Michelle Moyal, DVM (Host): Welcome to the Cornell Veterinary Podcast, where we deep dive into the discovery, care, and learning that happens at Cornell University's College of Veterinary Medicine. I'm Dr. Michelle Moyal, General Practitioner and Head of Primary Care Surgery at the college and former roller derby player. For those of you who don't know, my roller derby name was Dr. Turmoil. And I am here today with Dr. Jethro Forbes. He is an Assistant Clinical Professor in the section of Emergency and Critical care at the college, and he received his veterinary degree from the Ontario Veterinary College in Guelph. He is a Diplomat of the American College of Veterinary Emergency and Critical Care. That's a mouthful. At Cornell, he has recently acquired a new piece of technology, oh, we love technology here at the college that can help cleanse a patient's blood outside of its body, which he will get into, don't worry listeners, and is using to help all of our hospital patients, which is incredible.

Welcome, Dr. Forbes. How are you?

Jethro Forbes, DVM: I'm great. Thank you so much for having me. I'm really excited to chat with you today.

Host: Yes, I'm so excited. And I'm just going to throw out like a little piece of knowledge. Dr. Forbes and I, have come across each other in the college quite a few times, and you may or may not remember this, but I found a picture of when I was a student at the North American Vet Conference. Now, everybody might know it as VMX. And you and I were in the same group photo.

Jethro Forbes, DVM: Well, and we, we cross paths at airports. Last year going to New York for, you know, with weather delays, we're intertwined somehow. So it's kind of apropos that we're back here together again on this podcast.

Host: I love that. And for those of you who don't think the veterinary community is small, it is, in fact, small. So network now. Network with your colleagues, like your classmates, network with people on LinkedIn, you, it just, you never know. But let me get right and into this because I'm so excited. It's really important to me to let our listeners know, kind of, how everybody found their path. So, could you tell me, like, what led you to become a veterinarian?

Jethro Forbes, DVM: Yeah, this is actually a question that I answer a lot without even being asked. So I'm glad you asked. So I don't have to offer it because I didn't know I wanted to be a veterinarian and that's what I'm really proud of the path I took. I was a psychology major and I went into the human health services, I worked with adults with developmental challenges and worked in community integration settings and group homes and just making lives better for folks that I worked with.

That was the goal. And it was incredibly rewarding. I made a difference. And I'm going to come back to that statement a couple of times here, because making a difference is I think what we all get into this to do. And I did that for a number of years and it felt good. It clicked. But I didn't have pets at the time.

And my partner and I were volunteering at a shelter and there was something, you know, we were out on a walk. It was, this was downtown Vancouver, British Columbia one day. I'm Canadian. And we were walking this big rotty mix and he was so ill-mannered, bouncing all over the place. And there was just something that clicked on that sunny, spring day.

And I said, you know what, I really enjoy this working with animals. And I really enjoy the challenge that comes with learning how to solve the next problem. And it it struck me that there was a way that I could make a larger difference for a population, being animals, that were really somewhat at risk of needing our help.

And so anyway, I went down that pathway and this will be the silly part here for a second here. Bear with me. I've got dad jokes coming out in my both ears and everywhere else.

Host: Oh,we're here for it. We're here for it.

I

Jethro Forbes, DVM: took in school, all the psych courses and the sciences I took to fulfill my graduation requirements were rocks for jocks and physics for poets. No, lie. That's, what they call them.

Host: I'm sorry, wait, rewind. Did you just say physics for poets?

Jethro Forbes, DVM: Physics for poets which was the, the least intensive physics course one could take at the school I went to. So we talked about the stars and we talked about the history of folks that studied physics over time. Copernicus and all this really interesting.

It was half philosophy and half physics. There was a little bit of math in there too, but not too much. And when I decided I wanted to become a veterinarian, a light bulb went off and, you know, I had this like internal like spark that just like generated this passion and I was like, wow, I found my path. The world didn't see it the same way I did, the vet world. And all the prerequisites that you need to get into vet school certainly didn't jive with what I had taken on my previous path.

So I spent a number of years going to school part time and getting prereqs and then going full time because some of the schools wouldn't take them if they were part time, all while working and supporting my family and I'm volunteering at a vet clinic now, knowing that I loved it.

And eventually I got to the place I needed to get to, which was the Ontario Vet College in Ontario, Canada. And class of 2008, I was almost the oldest in my class because I'd, been around the block a few times and it struck like I was home. I was in the place where I could learn to make that difference, where I could provide leadership for my younger colleagues. I could save lives and really get to solving that problem and solving the puzzle that is veterinary medicine on a daily basis.

Host: Oh, I love that story so much! I love it so much! And the reason why I love it, and so, sorry, my excitement is pouring out into your story, but the reason why I love it is, well, one, our audience is probably Googling physics for poets, which is amazing. But two, And I want to make sure that everybody listening, because we have a varied audience, and I hope there are some students out there that are listening.

I think some students tend to think that if they didn't start veterinary medicine right away, like if they didn't know when they were kids and then go to college thinking veterinary medicine, then go right into vet school, that they're quote, too old or they can't do it. But you and I had very similar paths.

