April 15, 2025 • 17 mins
Breathing new life into brachycephalic airway surgery practices, this eye-opening conversation with Drs. Vanna Dickerson and Mason Hill reveals how implementing standardized protocols can dramatically reduce post-operative complications in our flat-faced canine companions.
The surge in popularity of brachycephalic breeds like French Bulldogs has brought increased attention to the challenges these dogs face during surgical procedures. Through collaborative efforts between surgery, anesthesia, and critical care specialists at Texas A&M University, the team developed a comprehensive perioperative management strategy that's making a real difference in patient outcomes. Their research demonstrated significant improvements in respiratory distress events, though dogs with pre-existing regurgitation issues remain a high-risk population requiring special consideration.
What makes this episode particularly valuable for veterinary professionals is the practical approach to implementation. Rather than complex interventions, the team created an accessible one-page protocol guide that practices can adapt to their specific environments. As Dr. Dickerson emphasizes, "The surgery isn't the hard part—it's managing the perioperative period that can go wrong." For dog owners, this research offers both reassurance about improving surgical outcomes and practical guidance about what questions to ask their veterinarians before procedures.
Whether you're a surgeon, general practitioner, or a devoted brachycephalic breed owner, this episode provides crucial insights that could potentially save lives.
JAVMA article: https://doi.org/10.2460/javma.24.09.0598
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Wellness Pet Foods (00:01):
Mealtime is more than a bowl of food.
It's the foundation for a longand healthy life.
At Wellness, dry recipes arecrafted with the highest quality
natural ingredients for a tastethat pets love and
scientifically proven throughAFCO feeding trials to ensure
that every complete and balancedmeal supports the five signs of
wellbeing.
With Wellness Pet Foods, petparents can share a life of
(00:25):
well-being together with theirpet.
Sarah Wright (00:31):
This is Veterinary Vertex, a podcast of the AVMA
Journals.
In this episode we chat abouthow the implementation of a
standard perioperative protocolreduces postoperative
respiratory distress events indogs undergoing surgical
correction of brachycephalicobstructive airway syndrome,
with our guests Vanna Dickersonand Mason Hill.
Lisa Fortier (00:51):
Welcome listeners.
I'm Editor-in-Chief LisaFortier, and I'm joined by
Associate Editor Sarah Wright.
Thank you so much for takingthe time to be with us here
today.
Vanna Dickerson (00:59):
Yeah, thank you for having us.
Mason Hill (01:01):
Yes, thank you.
Sarah Wright (01:01):
All right, let's dive right in.
So, Vanna, your JAVMA articlediscusses how the implementation
of a standard perioperativeprotocol reduces postoperative
respiratory distress events indogs undergoing surgical
correction of brachycephalicobstructive airway syndrome.
Please share with our listenersthe background on this article.
Vanna Dickerson (01:20):
Yeah.
So, I think you know, asveterinarians we're all very
well aware of how popular thesebrachycephalic breeds are
becoming.
I've been in the veterinaryfield since early 2000s and even
I can just massively see howmuch more frequently we're
seeing them.
And I think, especially assurgeons, maybe we see even more
of them to address theirairways, and along with that we
(01:47):
know how scary kind of thecomplications in the
perioperative period can be.
So we, shortly after I arrivedat Texas A&M, had a group
meeting between our surgery,anesthesia and critical care
teams where we all sat down kindof reviewed available
literature, and that's sort ofwhere the protocol that we
evaluated in this study was born.
Sarah Wright (02:08):
Yeah, like you said, I think they're definitely
very popular as pets and wechatted about this before we
started the podcast, but yourarticle is super popular on
social media, reaching over77,000 different people, which
is incredible, so a veryimportant topic.
I remember talking to some UGAsurgeons too and they were
talking about, like, the BulldogSpecial for the embrace of
hallux surgeries there, sodefinitely something worth
investigating.
Vanna Dickerson (02:29):
Yeah, yeah, for sure.
Sarah Wright (02:32):
So, Vanna.
What are the importanttake-home messages from this
JAVMA article?
Vanna Dickerson (02:36):
Yeah, so I think you know we made a lot of
changes in how we manage thesepatients pre and
post-operatively in our study.
And you know, of course,because we made so many changes
all at once, it is one of thelimitations, right, we don't
know what.
You know what actually made themost difference.
