acceptable level of risk for the client, it's not even always about are we at the high end of that risk factor, but more is it doable? A client who has the physical strength and the right tools to control that Great Dane or that mastiff and their basket muzzle trained, and we can provide enough space around that animal so that they're not coming into contact with their triggers, and it's predictable enough to know we can do that may actually have a very low-risk level at the end-point when all of those pieces are put in place. So it's, I think, avoiding that knee-jerk reaction and seeing how does that all come together. And again, what is doable in that scenario.

Dr. Watson [00:17:47] Yeah, I'm glad that you spoke a little bit to that concept of like acceptable risk. And bringing the client in on that too because, you know, just like you were saying before, we're used to giving injections all the time, you know, so asking them to do some of these things, I mean, I've had people that stare at me blankly when I ask them to put an e-collar on their dog and they're like, I just can't do that. Like, he can't go out the dog door. He can't do this. And so if we don't ask, you know, and we don't ask them what's acceptable to them because people's risk tolerance is different too, right? You know, so so I have I certainly, as I have gotten older and become a mother and things like that, my risk tolerance has changed significantly over the years. And so I think that those things are important to bring to light as well.

Dr. Pachel [00:18:44] Yeah, I very much agree. And I think sometimes what happens when we're talking about that acceptable level of risk is, you know, we as clinicians are in the clinic, and we may be deciding what's the acceptable level of risk for us in that environment as sort of the at what point do we go for sedation, for example, or say, no, no, no, I'm not going to push this animal because of safety concerns. So we we get it. I think the problem, one of the problems is potentially when we sort of use that observation, even an animal that might actually be significantly dangerous in the clinic, and we project that risk onto the client's living situation, or we assume that we know the full picture based on a relatively narrow data set, and that is hopefully not taking too much time here, but I remember having a conversation with a receptionist at a clinic where I was giving them an update on my on my patient. And this was a dog was a cockapoo of all things that was really, really dangerous in the clinic environment. And I remember this, this individual saying, gosh, I just can't believe that somebody would keep that dog in their household. And I said, I hear you, and I will tell you that I've done a house call and I've seen this particular dog in the office. I do not touch this dog in the office. In the home, the dog was next to me on the couch. We were playing ball. We were. I was doing a physical exam. Like, we don't always have the ability to know what that animal would look like in a different context. So we have to be curious and really be mindful of of do we have the data to form and inform our decisions and our recommendations?

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Dr. Watson [00:20:54] So expanding on that a little bit, you know, we've talked a lot about what constitutes acceptable risk. You know, how we can make sure that we're not projecting that on to our clients. You really take the position that the ultimate course of action, even when we're considering something like behavioral euthanasia, is really up to the client. And we as clinicians, we need to focus on presenting all of these options, but not make concrete recommendations. So how, you know, how do we balance like communicating our personal experiences and our concerns, you know, with things that we have seen, and, and fears that we might have about a pet's behavior without unduly influencing their decision-making process?

Dr. Pachel [00:21:52] Yeah, it's complicated. Number one, it is complicated. And so I tend to look at that in a couple of different ways. First and foremost, I lean into the medical model, which we do in the clinic every single day, right. So the most common example I give is let's say we have a middle-aged, large-breed dog who comes in nonweight-bearing in the hind limb, and we diagnose them with a partial or full tear to cruciate ligament, right. A common scenario in the clinic. Is it my job as the clinician to say you must do a TPO? You should do that. That is the right thing to do. Therefore you should do that. Or do we say we can do medical management, and it looks like this? We can use anti-inflammatory medications, and it looks like this. We could do physical therapy, and this would look like this. So we're giving sort of a budget, a prognosis, a predicted outcome based on those options. I do the same thing, especially knowing that, at least under current legislation, animals are property. It's not my job as the clinician to take on the weight of telling them what they, quote unquote, should do in that moment. It's my job to help them understand what are the risks, what are the pros, the cons, the costs, the prognosis based on different interventions, and hopefully arm them with the skills and the knowledge to be able to make informed decisions for themselves and for their unique needs. One of the only times that I really tend to deviate from that is when there's a vulnerable population at risk. So if there are kids in the home, or maybe there's an individual that suffers from cognitive impairment or memory decline, or something along those lines where I say, no, no, no, we actually need as professionals to advocate for the safety of these individuals, in which case then I may let the client know there are benchmarks that we need to be able to reach in terms of our management plan. The child needs to be safe, the elderly individual, you know, or whatever the individual, the cognitively impaired individual must be able to live within their home free of danger. What will it look like to be able to do that? So there may be some cases where I get a bit more insistent on a certain level of management, but it's still not my job to say this is what you must do. If that individual is behaving in a way that endangers a vulnerable population, I may, in rare cases, actually involve child protective services or an elder care organization in my community so that they can step in as they are trained to do, to advocate for the needs of that individual. But it's not my responsibility to be the one to make that decision for them.