I did the same thing. I only kind of discovered I wanted to do this after college. I went back to school. I volunteered, but I had to work full time and took classes. So I love this path. And then you pointing out that in a way you can be an asset to your colleagues, right? Having some leadership, having some experience under your belt for your classmates. So I love that so much. So everybody listening, it's never too late. Please think about that.

Jethro Forbes, DVM: Never too late. And you know, as we get further into this conversation, even within the veterinary field, we're not necessarily locked into one pathway and one course, throughout the whole time. So whether that's life in general or us as veterinarians or aspiring veterinarians, there's so many different ways to get where we can both be happy and excel and make a difference, but also be satisfied with what we're doing.

Host: Oh, I love that. Absolutely. If someone had asked me, almost 20 years ago if I thought I would be in academia doing something, I would tell you it probably would have been a hard no, right? Because I thought I would be in practice this whole time. So I love that. And so with that, because I love that you're talking about making a difference for the world; and that's part of the reason that led me to Cornell, right? We have this whole motto that we want to do the greatest good. But what led you to emergency and critical care specifically?

Jethro Forbes, DVM: I had no idea I loved emergency and critical care as much as I do now. Similar kind of spark that I described when you know, I figured out that being a veterinarian was the pathway for me. All through veterinary school, I didn't do a lot of emergency medicine. I did actually a lot of shelter medicine. I participated with the Humane Society Vet Med Association, the RAVS program, Rural Area Veterinary Services. Went on about 30 trips as a student through my four years and, and the years after. I wanted to touch every size, shape, and type of animal out there possible and participate that way in the field.

And as I got closer and closer to the end of my academic training, I had some great mentors in the RAVS community that coached me towards an internship. And so I went down that pathway and my first rotation in my small animal rotating internship in private practice was on overnight emergency medicine.

And 6 p.m. came, you know, the rest of the day folks all left the hospital for the night. And it was us. It was the ER. It was, we had this control over our entire universe in that place. And we didn't know what was coming in the door and we were on the spot, solving problems, figuring out what was really going on from a host of different presentations, making critical decisions on the spot to make or break, the outcome of a case, and it just clicked within a couple of days, literally a couple of, well, nights, I should say.

Um, on that rotation I was hooked. It was within a couple of months of starting my internship that I actually signed on to be an emergency doctor at the end of my internship. So, I stayed on in the same practice and it continued to click and I learned lots. That's the other thing.

And now this is the hard part about our profession. I learned a lot by doing. But also by not having successful outcomes and by looking back on decisions I made and saying, I would do it differently this next time. And that's a hard way to learn. And sometimes on the spot in the ER and the emergency service or in any part of veterinary practice, that's how we learn and how we get better. But man, it chips away at the ego a little bit. And the sense of self for sure. Again, that atmosphere and that style of learning worked for me.

Host: I think there's few good themes in there, right? Because I think when we teach, as people who teach in an academic setting, our students think that we have to be perfect all of the time. And when I say that the audience, we want to be perfect, but medicine unfortunately isn't perfect. Right? It's not as straightforward as one might think, and we do the best with the information we have as doctors, and sometimes the outcomes surprise us in both good and unfortunately sad ways. And so I'm really glad you brought that up. And for our audience, I want to make sure for everybody listening, Dr. Forbes brought up some really neat things that I wanted to mention. When we graduate from veterinary school and we pass our national boards or whatever board exam, we are veterinarians who can go into practice. We are doctors. We could do all sorts of things. Some of us elect to apply for some advanced training and that would be an internship, which is about a year.

You can do internships in lots of different fields. Dr. Forbes mentioned rotating, which meant he rotated through different topics in veterinary medicine, emergency, sometimes it's things like internal medicine and surgery, and then he worked, but eventually he did go on to specialize. So just like in human medicine, veterinarians can specialize in different, I'm going to call it like broad topics, broad, not so broad, right. So we can have veterinary ophthalmologists and criticalists like Dr. Forbes and specialty surgeons, and so I wanted to make sure that everyone knew that, that was a thing. And RAVS, or Rural Area Veterinary Services, is really neat for students, and you mentioned it, right? So, essentially, groups of students and really skilled doctors go to these communities and they do all sorts of spays and neuters and things like that. So what an education you had leading up to going into emergency medicine.

Jethro Forbes, DVM: Well and I saw my, should I call them younger colleagues? They were younger for sure, but I saw them on the pathway that they, you mentioned it earlier. They knew from the age of two years old, five years old, 10 years old, whatever it was. And they were on this straight and narrow path to get where they were going.

And they got there quicker in life than I did. But I appreciate their journey for the value that it has. I also appreciated the fact, as you point out, having some perspective on different areas of the field and things outside the field and different experiences, I think shapes a lot of how I approach our clients and now in the teaching capacity, how I try and approach the individuals that I'm fortunate to work with and hopefully make some positive influence on their progression and their pathway. It's brought a lot of the twisting and turning has been valuable for me and how I approach different challenges now that I'm where I'm at in life.