But I think for me, I think thebiggest takeaway is just this
(02:56):
is another study sort ofpointing to you really do need
to treat these dogs a little bitdifferently than maybe our
doliosophallic counterparts inthe perioperative period, and
that's true, I think, whether ornot we're performing airway
surgery.
So I think it's just anotherkind of piece of the puzzle to
me that shows we really kind ofhave to think differently with
these guys.
Lisa Fortier (03:17):
Yeah, before their .
What did you call it?
Surgence in popularity orsomething like that?
It used to be the Dobermans wewere worried about.
Nobody really talks aboutDobermans anymore in their
surgical risk.
It's all relative, I guess.
Vanna Dickerson (03:33):
Yeah, yeah.
Lisa Fortier (03:34):
Mason, what sparked your interest in
brachycephalic obstructiveairway syndrome?
Mason Hill (03:41):
Yeah, so similar to what Vanna said.
You know, especially when I wasat A&M and still true here up
at Ohio State, Brachycephalicdogs constitute a large
proportion of the dogs that wesee on soft tissue surgery, for
airway surgery, but also we seethem throughout the hospital on
our orthopedic service formusculoskeletal abnormalities
and our neurology servicerelated to intervertebral disc
disease, and the scope of thispaper was very much focusing on
(04:03):
their perioperative outcomesrelated to upper airway surgery,
but certainly both the questionof should we be considering
implementing protocols similarto this, you know, whenever they
come into the hospital becausewe can see them have these
respiratory distress events orregurgitation aspiration,
whether they're with us or withother services.
So, you know that was kind ofour starting place.
(04:23):
And the you know.
Next thing, as Vanna alluded toas well, was that the
complications that thesepatients do experience when
they're here seem to be morefrequent but also more severe,
and they can be both financiallyand emotionally devastating for
families.
And so researchers at TuftsUniversity, originally a few
years back, implemented aprotocol similar to the one that
(04:44):
we implemented.
That really sparked an interestin the team at Texas A&M,
because they were able to reduceregurgitation events in their
patient population, and sospecialists across multiple
disciplinaries came together andmade this protocol, and I, as a
student and then as an intern,was in a unique position to help
evaluate its impact on ourpatients.
Lisa Fortier (05:06):
Fantastic.
Vanna talked a little bitearlier about some of the
take-home messages, and yet many, many things were investigated
at the same time.
So for you, what were some ofthe very surprising things from
this research article that youfound?
Mason Hill (05:20):
Yeah, you know, I don't know if it'll necessarily
be surprising, but I think amajor point of interest for us
was that in our post-protocolgroups the group of patients
dogs that were enrolled afterprotocol implementation and when
we evaluated their historicalfindings, they had an increased
incidence of regurgitationcompared to those dogs enrolled
prior to protocol implementation.
(05:45):
When we were evaluating ourresults, we ultimately did not
find a significant difference inthe outcomes of regurgitation
and aspiration in thispost-protocol group.
And so the question became thenwell, was it related to the
protocol or was it more relatedto the fact that these patients
historically regurgitated moreand again?
Kind of makes the point that'skind of straightforward that
well, regurgitation pre-op maybeget regurgitation in a peri-op
and post-operative period forthese patients.
(06:07):
You know, multiple studies haveidentified this as a problem,
though to my knowledge, at leastat this point, this hasn't been
evaluated prospectively.
But I think it certainly makesus have to wonder.
You know, not only do we needto be treating our
brachycephalic patients,especially because we know that
they're in increased risk, butthis specific group of
brachycephalics that hashistoric regurgitation, I think
(06:29):
is going to need additionalevaluation and care moving
forward.
Lisa Fortier (06:34):
Off a completely beaten path.
Do either one of you think thatthe popularity in these breeds
will go down now that a giantSchnauzer finally won the best
in show at Westminster?
Vanna Dickerson (06:45):
Uh?
you know, maybe I don't know.
I feel like they're especiallythe Frenchies.
I mean, they're stinking cuteman and they're the perfect size
to be in lots of differenthouseholds.
So I don't know.
Lisa Fortier (06:59):
Yeah, very true.
How about you, Mason?
What do you predict?
Mason Hill (07:03):
Yeah, I agree with Vanna, I'm not entirely sure,
you know.
I just hope you know, whenfolks invest in these dogs
because they are precious andthey are perfect family members,
and that you know they're justaware that they can come with
some increased chance and riskfor complications related to
their airway and otherwise, so Ithink us, you know, as a
(07:24):
veterinary profession, justdoing our best to educate our
clientele and let them know whatcan occur is really really
important moving forward.