Dr. Watson [00:24:47] That's really interesting. And I'm going to spring a question on you that was not that you're not prepared for. So, do you know if the veterinarian has any legal responsibility in any of those situations, and how we need to handle that?

Dr. Pachel [00:25:04] It's a great question. And it's a really common question here as well. And it really it really depends on the community, depending on the state, depending on the community, whether we are mandated reporters or not. So if you and your community, you know, to the listener, if you're not sure, that's a great question to be able to ask even with a quick Google search. Am I, in my case, in Portland, Oregon, as a veterinarian, a mandated reporter? And if so, for what? Is that for abuse cases? Is that child endangerment? Is that spousal abuse or domestic violence? Like, what am I a mandated reporter for? Or even if I'm not a mandated reporter, what are my avenues for taking action in a scenario where I have knowledge of, or I have suspicion, that someone is at risk? What can we do? So it's very, very regionally specific, at least in my experience.

Dr. Watson [00:25:58] And I think, you know, just thinking about that for, you know, each individual person as what did they feel their ethical responsibility is too is a good thing to just maybe have some mindfulness about and just take some time to think about that. So thank you for answering that. Oftentimes, I will find that, you know, we're saying right now we really need to let people make this decision for themselves. But I will tell you, I find that there are lots of times that clients really come at me and I feel pressured, like they want me to make a decision for them. I'm, you know, I'm sure everybody out there listening has had, what would you do if it was your pet? And, that's such a hard question to answer. So what are some strategies to gently guide the client back into, you know, the the driver's seat, if you will?

Dr. Pachel [00:26:53] Yeah, I will say that my response to this looks very different now, 20 plus years into practice than I did when I was a new grad, trying to kind of find the lay of the land. And I, I remember those first couple of, of times where that question was raised, what would you do? And I remember, like, breaking out in a cold sweat like, oh my God, I don't, I don't know what I would do. What? Oh my God. And I often would jump in with a story or a similar example or something along those lines. And I've had a number of conversations over the years with individuals in the veterinary social work industry, which, if that's not on your radar as a listener, it's an amazing, amazing group of individuals who have specific training around topics and issues like this to be able to support us in the delivery of veterinary care as it relates to clients and their decision-making and their support networks and all of those things. And so at this point in time, when I get that, "what would you do, doc" sort of a question, my typical reaction is two-fold, especially when we're on this conversation of consideration of behavioral outcomes. The first thing I usually do is acknowledge the client, how grateful I am that they've asked my opinion. I lean into that I am grateful that you trust me enough to ask, that we have a safe relationship within which you feel that comfort, in whatever way makes sense within the tone of the conversation that we're having. And then the second part of the answer is sort of a part A and a part B. The part A is I don't know. I don't know what I would do in your situation because I'm not you, and I don't have your relationship with this particular animal. I don't have your kids. I don't live in your house. I don't have your budget. I truthfully don't know, and I think it would be unfair for me to try to project myself into your situation and give you advice on what I think I would do because I truthfully don't know. And part B, these are the things that you've already shared with me that give me some cause for concern. I'm concerned that you've mentioned you've got a Great Dane with an unpredictable history who's giving level four. These are the things that you're going to need to navigate in order to move forward safely. How can I best assist you in doing that?

