CVMA VOICE 2016:2 by CVMAMedia

CV M A VO ICE

Today’s Voice, Tomorrow’s Vision

• Veterinary Wellbeing • Compounding Bill Passes • CVMA Convention 2016

2016, ISSUE #2 CVMA Voice 201 6 : 2 | PAG E 1

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CV M A VO ICE

TABLE OF CONTENTS Inside President’s Post . . . . . . . . . . . 4 Briefings . . . . . . . . . . . . . . . . . 5 Of Note . . . . . . . . . . . . . . . . . . 6

6 PetCheck 2016

Nearly 1,200 Pets Seen at PetCheck 2016! . . . . . . . . . . . . . . . . . . . . . . . .

CVMA Convention 2016: Look What’s New . . . . . . . . . . . . . . . . . . . . . .

CVMA Legislative Efforts Expand Options for Veterinary Access to Componded Drugs . . . . . . . . . . . . . . . . . . . . . 10 Internationally Trained Veterinarians Integrating in Colorado . . . . . . . . . . . . . . . . . 13 Veterinary Wellbeing . . . . . . . . . . . . . . . . . . . 14 PetAid Announces Expansion Plan for Care Grants! . . . . . . . . . . . . . . . . . . . . . . . . 17

Disaster Services Program Comes to an End . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

HB16-1324 Passes

Thanks to Our Partners . . . . . . . . . . . . . . . . . . 20

Government Affairs . . . . . . . 20 2016 Legislative Summary . . . . . . . . . . . . . . . 23 Student Legislative Fly-in 2016 . . . . . . . . . . . 24 Do You Issue Health Certificates? Here’s What You Need to Know . . . . . . . . . . . 25

Science Update . . . . . . . . . . 27

Zoonosis News . . . . . . . . . . . . . . . . . . . . . . . .

Five Tips to Use Titer Interpretation to Improve Clinical Decision-Making . . . . . 28

Legislative Fly-in

CVMA Events and Deadlines July 21 Ways Receptionists Can Market Your Practice | Webinar August 16 Dermatology Toolbox: An Interactive Case Discussion and Diagnostic Approach to the Pruritic Pet — Denver August 18 Creating the 5-Star Experience for Surgery and Dentistry | Webinar August 24 Personal Wellbeing | Webinar September 14 PDS: Immune Blood Disorders and Fever of Unknown Origin — Denver September 15 Follow-Up Calls That Increase Patient Visits | Webinar September 21 The Top 5 Customer Service Tips to Set You Apart | Webinar September 22–25 CVMA Convention 2016 — Loveland October 8–9 CVMA CE Southwest — Durango October 20 10 Ways to Get Cats to Return for Care | Webinar October 21–22 CVMA BIG Ideas Forum | Fall 2016 — Breckenridge October 26 PDS: Hematology, Cytology, and Hemostasis to Aid in Diagnosis of Disease — Denver

In Practice . . . . . . . . . . . . . . . 30 Do Our Clients Value the Things We Think They Value? . . . . . . . . . . . . . . . . . . . . . 30 Attracting Strong Applicants in a Hot Veterinary Technician Job Market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

36 Self Care Strategies

Clearing Up Mis-Interpretations of Dog Behavior . . . . . . . . . . . . . . . . . . . . . . 34 Staying Afloat: Self Care Strategies to Help Improve Your Overall Wellness . . . . . 36

CVMA News . . . . . . . . . . . . . 38 Chapter Connections . . . . . . . . . . . . . . . . . . . . 38 CVMA CVA Program . . . . . . . . . . . . . . . . . . . 39

Our Mission To enhance animal and human health and welfare, and advance the knowledge and wellbeing of Colorado veterinarians.

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Colorado Veterinary Medical Association

PRESIDENT’S POST

191 Yuma Street Denver, Colorado 80223 303.318.0447 or 800.228.5429 Fax 303.318.0450 info@colovma.org www.colovma.org MANAGING EDITOR Cami Cacciatore PUBLISHER Ralph Johnson The CVMA VOICE is published quarterly to members (Core and Premium members will receive a mailed print copy and Basic members will have online access only) and once a year to nonmembers free of charge. Information and advice presented in this publication do not necessarily represent the views of CVMA.

Deadlines for Submission All articles, contributions, and display ads must be received in the CVMA office by the dates below. For more information or to obtain a rate schedule, contact the CVMA office at 303.318.0447 or info@cvma.org. Issue Issue Issue Issue

#1 — January 15 #2 — April 15 #3 — July 15 #4 — October 15

Curtis Crawford President

Clyde was a camel. We met after his owner called one day with the dreaded question that begins “Do you all do . . . ?” and this time ended with the phrase “castrations on camels?” I should have ducked into the bathroom when our receptionist came dancing down the hall with that goofy grin that said, ‘Boy, do I have a good one for you!’ written all over her face. Now, I have neutered everything from rabbits to stallions, but this was a new one. My boss glanced at the call-back note in my hand and gleefully answered for me, “Sure he does!” and the appointment was scheduled before I could object. A new procedure requires due diligence and research before engaging in it. But who do you call about camels? Then I remembered a classmate who had started raising them in Utah for whatever reason you raise camels for. So I searched her out and called her up. My first concern was my personal safety. I have been bitten by mice, turtles, birds, cats, ferrets, dogs, goats (yes, goats) and horses. I had been kicked by llamas, cattle, horses, sheep, and dogs. I had been run into by chickens, pigs, cattle, sheep, alpacas, and horses. I wanted to know how to avoid being where this beast could hurt me, so the first question out of my mouth was “Where is the safest place to be when working around a camel?” With horses, you don’t stand right in front or directly behind them unless you like getting kicked or bit. With cattle, directly behind is the safest place. Her answer did not inspire confidence. “Outside of the pen,” she dead-panned. Camels can apparently run you over, strike with the front legs, and kick with the back legs in every direction—and what their back legs can’t reach, well, they can bite within a radius of 6 feet of their bodies with those long necks. They can also spit some of the most vile crud ever imagined. If you think they stink on the outside, you just wait until you smell their insides. My heart sank even deeper than my confidence.

The dreaded day arrived. Although everyone else’s appointment slots were fully booked, the parking lot and waiting room were strangely empty when this kind, grandmotherly lady pulled up with an extra-tall horse trailer containing Clyde. Clyde was surprisingly well-mannered and halter broke. He did not particularly care for the anesthesia needle, but thankfully he held his spit. While we were waiting for him to go down, I had to ask how this little old lady ended up with a huge old camel. Turns out it was a “bucket list” item gone bad. She had faced down a fatal form of cancer and while undergoing treatment she had compiled a “bucket list” of things she wanted to do if she survived. On that list was, of all things, to ride a camel. The cancer treatment was successful and she did, indeed, find herself riding a camel, when the owner asked if she wanted to buy it. The chemo must have affected her inhibitory centers because now here she was watching Clyde drunkenly settle into a cush position and lay his head on the ground. I knelt behind Clyde and immediately noted his scrotal tissue was thicker than bull’s hide. However it was still pretty sensitive because as soon as I started my first incision, Clyde jumped to his feet and swung that head clear around to his butt to stare me in the eye as he started to hock up a big, green loogey. I backed off. I re-dosed the anesthetic, and he lay back down. This time my hand must have been awful cold, because just the touch of my gloves had him back up again. I was unsure of how much more anesthetic I could safely give him. I sure didn’t want to kill one of the reasons this lady had pulled through cancer, so we instituted Plan B and guided him out to the horse stocks and stuffed him in. I drew up a local anesthetic and started to inject the scrotum. The needle bent before getting through the skin. I got a larger gauge needle and started the local again. This time Clyde sat down on the butt bar of the stocks to protect himself. We huffed and puffed and pushed him up enough President’s Post continued on page 13

CV M A VO ICE

BRIEFINGS

CVMA Executive Committee Dr. Curtis Crawford President Dr. Sam Romano President-elect

Ralph Johnson Executive Director

Greetings from CVMA! As I prepare to dive head first into the crazy road trip tour that is Chapter and District Visits every year, I am thinking on what Dr. Romano and I will be sharing as we crisscross the state to meet with you all. There’s always so much to cover and I am always amazed at how much CVMA is getting done and doing for our members. Veterinary Wellbeing

CVMA BIG Ideas Forum | Spring 2016 This is such an important topic, consisting of so many complex and deeply personal levels. From self care to substance abuse issues to economic and career pressures, everyone in this demanding profession has something that keeps them awake at night or wears on them throughout long, busy days. Before our BIG Ideas Forum | Spring 2016 held March 12 in Denver, CVMA sent out a survey to our members to solicit your feedback on the issue. The anonymous results were shared with Elizabeth Strand PhD, LCSW, our issue expert, who led an incredibly thoughtful and enlightening discussion on veterinary wellbeing. As a group, we explored the seriousness of the problem, what resources and help exist and the barriers to seeking care, some useful coping mechanisms and preventive tactics and what actions we can take—as individuals, as practice teams, as an association—to improve the wellbeing of veterinarians and veterinary teams. Dr. Sam Romano has written a summary article that can be found on page 12. AVMA Wellness Efforts AVMA hosted a veterinary profession wellness roundtable in March, which will generate a report that provides examples of wellness programs and activities already in place across the U.S., highlighting what is working in those programs and what is missing. The report also will create an initial plan to support and promote wellness for the profession. AVMA’s 2015–2016 class of Future Leaders

Dr. Jenelle Vail Secretary/Treasurer

has embraced a wellness theme as well, focusing specifically on developing a guide to wellness in the workplace, building on the work of the 2014-15 Future Leaders class, which was instrumental in expanding and improving the wellness resources on AVMA.org. The roundtable outcomes should also allow AVMA to leverage the power of its two insurance trusts, the AVMA PLIT and AVMA LIFE, to support veterinarians’ wellness. AAVMC Veterinary Health and Wellness Summit 2016 The Association of American Veterinary Medical Colleges, Colorado State University’s College of Veterinary Medicine and Biomedical Sciences, and event sponsors will be holding the fourth annual AAVMC Veterinary Health and Wellness Summit on November 4-6 at CSU in Fort Collins. The summit is sparked by the growing body of evidence showing that veterinary students and practitioners experience high levels of stress, anxiety, and depression—and that these factors impact productivity, career longevity, and enjoyment in practice. The summit will bring together veterinary students, administrators, practitioners, social workers, counselors, and industry partners to develop a common understanding about health and wellness issues within the veterinary profession. Highlights of the summit include sharing specific interventions for enhancing and protecting health and wellness within the veterinary profession; defining best practices used to address these issues and form collaborations to advance best practices; and formulating strategies likely to result in specific programs and initiatives that will support veterinary students, administrators, and practitioners in achieving personal and professional wellbeing. CVMA will continue to bring members more information, resources, and education on veterinary wellbeing, including quarterly self-care webinars presented by Peer Assistance Services (visit colovma.org for more information) and ongoing articles in the Briefings continued on page 13

Dr. William French Secretary/Treasurer-elect Dr. Peter Hellyer Immediate Past President Dr. Melanie Marsden AVMA Delegate Dr. Rebecca Ruch-Gallie AVMA Alternate Delegate Mr. Ralph Johnson Executive Director*

Chapter Representatives 1 – Dr. Kimberly Radway 2 – Dr. Wayne Jensen (D) 3 – Dr. Merideth Early 4 – Dr. Adam Tempel 5 – Dr. Colleen Carnes 6 – Dr. Heather Reeder 7 – Dr. Debra Stirling (D) 8 – Dr. Dale Davis 9 – Dr. Kayla Henderson 10 – Dr. Marguerite Flett 12 – Dr. Randal Hays 13 – Dr. Connie Stapleton 14 – Dr. Matt Braunschmidt 15 – Dr. Mark Ryan 16 – Dr. Mark Cowan 17 – Dr. Leon Anderson (D) denotes district

Student Chapter Representatives Fourth year – Kevin Lavelle Third year – Madeline Anna Second year – Courtney Mael First year – Amy Zug * Ex-officio, non-voting

Nearly 1,200 Pets Seen at PetCheck 2016! Lauren Gladu, MA CVMA Communications and Content Specialist The seventh annual PetCheck was held April 9 and 10 throughout Colorado, and thanks to the generosity of CVMA members, nearly 1,200 pets received much-needed wellness exams and rabies vaccinations (if appropriate)! Through the collective effort of PetCheck, we are afforded an unparalleled messaging opportunity that neither CVMA nor individual veterinarians could afford to undertake. Strategically, PetCheck affords tremendous public relations exposure for Colorado veterinarians to positively portray the profession and underscore the importance of preventive pet healthcare as well as the veterinarian’s crucial role in public health protection. The media coverage surrounding PetCheck—before, during, and after the event—puts veterinarians on the air and in the spotlight in a way we’ve only been able to dream about! With 62 clinics across the state providing wellness exams and rabies vaccinations to nearly 1,200 pets this year, CVMA members have a lot to be proud of! Pets helped with the PetCheck program belonged

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to financially disadvantaged pet owners. With PetCheck, these owners were able to access and receive needed care for their cat or dog that they may not have otherwise been able to obtain. Thank you to all the generous clinics that donated their time, staff, and resources. This year, we doubled our media coverage about the event and the importance of preventive care, thanks to 9News KUSA, KOAA News 5, and print media outlets across the state, including The Denver Post, The Coloradoan, Steamboat Pilot and Today, The Greeley Tribune, and The Gunnison Country Times. Our social media efforts were ramped up this year as well, with clinics posting about PetCheck involvement and asking their community members to spread the word. Through media coverage about PetCheck, CVMA is able to educate a large audience about preventive care, and not just to those receiving exams through the program. Dr. Randa MacMillan, Dr. Wendy Hauser, Dr. Jeff Fankhauser, Dr. Angela VanHouse, and Dr. Cynthia Florek served as spokespersons for the event. These CVMA member veterinarians utilized their on-air time to discuss what veterinarians look for during an exam, common health issues that often go undetected by pet owners, and the importance of annual exams.