Lisa Fortier (07:37):
I like what you said, and otherwise it's not
just anesthetic complications,it's, and otherwise.
Sarah Wright (07:42):
Yeah, funny enough , the soft tissue surgeon from
my rotating internship owned aFrenchie.
I remember learning that and Iwas like huh before you know, so
did not expect that.
So, Mason, you did talk aboutsome areas of future research,
such as looking at likeregurgitation events, but are
there any other areas for nextsteps for research in this topic
?
Mason Hill (07:59):
Yeah, I know I really did allude to my kind of
next point here, which is that Ithink us really evaluating this
population of brachycephalicpatients that have historical
regurgitation, how we can impactthat, moving forward, looking
at prospective studies, reallywanting to evaluate for me how
the use of prokinetics maybereceiving them more long-term
(08:20):
prior to hospitalization andPPIs, would be really beneficial
, just because in a lot of ourpatients their prokinetic
administration and kind ofmedical management strategy was
initiated very close to time ofhospitalization, and so I just
wonder, if we prolong that,could we potentially benefit
them?
But I think there is a breadthof research that remains to be
(08:41):
done, looking at these patientsas a whole.
Sarah Wright (08:44):
Well, we look forward to hopefully seeing a
manuscript about that in thefuture.
So, AI is definitely a reallyhot topic and we actually have a
AI supplemental issue comingout in AJVR in March about AI
and veterinary medicine.
So, Mason, do you see a rolefor AI in this area of research?
Mason Hill (09:24):
Yeah, I think you know important for me to mention
is that I have not yet myselfdelved super far into the
utility of AI, but I'm reallyexcited that were really
embracing it as a field andthink that it will be very
impactful for us.
Areas where I think it can bebeneficial especially on the
conversation of looking at thesepatient populations that
regurgitation m ofmulti-institute this study
evaluating these patients andusing AI to help assimilate that
information and help developthe protocol that could impact
these patients.
And that's kind of my generalthought and I didn't know if you
had anything you wanted to addto that
Vanna Dickerson (09:44):
and I do wonder one of my colleagues here just
recently published, I think, inveterinary surgery, a paper
where they're trying to look atcould we remotely grade how
severe brachycephalic airwaysare?
You know, in the UK there's abigger push to maybe work a
little bit harder to sort ofbreed for better kind of more
(10:05):
health sustainingsustainingtraits in these dogs.
And I mean I wonder if we everget to a point.
Could we train AI to listen tohow severe stutter is and maybe
combine it with things like theBrisk score that's been
published to help us quicklyidentify which patients are more
at risk?
Sarah Wright (10:25):
Yeah, it's a super cool question.
We're actually going to begoing back and looking at all
the answers and combiningeverything for some future
research topics, so it's prettycool.
And for those of you justjoining us, we're discussing how
the implementation of astandard perioperative protocol
reduces postoperativerespiratory distress events in
dogs undergoing surgicalcorrection of brachycephalic
(10:45):
obstructive airway syndrome.
Lisa Fortier (10:47):
With our guests Vanna and Mason correction of
brachycephalic obstructiveairway syndrome with our guests
Vanna and Mason.
Vanna, you described how youdesigned this protocol with a
multi-team approach and then youhad to implement it and do the
research and write themanuscript and get it across the
finish line.
How did your previous trainingprepare you to get all that done
?
It's hard to get from theconcept to get everybody on
board and really finish it.
I think that would be reallyinteresting to hear what you
(11:09):
have, the advice you have togive to other authors.
Vanna Dickerson (11:12):
Yeah, I mean I was fortunate.
You know Mason is, you know,one of those vet students as
many of them are that are justincredibly eager to help with
things like this.
So a big help was having her beso excited about the topic and
really taking it head on.
But you know, sarah, youmentioned UGA earlier.
I was there for actually 10years through vet school and
(11:33):
then I did do a researchfellowship and my residency
there.
So you know, I think for thistopic specifically had a ton of
exposure to what we called thebulldog special there, but just
brachycephalic, you know, dogsin general, and we did during my
residency, also publish anarticle looking at a different
way of doing their rhinoplasties, which it's interesting to me.
(11:56):
I don't even do them that wayanymore and I think it just
speaks to how quickly this, youknow field is changing.