Host: Oh, I love that. Well, you were established, you were working as an emergency doctor, which again is really funny. I did the same. So after my internship, I stayed on, I was doing emergency medicine. What made you decide, like, no, I want to deal with critical care. I want this to be this is my passion. I want to be board certified. Where did the push come from?

Jethro Forbes, DVM: I just want to point out to our audience that Dr. Moyal and I are in two different places right now, because it sounds like if you were to hear our stories side by side, we're kind of the alter ego of each other here. So we can't be in the same place at the same time by the sounds of it. Otherwise, there'd be some, some disruption in the space time continuum or something here.

Host: I love this so much.

Jethro Forbes, DVM: But to your question, I thrive on challenges and seeking that next step of growth, whether it's on a personal level and looking at myself as an individual and an emotional being and that journey and that process, or as a clinician, which is the point of your question, the critical care. I spent a couple of years as an emergency clinician, and thought I was doing a good job, and I was, but there was more that I wanted to learn and get deeper into physiology. Why diseases did what they did, what was happening at a micro level, cellular level, as well as, work with some of the sicker, the more critical style of patients and to be involved in some of the advanced modalities that being a critical care specialist would allow me to participate in.

And some of those are what we're here to talk about today. In addition to everything else we've been covering, but mechanical ventilation. So, breathing for a patient whose lungs are so damaged that they can't transport oxygen out of the air and into their blood. Providing outside the body blood purification with dialysis for advanced kidney failure and a few of the other applications that we're going to get to here.

So I transitioned into the opportunity to do my residency actually ended up being four years long because I did it jointly in the same private practice where I started and at Colorado State University where I got the little bit of the best of both worlds, the private practice experience and the academic teaching hospital experience at a university setting.

Host: That's so cool. And so, okay, let's dive in because I'm sure everybody really wants to know. I love this because it's written down because I have notes, guys. It's written down, there's a new piece of technology to the hospital, right? And so tell me, it's called the EBP unit. And so can you tell me what the heck that stands for and like what it does?

Jethro Forbes, DVM: That sounds crazy. Extracorporeal blood purification is what I'm calling our unit in terms of the team and the equipment that we use to help our patients. The machine itself will, oh gosh, I feel like I need to take a step back if that's all right.

Host: Deep dive. Science.

Jethro Forbes, DVM: Little bit of a step back to just set the groundwork for how I got to Cornell, too. You touched on something earlier that again, resonated pretty intrinsically for me as well, which is, what am I doing at this Ivy League institution that with Big Red and all the bells and whistles and the ivory tower kind of sense that comes with it.

Well, after my residency, I left academic teaching and I went to private practice and I, knew that academic setting was not for me. Nothing against it. I just, I love the private practice flow and that's again, at that point in my life and career, that's what clicked for me.

I started one of these extracorporeal units in Connecticut, in private practice, and I'd been involved with one in my internship as well. We did dialysis back in Seattle where I was practicing as an ER doctor and then started my residency. And I started my own dialysis unit in Connecticut. And it was through some connections I had made through my pathway, back to your point about, networking and making connections; it was a friend and colleague of mine that I'd met way back at Colorado State in 2014, I think, that I reconnected with in around the 2018 2019 mark.

And she invited me or she opened the doors for me to come and be a guest lecturer at Cornell to talk about extracorporeal blood purification and all the ways that we can help cleanse patients, primarily dogs and cats, but we help horses and sheep and goats and you name it, if it's got blood, we can clean it.

But she opened the door for me to come and visit. And it was an honor and I got to meet all the great team at Cornell and the emergency and critical care department. And, we went back and forth over a couple of years and stayed in touch. And I came out again and gave another guest lecture for a seminar.

And when an opening, an opportunity came about for expanding the faculty team, I investigated it. Without any intention of well that's probably not very professional to say, I was open to the potential that it could work. However, I had that thought, this is not the place for me. I don't do research.

I'm, I'm a teacher, but this is like high level teaching. And you know what, as I got through the interview process and spent a couple days with all the folks at Cornell and saw what kind of difference I could make for younger you know, to be veterinarians, as well as specialists in training and colleagues and patients and owners; it really was such a great opportunity that I jumped at it when I put all those pieces together, and it truly feels like I've been working my entire veterinary career, and maybe even before that, to be here at Cornell to make a difference in as many different lives as I can, whether they be young colleagues on their way to becoming veterinarians, colleagues on their way to becoming specialists, colleagues that are already specialists or practicing veterinarians in our community and in our halls themselves.

There's so many different folks that I get to interact with on a daily basis and learn from and hopefully provide a little bit of insight into some of their cases too and just be colleagues and friends with so many different folks. So, that's how I got here anyway.

Now I came with the intention of setting up this blood purification unit and it it took a couple of years because of COVID. We had some setbacks and you know, some delays. Yeah, yeah I joined the team right in the midst of it in 2020.

Host: Oh, that's so funny. So did I.

Jethro Forbes, DVM: I started August 1st, 2020.

Host: I started just a few months before.