Our phone bank was busy as ever, with high demand for appointments. We are overjoyed to hear the response from the community members in need, who would not have been able to have their pets visit a veterinarian had PetCheck not been available for them. We heard amazing stories from so many caring pet owners that have warmed our hearts and shown us how much this program means to so many. “Thank you so much for the pet wellness check and shots,” said one PetCheck client. “We were able to take our dog Mufasa Joe. Without your help, he wouldn’t have been able to get his checkup and shots. Thank you.” Clinics that participated reflected back on the weekend, happy that they could participate in this wonderful community event. “We had so much fun and wanted to thank CVMA and 9News for getting everything together, as well as the wonderful clients we had the opportunity to meet,” said one PetCheck clinic. “I hope we will be able to continue participating with you for this awesome event!” “We had a blast!” said another clinic. “Thanks for organizing and allowing us to contribute.” In addition to the veterinarians, veterinary technicians, and administrative staff that made PetCheck

possible, CVMA would like to thank our generous sponsor, Merial, who provided rabies vaccine trays to each clinic. CVMA also owes a heartfelt thank you to our 20 phone bank volunteers, who donated their time on April 4, and in less than three hours had filled nearly 1,200 appointments. This also could not have been a success without the wonderful assistance of the CVMA staff, who all helped make the program positive for everyone involved. We couldn’t have made the event successful without the help of our volunteers and team! And a special shout out to the CSU students who came to Denver on Saturday to staff the clinic at PetAid Animal Hospital. Their enthusiasm was infectious and they served 60 pets in need. It was great to see the next generation of veterinary medicine in action and the pet owners were incredibly grateful for their service. Last but not least, a big thank you to the news teams at 9News KUSA and KOAA News 5 for being our media sponsors. Both 9News and News 5 did a fantastic job of highlighting the importance of wellness exams and rabies vaccinations for pets in need. Thank you for participating in the PetCheck program in 2016, and we hope you’ll join us for another successful event next year! n

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OF NOTE CVMA Convention 2016: Look What’s New! CVMA Convention 2016 registration is now open! As always, we’re offering up excellent education from national and inter national presenters with a world-class line-up of topics and information on the latest developments in veterinary medicine. And of course, all the social activities and collegiality you’ve come to expect. While none of that has changed, we’ve shaken things up a bit this year to bring you a four-day experience like no other. CVMA Convention 2016 Opening Session: Veterinary Drug Handling Protocols and Regulations

Join us for CVMA Convention 2016 Opening Session from 1:00-5:00 PM. We are pleased to have Dr. Heather Lindell (PharmD) from the University of Georgia, College of Veterinary Medicine as our presenter, sharing her knowledge of Veterinary Drug Handling Protocols and Regulations. She specializes in veterinary pharmacy and has written drug information articles for medical journals as well as for Mane and Tail Magazine. Topics include drug shortages, compounding in veterinary medicine, counterfeit drugs, medication errors, online pharmacies, and controlled drugs in ambulatory practice. Don’t miss this powerful education opportunity! Open to all full convention paid registrants. Convention App

Have we got an app for you! Make the most of your time at CVMA while utilizing the latest trends in conference technology. With the distinctive CVMA Convention 2016 app you can organize your day by tailoring your education schedule, downloading handouts, targeting must-see exhibit booths, exploring the convention brochure, and much more! Upon registration you will receive instructions and the link to download the app and begin your convention experience. Student Roundtable Breakfast

Students are encouraged to sign up for this new event where students and veterinarians discuss various topics pertinent to successful veterinary practice. These facilitator led discussions

will provide the opportunity for open discussion and Q & A in a relaxed atmosphere. Jump start your day with food, fun, and excellent peer-to-peer exchanges. (Students: Using the student registration form from your student rep, select your topic of choice and join us Saturday morning.) Sponsored by Simmons Education Fund. National Rabies Awareness Initiative

Sponsored by Merial, join Dr. Ford during this interactive presentation on rabies immunization practices vs. laws and regulation, emphasizing how laws vary from state to state and the importance of understanding how state or local law can impact decisions made in practice. Dr. Richard Ford is Emeritus Professor of Medicine at North Carolina State University, is Board Certified in Internal Medicine, an honorary diplomate in the American College of Veterinary Preventive Medicine, and has co-authored both the AAHA Canine Vaccination Guidelines and the AAFP Feline Vaccination Guidelines. Dr. Ford began this initiative in 2014 and “launched” this initiative at NAVC this past January. Casino Night

Saturday night is family night! Join us in the family-friendly casino for games, food, and fun. Each attendee receives “500 CVMA dollars” in tokens to use in the casino for Texas Hold’em poker, Black Jack, craps, or at the roulette wheel. At the end of the evening, you can “cash in” your tokens for raffle tickets for prize drawings. It’s a fun evening and a great way to wind down after a day of exceptional learning. Membership 2017 Renewal

Save time and stress . . . Renew your 2017 membership at CVMA Convention 2016! Stop by the membership table to renew your CVMA membership and give yourself peace of mind knowing your benefits have been guaranteed for another year. PLUS, if you renew at the Core membership level, your name will be entered into a drawing to win a FREE full registration package to CVMA Convention 2017, September 21–24, Loveland. Continued on next page

SEPTEMBER 22-25

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OF NOTE Continued from previous page Learning Labs and Workshops

Learning labs and workshops provide optional education opportunities to those who want to expand their learning, or who can’t attend convention but still want to engage in excellent education opportunities. In an exciting lineup, we’ve dedicated Thursday to learning labs and workshops to get you the interactive experience you want! We have five to choose from: Dental Radiology Learning Lab Your instructor for this small animal dental radiology learning lab is Dr. Kris Bannon, who specializes in the treatment of small animals and is a Diplomate to the American Veterinary Dental College and a Fellow of the Academy of Veterinary Dentistry. Join Dr. Bannon as she covers the “hows” and “whys” of dental radiology. Learn how to efficiently take full mouth radiographs for both dogs and cats using cadavers. Conducted in the Embassy Suites Hotel and Conference Center, this learning lab is open to veterinarians and veterinary technicians. Class limited to 15 participants. Additional fee required. Pathway to Excellence: Understanding Your Strengths Are you striving to contribute your best work, every day? Infusing a strengths-based approach provides the foundation necessary for you to achieve excellence in your career. Popularized by the best-selling books Now Discover Your Strengths and Strengths Finder 2.0, the Strengths Finder Assessment is a powerful tool for individuals to discover their unique combination of strengths. This workshop will provide the tools you need to incorporate strengths into your approach to work. Learn the tools for strengths development and how to utilize the strengths development model. Put your strengths to work to achieve personal and organizational goals. Class limited to 25 participants. Assessment materials and instructions for participating will be emailed upon registration. Leadership and Influence—Putting Theory in to Practice CVMA is excited to collaborate with the Veterinary Leadership Institute (VLI) to provide an experiential and evidence-based workshop with Dr. Betsy Charles that will help participants better understand the connection between leadership theory and specific leadership behaviors with a focus on using these ideas to have positive influence in the veterinary profession. Through discussion and interaction, this workshop will allow participants to consider a different leadership paradigm, one where all have the ability to be leaders, regardless of position or title and also evaluate their own leadership theories and behaviors. The specific skills presented throughout the workshop will prepare participants to hit the ground running with practical strategies to implement when back at work.

Euthanasia Skills Techniques Learning Lab Join Dr. Kathleen Cooney in a hands-on euthanasia techniques learning lab. Using companion animal cadavers, participants will practice techniques that can be used in home or at the clinic. Techniques will include isolating venous pathways, organ injections, testing various supplies, making paw ink prints, and much more. Pre-euthanasia sedation and anesthetic protocols will also be discussed. This is an opportunity for an anatomy re-fresh and to gain invaluable technique training. This highly interactive session provides great take home techniques and the opportunity for peer to peer learning. Additional fee required. Open to veterinarians and veterinary technicians. Class limited to 30 participants. Dental Extraction Learning Lab Your instructor for this small animal dental extraction learning lab is Dr. Kris Bannon, who specializes in the treatment of small animals and is a Diplomate of the American Veterinary Dental College and a Fellow of the Academy of Veterinary Dentistry. Attendees will learn extraction techniques for canine and feline small animals. Conducted in the Embassy Suites Hotel and Conference Center, this Learning Lab is available to veterinarians only. Class limited to 15 participants. Open to veterinarians only. n

CVMA Convention 2016 Registration Brochures Have Mailed!

Look for yours and check out everything this year’s event has to offer. You can also access the full brochure on the website at colovma.org, where you can quickly and e asily register online. Registration rates are based on your CVMA membership level (Premium, Core, Basic) so log in to get your member discount!