But you know, in terms ofgetting this published and
through the finish line, youknow we're fortunate here, I
think, to have a collaborativeenough environment for everyone
to be very excited about tryingsomething new and seeing if it
can help our patients.
So I think that was kind ofstep one here is just getting
(12:18):
everyone excited about it,getting everyone on board.
And then, since we looked at itretrospectively, then a lot of
the work really was on DearSweet Mason, who made a very
large spreadsheet and helped usto get through it, and we did
make sure to have, you know,authors from all different kind
of specialties on this articleas well, just to make sure we
(12:39):
were kind of encompassingeveryone's thoughts.
Sarah Wright (12:42):
I think it's really cool how collaborative
everyone's being on this topic.
We actually my husband and Iwere watching the Illinois
basketball game the otherweekend and they actually had a
commercial for the vet school,but the focus was on Heidi
Phillips and her likebreak-cephalic research as far
as like self-dischiever surgerygoes.
Vanna Dickerson (12:55):
So I was like we had kind of a little special
group that talked just aboutthese brachycephalic dogs and
kind of you know, what could webe doing in research in the
future?
Sarah Wright (13:14):
So so our next set of questions is going to be
very important for our listeners.
Vanna, what is one piece ofinformation the veterinarian
should know about the surgicalcorrection of brachycephalic
obstructive airway syndrome?
Vanna Dickerson (13:28):
Yeah, I mean.
So I tell my veterinarystudents all the time that the
surgery is not the hard part ofmanaging these dogs, especially
if you're speaking, you knowspecifically about airway
surgery.
It really is that perioperativecrap that can go wrong and
making sure that you can handleit.
So I mean, I really think it'simportant for every practice if
(13:48):
you're going to be seeing thesepatients and certainly if you're
going to be anesthetizing them,to try to figure out what's
going to work for you.
We did put our here when weinstituted this protocol.
Dr Ito, one of theanesthesiologists on it, helped
makea really pretty kind of onepager that we could just put up
in the hospital, make it reallyeasy for everybody to see and
(14:08):
use as sort of a checklist.
So and that's available as asupplementary material on the
article.
So I think people maybereference that but kind of try
to develop what protocol isgoing to make the most sense for
you with what drugs you have inyour practice, how much
monitoring you have and maybethese higher risk dogs that do
already have a history of a lotof regurg and things like that,
you know, even though thesurgery is not that bad, you
(14:30):
know, maybe those are dogs yourefer, just because of the
potential need for really heavyaftercare.
Sarah Wright (14:38):
On the other side of the relationship.
What's one thing that clientsshould know about this topic?
Vanna Dickerson (14:42):
Yeah.
So you know, even though wetalk about a lot of scary things
that can happen with thesesurgeries, I do still think that
in most cases the benefitsveterinarian about hey, you know
how much experience do you haveanesthetizing these dogs?
What is the plan if somethinggoes wrong?
(15:12):
Are we five hours away from thenearest emergency clinic?
Or, you know, do you havesomeone overnight that can help
watch my pet as they recover?
But I do still think, eventhough there are scary things
that can happen, it is uncommon.
Mortality rates actually bothpre and post protocol in our
(15:33):
study were less than 10 percent.
So they usually still make itthrough it.
Lisa Fortier (15:35):
It just sometimes is a little bit of a rocky road,
exceptionally well summarized.
As we wind down, we like to aska little more of a fun question
.
So, mason, for you, what is theoldest or the most interesting
item on your desk or in yourdesk drawer?
Mason Hill (15:48):
We have a very large 1980s Rolodex on our desk at
home to keep contact informationfor friends and such.
I have no idea of where it camefrom, but it is a unique staple
to the house now.
Lisa Fortier (16:06):
Very cool Because everything's in my phone.
If I lose that, I'm in bigtrouble.
Right, it's an old school back,Vanna.
This one usually dates people,but what was the first concert
you attended?
Vanna Dickerson (16:18):
Yeah, so the first one that I can remember,
being kind of big, that I wentto was Weezer actually, and it
was so much fun.
And actually this question mademe think about how I need to
start going to more concerts,where did you go see them In
Atlanta?
Lisa Fortier (16:34):
Okay, yep, wow, do you want to answer that too,
Mason, you look a lot youngerthan the rest.
Mason Hill (16:39):
Well, maybe not Sarah, but I grew up listening
to a lot of like red dirt, Texascountry, probably no like big,
big names, but they're fantastic.
So if that's something thatinterests y'all, I implore you
to dig in.