Dr. Watson [00:29:27] That's absolutely wonderful. And, you know, as... Just having something a little bit scripted to kind of fall back on, like you said, and remember, okay, you know, they're trusting us. Thank you. You know, reiterating, like you said, nobody's in the same situation. And that's where I oftentimes have trouble, too. You know, sometimes I'm thinking, well, you know, I just it wouldn't something like, you know, an animal that comes in with a pyometra like, what would you do? You know, would you go to emergency surgery? And and I'm always like, well, that's I wouldn't be in that situation because I would have spayed my dog, you know. And not from a judgment standpoint, like I just I wouldn't be in that situation. And so it's very difficult for me to know what I would do. And so so that was very helpful. Thank you. I think, you know, you kind of talked a little bit about this, but but let's see if we can just maybe even clarify and give a little bit more detail. You know, if we think that the owner is having, denying their pet's behavior or just not recognizing, you know, do you have some useful strategies or phrases to help clarify that for the owner? And, and, you know, again, without judgment or without, you know, being accusatory, being able to just kind of enlightened that situation for them.

Dr. Pachel [00:31:04] Yeah, I think this changes a little bit for me based on whether the client is asking for help or not.

Dr. Watson [00:31:11] Okay.

Dr. Pachel [00:31:12] So if I have a client who says I'm concerned about X, Y, and Z, fear, anxiety, stress, aggression, something along those lines, I find it a lot easier to ask them something like, can I share with you what I'm seeing as I ask you some additional questions and understand, you know, can I share when I see signs of stress? Can we fact-check that to see whether you're seeing the same thing that I'm seeing? But I think we start out on sort of the same side of the conversation more easily in those scenarios. And and yet I still always ask that question, can I share? And it changes the conversation in terms of the openness of the client to truly hear something, especially if my perspective is different from theirs. So I'm trying to create a little bit more of that openness and flexibility. Even if we're not going to fully agree. I want to hear them and I want them to hear me, and then we can decide where we take that. I think it's a lot harder in situations where we see something that they're not seeing, and perhaps we're concerned about something that they're not concerned about. And while, you know, I could lean into that from the behavior perspective, I think this happens in other scenarios, too, where maybe it's a client who comes in for a rabies booster, just picking something very, very transactional in some ways. And we recognize mobility issues or raging pyoderma or fill in the blank.

Dr. Watson [00:32:42] Right.