Jethro Forbes, DVM: See, again, our, our pathways seem to be intertwined. Um, so I came on board and you know, it's taken me a the few years to get things together, to get the equipment, to train the team to do what we're here to talk about which is cleanse the blood in our patients, whether they be cats or dogs, that's what we've done so far, but we have the capacity to do other animals as well.

There are a couple of ways that we can apply the therapy. We have one machine with us right now and it is truly what's called a renal replacement machine or kidney dialysis machine. But we have ways to make it do a number of different cleansing applications. The one that we think about the most is for dialysis.

Just like with people, when cats and dogs and other animals sustain an injury to their kidneys, the kidneys stop getting rid of all the toxins that they normally do. They're amazing filtering organs. They maintain normal blood pressure and normal water balance and electrolytes like sodium and potassium, and they get rid of the toxins out and excrete into the urine that the body doesn't need.

And they're amazingly smart and intelligent organs, but they get injured. And they get injured from infections, toxins, like cats, we see lilies that hurt the kidneys and dogs, we see medications like anti inflammatories, antifreeze or grapes and raisins, sometimes infections.

I mentioned earlier bacterial infections. There's another one that gets dogs a lot called leptospirosis. And that's spread through the urine of wildlife that dogs will lap up in puddles. And then those are special bacteria that go and hurt the kidneys and the kidneys stop doing all the amazing things that they do.

Host: For those of you listening, there's a vaccine for leptospirosis. Ask your veterinarian about it, right? We would much rather you have the vaccine before being exposed to this, so Dr. Forbes has to see you. I don't want that for you. No offense, Dr. Forbes is awesome. Yeah, and just like a quick kind of question about this for our veterinarians that are listening, this is more for acute injury, right?

So we're are we using this for our chronic? So I know some people might be listening. They're like wait I have a cat with kidney disease. Maybe my cat can just my 18 year old cat can just get some dialysis and then be free of kidney disease.

Jethro Forbes, DVM: Right. Amazing question. Yes, we primarily do treat the acute kidney injury. So, all we're doing with the machinery and the technology is taking blood and purifying it of all the toxins that are supposed to be being eliminated by the kidneys. We can balance the acid base status in the patient's blood and balance their electrolytes and their water balance and help them feel a ton better so they can go home rather than be sitting in the hospital undergoing treatment there.

And then they come back every couple of days for an outpatient treatment, but in between they're usually feeling pretty well and eating and drinking. And, I mean, this is going to say a little bit about how let my dogs run the household where I am, but those pets can be on the couch with their people.

They, you know, they're where they belong, right? Not, in a very well run, intensively managed and very highly cared for place like our intensive care unit at Cornell, but they're back where they should be.

Host: Yeah, and for those of us in medicine, we know that being in a hospital setting, I mean, when it's needed, it's absolutely needed. But if you could do something like Dr. Forbes is doing, right, so we all know that anxiety in pets can slow healing, right? And we want these pets to heal and being at home with their people and they're in a high comfort level with the people they love can help with healing. So I love hearing this.

Jethro Forbes, DVM: And they're emotional and you know, state and stress levels, but also, I mean, I know what it's like when my dog is away for half the day for whatever reason, and I come home and those tic tac of the nails on the floor or the tail wag, the licks and all that. I mean, for our, family, it affects us as well not to have our pets there.

Host: Absolutely.

Jethro Forbes, DVM: So these acute injuries, ones that come on suddenly and make them quite ill, quite quickly can be transitioned to, you know, being outpatient and at home and they come in every couple of days for two to three weeks on average before we know if their kidneys are going to heal.

We're not actually healing the kidneys with dialysis. We're just giving the body and the environment that the kidneys are in, the chance to heal on their own. And that's, you know, there's never a guarantee that that's the case, but we give them the best chance that they can have that way.

The difference between that acute treatment and a chronic case, people are familiar with chronic dialysis for humans that have end stage kidney disease, where they go to the dialysis center two, three times a week for the rest of their life and have that managed, or they pursue a kidney transplant.

We, we can do that with dogs and not cats, and I'll touch on that in a minute. We can help them feel better by being their kidneys of sorts. But it is a lifelong commitment. If we're at the end of any kind of kidney function that's salvageable, then we're treating these kidneys or these patients as if we are their kidneys for the duration of their time left and there's still many other complications that go along with chronic kidney disease. So for the vets out there, we still have to manage the electrolyte imbalances and chronic anemia. So low red blood cell counts and protein loss through the kidneys.

There's a lot of management that goes into treating those patients as chronic dialysis candidates; such that cats, unfortunately, just don't fit into the category of a patient that tolerates that long term treatment over a long period of time. So, cats, rather than going down the road of chronic dialysis, will typically be given the opportunity to pursue a kidney transplant at one of the centers that does that.

Cornell doesn't currently. Now, you specifically mentioned the 18 year old chronic kidney cat that's been managed throughout its latter years with a number of medicines and blood pressure control and all the rest of those things.

Host: Cough, cough. My cat. My cat.