But very cool Good times.
Sarah Wright (16:56):
Yeah, it's a fun question.
We haven't asked that one in awhile, so I was happy to bring
that one back.
Thank you, Vanna and Mason.
We really appreciate youspending your time with us today
, and also for contributing yourresearch to JAVMA.
Yeah, thanks again for havingus.
Mason Hill (17:10):
Yeah, thank you all so much.
Sarah Wright (17:12):
And to our listeners.
You can read Vanna and Mason'sarticle on JAVMA.
I'm Sarah Wright with LisaFortier.
Be on the lookout for nextweek's episode and don't forget
to leave us a rating and reviewon Apple Podcasts or whatever
platform you listen to.
Mealtime is more than a bowl of food.
It's the foundation for a longand healthy life.
At Wellness, dry recipes arecrafted with the highest quality
natural ingredients for a tastethat pets love and
scientifically proven throughAFCO feeding trials to ensure
that every complete and balancedmeal supports the five signs of
wellbeing.
With Wellness Pet Foods, petparents can share a life of
(00:25):
well-being together with theirpet.
Sarah Wright (00:31):
This is Veterinary Vertex, a podcast of the AVMA
Journals.
In this episode we chat abouthow the implementation of a
standard perioperative protocolreduces postoperative
respiratory distress events indogs undergoing surgical
correction of brachycephalicobstructive airway syndrome,
with our guests Vanna Dickersonand Mason Hill.
Lisa Fortier (00:51):
Welcome listeners.
I'm Editor-in-Chief LisaFortier, and I'm joined by
Associate Editor Sarah Wright.
Thank you so much for takingthe time to be with us here
today.
Vanna Dickerson (00:59):
Yeah, thank you for having us.
Mason Hill (01:01):
Yes, thank you.
Sarah Wright (01:01):
All right, let's dive right in.
So, Vanna, your JAVMA articlediscusses how the implementation
of a standard perioperativeprotocol reduces postoperative
respiratory distress events indogs undergoing surgical
correction of brachycephalicobstructive airway syndrome.
Please share with our listenersthe background on this article.
Vanna Dickerson (01:20):
Yeah.
So, I think you know, asveterinarians we're all very
well aware of how popular thesebrachycephalic breeds are
becoming.
I've been in the veterinaryfield since early 2000s and even
I can just massively see howmuch more frequently we're
seeing them.
And I think, especially assurgeons, maybe we see even more
of them to address theirairways, and along with that we
(01:47):
know how scary kind of thecomplications in the
perioperative period can be.
So we, shortly after I arrivedat Texas A&M, had a group
meeting between our surgery,anesthesia and critical care
teams where we all sat down kindof reviewed available
literature, and that's sort ofwhere the protocol that we
evaluated in this study was born.
Sarah Wright (02:08):
Yeah, like you said, I think they're definitely
very popular as pets and wechatted about this before we
started the podcast, but yourarticle is super popular on
social media, reaching over77,000 different people, which
is incredible, so a veryimportant topic.
I remember talking to some UGAsurgeons too and they were
talking about, like, the BulldogSpecial for the embrace of
hallux surgeries there, sodefinitely something worth
investigating.
Vanna Dickerson (02:29):
Yeah, yeah, for sure.
Sarah Wright (02:32):
So, Vanna.
What are the importanttake-home messages from this
JAVMA article?
Vanna Dickerson (02:36):
Yeah, so I think you know we made a lot of
changes in how we manage thesepatients pre and
post-operatively in our study.
And you know, of course,because we made so many changes
all at once, it is one of thelimitations, right, we don't
know what.
You know what actually made themost difference.
But I think for me, I think thebiggest takeaway is just this
(02:56):
is another study sort ofpointing to you really do need
to treat these dogs a little bitdifferently than maybe our
doliosophallic counterparts inthe perioperative period, and
that's true, I think, whether ornot we're performing airway
surgery.
So I think it's just anotherkind of piece of the puzzle to
me that shows we really kind ofhave to think differently with
these guys.
Lisa Fortier (03:17):
Yeah, before their .
What did you call it?
Surgence in popularity orsomething like that?
It used to be the Dobermans wewere worried about.
Nobody really talks aboutDobermans anymore in their
surgical risk.
It's all relative, I guess.
Vanna Dickerson (03:33):
Yeah, yeah.
Lisa Fortier (03:34):
Mason, what sparked your interest in
brachycephalic obstructiveairway syndrome?