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OF NOTE CVMA Legislative Efforts Expand Options for Veterinary Access to Compounded Drugs After months of preparation and constant presence at the Capitol, CVMA is pleased to announce that House Bill 16-1324 (titled Veterinary Access Compounded Pharmaceutical Drugs) has passed both houses of the Colorado General Assembly. Representative Joann Ginal (D-Fort Collins/House District 52) and Senator Jerry Sonnenberg (R-Sterling/Senate District 1) were the prime sponsors of the bill, and CVMA is immensely grateful for their willingness to address this critical issue. Governor John Hickenlooper signed the bill into law on June 10, and it will take effect on August 10, 2016. Why CVMA Undertook This Action

A 2014 survey of CVMA members underscored the importance of veterinary access to compounded drugs (see VOICE 2014:4 or “Drug Compounding” on the Issues section of the CVMA website at colovma.org). Recognizing that patient care was being compromised because of the barriers surrounding compounding medications, CVMA leadership made it a high priority to find a legislative solution that clarifies office use, allows office stock with dispensing in certain situations, and addresses access to compounded controlled drugs. There are important distinctions between current law and the revised law that results from the passage of HB16-1324, as follows: • Office use—Under current law, a compounding pharmacy may provide up to 10% of its volume of a compounded drug for office use (i.e., in-office administration). CVMA members have reported that some pharmacies are unaware of this allowance, or aware of it but unsure that it applies to veterinary compounded drugs. HB16-1324 makes it clear that the 10% allowance for office use DOES apply to veterinary compounded drugs. • Office stock—Under current law, there is no provision for a veterinarian to maintain stock of a compounded drug for subsequent dispensing. HB16-1324 allows and defines office stock as “the storage of a compounded drug that was distributed or sold by a registered prescription drug outlet to a veterinarian, without a specific patient indicated to receive the compounded drug, and that the veterinarian may subsequently administer to a patient or dispense to a client.” A veterinarian may dispense a compounded drug from office stock only if (a) the compounded drug is necessary for the treatment of a patient’s emergency condition AND (b) as determined by the veterinarian, the veterinarian cannot access in a timely manner the compounded drug through a registered prescription drug outlet. Further, a veterinary may not dispense a compounded drug in an amount greater than the amount required to treat a patient’s emergency condition for five days. The bill requires that a veterinarian shall not administer or dispense a compounded drug from office stock without a valid veterinarian-client-patient relationship in place at the time of PAG E 10 | CV M A Vo ice 2016 : 2

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I n short, HB16-1324 significantly changes the landscape for veterinary compounded medications in Colorado. Licensed veterinarians can now access compounded medications, both controlled and nonscheduled, from in-state or non-resident compounding pharmacies—and maintain those medications for office use or office stock, with an allowance for dispensing up to a five-day dosage of the drug.”

administering the compounded drug to an animal patient or dispensing the compounded drug to a client. • Resident vs. non-resident pharmacies—Under current law, only prescription drug outlets in Colorado (i.e., in-state pharmacies) are allowed to provide compounded drugs for casual sale (that is, on a non-patient specific basis). Because no compounding pharmacy in Colorado currently holds a DEA manufacturing license, which allows a compounded controlled drug to be provided to a veterinarian rather than the end user, it has been impossible for Colorado veterinarians to obtain compounded controlled drugs. HB16-1324 allows any registered prescription drug outlet, whether in-state or non-resident, to provide compounded medications—whether controlled or non-scheduled—to a Colorado licensed veterinarian for office use or office stock. To compound and distributed a controlled substance, the bill requires that a registered prescription drug outlet possess a valid manufacturing registration from the federal Drug Enforcement Agency. In short, HB16-1324 significantly changes the landscape for veterinary compounded medications in Colorado. Licensed veterinarians can now access compounded medications, both controlled and non-scheduled, from in-state or non-resident compounding pharmacies—and maintain those medications for office use or office stock, with an allowance for dispensing up to a five-day dosage of the drug. CVMA extends a heartfelt thank you to our lobbyist, Leo Boyle; bill sponsors Representative Joann Ginal and Senator Jerry Sonnenberg; members of the CVMA Executive Committee that helped prepare or testify on the bill’s behalf; CVMA staff for their efforts and time investment; and Dr. Ashley Morgan of the AVMA Governmental Relations Division, who provided technical advice throughout the legislative process. Without this combined effort on the parts of so many, this crucial legislation would not have passed, protecting your profession and greatly improving your ability to practice veterinary medicine in Colorado. Dr. Curtis Crawford, CVMA President

It has been extremely frustrating as a veterinarian working “out in the sticks” to comply with the current laws regarding compounded Continued on next page

CV M A VO ICE

OF NOTE Continued from previous page medications. There is not a compounding pharmacy in our area, so I can’t run down to the corner store with a prescription for a specific patient when an emergency situation arises. We have to call in a prescription and trust the mail system to get it to us, hopefully within a couple of days. If your luck is like mine though, that emergency situation arises on the Friday evening of a three-day weekend and it isn’t until Tuesday that you can even get the prescription filled and shipped. That means a full five days of suffering and additional illness for that patient. I needed the ability to have a compounded medication on my shelf, ready to go for that emergency situation, when time is of the essence. The CVMA recognized the need, and through careful crafting with the Task Force on Pharmaceuticals, Dr. Pete Hellyer and Ralph Johnson came up with a straightforward bill that would address the issue. It looked like a no-brainer to have legislation introduced that would allow veterinarians to carry a limited stock of compounded medications for in-office use and dispensing. I couldn’t have foreseen all the obstacles and objections that could be raised over this bill. I have never heard the phrase “You have got to be kidding” and all its various permutations used so often by the Executive

“

his bill benefits the entire veterinary T community in Colorado and serves to underline another reason that organized veterinary medicine is essential to the wellbeing of veterinarians and their patients.”

Committee as we tackled all the roadblocks that came up—and there were many. It took the diligent vision and experience of Leo Boyle, our CVMA lobbyist, watching for problems; the tenacity of Ralph Johnson and the Executive Committee in reaching out to and discussing the conflicts with each possible stakeholder; and the competent testimony of Drs. Will French, Randa McMillian, and Bill Fredrigill before the legislature to finally get this bill passed. And of course, a big tip of the hat to Rep. Ginal and Sen. Sonneberg for listening to the need and sponsoring the bill. This was a project that could not have been accomplished by one person. It took the resources and commitment of the whole CVMA community to bring it about. This bill benefits the entire veterinary community in Colorado and serves to underline another reason that organized veterinary medicine is essential to the well-being of veterinarians and their patients. Dr. Peter Hellyer, Chair of the Task Force on Veterinary Pharmaceuticals

I would like to acknowledge the CVMA Task Force on Pharmacy Issues for beginning the process that ultimately led to the drafting of a bill designed to improve the ability of Colorado veterinarians to treat their patients with compounded medicines in a timely manner. The task force collected information from a variety of sources to better understand how federal legislation and

state pharmacy rules and regulations were impacting the ability of veterinarians to do their job. The task force evaluated how other states were handling the issues of compounded drugs for office use and office stock and modified legislation from those states to fit with the regulatory environment in Colorado. The proposal that started with the task force went through several iterations that ultimately led to the framework for legislation that other members of CVMA moved through the legislative process. Dr. William French, CVMA Secretary/Treasurer

The 2016 legislative session marked my introduction to the legislative process in Colorado, and it was certainly eye opening. What started as a request from Ralph Johnson to discuss compounding issues in front of the CLAW Caucus at the start of the session, turned into being involved in stakeholder meetings, lobbying legislators, and presenting formal testimony in front of two House and one Senate committees. Seeing the journey of this very important bill from its infancy to being signed by the governor drove home to me the absolutely critical importance of organized veterinary medicine being involved in the conversation of policy at all levels. “Advocacy” sounds like a feel-good thing that CVMA does, but in this case it is so much more. The passage of this bill will make a tangible difference in my daily practice of medicine, and improve patient outcomes by providing easier access to critical medications. One of my mentors, and past CVMA president Dr. Terry Swanson, has told me numerous times that the reason organized veterinary medicine is so important is because no one is assigned to be the gate keeper of our profession besides ourselves. In other words, if we don’t ensure as professionals that veterinary medicine is headed in a direction that we decide to collectively pursue, that direction will be decided for us. Regulators and legislators have shown they are more than willing to tell us what they think is best for our profession and patients. Having a seat at the table, a voice in the conversation and to advocate for veterinary medicine, is a crucial role of the CVMA that was underscored time and time again during this process.

“

he passage of this bill will make a tangible T difference in my daily practice of medicine, and improve patient outcomes by providing easier access to critical medications.”

The other aspect that was striking to me was how fluid the legislative process is. There were numerous times when the future of the bill hung in seeming perilous balance over unrelated political wrangling, or was threatened as other groups were unsure of how the bill would change their professional landscape. During these times, it was extremely important that CVMA be able to respond immediately and articulately to “put out fires.” Having our lobbyist Leo Boyle present was invaluable to help Efforts continued on page 12 CVMA Voice 201 6 : 2 | PAG E 1 1

2 016 , I ssue # 2

OF NOTE Efforts continued from page 11 navigate the minefield that is the political process. And having CVMA past and present leaders and our executive director present to continually reinforce the importance of the bill allowed guidance for legislators, and nudging where appropriate, to ensure a desirable outcome. I was encouraged with how well veterinarians are received and respected at the capitol, and this speaks to hours and years of building relationships that Ralph Johnson, Leo Boyle, and past leaders of the CVMA have put in place.

“

dvocacy is one of the most important and A vital endeavors of the CVMA.”

Being involved in the process of HB 1324 has left me optimistic about future endeavors under the Golden Dome, but also has solidified my belief that Advocacy is one of the most important and vital endeavors of the CVMA. Dr. Ashley S. Morgan, Assistant Director, AVMA Governmental Relations Division

Veterinary medicine is unique in that we treat a multitude of species with an even greater number of unique diseases and conditions. Compounding is a necessary practice for veterinarians because there are, and always will be, a limited number of FDA-approved drug products for the many species and conditions that we treat. Veterinarians must also be able to legally maintain sufficient quantities of compounded preparations in their office for urgent administration needs or emergency situations; without access, animals would die before the medication could be delivered. Many of these preparations are not only needed for immediate in-house administration by the veterinarian, but also for dispensing to the patient’s owner or caretaker for treatment at home.

Leo Boyle, CVMA lobbyist

HB16-1324 is the most challenging and ambitious piece of legislation that the CVMA has promoted since I have been working with the profession over the course of more than 20 years. The most difficult part of this effort was the drafting of the bill. Countless versions were written and rewritten (and rewritten again) before the final product was concurred by the House of Representatives, just days before the legislature adjourned for the year. Great credit must be given to Representative Joann Ginal who, due to her education in animal science at CSU, had the background to understand the complexity of all the issues involved with compounding. She convened multiple stakeholder meetings with different pharmacies to iron out all nuances of the intersecting DEA, FDA, and Colorado statutory rules and regulations. Without her leadership, I doubt this bill could have passed. Senator Jerry Sonnenberg was masterful in shepherding the bill through the Senate Agriculture Committee and the floor action in the full Senate. Ralph Johnson requires enormous credit for his mastery of the intricate detail needed to write a comprehensive statute for compounding veterinary drugs. Drs. Will French, Randa MacMillan, Sam Romano, and Bill Fredregill deserve accolades for their clear and persuasive testimony before the House and Senate Committees for the bill. Representative Joann Ginal

I am always honored when I can help my friends in the veterinary community to deliver the highest quality of animal care. HB161324 will significantly improve Colorado veterinarians’ ability to treat animals in a timely manner with the kinds of pharmaceuticals most appropriate for their patients. As a legislator from Larimer County with a PhD from CSU’s College of Veterinary Medicine and Biomedical Sciences in reproductive endocrinology, I consider it my responsibility to look out for animal health and welfare and for the integrity of the veterinary profession. Senator Jerry Sonnenberg

“

assing HB16-1324 is a victory for Colorado P veterinarians, proving once again how critical advocacy at the state level can be and how profoundly it can affect the ability of veterinary professionals to do what’s best for their patients.”

There has been an enormous amount of activity at the state and federal level on compounding for both humans and animals over the past few years. Much confusion still exists, but veterinarians voicing their needs will ensure access to needed compounded preparations. Passing HB16-1324 is a victory for Colorado veterinarians, proving once again how critical advocacy at the state level can be and how profoundly it can affect the ability of veterinary professionals to do what’s best for their patients.