Jethro Forbes, DVM: You know, kidney transplant in your cat, and the choice is different for everyone that's, you know, involved with it, may or may not be the best choice for that particular individual. But that's a whole other discussion outside the realm of dialysis. Long story short, chronic kidney disease at the end stage doesn't really go well with dialysis for cats.

We can look at it for dogs. Still pretty intensive but they feel good in between sessions and we can do that for as long as the folks and the family want to do it.

Host: That is so neat, and I know that this isn't something I'm going to dive too much into, but I try to be mindful of lots of populations that come to see us as veterinarians, and this is a bit of a financial undertaking. Yes?

Jethro Forbes, DVM: Absolutely. Yeah.

Host: So I don't want a veterinarian to listen to this and be like, great, I'm just going to refer my client's dog with a kidney. They'll just get some quick dialysis and then they'll feel better, because we want them to educate our clients. So, not going into exact cost, but

Jethro Forbes, DVM: Yeah, absolutely. I mean, the technology, at the root of anything that costs something is the value of it and and the expertise and the equipment and the disposable types of systems and circuits that we use. And so just kind of backtracking a little bit to what we're doing with the current machine that we've got.

We place a large catheter in the jugular vein of an animal and it's got two ports, one in, one out, and we take blood from one side and we run it through a filter. And that filter is essentially thousands of little straws that have little pores in them that we can manipulate what moves in and out of the bloodstream to the benefit of the patient and then return that blood back to them purified and, cleaned.

And we run their, blood through it for a number of hours depending on what we're doing with it. And,

Host: Are they sedated for this? Like, are they just awake and hanging out?

Jethro Forbes, DVM: They are awake and hanging out. I have photos upon photos of my patients just hanging out, looking at me, they're getting a snack, they're getting pets from whether it's a couple of the nurses, myself, you know, some of the folks that are coming in to see what's going on.

Um, at the start of these treatments, they're often quite ill. And so they're kind of hanging out as they were while they get treatment. And then I, now listen, I, I anthropomorphize with the best of them. Um, I see the light in their eye when they come in. Let me tell you about Hazel real quick.

Hazel was a kidney dog that we treated just about a month ago. She finally graduated from not needing dialysis. We brought her to the treatment area where we did all of her treatments and she almost literally jumped up on the table where she would hang out for her treatments.

And we were just there to take out her catheter because she was well, she was fixed, she was ready to go. She got up there. And up on the table and she stretched her neck out and just rested it in my arms and looked up into my face like she always did during treatment, gave me a little kiss. It was like, there was no place she would rather be in that time. And that's the kind of image I want to give folks, which is they're not stressed. They're not uncomfortable. They're not sedated. They're happy to be there again, anthropomorphizing as I do. They know that this is the place where they feel better when they're done with all the couple hours of treatment.

Host: It is pretty miraculous and I've seen that too over the course of many years, right? Like, animals who get their insulin, or sometimes if they had fluid in their abdomen and we would drain it, just how much better they would feel. So they would stroll in looking not really stressed like one might expect. I love hearing that.

Jethro Forbes, DVM: They're smart, intelligent, emotionally intelligent beings. You know, they're like, this is the place that makes me feel better. And I think that reflects on again, you and how you would help that patient with the fluid in her belly and how you would interact with them and, how you would create an environment the same as, as we're aiming to do that is there for healing and for comfort and for treating them as not just a patient. And I don't mean that in any kind of disparaging term, but as an individual, as a, living being and everything that goes into that connection; that's what we strive for in our dialysis setting as well.

Host: And I know you mentioned Hazel. Is there another patient that kind of stands out in your mind where you use this amazing technology, right? Where you're like, oh, yes.

Jethro Forbes, DVM: Yeah, there's so many to choose from, and I'm going to choose some that I met at Cornell here and Sahara is going to help us illustrate another way we use the filtering technology. Sahara, yeah, a middle aged, husky cross. I met Sahara and she was so sick with her immune system was hyperactive and was attacking her own body. It was destroying her red blood cells, a condition called immune mediated hemolytic anemia. And she had received a number of blood transfusions. She was getting all kinds of medications to try and shut down her immune system so it would stop attacking her own body. It's this crazy disease that we see a fair bit of at veterinary medicine.

And her body was rejecting all the red blood cells. Her eyes were so jaundiced, so, icteric, they were bright, bright yellow. And she had these beautiful blue eyes. Once we got rid of the jaundice to her eyes, her blue eyes just popped out at us. Um, but she was so sick and ill and was barely able to move and get up. And for the folks that understand what this number means, her bilirubin was 60, which it should be, yeah, should be less than one. And that's just bilirubin for folks that don't know, that's a breakdown product of all the red blood cells that her body was destroying.

And that bilirubin is highly toxic as well. It was affecting her brain, affecting her muscle, her heart, her kidneys, her whole body. So we were brought into the picture here. And we did the same thing I described earlier. She had a catheter in a vessel, a large vessel in her neck, the jugular vein. And we withdrew her blood from one side of the catheter and ran it through a similar filter to what I described for kidney failure and dialysis, but the pores are much, much larger.