Dr. Pachel [00:32:43] And if I just jump in and say, well, here's all the things that are wrong with your pet, and here's all the things that you should fix, and here's your estimate for $900 and and and, and the client's like, yeah, no, none of that's on my radar. I'm really just looking for the booster because I need to get my dog registered so I can send him to the kennel because I'm going on vacation. So that's my radar right now. All of this other stuff, you're you're spinning your wheels. You're wasting your time. You're wasting your breath. I'm not going to do it. And so I say that I'm sort of hopefully painting a very sort of black and white scenario in this because I think in those scenarios, if I'm seeing something that the client isn't seeing or I'm concerned about something they're not concerned about, I really double down on that question first. Meaning, if I have some observations, if I'm seeing something in the screening your pet for suitability for your rabies vaccination, tying back to the reason why they scheduled an appointment in the first place. If I have some observations, is today a good day to share that information with you? Do you want me to jot that down? Do you want to schedule additional time? Or, do you have time to talk through that today? I really want to make sure that I'm not only doing what you've asked for, assuming that it's safe to do so, but that I'm also leaning into my job as a veterinarian and really trying to advocate for the health and wellness of your pet. Bottom line, is today a good day? And if the client says no, it's really not. I got to pick up my kids from daycare. I am so in the weeds with all the things, but I so appreciate you sharing that information. Awesome. Let's schedule some additional time to talk through that in another day. I remember there was a client of mine when I was in general practice who I think it was the second or the third appointment, I was giving recommendations about all the things that I was seeing that I thought we had opportunities to address. And he said, listen, doc, you're young, you're really energetic. And I get I get it, but I'm not going to do any of that stuff. Like, that's just not what I'm doing here. Set the bar a whole lot lower, and I remember sort of pausing and thinking, oh my gosh, I'm never going to work with this client ever again if they don't care and they don't... We came to an agreement. I said, okay, I hear you, and I'm grateful that you shared that information with me so that I know how to frame my recommendations. I am not going to shame you or guilt you or try to pressure you into doing something that you don't want to do. And if you choose to schedule an appointment with me, I need you to know that I'm going to notice some things, and I'm going to bring them up because that's what it looks like for me to do my job. If you want me to do my job, we're going to get along just fine. And you can decline, decline, decline, but I'm going to need you to also participate. If that's not a good fit for you, I'd be happy to give you a referral to another clinician in the area who might be a better fit for your for your practice style, for your ownership style. And and that's what what do you want to do next? And I remember he paused and said, you know what I think we're good. Yeah. Like, I can work with that. And just by setting those expectations and what that communication was going to look like, we had a great relationship. And. And yet I could have been fighting him head-on every single appointment and then talking bad about him to my team members or venting about all the things he wasn't doing versus actually coming to terms with what this relationship was going to look like right from the start.

Dr. Watson [00:36:08] Yeah, that's excellent. I think I've gotten better at that over the years as well. And I, I like, I like phrasing it like, I wouldn't be doing my job if I didn't tell you this, and then you can do with that information whatever you want. Well, we'll move forward from there. But, yeah, this is what I'm seeing, so. I'd like to kind of talk a little bit about the mental health of both the clinician and and our staff members, you know, when it comes to these types of cases. I was really glad to see that you acknowledged, you know, in your article that, and we talked about it a little bit earlier in the episode too, advocating for the patient and the client or others in the household can sometimes feel at odds, when we're dealing with an otherwise physically healthy animal. You know, I, I for me, I know it's it's a little bit easier to have these discussions when I have an animal that I feel is physically suffering. And so are there resources that exist for us as clinicians so that we can decompress a little bit? We're not transferring this this burden onto ourselves.

Dr. Pachel [00:37:23] Yeah, it's a really complex issue, and there's so many different ways in which we process grief or anger or disappointment in in ways that hopefully will be helpful in a way that sort of keeps us able to continue doing our jobs. And yet I remember having a conversation early in my career, it was during my residency, I had reached out to a veterinary social worker saying, hey, I'm really struggling with some stuff. I'm coming into some of these cases, and I don't think I have this skill set for navigating the emotional weight that I now am carrying. Help. What do I do? And I remember she asked me a couple of very, very specific questions, including one which was how many clients can you see and how many hours of therapeutic intervention can you log before you yourself need to speak with a mental health professional to offload some of that weight. And, I remember looking at her with this blank look on my face. I don't understand your question. Well, what do you mean, how many, how much work can I do before I need therapy? I don't understand what you mean. And the look of sort of, well, there was a lot of emotions that crossed her face in that moment. But the idea that in the human mental health professions, a lot of which is, you know, as we're really guiding clients in these decision-making process, there are typically within those credentialed positions, there are limits as to how many clients you can help and how many hours of therapeutic intervention you can log before you need to actually speak to someone about it to make sure that you are processing appropriately, that you're offloading what you need to offload. And so for me, that awareness sits with me 20 years later that we as a profession are so underprepared and under-resourced. Even though the resources are there, we often don't go down that path. We we often, and this is what I hear from a lot of folks, is that, oh, I know I'm fine. I'm fine. It's a hard job. I expect it to be hard. So I'm just going to suck it up and and move on forward. And the answer is sure. It is hard, and I don't expect it to be easy. Going to therapy is not going to make it easy. But there are so many things that we can do. And whether that's a staff education event, whether it's a mindfulness practice in some way, shape, or form, which could even just be acknowledging the hard in a way that allows team members to shake it off and continue doing the work that we do. There are so many practices around that. And so I'm I'm a huge fan of working with mental health practitioners, and especially the veterinary social work industry, to provide staff education, to provide resources, to be able to try to onboard some of these skill sets that allow us to deal with not only the stressful cases like those that involve behavioral euthanasia, but even just the difficult clients that are sucking the life out of us some days. And I say that with full transparency, you know, to any pet owner who is listening to this podcast, please know that I'm not just I'm not speaking of pet owners in a disparaging way, but when we have difficulties of communication or my availability to meet you where you are is really compromised by all the other things I've got going. Man, it takes everything we have as an industry to continue showing up in those moments. It's doable, and it's hard. So I really lean into any of those strategies that we that we have available. And again, I keep mentioning veterinary social work but literally Google it. Veterinary social work. It's a mind-blowing exploration.