PAG E 12 | CV M A Vo ice 2016 : 2

I was happy that I could carry this bill that will help rural veterinarians to treat sick and injured animals in a timely manner. Living in rural Colorado, we know that access to vital medicines and pharmaceuticals is not always available, making our animals vulnerable to needless suffering and even death because of our inability to obtain these medicines quickly. Now, the quality of animal life and health in Colorado has been measurably improved. n

CV M A VO ICE

OF NOTE Internationally Trained Veterinarians Integrating in Colorado Carrie Miller, Career Development Coordinator Colorado Welcome Back Center | Spring Institute for Intercultural Learning

Which country were you educated in? Was your education completed in the U.S., in U.S. recognized countries (i.e., the U.K., Australia, New Zealand, or Canada), or outside these countries? The answers to these questions are more important than the average person may realize, especially for veterinary medicine. Nearly 1 in 10 Coloradans is foreign-born, and of this population, over 26 percent hold a Bachelor’s degree or higher from abroad to practice as a veterinarian. Needless to say, these professionals, even those who have international credentials and impressive employment histories, cannot legally practice medicine until they go through all mandatory licensing requirements. While there are pathways for most healthcare professionals to become recertified in their given professions, there are more barriers to licensure than solutions. Many highly skilled immigrants drop out of the process—not because of deficient skills or poor training, but because of how long and complicated these pathways are, how much they cost, and the bias against international training. Accordingly, many immigrants find themselves underemployed, working in low-wage and low-skilled occupations (e.g., taxicab drivers, cashiers, production workers). This phenomenon is a tragic waste of skills and talent that continues to reverberate across the nation. There must be a better solution, one that utilizes the skills and talents of these high-skilled immigrants. That’s where the Colorado Welcome Back program comes in. As a program of the Spring Institute for Intercultural Learning (a not-for-profit organization), the Colorado Welcome Back (CWB) program was launched in 2010 to help internationally trained healthcare professionals re-establish their careers in healthcare. There are over 600 participants enrolled in CWB from 86 countries and over 40 different healthcare careers represented in the program (e.g., physicians, nurses, pharmacists, dentists, caregivers, and veterinarians). Services are extended (free of charge) to anyone who has education, training, and/or work experience from a country outside of the U.S. in healthcare. These services include, but are not limited to, career planning and development, educational case management, referrals to academic programs and community resources, professional development workshops, and job placement support. In short, CWB helps these professionals gain U.S. experience as well as obtain volunteer and employment opportunities that will help them achieve their long-term career objectives. We also work with veterinarians in the program. Our veterinarians come with rich, diverse experiences from Mexico, Peru, Sudan, and Iraq and speak English, Spanish, and Arabic. Their length of residence in the U.S. ranges from just a few months to over 18 years. Several of them hold VMD degrees, whereas a few hold degrees in Animal Production. International graduates

who wish to follow the recertification process must get their education evaluated and their language abilities and clinical skills assessed before they can register for board exams, complete internships, and navigate through the pathway. Others choose a different pathway entirely—going back to school, which was the case for Huda Tawir. Huda Tawir is a veterinarian from Sudan who has a family and a sweet demeanor, and is excited about her future. She graduated in 1998 from the University of Nyala in Sudan obtaining a Bachelor’s Degree in Veterinary Science. In Sudan, Huda had nearly 10 years of experience working in the veterinary medicine field, mostly for the state government in a number of capacities, including as a veterinary extension officer, manager of slaughterhouse, reporter/correspondent, and veterinary practitioner. Some of her day-to-day responsibilities included educating farmers about humanely raising their sheep, goats, camels, and cattle; increasing public awareness about zoonotic diseases; and broadcasting to the media and communities about such issues. Huda moved to the U.S. a few years ago to get a better education, but her career interests and passions remain the same. In 2014, Huda completed her Master’s degree in Integrated Resource Management from Colorado State University and has been accepted into CSU’s School of Public Health for another Master’s degree. A few of Huda’s goals include working with an international health organization and completing an internship with the U.S. Department of Agriculture. These are not small goals by any means. Huda enthusiastically commented that she “has to prove her skills, increase her English and computer experience, and [gain more] experience.” With that determination and drive, Huda will certainly go far. “It’s still hard, but I feel lucky and . . . I still have hope [so I will] give it a chance.” While Huda has made significant progress identifying her career pathway, her journey is not complete, but is nevertheless promising with continued support from her networks. The majority of high-skilled refugees and immigrants, however, find themselves unsure of how to navigate these career pathways, which one to take, and how to cultivate the resources (e.g., money, social capital) necessary to get back to their original career. Their journeys are indeed long and complicated, but not impossible. Through the Colorado Welcome Back program, we are able to get these high-skilled professionals back on their feet and into satisfying occupations. If you would be interested in learning more about connecting with these veterinary professionals or for more information about Colorado Welcome Back or to explore how our participants can meet your volunteer or employment needs, please contact Carrie Miller at 303.831.1104 or cmiller@springinstitute.org. n

CVMA Voice 201 6 : 2 | PAGE 1 3

2 016 , I ssue # 2

OF NOTE Veterinary Wellbeing

How important do you feel it is for CVMA to develop resources for you as a veterinary professional?

Sam Romano, DVM, MBA CVMA President-elect

CVMA is committed to improving the personal wellbeing of our members, striving to provide valuable education, information, and resources. To that end, the BIG Ideas Forum held in March focused on “Can the veterinary profession find the pathway to wellbeing?” To frame the Issue Forum led by Elizabeth Strand PhD, LCSW, a survey was sent to members prior to the event to solicit anonymous feedback on the subject. The intent of the survey was to better understand the issue of compassion fatigue and burnout within the CVMA community and to help inform possible solutions. CVMA would like to thank the participants at BIG Ideas and especially all of you who completed the wellbeing survey. Following is a compilation of the major results. The survey had 158 respondents for an overall 9% response rate. Respondents were 65.5% female and 35.5% male, with 52% representing suburban practice location,18% rural, and 30% urban, respectively. Of the respondents, 8% were 29 years or younger, 23% were 30–39, 29% were 40–49, 23% were 50–59 years of age, and 17% were 60 years or older. Compassion fatigue, defined as a feeling of overwhelm, fatigue, and burnout, was reported in a majority of respondents. Over 50% of respondents reported compassion fatigue “all” or “a moderate amount” of time. Nearly 50% of respondents reported sleep issues as well. Dominant factors negatively impacting wellbeing were concerns over finances and lack of work/life balance. Concerns about practice staffing, career direction, and the welfare of family and friends were also consistent findings. Manifestations of compassion fatigue included depression, feelings of loneliness, low self-esteem, and anger. Body pain was mentioned as a physical manifestation of compassion fatigue. Suicide and substance abuse were mentioned in a small percentage of respondents.

Compassion Fatigue

Not sure Somewhat unimportant Not important

30%

resources to improve member wellbeing. A sense of anonymity appears to be a key motivator for individuals seeking help. This is important when considering potential long-term solutions and programs. Online resources and veterinary peer assistance programs scored highest as the means members would most likely use in seeking future assistance.

Seeking Assistance in Past Exercise/yoga/meditation Coworkers Mental Health Prof

Online resources Physician Religious Leader Professional Assoc In-person Seminars Support group Friends Family

100

120

Have used

100 47

50%

Somewhat important

Hospitalization

140

36%

26%

Vet Peer Assist Prgm

160

Very important

Colleagues

180

120

5% 3%

Overwhelmed

Fatigue

Burnout

Sleep

Compassion Fatigue

All the time/quite a bit

A moderate amount

A little bit/not at all

In dealing with wellbeing issues, exercise, meditation, and yoga rank highest as current means of managing burnout and fatigue. A majority of members feel it’s either “very important” (36%) or “somewhat important” (30%) for CVMA to develop PAG E 14 | CV M A Vo ice 2016 : 2

CVMA is fortunate to have partners equally committed to the health and wellbeing of its members. Peer Assistance Services, Inc. (www.peerassist.org) provides prevention and intervention services focusing on substance abuse and emotional health for veterinarians and other healthcare professionals, including dentists and pharmacists. They understand the pressures involved with professional veterinary practice and provide effective strategies to improve physical and mental health. Our BIG Ideas Issue Illuminator, Dr. Elizabeth Strand, is also the director of veterinary social work at the University of Tennessee, and is passionate about helping veterinary professionals and the humane treatment of people and animals. She suggested the online tool (www.mentalhealthamerica.net/mental-healthscreening-tools) as a starting point for self-assessment in various areas of mental health including depression, anxiety, PTSD, and Continued on next page

CV M A VO ICE

OF NOTE Continued from previous page bipolar screening. CVMA looks forward to future collaboration with Dr. Strand and is grateful for the dedication she brings to helping people and animals. Like many of you, I’ve suffered the effects of compassion fatigue and burnout while also witnessing the toll it’s taken on colleagues and friends. However, it is not possible to improve personal health and wellbeing without also considering the numerous disruptive changes occurring in veterinary medicine. Reducing the headwind of rising student debt and acknowledging the changing veterinary economic landscape is important when designing solutions. Fortunately, the topic of wellbeing is also firmly on the radar of the AVMA, CSU, and other allied organizations (see Briefings, page 4). Together we can make a sustainable difference by helping each other while we help the profession. As the African proverb says, “If you want to go fast, go alone. If you want to go far, go together.” n Briefings continued from page 5 VOICE. We encourage you to take advantage of these offerings, as well as those from AAVMC and AVMA. CVMA Advocacy

As announced in eVOICE in May (and detailed further here on page 10) CVMA’s tireless efforts have resulted in the successful passage of HB16-1324 Veterinary Access Compounded Pharmaceutical Drugs, which authorizes a compounding pharmacy to compound and distribute a drug to a veterinarian without a specific patient indicated to receive the compounded drug. And while it may seem cliché to say “tireless efforts” it is absolutely true in this case. This bill saw many twists and turns and unexpected hurdles, requiring an almost constant presence under the dome this legislative season. CVMA staff, our lobbyist, members of the Executive Committee, our bill sponsors, and even the assistant director in AVMA’s Governmental Relations Division—all played an integral part and, between them all totaled, put in a staggering number of hours to make sure this bill was sent to the governor’s desk on May 18. While you can read the full story (Drama! Suspense! Plot twists! Heroic efforts!) on page 10, I want to stress the importance and value of the advocacy work that CVMA does on behalf of you, our members, and the profession as a whole in Colorado. As this bill has proven, it takes a team effort—and we can all play a part. Do you know an elected official? Do you sit on a board or belong to another professional veterinary organization where common interests are served? If so, you can share your concerns and voice your support for practice-friendly legislation like HB16-1324. That is the beauty of being a member of CVMA. As your state association, we perform a role that no other individual or organization does: We protect the practice landscape and the welfare of animals in the state of Colorado. So as we make our way around the state and visit your chapter or district, we have good news to share, issues to address, and a lot to talk about. Thank you for being a part of it and helping to move CVMA forward. See you on the road! n

President’s Post continued from page 4 to get the local in. But then when I started the incision, Clyde not only sat back down, he also crossed his legs. Finally, with two men pushing up on his haunches and his legs tied apart, I got the job done. It was still a bit unnerving having him bend his neck around the front of the stocks and rest his head on his rump as he watched the procedure sleepy eyed and slightly drooling. There was a huge sigh of relief as we loaded Clyde back into the trailer and sent them down the driveway to his new life of celibacy. What does this have to do with CVMA? Nothing. And everything. The story itself is just a typical of what you can hear every time a group of veterinarians get together. It helps form the special bond of the profession. I could tell that story to my mother-in-law and only get a polite smile (and that just because I am the father of her grandchildren). But if I share that story with you, I get a connection because you’ve been there. Well, maybe not exactly there, but you know what it’s like to face a new procedure, a new client, or a new species with the impossible expectation that you know everything and can alter the course of nature. You understand the anxiety, the frustration, the emotions, and the challenges (and hopefully the humor) of the situation. No one understands what I go through every day like you do. Our shared experiences are one of my favorite parts of the CVMA experience. It improves my emotional wellbeing. A chance to vent and laugh (or even cry) about it with people that have been there really helps put things back in perspective and rekindles the joy of life and this amazing profession. But sometimes there is more affecting our wellbeing than what a simple time together can change. It may be financial stress, it may involve family issues, or it may go as far as serious depression and substance abuse. The long and the short of it, our wellbeing suffers. Our practice suffers. Our family suffers. And our patients suffer. In this issue of the VOICE, we will look at the last BIG Ideas Forum where we had a packed house examining the wellbeing of veterinarians. CVMA has long recognized that the physical, emotional, financial, and psychological health of the individual veterinarian is paramount to our success. We came into this field because we love what we do. Yet there are few professions that test the mettle of our inner strength more than veterinary medicine. Join with me as we look at some of the factors that take the joy and peace out of our lives. Consider the suggestions and explore the possible avenues of healing the CVMA has found in our efforts to bring healthier success to the veterinarian. And party with us as we celebrate the passage of HB161324, Veterinary Access Compounded Pharmaceutical Drugs in Colorado. A tremendous amount of effort went into this landmark legislation that will allow us to legally maintain and dispense a limited amount of office stock of the essential compounded medications we need to treat and alleviate the suffering of our patients. CVMA worked incredibly hard on getting this one for you and deserves a huge pat on the back for a job well done. But watch out for that receptionist with the impish grin. She has another good one for you. . . . CVMA. Welcome to the herd. n CVMA Voice 201 6 : 2 | PAG E 1 5

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CV M A VO ICE

OF NOTE PetAid Announces Expansion Plan for Care Grants! Malachi, a young dog, was hit by a car and suffered from a prolapsed eye. His owner, a 57-year-old cancer patient, could not afford the needed enucleation surgery. But with the help of a PetAid Care Grant, Malachi was able to get the surgery he needed and happily return home. “I live alone,” says his grateful owner. “My little buddy is my kid, my baby.” Pet owners in rural and frontier counties have fewer options for veterinary care, and many have limited financial resources. Because practices in these areas have fewer charitable funds to help pet owners in need, PetAid Care Grants provide funding to supplement your charitable care for animals and owners in rural and frontier counties in need of a last-resort financial option to support a one-time surgical or medical intervention for a pet with a good to excellent prognosis. The primary goal of a Care Grant is to keep the human-animal bond intact by eliminating barriers to care faced by non-urban families and resolving medical issues that will restore the animal’s health. Without such emergency funding, an otherwise treatable animal might be unnecessarily euthanized, relinquished, and/or endure excessive suffering. The Care Grant program was founded by PetAid Colorado in September 2010, to supplement a veterinarian’s charitable care for animals of the economically disadvantaged. The program was first piloted throughout Archuleta County and then moved to Logan, Morgan, and Otero counties. PetAid has long had a goal of expanding Care Grants statewide. Due to the success of the program and commitment from our donors and supporters, the PetAid Board of Directors recently approved the expansion of our Care Grants program to all rural

and frontier counties as defined by the Office of Management and Budget (OMB). We invite you to participate!