And the pores in those straws allowed all of the immune cells, the immunoglobulins, to be sucked out of her bloodstream. Now these immune cells and a few other things that we pulled out, these are what I call the weapons of the immune system. So these are the elements of her immune system that were attacking all the red blood cells and other parts of her body as well.

And we were able to remove those from the bloodstream so that they weren't able to destroy her red blood cells anymore, by filtering and purifying her blood with the same filtering technology that we described before. And after two treatments, we saw in her blood work that she was no longer destroying her red blood cells.

And all of the classic changes that we would see in blood work as far as this disease being in its highly active state were starting to clear and resolve. And we treated her one more time. And she never looked back from there. And in the course of that, she became less and less yellow and jaundiced and her bilirubin numbers came down.

She didn't need any more blood transfusions and she bounced her way out of the hospital again as well.

Host: With those blue eyes.

Jethro Forbes, DVM: With those blue eyes and here's the part of her that sticks out to me and amongst all the other amazing elements of the story is that she started singing, and we we all know those Huskies have, have that beautiful melodic voice.

Host: You husky owners, you're brave.

Jethro Forbes, DVM: I know, right? Um, but when she felt good enough to start singing again, her family, her folks were so thrilled. And, our whole team was incredibly happy to just see her feeling so well. And she had, you know, when I talk about the team in all of these cases her team involved internal medicine specialists, critical care folks, student veterinarians, ICU nurses, other nurses, her regular veterinarian, her, I should say her family veterinarian is what I meant and just a whole wide berth of folks that are involved in the care and the treatment that we were able to provide with these therapies.

Host: Yeah, I really appreciate that comment. Just because I think sometimes if someone is facing the client, maybe they're the person that the client talks to each day for updates. The client's like, thank you, you're the person. But really, there are like droves of people. In general practice it is the same. It is the same in an academic setting. We have our nurses. We have our animal care attendants who are cleaning cages and taking care of these animals and taking them on walks with the nurses and again, our technicians. And so it's really an incredible amount of teamwork that goes into this and caring that goes into the success for when this patient leaves the hospital. So I'm so glad you highlighted that.

Jethro Forbes, DVM: Yeah, no, I get to be the mouthpiece. Apparently I like to talk, so. But, uh.

Host: You know how I feel about talking everyone. Um, can I quickly ask? So, when you use this for different types of things, so, you know, when you use the dialysis setting and then when you use it in this setting, is it just a change in the filter size?

Jethro Forbes, DVM: Yeah, for this particular machine that we have, and we could get into a lengthy discussion about other machines that I'm hoping to bring in and we can expand how we do this but with the current setup that we have, it is literally just changing out the filter and a few of the other nuts and bolts of the set.

Host: Sure.

Jethro Forbes, DVM: And with that, we can do couple of other things with those filters too. The filters that I've described already for kidneys or for I didn't appropriately label it, I apologize, but for therapeutic plasma exchange, that's what we did for Sahara.

We can also use those same filters to remove other toxins from the body.

So when, I mentioned earlier that dogs that eat a large number of anti inflammatory medications because we make them nice and tasty, so it's easier for folks to get them into their dogs. Well, some dogs get into those bottles and eat the entire bottle, which has the potential to really do some harm to their kidneys in particular, but their liver and gut as well. Well, if we meet them early enough, we can actually hook them up to the same type of circuit I've described and remove the anti inflammatory medication from their blood before it has a chance to do all that damage to their internal organs. So, decontamination from accidental ingestion or overdose of medications and antifreeze is another one that we can pull out.

You name a medication or a drug or a toxin, we have a modality in our arsenal to be able to remove that from the blood and purify it; their blood before it becomes a problem for their internal organs, which is another great application that we have available.

Host: Oh, that's incredible. Prevention, right? Versus treating the ill effects or potential permanent damage. That's incredible.

Jethro Forbes, DVM: Yeah I've been doing this for 10 plus years and I'm still just thrilled to talk about it every day and just amazed at the types of, the difference that we can make on a whole nother level here.

Host: My gosh. Okay. So, you mentioned it before that there are some other technologies maybe in the human medical space that you would love to see us have here in the veterinary space. Could you briefly just name one or two that you would love to share with the viewers and by viewers, I mean people listening because no one's watching.

Jethro Forbes, DVM: I was glad that we weren't turning cameras on for this. I was ready though, but, so yeah, I've got two, two to really highlight and I'll, start with a, another filter that we can put onto the machines that we have currently. And this is a filter that's been used in human medicine to actually remove pathogens.

So it's the same type of, you know, it's a column with a thousands of straws inside, but the straws are sticky. They've got some branches of heparin sulfate for the folks out there that want to know some of the deeper details, but they've got these little fingers inside their straws and those fingers actually stick to bacteria, to viruses, to fungal organisms, and they catch them and remove them from the bloodstream that way. And they've, we're using them a lot in COVID times, know, that's, when some of this technology really came to, to some prominence but as well with bacterial pneumonia. They have human patients that are on the verge of going on a ventilator and they purify their blood with this pathogen removal device, clean out all the bugs from their bloodstream, and have saved them from going on to the ventilator.