Mason Hill (03:41):
Yeah, so similar to what Vanna said.
You know, especially when I wasat A&M and still true here up
at Ohio State, Brachycephalicdogs constitute a large
proportion of the dogs that wesee on soft tissue surgery, for
airway surgery, but also we seethem throughout the hospital on
our orthopedic service formusculoskeletal abnormalities
and our neurology servicerelated to intervertebral disc
disease, and the scope of thispaper was very much focusing on
(04:03):
their perioperative outcomesrelated to upper airway surgery,
but certainly both the questionof should we be considering
implementing protocols similarto this, you know, whenever they
come into the hospital becausewe can see them have these
respiratory distress events orregurgitation aspiration,
whether they're with us or withother services.
So, you know that was kind ofour starting place.
(04:23):
And the you know.
Next thing, as Vanna alluded toas well, was that the
complications that thesepatients do experience when
they're here seem to be morefrequent but also more severe,
and they can be both financiallyand emotionally devastating for
families.
And so researchers at TuftsUniversity, originally a few
years back, implemented aprotocol similar to the one that
(04:44):
we implemented.
That really sparked an interestin the team at Texas A&M,
because they were able to reduceregurgitation events in their
patient population, and sospecialists across multiple
disciplinaries came together andmade this protocol, and I, as a
student and then as an intern,was in a unique position to help
evaluate its impact on ourpatients.
Lisa Fortier (05:06):
Fantastic.
Vanna talked a little bitearlier about some of the
take-home messages, and yet many, many things were investigated
at the same time.
So for you, what were some ofthe very surprising things from
this research article that youfound?
Mason Hill (05:20):
Yeah, you know, I don't know if it'll necessarily
be surprising, but I think amajor point of interest for us
was that in our post-protocolgroups the group of patients
dogs that were enrolled afterprotocol implementation and when
we evaluated their historicalfindings, they had an increased
incidence of regurgitationcompared to those dogs enrolled
prior to protocol implementation.
(05:45):
When we were evaluating ourresults, we ultimately did not
find a significant difference inthe outcomes of regurgitation
and aspiration in thispost-protocol group.
And so the question became thenwell, was it related to the
protocol or was it more relatedto the fact that these patients
historically regurgitated moreand again?
Kind of makes the point that'skind of straightforward that
well, regurgitation pre-op maybeget regurgitation in a peri-op
and post-operative period forthese patients.
(06:07):
You know, multiple studies haveidentified this as a problem,
though to my knowledge, at leastat this point, this hasn't been
evaluated prospectively.
But I think it certainly makesus have to wonder.
You know, not only do we needto be treating our
brachycephalic patients,especially because we know that
they're in increased risk, butthis specific group of
brachycephalics that hashistoric regurgitation, I think
(06:29):
is going to need additionalevaluation and care moving
forward.
Lisa Fortier (06:34):
Off a completely beaten path.
Do either one of you think thatthe popularity in these breeds
will go down now that a giantSchnauzer finally won the best
in show at Westminster?
Vanna Dickerson (06:45):
Uh?
you know, maybe I don't know.
I feel like they're especiallythe Frenchies.
I mean, they're stinking cuteman and they're the perfect size
to be in lots of differenthouseholds.
So I don't know.
Lisa Fortier (06:59):
Yeah, very true.
How about you, Mason?
What do you predict?
Mason Hill (07:03):
Yeah, I agree with Vanna, I'm not entirely sure,
you know.
I just hope you know, whenfolks invest in these dogs
because they are precious andthey are perfect family members,
and that you know they're justaware that they can come with
some increased chance and riskfor complications related to
their airway and otherwise, so Ithink us, you know, as a
(07:24):
veterinary profession, justdoing our best to educate our
clientele and let them know whatcan occur is really really
important moving forward.
Lisa Fortier (07:37):
I like what you said, and otherwise it's not
just anesthetic complications,it's, and otherwise.
Sarah Wright (07:42):
Yeah, funny enough , the soft tissue surgeon from
my rotating internship owned aFrenchie.
I remember learning that and Iwas like huh before you know, so
did not expect that.
So, Mason, you did talk aboutsome areas of future research,
such as looking at likeregurgitation events, but are
there any other areas for nextsteps for research in this topic
?