Tara McChesney, Director of Programs and Initiatives at PetAid Colorado, is able to assist you in participating in this program. The guidelines of the program allow a veterinarian to submit a Care Grant request for a client at their clinic that shows financial need for veterinary care of their pet. The Care Grant request must be for a one-time surgical or medical intervention that will improve the prognosis and wellbeing of the patient. The veterinary clinic is limited to $500 per case and $2,500 per year. We hope you will take advantage of this program. It gives you a way to help your clients when they need it most and care for their animals that may not otherwise be treated. Have questions or want to learn how you can use PetAid Care Grants in your practice to help your clients in need? Visit www.PetAidColorado.org for program guidelines and applications, or call Tara McChesney at 303.318.0447. n

DID YOU KNOW . . . PetAid Colorado (formerly the Colorado Veterinary Medical Foundation) is the charitable arm of the Colorado Veterinary Medical Association. Our unique programs, grants, outreach efforts, and volunteer opportunities help you care for your clients and our Colorado communities in need. PetAid Animal Hospital (formerly Harrison Memorial Animal Hospital) helps income-qualified clients when they cannot afford the care their pets desperately need. Our donor-subsidized, generously discounted fees make it possible to end suffering and avoid relinquishment and even euthanasia. PetAid Care Grants provide you funds to supplement your charitable care for animals and owners in need of a last-resort financial option to support a one-time surgical or medical intervention for a pet with a good to excellent prognosis. PetAid Community Outreach takes veterinary care to the most vulnerable populations, those pet owners who can’t access in-clinic care because of disabilities, lack of transportation, or homelessness.

CVMA Voice 201 6 : 2 | PAGE 1 7

2 016 , I ssue # 2

OF NOTE PetAid Colorado Disaster Services Program Comes to an End For over a decade, PetAid Disaster Services has been a leader in animal disaster preparedness. PetAid has worked hard to expand the capacity throughout Colorado to respond to the needs of animals in the event of disasters by training counties to develop their animal disaster planning and to create their own County Animal Response Teams (CARTS). In addition, PetAid has maintained the Colorado Veterinary Medical Reserve Corps (COVMRC) to provide veterinary professionals and animal emergency responders with the training and credentialing necessary to support animal health and public health emergency response during disasters on a statewide level. PetAid has held a seat at the state Emergency Operations Center (EOC), managed disaster relief trailers including the two donated to PetAid by American Kennel Club (AKC) for deployment when needed during a disaster, and worked with many partners to expand disaster relief efforts throughout the state. After deliberate and thoughtful consideration, PetAid has made the decision to no longer manage and maintain the Disaster Services program, including the COVMRC. This decision has not come lightly, but out of necessity as state and federal funds for disaster relief have been steadily redirected to other types of programs. The PetAid Board of Directors would like PetAid Colorado to focus staff time and funding streams on its other three programs—PetAid Animal Hospital, PetAid Community Outreach, and PetAid Care Grants. Please visit petaidcolorado.org for

PAG E 18 | CV M A Vo ice 2016 : 2

more information on these programs and how they can help Colorado veterinarians and communities. PetAid is confident in the systems put into place to respond to disasters, and while capacity building and consistent training will continue to be a future need, we recognize that all disasters begin and end at the local level. Therefore, we encourage volunteer veterinarians, veterinary technicians, and volunteer animal responders to get involved at their local county level by joining their local CART or either of the two statewide Medical Reserve Corps units and their local Medical Reserve Corps unit. PetAid will do its best to ensure the Disaster Services program, including the COVMRC, dissolve from its management umbrella with ease. The COVMRC will be transferred to Eagle Valley Humane and managed by their team on a statewide level; they will now be the housing and fiscal agent for the East and West units. Sarah Heckathorn has accepted the East unit coordinator position, while Char Gonsenica will continue management of the West unit. If you would like information on joining either of these units, contact Sarah Heckathorn at sheckathorn@hotmail. com for the East unit or Char Gonsenica at humane@vail.net for information regarding the West unit. Additionally, you can contact Koral O’Brien, the state Medical Reserve Corps Coordinator, at koral.obrien@state.co.us. The State EOC seat will be managed and filled by the appropriate governing body, which is no longer PetAid. The CART training materials PetAid has developed can be used by other trainers and county leaders to continue to build county CARTS where they are needed. The AKC trailers donated to PetAid for deployment statewide will also find a new management home and will still be available for deployment in the case of a disaster. Contact information will be provided for all these program components as PetAid finalizes plans and puts contracts in place with the appropriate parties. The PetAid website will be kept up to date with information and resources as PetAid moves through this process, and staff appreciates your patience as it navigates all the needs. The documents, trainings, and exercises on the PetAid website remain useful for anyone who is interested in participating in animal Continued on next page

CV M A VO ICE

OF NOTE Continued from previous page disaster response and recovery, so you are encouraged to continue to use those training resources. Both CVMA and PetAid appreciate your support of Disaster Services through the years and asks for your continued support and patience as the program is transitioned. While this decision was not an easy one, PetAid is extremely proud of the evolution of this program and the huge impact it has made on the lives of so many. Colorado communities have faced their share of disasters in the past several years, and PetAid is grateful to have been able to provide assistance and make a difference to the people and pets in need—and provide a foundation for the work of the program to continue well into the future. PetAid would like to thank all who have been involved over the years and who have helped build disaster response capacity and resiliency in Colorado, from every individual who has volunteered their time and expertise to the agencies that partnered to carefully build and expand response capabilities. Because of their combined efforts and support, there is so much success to celebrate as next steps are planned and taken. If you have any questions or concerns, please contact Tara McChesney, Director of Programs and Initiatives, at TaraMcChesney@petaidcolorado.org. The evolution of Disaster Services

As Disaster Services evolves out of the scope of PetAid Colorado’s mission, we asked Debrah Schnackenberg, the program’s last director, to provide some insight into the history of the program, and what it’s meant to Colorado. The Colorado Veterinary Medical Foundation (CVMF) Animal Emergency Management Program (AEMP) was formed in late 2001 with a mission to create a State Animal Response Team, support the efforts of local communities to create their own Community Animal Response Teams (CARTS), provide a home for the Colorado Veterinary Medical Reserve Corps (COVMRC), and provide expertise to the State Emergency Operations Center for companion animals response during disasters. Under the leadership of Kevin M. Dennison, DVM, the program created the important foundational work for statewide animal emergency planning and, in partnership with numerous government and non-governmental organizations, a statewide animal disaster response network. In addition, the AEMP provided veterinary professionals and support personnel with the training and credentialing necessary to respond to large scale emergencies and disasters involving animals. In August of 2009, Deborah Foote, MPA, became the director of the AEMP and, building on the foundation of the previous eight years, provided vision, leadership, and strategic planning for animals in disasters, facilitated local community planning, and continued to assist local communities to grow their animal emergency response capabilities. Over the next three years, the AEMP would expand the reach of the COVMRC through targeted recruitment and training of the state’s veterinary professionals and was instrumental in working with the Colorado Department of Emergency Management and Homeland Security

in creating an Essential Support Function at the State Emergency Operations Center that would be dedicated to the needs of companion animals during large scale events and put all of these elements into play with responses to several Colorado wildfire disasters. In early 2012, the CVMF transitioned to its new identity as PetAid Colorado, and the AEMP program became PetAid Disaster Services. In August of 2012, Debrah Schnackenberg became the director of PetAid Disaster Services. Under overlapping federal grants from the Department of Homeland Security and the U.S. Department of Agriculture in partnership with CSU Extension Services, the mission of Disaster Services would become more intensely focused on assisting local communities in building local capacity for animal disaster response through direct assistance with animal disaster planning, and in recruiting, developing, and training Community Animal Response Teams (CARTs). By the spring of 2015, PetAid Disaster Services had assisted half of all counties in Colorado with training, animal emergency planning assistance, and CART development. The program provided Emergency Operations Center coordination and the COVMRC deployed trained responders to assist citizens and their pets in the tragic Waldo Canyon and Black Forest Fire disasters and the massive flood disaster of 2013. “The citizens of Colorado and their pets have been very well served by the PetAid Colorado Disaster Services program. The focus on assisting local communities in developing their animal disaster planning work and in supporting efforts to create and to maintain local animal response teams has been a critical factor in saving lives in Colorado disaster events. The program and its efforts have been a role model for many other states across the nation. What PetAid Colorado and its donors and partners have created in the animal disaster response arena over the past 15 years has been important and unique, and I am extremely proud to have been a part of PetAid Colorado’s animal disaster support mission.” n

CVMA Voice 201 6 : 2 | PAGE 1 9

2 016 , I ssue # 2

OF NOTE Thanks to Our Partners Our gratitude to the following organizations for their generous support of CVMA, DAVMS, and PetAid Colorado in 2015.

Platinum Plus ($35,000+)

Gold ($34,999–$15,000) Royal Canin Veterinary Diet

Silver ($14,999–$10,000) Patterson Veterinary Supply Zoetis

Bronze ($9,999–$5,000) Carr HealthCare Realty Dechra Veterinary Products iM3, Inc IT-Guru Mesirow Financial MWI Animal Health Nationwide Sontec Instruments Veterinary News Network (VNN)

Copper ($4,999–$1,500) Abaxis Inc. Alfred T. Videen Fund American Animal Hospital Association Animal Arts Design Antech Diagnostics AVMA PLIT Boehringer Ingelheim PAG E 20 | CV M A Vo ice 2016 : 2

Carecredit Catalyst Veterinary Practice Consultants Chuck & Don’s Pet Food Outlet Companion Therapy Laser by LiteCure LLC Diagnostic Imaging Systems Inc. DVM Consultants West LLC Elanco Animal Health Fortune Management Henry Schein Animal Health Hill’s Pet Nutrition Inc. Merck Animal Health Merial Monument Pharmacy Inc. Multi Radiance Medical, Inc. Nutramax Laboratories Pencol/Cornell Pharmacy Pet Cremation Service Powers Pet Emergency Rocky Mountain Veterinary Cardiology PC Rocky Mountain Veterinary Neurology Simmons Intermountain Inc./Dr. King or Simmons & Associates The Clean Team2 Universal Imaging/Universal UltraSound University Hills Animal Hospital US Army Health Care Careers VCA Alameda East Veterinary Hospital Vetoquinol USA Virbac Corporation VRCC Veterinary Management Services Western Veterinary Conference Wheat Ridge Veterinary Specialists

Other ($1,499 and less) AescuLight Surgical Lasers Airius, LLC AKC Reunite Andersen Products, Inc. Animal Emergency & Specialty Center AVID ID Systems Inc. AVMA Group Health Life Insurance Trust Co (GHLIT) Bayer Health Care Animal Health Beside Still Water Boarding & Beyond Carefree Cats Veterinary Hospital Central Park Plaza CEVA Animal Health LLC Cornerstone Computer Solutions (C)