Dr. Watson [00:41:15] Yeah, no, I think that's wonderful. I also, you know, one of the things that it took me a long time to realize, but you know, like, like you said, I've been in practice for 20 years, and like, I used to be bright-eyed and bushy-tailed, and this was all the exciting things we could do. And I still, I still am in love with all the exciting, fantastic things we can do and our, you know, our ability and techniques are exploding right now with all of the wonderful things we can do. But I think I've also matured a little bit over those years into the just because we can do something doesn't necessarily mean we it's the right thing for this particular patient, for this particular family, for this, you know. And the other thing that I found is sometimes I'll go into an exam room, you know, and I'll walk out, and I'll have had this very long, detailed conversation with the client where they've shared a lot of things with me that the rest of my staff is not privy to at all. And I walk out of that room and say something like, we're going to euthanize, and everybody's face just falls because they weren't there for that conversation. And I would love to be able to, you know, help give better communication to my staff and kind of like debrief them. And I didn't know if you had any recommendations about that.

Dr. Pachel [00:42:44] Gosh, I love I love that question. And my heart breaks at the same time, even hearing that because I'm am picturing myself in so many moments in exactly that scenario on either side, right. Where I could be, I could be doing my thing, and I hear that, you know, and maybe it's an animal that I actually know reasonably well, and the circumstances have changed in a way that perhaps makes end-of-life decisions the right thing to do. I may not be privy to that, and it's really hard not to have an emotional reaction in that moment. And so I think for me, this comes down probably more than anything else, it comes down to to practice culture. And are we creating an environment where we can have those tough conversations? Maybe not in that moment... Getting choked up about this... Maybe not in that moment, but to be able to say, I hear you. In this moment, I need to support this family through this decision. Do you trust me to know that I would have considered all of the things, or even the majority of things that are on your on your mind right now? I will be more than happy to deconstruct this later on. Right now, I need to support this family. And being able to move through that in a way that allows us to deliver care and still acknowledges that individual team member's response to that situation as valid and that we will address it. You know, or I may, even, depending on the circumstances, say, is there something that you need to share with me in this moment that potentially would impact what we choose to do next? Sometimes yes. Sometimes no. And, you know, and as a clinician, maybe we don't have the bandwidth for that in that moment, and so then again, we may lean on the previous strategy. But, I think culture-wise, developing a trust relationship that that my team ideally will give me the clinician the benefit of the doubt to know that I've done my absolute best to troubleshoot, to problem solve, to offer strategies, and if I'm saying this is what we're doing next, I would rather that they ask me more of a "can you tell me why?" As opposed to no, you shouldn't. And just as we're trying to do with our client communications, leaning on with leaning in with curiosity, with questions, rather than judgment or assumptions about what may have led us to this particular place. And, the more we can do that I find the more the more satisfaction we're able to bring to the jobs that we do and the deeper these relationships with our coworkers, our colleagues, and our clients really has the potential to become.