Uh, sepsis, which is a widespread and the body shutting down from the results of massive response to an infection, usually a bacteria; those patients can be brought back from the brink of really critical illness or even, not making it out of the hospital by cleansing their blood of these pathogens and for that matter with some of the other markers and weapons of the immune system that are also at work in those types of patients as well.

So this is a filtering device that's just recently come into the veterinary realm and we're just working on getting that into the companion animal hospital and as well as the large animal hospital so that we can start to treat some of those septic foals, for example, or other animals that have widespread infection and with the hope that if we treat them early enough, you mentioned prevention with the toxin removal; but if we can remove the bacteria or the fungus or the virus before it starts to shut down and cause all the havoc it does in these patients then we can get them back home again sooner than we would otherwise. And likely even save their lives, whereas they might be a real challenge to do that with otherwise. That's one I'm really excited about.

Host: I practice in California and I have to say fungal disease, I'm sure a lot of our doctors know here too. Sometimes it just seems like we can't overcome it. So I love hearing that there might be an option to help with that.

Jethro Forbes, DVM: Yeah, it's, just scratching the surface of how we can apply this particular filter to our veterinary patients. So the next time we talk, you know, whether that's a year down the road or whenever it is, my hope is I'll be able to tell a story about a patient that we've saved with this pathogen removal filter as well.

Host: You heard it everyone. He's talking part two. What's the second piece of technology?

Jethro Forbes, DVM: The second piece, if I can boil it down, it's like a giant centrifuge. And for anybody that's not familiar with a centrifuge, it's a machine that spins around and around and we set it to a specific spinning rate. And in this particular case, the blood is removed from a patient and it's spun through the centrifuge.

And based on how hard we spin it, we can actually separate out different cell types and skim them off out of the blood. Again, another blood purification technique. We can use that for some of the same things we've talked about already. Removing plasma from a patient that's got immune cells that are out of control or toxins that need to be removed.

But the other really cool application of this is skimming off some of the white blood cell layer of the blood. And what we find in some of the applications for this would be removing cancer cells, for example. Some cancers create an overabundance of white blood cell types in the bloodstream that are harmful to the patient.

And we can actually skim those out and remove them. The other application kind of along the cancer lines here are to remove specific white blood cells, that we can then change and make them specifically active towards cancer cells and give them back to the patient. So it's actually making a vaccine for cancers that our patients might be experiencing by skimming out these white blood cells, part of the immune system, reprogramming them so that they attack cancer cells and giving them back to our patients. That's something that's happening already with these technologies as well.

Host: Wow. And not just any vaccine. This is a personalized vaccine. This is their vaccine, right? Like, to use quotes, right?

Jethro Forbes, DVM: Exactly. This is their vaccine for their cancer which is really incredible. So much, I mean, when I talk about the skimming the surface of what's to come with these modalities, we're on the precipice of doing some pretty incredible things.

Host: That's so cool. Oh my gosh. Okay. My brain is just exploding with excitement. But I want to be mindful of time. And even though I know that there's probably a lot of amazing stories that you could share with us or things about your job that you love. Is there like one favorite part of the job you do? Like if there's one thing you're like, this, this is why I do it. It's my favorite thing. Is it solving the puzzle? Is it helping the patient? Talking to the client? There's so many things. I don't know if you can narrow it down.

Jethro Forbes, DVM: the common thread through all this, and, I have a feeling you're, going to identify with this a little bit as well, just, knowing how our pathways are. But the common thread for me amongst all those ways to make a difference is by teaching along the way and is by bringing folks along, whether that's all the team that we've built and grown to provide these extra corporeal outside the body blood purification services, whether it's the students that come along and learn in the clinic, in the classroom, that then take this knowledge and this experience out into the world of veterinary medicine and make their own differences. Whether it's taking; this is how I describe it to students and folks that are learning with me. Taking an owner on a journey of understanding and learning to understand why their dog or their cat or their horse or their sheep or their goat or whatever other animal it is that I haven't listed, why they might not be feeling well and what are some of the reasons that could be contributing and how we're going to get to the bottom of figuring out which one of those reasons it is or it isn't.

And really kind of again, navigate down this pathway with them and finding that connection. So that teaching, learning, connecting with folks is all intertwined with solving the problem, getting to the heart of the medical issue, providing these really advanced techniques that we're able to help our patients with, right down to the more simple illnesses and conditions that folks come to see us for as well. It's woven in throughout all of that.

Host: Oh my gosh, I could not have said it better, right? It's like throwing the stone into the lake and just watching the ripple effect. It could be so widespread and our students do that and our colleagues do that when they interact with us and learn about all these new technologies and learn all of these things and oh, I love this so much. This has been amazing. I have a few more questions. It's going to be in little lightning round format if you're okay with that.

Jethro Forbes, DVM: I'll try and make my answer shorter. I'm ready.

Host: you, all right, people

Jethro Forbes, DVM: If

Host: think about your own answers.