Cosain Data CryoProbe Cuattro Digital Imaginig Custom X-Ray Sales & Service Denver Animal Shelter DVM Multimedia Elsevier ENT Federal Credit Union Epic Medical Distribution First National Denver Foothills Animal Shelter Four Seasons Veterinary Specialists LLC Friedlander Commercial Real Estate Good Day Pharmacy Heska Corporation Humane Society of Boulder Valley IDEXX Laboratories Inc. iVet Professional Formulas Jorgensen Laboratories Inc. K-Laser USA KONG Company Krisers Natural Pet Longs Peak Financial Loving Family Animal Hospital LTC Global—Affinity Markeing Division Mountain Mutt Dog Coats Multimin USA, Inc. Noble Beast Dog Training Peak Veterinary Consulting Peer Assistance Services PulseVet Technologies Puppy Up Foundation Purina Veterinary Diets Purina Veterinary Symposium Roadrunner Pharmacy Rocky Mountain Microscope Corporation Sally Terroux Dog Training Servet Taylor & Francis Vet Books Simmons Education Fund Sound Spiral Consulting Summit Accounting Solutions Synergie, LLC - DBA - Purina Veterinary Symposium The International Cat Association, Inc (TICA) The K9 Body Shop Vedco Animal Health Vetfinity Veterinary Business Solutions Veterinary Loans.com

Continued on next page

CV M A VO ICE

OF NOTE Continued from previous page VetMatrix, An iMatrix Company Wells Fargo Practice Finance Wheat Ridge Veterinary Specialists Blood Bank Wild West Veterinary Conference LLC

In, 2015, the following supported PetAid Colorado with gifts of $1,500 and above Animal Clinic, LLC Anschutz Family Foundation Auxillary to the Colorado Veterinary Medical Association Axium Inspections Banfield Foundation Beds-N-Biscuits Colorado Department of Public Health and Environment Colorado’s Helping Hands Foundation Colorado Veterinary Medical Association Community First Foundation Community Shares of Colorado EnCana Cares (USA) Foundation Evans East Animal Hospital PC JDS Professional Group John G. Duncan Trust Lucile Drinkwater Allen Trust National Association of County and City Health Officials Odyssey Foundation Pet Cremation Services, Inc. PetSmart Gives Back Putney, Inc. Scarlet Salon Ted’s Clothiers Tender Touch Animal Hospital The Barry S. Crown Charitable Trust The Dr. Mary E. Bates Trust Fund The Freda Hambrick Foundation, Inc. The Hadley and Marion Stuart Foundation The Melvin and Elaine Wolf Foundation, Inc.

Tricuzz Productions c/o RMA Entertainment Uber Vollbracht Family Foundation Wags & Menace Make a Difference Foundation Waxing the City White House Black Market

Safety Net Partners And a special thanks to the following 2015 veterinary practice supporters. Cumulatively their support equates to $32,075 annually, helping make Colorado a better place for animals and people. Altos Veterinary Clinic Animal Clinic, LLC Animal House Veterinary Clinic Arvada Flats Veterinary Hospital Arvada Veterinary Hospital Aspen Arbor Animal Hospital Aspen Creek Veterinary Hospital Aspen Meadow Veterinary Specialists Banfield Pet Hospital of Arvada Banfield Pet Hospital of Northglenn Banfield Pet Hospital Park Meadows Boulder’s Natural Animal Hospital Bouton Veterinary Hospital Calhan Veterinary Clinic Cherry Hills Animal Hospital PC Cheyenne Mountain Animal Hospital Clear Creek Veterinary Clinic Coal Creek Veterinary Hospital Coal Mine Animal Hospital Columbine Animal Hospital & 24 Hr. Emergency Clinic Community Pet Hospital Deer Creek Animal Hospital Dr. Bob’s Vet Shop and Clients Dublin Animal Hospital Evans East Animal Hospital PC Foothills Animal Hospital Four Seasons Veterinary Specialists

Gentle Touch Animal Hospital GoldenView Veterinary Hospital Highlands Animal Clinic Highlands Ranch Animal Clinic Just for Paws Veterinary Hospital Lakewood Veterinary Hospital Laurel Veterinary Clinic Left Hand Animal Hospital Lone Tree Veterinary Medical Center Longs Peak Animal Hospital Louisville Family Animal Hospital Loving Family Animal Hospital Mountain Parks Veterinary Hospital New Castle Veterinary Clinic, PC Overland Animal Hospital and Pet Resort Park Hill Veterinary Medical Center Parker Center Animal Clinic Peak View Animal Hospital Pets & Friends Animal Hospital Pets on Broadway Animal Clinic Pets Vet of Arvada Pikes Peak Veterinary Clinic Planned Pethood Plus Seven Hills Veterinary Hospital Sheep Draw Veterinary Hospital Special Friends Veterinary Clinic Stapleton Veterinary Hospital Table Mountain Veterinary Clinic Tender Touch Animal Hospital The Center for Animal Wellness The Meadows Veterinary Clinic The Melvin and Elaine Wolf Foundation, Inc. University Hills Animal Hospital VCA Alameda East Veterinary Hospital VCA Aspenwood Animal Hospital VCA Park Hill Animal Hospital VCA Southeast Area Animal Hospital VRCC Veterinary Specialty & Emergency Hospital West Ridge Animal Hospital West Ridge Animal Hospital at Mountain Vista

CVMA Voice 2016 : 2 | PAG E 2 1

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CV M A VO ICE

GOVERNMENT AFFAIRS 2016 Legislative Summary The 2016 Colorado legislative season proved to be particularly challenging, as discussed in Briefings and the HB16-1324 article on page 10. Here are the bills CVMA worked on or followed this year; those with full text details were the ones being mostly closely monitored and/or legislated for by CVMA. HB16-1112 Training Veterans to Train Service Dogs Pilot Program CVMA position: Monitor Laid Over Daily (05/10/2016) HB16-1120 Rabies Requirement for Dogs & Cats CVMA position: Support Amendment(s) Failed (03/17/2016) Under current law, local governments may determine whether to require pet owners to vaccinate their pets against rabies through a licensing program. Additionally, when public health and safety are at risk, county or district health departments may order all dogs, cats, other pet animals, or other mammals in the in the county or district to be vaccinated against rabies. The bill imposes a statewide requirement that all dogs and cats that are 4 months old or older be vaccinated against rabies. Dog and cat owners must ensure that their animals are vaccinated within 90 days after assuming ownership, and a licensed veterinarian must administer the vaccination and issue to the owner a rabies vaccination certificate and a tag to be attached to the animal’s collar. HB16-1124 Registered Brand Inspections CVMA position: Monitor Postponed indefinitely (02/03/2016) HB16-1201 Health Professionals Companion Animals CVMA position: Monitor Postponed indefinitely (03/03/2016) HB16-1297 Reestablish Check-offs Excluded From 2015 Tax Form CVMA position: Support Signed by the Governor (04/14/2016) HB16-1308 Fraudulent Misrepresentation of a Service Animal CVMA position: Support Postponed indefinitely (04/11/2016) HB16-1324 Compounding CVMA position: Support Signed by the Governor (06/10/2016) Under current law, a veterinarian cannot maintain an office stock of compounded drugs, which are drugs that are combined, mixed, or otherwise altered to create a specific drug or formulation, for later distribution or administration to patients. The bill authorizes: • A compounding pharmacy to compound and distribute a drug to a veterinarian without a specific patient indicated to receive the compounded drug; and

• A veterinarian to dispense a compounded drug, maintained as part of the veterinarian’s office stock, in an amount not to exceed 5 days’ worth of doses, if a patient has an emergency condition that the compounded drug is necessary to treat and the veterinarian cannot access, in a timely manner, the compounded drug through a compounding pharmacy. SB16-062 Veterinary Pharmaceuticals CVMA position: Support Sent to the Governor (05/12/2016) The bill creates a Veterinary Pharmaceutical Advisory Committee to the State Board of Pharmacy that will be consulted on any issue coming before the Board that involves veterinary pharmaceuticals. The three-person committee will be appointed by the state veterinarian and will consist of one veterinarian who is primarily a large-animal veterinarian, another veterinarian or a wholesaler of veterinary pharmaceuticals, and an individual who is neither a veterinarian nor a veterinary pharmaceutical wholesaler, but who has an interest in agriculture. No member can vote on an issue in which he or she would have a direct financial interest or benefit, and there is a requirement that at least one member of the committee does not do business along the Front Range. The committee’s recommendation to the Board will be binding, unless there is a compelling reason for the board to disregard or overrule it. The bill revises the fining schedule for violations not less than $50 nor more than $5,000 for each violation, with a maximum aggregated fine of $5,000 for multiple violations. SB16-085 Uniform Trust Decanting Act CVMA position: Monitor Sent to the Governor (05/10/2016) SB16-098 Restore Judicial Discretion in Criminal Sentencing CVMA position: Oppose Postponed indefinitely (02/22/2016) n Advocacy Matters As you read in the article “CVMA Efforts Help Pass HB16-1324” on page 10 of this issue, one of the most vital and impactful things CVMA does is advocate on behalf of the veterinary profession in Colorado. Without the strength of our 2,000+ members behind us, and without your annual membership dues, we could not effectively work under the golden dome to protect you and your practice. We fight to make sure legislators know how proposed bills can help or hurt your livelihood, veterinary medicine, and animal health and welfare. This is no easy task and no one person alone could hope to achieve what we can accomplish when we come together as a single voice. Make sure your voice continues to be heard. Make sure we can continue to protect your interests. Support CVMA with your continued membership. Together, we can protect veterinary medicine in Colorado.

CVMA Voice 201 6 : 2 | PAGE 2 3

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GOVERNMENT AFFAIRS Student Legislative Fly-in 2016 Conor Blanchet, MBA, DVM Class of 2019 Christi Leong, DVM Class of 2018

Three pairs of feet pattered against the marble floors of the Senate Building, each of us quietly rehearsing our stump speeches for our looming meetings with legislative staffers. The oak-paneled rooms and ubiquitous red or blue ties stood in stark contrast to the necropsy floor at Colorado State University. As we walked, CVMA member and former AVMA President Dr. Ted Cohn and his wife Becky diligently coached on us how the meetings should unfold. Capture the staffer’s attention, make it personal, convey issues, and be memorable. Two pieces of legislation occupied most of our time on the hill: The Fairness to Pet Owners Act and the re-authorization of the The Higher Education Act. The Fairness to Pet Owners Act promised to slow every veterinary pharmaceutical transaction, requiring the veterinarian to hand the client a prescription whether they asked for it or not. “The Veterinarian’s Code already requires this!” Dr. Cohn exclaimed, “We’re not making any progress here, just adding more rules at the behest of the drug companies.” The Reauthorization of the Higher Education Act would touch the lives of every veterinary student; a commitment of the federal government to reduce interest rates on student loans or create an ability to refinance debt (akin to a home mortgage) would powerfully alter the debt-to-income projections for incoming students. If we want to continue recruiting the best and brightest, we have to manage our financial futures. The antechamber of Colorado Senator Michael Bennett’s office simultaneously conveyed the influence of Washingtonian power, but distinctly reminded of us home. Colorado landscape paintings hung on the walls and the staff smiled broadly at the presence of some real constituents. We anticipated that we wouldn’t get to meet with our congressman, but glanced at each other when we were pulled out into the hallway and huddled next to a fern. Bennett’s staffer raised her pen and looked at us intently, “What can I help you with today?” We all threw our verbal weight behind our two pieces of legislation, creating an argument that tugged on the heartstrings but remained grounded in facts. Jessica Bowen, Senator Bennett’s Legislative Fellow, nodded vigorously and quickly jotted notes as we spoke. She paused periodically to ask targeted, specific questions. She took our information sheets, filed them into a binder under her arm, thanked us, and gracefully slipped back into the office. What felt like an hour had passed in just a few minutes. Dr. Cohn nodded approvingly, complimented us on our technique, added a few pointers, and said “It only gets easier from here. Are you ready for the next one?” The next appointments passed much more smoothly after managing our befuddlement of our first meeting, and we approached the next pitch with a greater comfort level and