Dr. Watson [00:45:29] That was wonderful. Your response got me choked up, so. So, this has just been fabulous. I know, you know, it's a heavy-weighted topic, and but it's so, so important. And I just I cannot tell you how much I appreciate you sitting down with us, taking the time to walk through all this. And again, the article is just so fantastic. We have got nothing but, you know, positive feedback from our audience on it. So, after that, let's maybe just lighten the mood a little bit. I have a couple, you know, let's end on a little positive note. I have a couple just fun would you rather questions for you. This is kind of how we we end our episodes. We play a little game. Would you like to play with us?

Dr. Pachel [00:46:17] I would, and thank you for asking rather than just assuming because I know the format that I know this is where we're going. The opportunity to opt in. Yeah, absolutely.

Dr. Watson [00:46:26] That's good. Good. I'm glad that you do want to play. All right, so, would you rather your canine patients or your feline patients could speak?

Dr. Pachel [00:46:38] Ooh, I would say my feline patients.

Dr. Watson [00:46:42] Really?

Dr. Pachel [00:46:43] I feel like I do a pretty good job of listening to my dog patients. And I think dogs are often often better equipped to navigate conversations with us, both in terms of requests and denying. I think cats are often misunderstood, and I would love for them to be able to have a greater voice than what they currently have in our industry.

Dr. Watson [00:47:04] Oh, that's wonderful. Okay, if you were flying across the country for an important lecture, you realized you left something at the security checkpoint. Would you rather it was your phone or your laptop?

Dr. Pachel [00:47:20] Oh my God, these are hard questions. I would rather leave my laptop.

Dr. Watson [00:47:26] You would rather leave your laptop? Gotta have your phone.

Dr. Pachel [00:47:28] I would rather leave my laptop. Everything's on Dropbox. Everything's on digital, so I can deal with that. It's going to be stressful. It's going to be crazy. Right. It's all in the cloud. It's somewhere out there. And so I can navigate that. But oh my God, you take my phone away, and I feel like I'm completely broke.

Dr. Watson [00:47:43] Like, yeah, you're just always looking for it. Yeah, I'm the same way. Okay. If you had to repeat one of them, would you rather repeat your residency or high school?

Dr. Pachel [00:47:57] Oh, wow. For different reasons, I would rather repeat my residency even though it was super, super challenging. I feel like now that I've been practicing for 20 years, there's so many things that I think I probably memorized but didn't know what to do with. And now the opportunity to, like, dive back in and learn all of those things and process them, I can only imagine the clinician I'd have the opportunity to be by by diving back in.

Dr. Watson [00:48:26] Alright, excellent. If you had to pick one to practice without, would you rather practice without gabapentin or without trazodone?

Dr. Pachel [00:48:37] Oh my God, it's amazing. I would rather practice without trazodone.

Dr. Watson [00:48:45] Okay. Interesting. For both dogs and cats? That's fine. We'll just take that one.

Dr. Pachel [00:48:52] Yeah, no. I, I think for me, I love the gabapentin for me is more multimodal. Okay. I love what I can do with gabapentin for both of my patients. And that is why I can I can get away with it. I can mimic trazodone with other, other drug classes.

Dr. Watson [00:49:06] Got it. Got it. Okay. Final question. Most important. If you are going to be the inspiration for a veterinary superhero, would you rather be in the Marvel Universe or the DC Universe?

Dr. Pachel [00:49:18] Oh my goodness. I will be honest and say... I'm going to go Marvel. Yeah, I'm going to go Marvel.

Dr. Watson [00:49:28] Excellent. They need a little help these days. So I think that they should really, Kevin Feige I hope is listening. We need a veterinary superhero.

Dr. Pachel [00:49:39] Yes. That would be amazing.

Dr. Watson [00:49:42] All right. Thank you so much, doc. Again, fantastic. Thank you to our listeners. We'll catch you guys next time.

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