Jethro Forbes, DVM: it's short answer. Oh,

Host: That tends to happen in veterinary medicine. Okay. Pickles or olives?

Jethro Forbes, DVM: Olives. The follow up question would be what type of pickles?

Host: Oh, well, dill or, there is a bread and butter pickle that's a sweet pickle, and I'm sorry, listeners, I'm not here for it. But well, there's a half sour too.

Michelle Moyal, DVM (Host): We're

Jethro Forbes, DVM: Stick with my olives then. I'll stick with my olives.

Host: Deep diving into pickles and I didn't expect it, but again, I love pickles. Yes, but I find that people are either olives yay or nay, which is interesting.

So you are yay. I also am yay olives. Crunchy or creamy peanut butter?

Jethro Forbes, DVM: Crunchy.

Host: Ooh, I'll support that. I'll support that. This one may be, again, controversial. A lot of these are food questions again, if listeners are thinking about why I'm obsessed with food, it's because I, I'm obsessed with food. Pineapple on pizza. Yes or no?

Michelle Moyal, DVM (Host): Oh,

Oh

Jethro Forbes, DVM: this a family divide in my household, actually.

Host: I love that.

Jethro Forbes, DVM: I'm okay with pineapple on pizza.

Host: Same! I'm really sorry to those of you I little salty, little sweet. Sometimes I throw jalapenos on that bad boy and it's really good.

Jethro Forbes, DVM: Throw one out for you. Back on the black olives, feta cheese and pineapple on a pizza?

Host: Oh, I've never. You just blew my mind. That was amazing. I even have more lightning round questions, but I'm just wondering before we end this conversation, because it has just been such a thrill to talk to you about all of these amazing things. Is there anything that I, didn't ask you, but you think I should have?

Like, is there anything you would love our listeners to know about what you do, what you do at Cornell, what you do with these machines, what you do for patients? Anything that you'd like to share?

Jethro Forbes, DVM: I think the, one thing that I want to provide more of an invitation, I guess, to talk more about the pathways to get to being a veterinarian, the pathways within being a veterinarian. The challenges, the rewards, the hardships. There's, some pain in this field as well as you know, a lot of our listeners can probably have some awareness of.

I want to, put that imitation out there as a, Hey, you know what, if you're thinking about it, if you're challenged by what you're experiencing within what we do in the profession, wherever, whatever stage or place or location or, whatever you're doing with it that there's somebody out there that wants to hear and just be sounding board.

And I'm that person because I've met some of those challenges and those struggles. And I've been in some of those places that took a lot of work and a lot of, a lot of friends and support and mentors to help claw out of. It's a tough road. It's an amazing road at the same time.

And I think there's a lot to be said and a lot to be learned from other folks experience. And if anything that I've gone through can help somebody else avoid some of the pitfalls, I'm all there for that. And then the other part of that invitation you know, you, you brought up is this patient a candidate for some of these therapies that we've talked about?

And that's certainly something that I would love to talk to anybody more about on a one on one case by case basis. And so I, don't know how to get contact out there otherwise, but social media wise, if, you're interested in reaching out. Dialysis4pets. That's the number four dialysis, number four pets on Facebook, on X and a little bit of presence on Instagram as well, although I'm not as solid of a caretaker of that account.

I'd be happy to connect with you offline as well, but those are some, easy ways to get ahold of me or dialysis4pets again, that's the number four at Gmail are all ways to get in touch so that we can talk more about those cases, those candidates yea or nay, whether or not they're good candidates, talk about some of the nuts and bolts and the finances as well, which have to be a part of everything we do also so that we can, take this conversation to the next step as well.

Host: Those are great last sentiments, last talking points. I want to make sure, again, our listeners know follow this on social media, right? We said dialysis4, the number four, pets. I think sometimes veterinarians forget that you can reach out to your colleagues just for some advice.

Whether or not it be on care or, some other things, but maybe you have some questions about your own patient or your own pets and you just want some more information. And so, they're ready for you. They're ready to help you out. And I love that about the Cornell culture, right? We just want to help others learn.

And to the other note, I think it's super important that we do talk about kind of like background and experiences and I do a lot of talks about well being and I think it is something that we tend not to talk about. And one, you can pivot your career at any time and sometimes you don't want to pivot.

You just need to know that there are people out there that have experienced the same things. And Dr. Forbes, with your psychology background, I really, really appreciate you mentioning that because we're people and we go through a lot in veterinary medicine. So thank you for that. And thank you again for joining us today.

This has been incredible.

Jethro Forbes, DVM: Oh, thank you for the invitation and for letting me expand on all these exciting things that we've been talking about and yeah, just to close it out, no one's alone out there. We're all going through our journeys and connection is one of the best ways that I've been able to get through some of my journey.

So hope to chat with some of you guys soon and in other forms. And thank you again,

Host: Absolutely. You heard it here. Please feel free to reach out and again, share this podcast with your friends, hopefully give us some good reviews. We can split the pizza, half of it can be pineapple, half of it could not. But thank you everyone for joining us today and I hope you'll join us again sometime soon.

Take care.