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CSU Students Conor Blanchet, Jessica Carie, Christi Leong, and Liz Millman at the Supreme Court confidence. It helped that amongst the staffers we met, one was a Colorado State University alum, another’s father was a veterinarian, and Representative Jared Polis’ office had an adorable canine mascot, Gia! Clearly, those from the great state of Colorado love their animals! We connected with the folks on Capitol Hill and hopefully made an impression on how proposed policy will negatively affect the veterinary profession. We have continued to contact and urge our politicians to keep veterinary students in mind when evaluating these proposals. We want to extend our sincere gratitude to CVMA for allowing us this unique opportunity and the chance to represent our school and the profession at the AVMA Legislative Fly-In. Thank you for providing us the means to get a window into the legislative process and lobby on your behalf! n

CV M A VO ICE

GOVERNMENT AFFAIRS Do You Issue Health Certificates? Here’s What You Need to Know Alex Turner, DVM Traceability Veterinarian Colorado Department of Agriculture, Animal Health Division

Many CVMA members issue health certificates for their clients and animals, large and small. Both a dog going to Hawaii and a horse traveling to Utah require a Certificate of Veterinary Inspection (CVI) to be completed by a Colorado-licensed and USDA APHIS accredited veterinarian. If you are an accredited veterinarian in Colorado, chances are that this is one of the most common ways that you use your accreditation. Some veterinarians perform this task on a weekly or daily basis while others may only issue a CVI once a month or less. Whatever the frequency that you perform this important accredited duty, there are some CVI requirements that have changed over the past three years that affect you. In 2013, the U.S. Department of Agriculture (USDA) published the Animal Disease Traceability (ADT) final rule establishing general guidelines for improving the traceability of U.S. livestock moving interstate. This rule affects accredited veterinarians in regards to issuing CVIs. Accredited veterinarians are responsible to make sure that the CVI document is in compliance with state and federal guidelines. Many veterinarians in Colorado have mentioned to us here at the State Veterinarian’s Office that they have received more correction notices or noncompliance letters from other states. This has been true across the country as USDA and states are now focusing on enforcement of the ADT rule. Many states take this to mean enforcing all of the requirements for a complete CVI. You may have received CVIs returned to you marked as “Not Approved” if it is not in compliance with that state’s import requirements for the animals on the CVI and maybe even an official letter from the state veterinarian. To avoid these letters, and to be in compliance with the state and federal regulations, please take the following steps when issuing a CVI for your client. These steps may also prevent your client from having issues in the transport of animals to the state of destination.

3. Make sure you send the CVI to us at the State Veterinarian’s Office within seven days of the issuance of the CVI. This is the most common error we currently see from Colorado veterinarians. The USDA ADT rule specifies that each accredited veterinarian has seven calendar days to get the CVI to our office. Please send the paper CVIs to our office at 305 Interlocken Parkway, Broomfield, CO 80021 or send a scanned image of the document to animalhealth@state. co.us. There are other options rather than issuing a paper CVI; electronic CVIs can be much easier, cheaper, and faster to deliver to us than traditional paper CVIs. 4. Check the import requirements for the state to which you are sending the animals. For example, official ID requirements for livestock can vary and rabies requirements for dogs and cats can vary from state to state. Some classes of livestock need official ID, but the ID numbers may need to be listed on the CVI. It is always best to check with the state of destination to see what import regulations are required for the animals you are examining, as well as to see if an entry permit is needed. We also advise you to make a note of who you talked to in the state’s office so that the state of destination can follow up with that person before they contact you. By taking these four steps with your CVI, you will avoid many of the compliance pitfalls that could garner the attention of the state of destination. In some states, USDA enforcement actions have been pursued against accredited veterinarians who have demonstrated a lack of compliance with the ADT rule. We want to continue to help Colorado veterinarians to be in compliance with other state regulations and the federal animal disease traceability rule. If you have any questions about where to find state import requirements or would like to try one of the electronic options for issuing CVIs, or if there is any way that we can assist you in any veterinary regulatory issues, please call us in the Colorado State Veterinarian’s Office at the Colorado Department of Agriculture. Our office phone number is 303.869.9130. You can also find more information on our website at www.colorado.gov/aganimals. n

1. Make sure you have completely and accurately filled out the owner’s name and address, as well as the physical location of the origin of the animals if it is different from the owner’s mailing address. 2. Make sure you have completely and accurately filled out the destination address, again using a physical location, and not a P.O. Box number. If there is no postal address, be as descriptive as possible, or if available, even use GPS coordinates. We are able to use GPS readings or descriptions (1.5 miles west of the intersection of Hwy 119 and County Rd 16) and use those as locations when a mailing address doesn’t adequately describe the location.

CVMA Voice 201 6: 2 | PAG E 2 5

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SCIENCE UPDATE Zoonoses News Jennifer House, State Public Health Veterinarian Colorado Department of Public Health & Environment (CDPHE) Annual Colorado Zoonoses Report

CDPHE has compiled a summary report of human cases of zoonotic disease in Colorado. The report includes case counts from 2010– 2015. The full report can be viewed at https://www.colorado.gov/pacific/cdphe/animal-related-diseases. 5-Year Average Report Year

2010

2011

2012

2013

2014

(2010-2014)

2015

Anthrax

Brucellosis

1.4

Chikungunya

Dengue

Hantavirus

4.4

Malaria

29.8

Plague

1.8

Psittacosis

Q-Fever, Acute

4.8

Q-Fever, Chronic

1.4

Rabies, Human

Rabies, Animal

136

104

183

187

130

148

119

Rocky Mountain Spotted Fever

4.4

Tick-borne Relapsing Fever

4.6

Tularemia

4.8

West Nile Virus

134

321

118

131.8

101

Plague and Tularemia Risk in Colorado

Plague and tularemia continued to cause disease in both humans and domestic pets during the 2015 year. Veterinarians should consider these rare diseases in free roaming animals that present with an unexplained high fever. Guidance on management, diagnosis and treatment of these conditions is available at https:// www.colorado.gov/pacific/cdphe/animal-related-diseases. Rabies Update Q1 2016

Rabies in terrestrial animals has moved into the Denver Metro Area. Positive skunks have been identified in Jefferson County and Western Arapahoe County in addition to previously recognized areas of the Front Range. From January 1 to May 19, 2016 a total of 24 animals have been identified by laboratory testing, including 17 skunks, 6 bats, and a raccoon. Pets, livestock, and people have had exposures to some of these animals.

The south central skunk variant of rabies remains very active in the eastern part of our state. Pets should be current on their rabies vaccination and any exposures to rabid animals should be addressed according to the protocols established by local public health agencies. The Colorado Rabies Resource Guide was under revision at the writing of this article. Contact your local health department or animal control office for any updates to local protocols. Please visit the CDPHE rabies webpage for current information about rabies in Colorado, including educational materials for your clients, the current Rabies Resource Guide, and the latest statistics and maps of case locations: www.colorado.gov/cdphe /rabies. n

CVMA Voice 201 6: 2 | PAGE 27

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SCIENCE UPDATE Five Tips to Use Titer Interpretation to Improve Clinical Decision-Making Christie Mayo, DVM, PhD, Colorado State University Veterinary Diagnostic Laboratories Virology Section Head

puppy that is seronegative at 18 weeks should be revaccinated (perhaps with an alternate product) and then tested again 2 weeks later. A high titer result indicates protection. A second low titer or negative result may indicate that the pup is either a low responder or non-responder. A low responder may be protected form clinical disease but not from infection. Alternatively, the dog may lack antibody and be a genetic non-responder that is incapable of ever making an immune response to that particular antigen. It is to be noted that genetic non-responders are generally unable to respond to one (rather than all) CORE vaccine antigen and the estimated prevalence of non-responders in the US for CPV is 1 in every 1000 dogs and for CDV 1 in every 5000 dogs. Canine adenovirus non-responders are very rare (estimated <1 in every 10,000 dogs). Refine Lapsed Adult-dog Vaccination

Over the last two decades, the veterinary profession has become more accepting of the need to re-evaluate standard vaccination practices. Several strategies have been proposed, including: • Lengthening the interval between adult booster vaccinations to three or more years; • Measuring serum antibody titers to determine the need for boosters; • Separating booster vaccines to include fewer antigens given at one time; and • Administering booster vaccines for only clinically important diseases of dogs and cats. At CSU VDL, we routinely perform serum neutralization diagnostic assays to determine canine distemper and parvovirus titers for dogs, and panleukopenia, herpesvirus and calicivirus titers for cats. Serum titers are blood tests that measure whether or not your animal may be immune to a given virus. More specifically, a quantitative serum titer (e.g. 1:32) is a numerical value indicating the animal’s actual degree of immunity to a virus. For most of these viral pathogens, the presence of serum antibody able to neutralize infectious virus and prevent infection provides an extremely strong correlate of protection, but it is important to recognize the limitations of serology and to provide correct interpretation of the results. The following are some applications for the use of serological titers: Confirm Puppy Response and Protection

The use of serology can provide a simple measure of whether a puppy or kitten is protected after the initial series of vaccinations. Typically, final CORE vaccination occurs at 14-16 weeks of age. The puppy can be tested from 2 weeks after this vaccination (~18 weeks). Seropositivity at this stage indicates that the pup has made an endogenous immune response to the vaccine, as there can be no maternal antibody remaining at this time. A PAG E 28 | CV M A Vo ice 2016 : 2

Owners may be offered serology rather than automatic vaccination in circumstances where an adult dog has lapsed in vaccination schedule or the dog was adopted without a vaccination history. These dogs may not actually require vaccination because they have been previously vaccinated or have acquired natural immunity from field exposure to a virus, but it is important to note that if titers are low or non-existent, vaccination may still be recommended in addition to titer costs. Manage RIsk of Adverse Reaction

Adverse reactions of a wide spectrum are recognized post-vaccination in dogs and cats. The prevalence of these is low and most are mild; however, some are potentially life-threathening and if there is suspicion that vaccination might have been a trigger for a disease then such animals should be subject to rigorous benefit/ risk analysis before revaccination is considered. For CORE vaccine antigens, this decision is now made simpler by performing serology. A dog with serum antibodies to CDV, CAV, and CPV does not require revaccination and serious consideration should be given to which non-CORE products this animal receives. Expand Annual Health-check Options

It is becoming increasingly popular to perform annual health checks for animals within the United States. Many practitioners are offering the alternative of triennial revaccination and instead are offering triennial serological testing using serology and titer interpretation. Animals that are seropositive are not revaccinated with CORE vaccines, as these are not required. In these cases, it is of particular importance to point out serology only gives the practitioner an idea of circulating antibodies at that time of serum collection. Where this approach is used, it is recommended that the testing interval be reduced to annually for senior animals to ensure that immunosenescence (aging of the immune system) is not an issue. Manage Shelter Disease Outbreaks

One of the most valuable applications of serology has been in the management of infectious disease outbreaks in shelters Continued on next page

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SCIENCE UPDATE Continued from previous page (herd health medicine approach). This strategy is typically used for CDV, CPV, and FPV outbreaks. The ability to rapidly and cheaply test populations in order to identify animals that are protected or susceptible has allowed many animals to live (animals that might have otherwise been euthanized as they were of unknown status). In the face of an outbreak, all animals currently residing within the shelter should be tested. Those that are seropositive are protected and will not become infected or die. The susceptible population should not be adopted out of the shelter until after at least 2 weeks for CPV/FPV or until after at least 6 weeks for CDV (typical incubation periods of diseases). The susceptible population should be retested after these intervals. The second population under consideration includes those animals that are wishing to enter the shelter. Seropositive animals may enter as they are protected from disease whereas

seronegative animals should be revaccinated and then ideally sent to foster homes and not allowed to enter the shelter until they have seroconverted. Immunity induced by vaccines depends on the development of an acquired immune response after vaccination. The response that develops is dependent on the type of vaccine used and the host response to that vaccine. Protective immunity is dependent on many factors and the duration of protective immunity varies among hosts and diseases. Vaccines rarely provide duration of immunity that is greater than immunity after recovery from natural infection or disease, so it is important to consider all of these factors before making decisions for accurate interpretation of serologic titers, especially when using in lieu of vaccination. Reprinted with permission from CSUVDL LabLines,Volume 20:2 (Fall/ Winter) 2015 n

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CVMA Voice 201 6 : 2 | PAG E 2 9

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IN PRACTICE Do Our Clients Value the Things We Think They Value? Wendy Hauser, DVM Peak Veterinary Consulting