Mason Hill (07:59):
Yeah, I know I really did allude to my kind of
next point here, which is that Ithink us really evaluating this
population of brachycephalicpatients that have historical
regurgitation, how we can impactthat, moving forward, looking
at prospective studies, reallywanting to evaluate for me how
the use of prokinetics maybereceiving them more long-term
(08:20):
prior to hospitalization andPPIs, would be really beneficial
, just because in a lot of ourpatients their prokinetic
administration and kind ofmedical management strategy was
initiated very close to time ofhospitalization, and so I just
wonder, if we prolong that,could we potentially benefit
them?
But I think there is a breadthof research that remains to be
(08:41):
done, looking at these patientsas a whole.
Sarah Wright (08:44):
Well, we look forward to hopefully seeing a
manuscript about that in thefuture.
So, AI is definitely a reallyhot topic and we actually have a
AI supplemental issue comingout in AJVR in March about AI
and veterinary medicine.
So, Mason, do you see a rolefor AI in this area of research?
Mason Hill (09:24):
Yeah, I think you know important for me to mention
is that I have not yet myselfdelved super far into the
utility of AI, but I'm reallyexcited that were really
embracing it as a field andthink that it will be very
impactful for us.
Areas where I think it can bebeneficial especially on the
conversation of looking at thesepatient populations that
regurgitation m ofmulti-institute this study
evaluating these patients andusing AI to help assimilate that
information and help developthe protocol that could impact
these patients.
And that's kind of my generalthought and I didn't know if you
had anything you wanted to addto that
Vanna Dickerson (09:44):
and I do wonder one of my colleagues here just
recently published, I think, inveterinary surgery, a paper
where they're trying to look atcould we remotely grade how
severe brachycephalic airwaysare?
You know, in the UK there's abigger push to maybe work a
little bit harder to sort ofbreed for better kind of more
(10:05):
health sustainingsustainingtraits in these dogs.
And I mean I wonder if we everget to a point.
Could we train AI to listen tohow severe stutter is and maybe
combine it with things like theBrisk score that's been
published to help us quicklyidentify which patients are more
at risk?
Sarah Wright (10:25):
Yeah, it's a super cool question.
We're actually going to begoing back and looking at all
the answers and combiningeverything for some future
research topics, so it's prettycool.
And for those of you justjoining us, we're discussing how
the implementation of astandard perioperative protocol
reduces postoperativerespiratory distress events in
dogs undergoing surgicalcorrection of brachycephalic
(10:45):
obstructive airway syndrome.
Lisa Fortier (10:47):
With our guests Vanna and Mason correction of
brachycephalic obstructiveairway syndrome with our guests
Vanna and Mason.
Vanna, you described how youdesigned this protocol with a
multi-team approach and then youhad to implement it and do the
research and write themanuscript and get it across the
finish line.
How did your previous trainingprepare you to get all that done
?
It's hard to get from theconcept to get everybody on
board and really finish it.
I think that would be reallyinteresting to hear what you
(11:09):
have, the advice you have togive to other authors.
Vanna Dickerson (11:12):
Yeah, I mean I was fortunate.
You know Mason is, you know,one of those vet students as
many of them are that are justincredibly eager to help with
things like this.
So a big help was having her beso excited about the topic and
really taking it head on.
But you know, sarah, youmentioned UGA earlier.
I was there for actually 10years through vet school and
(11:33):
then I did do a researchfellowship and my residency
there.
So you know, I think for thistopic specifically had a ton of
exposure to what we called thebulldog special there, but just
brachycephalic, you know, dogsin general, and we did during my
residency, also publish anarticle looking at a different
way of doing their rhinoplasties, which it's interesting to me.
(11:56):
I don't even do them that wayanymore and I think it just
speaks to how quickly this, youknow field is changing.
But you know, in terms ofgetting this published and
through the finish line, youknow we're fortunate here, I
think, to have a collaborativeenough environment for everyone
to be very excited about tryingsomething new and seeing if it
can help our patients.
So I think that was kind ofstep one here is just getting
(12:18):
everyone excited about it,getting everyone on board.
And then, since we looked at itretrospectively, then a lot of
the work really was on DearSweet Mason, who made a very
large spreadsheet and helped usto get through it, and we did
make sure to have, you know,authors from all different kind
of specialties on this articleas well, just to make sure we
(12:39):
were kind of encompassingeveryone's thoughts.
Sarah Wright (12:42):
I think it's really cool how collaborative
everyone's being on this topic.
