Vet Spotlight: Identifying problems creatively and collaboratively with Dr. Byrd

Meet Dr. María Juárez Byrd from Jefferson City, Missouri, an exotic and small animal veterinarian who is trained in hospice and palliative care and has special interests in pain management, behavior, dermatology, nutrition, and husbandry. She has honed her virtual craft and shares great tips on how to help pet owners examine their animals.

“My clients and I work together through a modified physical exam. My clients count breaths with me; lift paws and lips; part fur; confirm colors, textures, and firmness, and help in ways that are generally unnecessary in a clinical setting.”

It's counterintuitive, but Vetster helps my clients better utilize in-person care and affords them a larger role in their pet's health. For example, in a virtual setting, I can explain how X-rays may help a coughing cat without my clients worried that I requested the test out of self-interest.

Vetster also helped me identify problems creatively and more collaboratively. My clients and I work together through a modified physical exam. My clients count breaths with me; lift paws and lips; part fur; confirm colors, textures, and firmness, and help in ways that are generally unnecessary in a clinical setting.

We discuss animal husbandry, differentials, testing options, signs of progressive illness, prescriptions, and over-the-counter medications without the perceived concern of me profiting from the options they consider.

Involving my clients in the exam has helped them understand the breadth of veterinary assessments, the complexity of medical decisions, and the necessity for additional diagnostics. I love many things about Vetster (scheduling, flexibility, promo codes), but improving the veterinary-client relationship by illuminating the medical thought process was a beautiful and unexpected twist.

Vetster is the better version of emergency phone calls. On Vetster, you set boundaries on when you receive consultations (e. g. 5 pm - midnight), determine the amount of notice you need before the consultation starts (15 min - 12 hrs), offer promo codes to your clients (10% - 100% off), set higher rates for non-clients (up to $320), work from any personal phone or computer, and make a more accurate assessment of the patient (compared to phone calls). You can update your availability within seconds. When our patients and clients need immediate expert advice, Vetster alleviates the pain of providing it.

I anticipate most general practitioners will move to incorporate virtual services in their practice. Teleconsultations enhance our capacity to triage emergency patients while significantly reducing the stress of being on-call. Virtual appointments improve access to experts for clients with exotic species, in rural areas, and those with mobility limitations. Virtual care enabled me to help a distant medical team direct a needle for a blood draw on an emaciated bearded dragon; virtual care allows me to watch my baby while coordinating her naps around consultations; and virtual care will continue to improve the way I preserve the human-animal bond.

Telehealth technology has already shown promising results in improving access to care, enhancing collaboration, and promoting work-life balance. As we continue to develop virtual services, we can expect to see more innovative solutions that will further improve the way we deliver healthcare services and strengthen the bond between pets and their owners.

I received an alert at 3 pm on a Saturday. A 2-year-old, female, spayed, Holland Lop named Niblet was scheduled for a virtual bunny appointment at 7 pm. Niblet spent the morning at the ER and her owner was looking for a veterinarian with rabbit experience. I confirmed the consultation and then quickly blocked off the preceding 30 minutes to ensure my baby would be sleeping. Between cutting some tomatoes and boiling pasta, I searched for exotic doctors near the owner - just in case she needed advanced in-person care - and was surprised to find that I was one of them.

When the pixels brought us face to face, Niblet's owner was visibly tense. The whites of his eyes and furrow of his brow betrayed his worry despite a steady voice. He apologized for taking a weekend appointment, bringing me a tinge of guilt as I sipped my water. He couldn't know it, but I love this version of being on-call. I signed up for this. Eagerly. He quickly divulged Niblet's saga. The previous evening she suddenly developed a reluctance to eat and a quiet demeanor. He rushed her to the ER, where the attending veterinarian diagnosed GI stasis and stabilized her. When she began eating Saturday morning, she was discharged with instructions to find an exotic veterinarian to determine the underlying cause of stasis. As he spoke, he turned the camera to Niblet. She lounged in the corner of her blanketed hut. Her body was long and sleek, forepaws snuggly tucked beneath her chest as she dipped her head into a food bowl and rhythmically munched on hay from a low feeder.

Her eyes blinked, unfazed, as the camera floated by her twitching nose. I used the gentle rise and fall of her chest to calculate a respiratory rate (it was normal), then directed him to show me different parts of her body. From tooth to tail, we worked through a modified physical exam to uncover clues of her illness. I thought out loud as he moved the phone, "Okay, her incisors are the correct length. Can you confirm she has no nasal discharge? Good. I see some white discoloration in the corner of her right eye. Is that new? Have you seen it in the other eye? She seems well-groomed to me. I don’t see crusts, hair loss, or matting. Do you agree?"

We discussed the ocular discharge and potential etiology. I recommended head X-rays to assess tooth root length and a nasolacrimal duct flush. Niblet appeared stable but required additional diagnostics to determine why she needed an ER visit in the first place. I recommended an in-person appointment for diagnostics and treatment. We also discussed husbandry. He swerved to her bags of hay and pellets, as well as the bedding, the cleaners, and the laundry detergents he used for her habitat. After reviewing the labels, we quickly identified opportunities for husbandry improvement. On our tour of the habitat, I noticed another rabbit and asked about the pen-mate. Willow is Niblet's sister. Willow also suffers from chronic ocular discharge but never required a vet visit. I recommended radiographs for Willow as well, then offered the names and numbers of a few clinics near him that could see rabbits. He thanked me profusely and felt confident with his options moving forward.

A few weeks later, I was surprised to meet Niblet and Willow in-person. As luck would have it, I provide relief services to one of the hospitals near them. He was prepared for the diagnostics the nurses would request and why they mattered for his pets. While I wrapped up another appointment, the nurses snagged blood for a CBC and chemistry on both bunnies and multiple radiographs. The X-rays revealed hidden dental disease in both rabbits. With bloodwork showing no contraindications to anesthesia, we scheduled dentals for the following morning.

I love that Niblet and Willow could visit me from the comfort of their hutch. I love that the video connection allowed us to identify Willow's problem, which would have otherwise gone undetected. I love that because their owner contacted me, the ER veterinarian could focus on more dire emergencies. I am so excited that the patients were connected to a hospital with the capacity to provide the advanced dental care they need. Most of all, I love that Niblet and Willow are stable and have long-term plans to help manage their dental disease before it becomes life-threatening.

If you're interested in being featured in our blog, please contact Jennifer, our Manager of Veterinary Success by emailing jennifer@vetster.com.

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