We actually my husband and Iwere watching the Illinois
basketball game the otherweekend and they actually had a
commercial for the vet school,but the focus was on Heidi
Phillips and her likebreak-cephalic research as far
as like self-dischiever surgerygoes.
Vanna Dickerson (12:55):
So I was like we had kind of a little special
group that talked just aboutthese brachycephalic dogs and
kind of you know, what could webe doing in research in the
future?
Sarah Wright (13:14):
So so our next set of questions is going to be
very important for our listeners.
Vanna, what is one piece ofinformation the veterinarian
should know about the surgicalcorrection of brachycephalic
obstructive airway syndrome?
Vanna Dickerson (13:28):
Yeah, I mean.
So I tell my veterinarystudents all the time that the
surgery is not the hard part ofmanaging these dogs, especially
if you're speaking, you knowspecifically about airway
surgery.
It really is that perioperativecrap that can go wrong and
making sure that you can handleit.
So I mean, I really think it'simportant for every practice if
(13:48):
you're going to be seeing thesepatients and certainly if you're
going to be anesthetizing them,to try to figure out what's
going to work for you.
We did put our here when weinstituted this protocol.
Dr Ito, one of theanesthesiologists on it, helped
makea really pretty kind of onepager that we could just put up
in the hospital, make it reallyeasy for everybody to see and
(14:08):
use as sort of a checklist.
So and that's available as asupplementary material on the
article.
So I think people maybereference that but kind of try
to develop what protocol isgoing to make the most sense for
you with what drugs you have inyour practice, how much
monitoring you have and maybethese higher risk dogs that do
already have a history of a lotof regurg and things like that,
you know, even though thesurgery is not that bad, you
(14:30):
know, maybe those are dogs yourefer, just because of the
potential need for really heavyaftercare.
Sarah Wright (14:38):
On the other side of the relationship.
What's one thing that clientsshould know about this topic?
Vanna Dickerson (14:42):
Yeah.
So you know, even though wetalk about a lot of scary things
that can happen with thesesurgeries, I do still think that
in most cases the benefitsveterinarian about hey, you know
how much experience do you haveanesthetizing these dogs?
What is the plan if somethinggoes wrong?
(15:12):
Are we five hours away from thenearest emergency clinic?
Or, you know, do you havesomeone overnight that can help
watch my pet as they recover?
But I do still think, eventhough there are scary things
that can happen, it is uncommon.
Mortality rates actually bothpre and post protocol in our
(15:33):
study were less than 10 percent.
So they usually still make itthrough it.
Lisa Fortier (15:35):
It just sometimes is a little bit of a rocky road,
exceptionally well summarized.
As we wind down, we like to aska little more of a fun question
.
So, mason, for you, what is theoldest or the most interesting
item on your desk or in yourdesk drawer?
Mason Hill (15:48):
We have a very large 1980s Rolodex on our desk at
home to keep contact informationfor friends and such.
I have no idea of where it camefrom, but it is a unique staple
to the house now.
Lisa Fortier (16:06):
Very cool Because everything's in my phone.
If I lose that, I'm in bigtrouble.
Right, it's an old school back,Vanna.
This one usually dates people,but what was the first concert
you attended?
Vanna Dickerson (16:18):
Yeah, so the first one that I can remember,
being kind of big, that I wentto was Weezer actually, and it
was so much fun.
And actually this question mademe think about how I need to
start going to more concerts,where did you go see them In
Atlanta?
Lisa Fortier (16:34):
Okay, yep, wow, do you want to answer that too,
Mason, you look a lot youngerthan the rest.
Mason Hill (16:39):
Well, maybe not Sarah, but I grew up listening
to a lot of like red dirt, Texascountry, probably no like big,
big names, but they're fantastic.
So if that's something thatinterests y'all, I implore you
to dig in.
But very cool Good times.
Sarah Wright (16:56):
Yeah, it's a fun question.
We haven't asked that one in awhile, so I was happy to bring
that one back.
Thank you, Vanna and Mason.
We really appreciate youspending your time with us today
, and also for contributing yourresearch to JAVMA.
Yeah, thanks again for havingus.
Mason Hill (17:10):
Yeah, thank you all so much.
Sarah Wright (17:12):
And to our listeners.
You can read Vanna and Mason'sarticle on JAVMA.
I'm Sarah Wright with LisaFortier.
Be on the lookout for nextweek's episode and don't forget
to leave us a rating and reviewon Apple Podcasts or whatever
platform you listen to.
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