Perspective, as defined in Cambridge Dictionary Online,1 is a particular way of considering something. When we attempt to answer the question “Do our clients value the things we think they value?” perspective becomes critically important. Take for example the 2015 Banfield State of Pet Health2 report, where researchers set out to answer the question “What is preventive care?” To understand the client perspective of preventive care, researchers performed “online anthropologic research” of over 2 million pet owner on-line conversations found in blogs and social forums. The findings are both disturbing and astonishing. To pet owners, preventive care means what they feed their pet, how they exercise them, and the love, interactions, and daily attention that they provide to their cherished companions. In stark contrast, when veterinarians were asked “What is preventive care?” we responded with all things medical: regular physical examinations, vaccinations, wellness diagnostics, dental care, neutering, and parasiticides. When pet owners were asked who was responsible for preventive care, they responded that pet owners were responsible for 81% while veterinarians only contributed 19% toward pet preventive care. Because pet owners are looking for a more holistic meaning of preventive care, is it any wonder that they are turning to other sources such as breeders, trainers, groomers, and daycare providers for advice on how to keep their pets healthy? How do veterinarians become the preferred partner in providing preventive care for pets? I suggest that we begin by paying attention to what our clients tell us they value. How do we know this? Below are some ways to determine the answer to this very valid question. Literature Reviews

In the past decade, there have been many studies3 that seek to answer what pet owners want from their veterinary interactions and experiences. Specific to preventive care, clients have indicated the following. Education and increased client awareness can increase adherence to recommendations. When veterinarians and veterinary teams do a better job explaining the value of preventive care by explaining the need for comprehensive examination procedures and diagnostic testing, clients more readily agree to the recommended services. One study found that adherence increased 40% with clear communication. Another study cited that while 9 out of 10 clients view these discussions as important for their pet’s health, only 6 out of 10 recalled having preventive care discussions with their pet’s healthcare providers. Clear and consistent recommendations are crucial when discussing preventive care services. Veterinary hospitals that offer thorough explanations and recommendations benefit from the increased perception that veterinarians are PAG E 3 0 | CV M A Vo ice 2016 : 2

only selling clients the things their pets need. While it is often the perception of the animal healthcare team that price is the barrier to client acceptance of recommendations, studies have demonstrated that only 2 in 10 clients declined care because they couldn’t afford it. The main reason for lack of adherence is that clients were confused or uncertain about how the recommendation would benefit their pet. This lack of clear communication led to misunderstanding and the owner perception that recommended preventive care services would not benefit their pets. Talk to clients about pet foods, exercise and behavior. To regain our status as the preferred pet care advisor and partner, it is important that we incorporate the clients’ perceptions of preventive care into our conversations and recommendations. At every wellness visit, animal healthcare teams should talk to clients about the following: • What and how they feed their pet. How much do they feed their pet, and what else does the pet eat other than regular meals? Veterinary teams should be comfortable offering owners’ specific guidelines for choosing a diet and be prepared to make specific diet recommendations that include brand and variety of the food and quantity to be fed. • What a day in the life of the pet looks like. How much exercise is the pet receiving daily and what type? Exercise guidelines for different life stages should be discussed, particularly for young and aging pets. • What behavior concerns the pet owner has about their pet. Veterinary teams should educate pet owners about forming appropriate behaviors in puppies and kittens, including socialization. If training and behavior services are not offered at the hospital, clients should be provided with reputable trainers and, if needed, behaviorist referrals. Make preventive care easy. Owners have indicated in multiple studies that veterinary teams can help make preventive care easier by regularly doing the following. • Providing written reports on examination results. These results should include clear recommendations for the care of the pet until the next visit, including when the pet should next be seen by a veterinarian and why. • Forward booking the pet’s next appointment before the owner leaves the hospital. In recent studies, 60% of pet owners would prefer to have their next appointment made before leaving the veterinary clinic. For more information about how to integrate forward booking into your practice, please see the article in CVMA VOICE. 2015:2, pp. 24–25. • Providing bundled preventive care plans that offer monthly payment plans. According to the Bayer Phase 3 study, “8 of 10 pet owners indicated interest in preventive care payment plans—and interest level was not determined by income.” Client Surveys

Another excellent tool to find out if clients value what we think they value is to ask them. There are many ways to survey clients. Many practice management software (PMS) packages have the Continued on next page

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IN PRACTICE Continued from previous page ability to send email surveys to clients after each patient visit. Other companies exist that provide these surveys independent of the PMS. Tailor questions on the surveys to determine what clients truly want. Some hospitals prefer to offer an annual client satisfaction survey, such as the one offered by the Ontario Veterinary Medical Association4. Partners for Healthy Pets offers very valuable free tools to train teams about preventive care and the benefits it conveys to pets and their owners. Veterinary Hospitals can access a free client survey, “The Opportunity,”5 designed to elicit clients’ opinions and needs about preventive care. Finally, focus groups offer veterinary hospitals the opportunity to directly interact with a select group of clients in a facilitated discussion to explore what clients really value. Notes 1. http://dictionary.cambridge.org/dictionary/english/perspective 2. http://www.banfield.com/veterinary-professionals/resources /soph-infographic 3. Executive summary of the Bayer veterinary care usage study http:// avmajournals.avma.org/doi/pdf/10.2460/javma.238.10.1275

Executive summary of phase 3 of the Bayer veterinary care usage study http://avmajournals.avma.org/doi/full/10.2460/javma.244 .7.799 2015 AAHA State of the Industry Fact Sheet https://www.aaha.org /graphics/original/professional/resources/library/aaha_state_of _the_industry_2015_fact_sheet.pdf Impact of the owner-pet and client-veterinarian bond on the care that pets receive https://www.avma.org/News/Journals/Collections /Documents/javma_232_4_531.pdf 4. https://www.ovma.org/ 5. http://www.partnersforhealthypets.org/opportunity_login.aspx Wendy Hauser, DVM, established Peak Veterinary Consulting in January 2015 after working as an industry Technical Services Veterinarian. With a DVM from OK State in 1988, she has practiced for 28 years as an associate and owner. She is highly engaged in AAHA, serving as a director and Vice President on the AAHA Board of Directors and currently serves as the AAHA delegate to the AVMA House of Delegates. Dr. Hauser is a communications coach at CSU’s CVM. The co-author of The Veterinarian’s Guide to Healthy Pet Plans, she enjoys consulting and presenting workshops on hospital culture, leadership, client relations, and operations. She may be reached at drhauser@peakveterinaryconsulting.com n

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CVMA Voice 201 6 : 2 | PAGE 31

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IN PRACTICE Attracting Strong Applicants in a Hot Veterinary Technician Job Market Cynthia Medina, MA

Supervisors are constantly sharing with Bel-Rea that they are having a hard time finding enough veterinary technicians for their Colorado practices, teaching hospitals, research centers, and specialized positions. Amy Martin, Bel-Rea’s Job Placement Director, and I both receive a steady flow of questions about how to hire enough technicians, retain proficient employees, and keep technicians in the field long-term. Recently, we have also been asked how veterinary employers and the veterinary technician programs can work together to attract higher numbers of quality employees to the veterinary medicine field. What current challenges are we seeing for veterinary employers in Colorado?

1. The recession economy has definitely shifted back to a seekers job market, and there are many more jobs posted than veterinary technician professionals looking. 2. General unemployment numbers are down, which is good for working adults in our society, but this creates enrollment challenges for vocational colleges. The result? A lower number of individuals pursuing an education and, therefore, a lower number of veterinary technician graduates entering the profession for you to employ. 3. The U.S. Department of Labor is reporting a 19% anticipated job growth rate for veterinary technicians, “much faster than average” for the 2014–2024 time period (www .bls.gov/ooh). 4. Many new grads choose to leave Colorado—some to be near family, some for unusual job opportunities, but more and more due to higher pay offers or lower cost of living in other states. 5. The current rental housing crisis in Denver. Between February 2010 and February 2016, average apartment rental prices in the Denver Metro Area increased approximately 57%. The average 1-bedroom apartment rental jumped from

$728/month to $1256/month, and the average 2-bedroom from $962/month to $1689/month (www.rentjungle.com). Please understand the housing barrier that new graduates and experienced technicians are facing in Colorado. After taking out 20% for basic tax withholding (Federal, Colorado State, Social Security, Medicare), the table below shows an approximate income vs. 1-bedroom rent comparison for a single employee with 1 Federal Allowance on their W-4 and no dependents. These are scary figures for local employees in “helping” fields such as veterinary medicine, education, and not-for-profits. Some graduates do have dual incomes, which can help take the percentage of income spent on rent into a more reasonable rate. Roommates can also help with housing expenses, but usually also bump up the monthly rental costs due to the need for additional bedrooms. The career changer and single parent graduates we speak with seem to face the greatest barriers with housing costs in the Denver Metro Area, as they typically are either at a stage of life where they do not want roommates or they cannot have roommates due to their children’s housing needs. What can you do to attract and retain credentialed veterinary technicians?

Structure your employee duties wisely. If your veterinarians, technicians, assistants, managers, and other team members are not performing appropriate duties for their training and experience level, you are throwing money to the wind. Consider working with a consultant for assistance with elevating and streamlining your business practices. Create a structure where personal initiative and perpetual enhancement of services are supported and highly encouraged. Realize that if your skilled employees are not getting to consistently do what excites, engages, and challenges them, they will seek sites that will provide them with a higher level of job satisfaction. Encourage professional improvement and challenge technicians of all ability levels to advance their skill sets. Nurture a growth-focused environment. Cover VTNE and state registration fees and encourage more CE than is required. Consider bringing in speakers, taking the whole tech staff to Continued on next page

ANNUAL FULL-TIME SALARY (52 weeks x 40 hours)

GROSS MONTHLY INCOME (annual/12 months)

% OF GROSS INCOME SPENT ON $1256 RENT

MONTHLY NET/ TAKE-HOME PAY

MONTHLY TAKE-HOME PAY AFTER $1256 RENT***

$10

$20,800

$1,733

72%

$1,386

$130

$12

$24,960

$2,080

60%

$1,638

$382

$15

$31,200

$2,600

48%

$2,016

$760

$17

$35,360

$2,947

42%

$2,268

$1012

HOURLY WAGE

$22

$45,760

$3,813

33% *

$2,883

$1627

$29

$60,320

$5,026

25% **

$3,644

$2388

* It takes $22 per hour before a Denver Metro Area employee will reach the 30 to 35% range of gross monthly salary spent on housing that most financial planners recommend. ** It takes a whopping $29 per hour to reach the 25% rent to gross income mark required by many local landlords. *** What do they still need to cover with the remaining take home pay? Health insurance costs/deductibles, medical expenses, additional housing space for children, childcare, utilities, transportation, food, recreation, retirement planning, student loans, and any additional financial responsibilities. PAG E 3 2 | CV M A Vo ice 2016 : 2

CV M A VO ICE

IN PRACTICE Continued from previous page local conferences or classes, supporting specialization, and covering both the cost of CE and the time off. Set an individual accountability and professional development plan with each employee that focuses on how you will help them progress in their skills and career; and then review and revise it annually. Reassess your benefits package, especially health insurance coverage, profit sharing, and retirement plans. Work with a tax professional to learn about potential tax write-offs. Calculate the specific amount each piece of your benefits package is worth, along with the grand total, and provide this information in writing to applicants and current employees. Consider adding a Personal Financial Planner to your benefits package, someone who can teach your employees how to live wisely and well on their current and future income levels. Reassess your starting salary range and the salary for your long-term employees. Strongly consider paying above “the norm,” which has not increased enough over the last 10 years to keep up with cost of living in Colorado. No one enters the veterinary field to get rich, but helping professionals still need to make a living and would like to retire someday. With a shortage of veterinary technicians, listing a higher salary range in a job ad goes a long way, especially for attracting and retaining career changers, professionals with children, and graduates with other financial commitments. Help with relocation expenses to attract a wider range of applicants. Moving from Denver to a nearby area will likely cost a graduate several thousand dollars due to apartment deposits and moving expenses. You can proactively remove this financial barrier. Concerned about the cost? Set a 1-year minimum commitment with a prorated repayment amount if they choose to resign during that time. Structure a comprehensive orientation and training process for new hires. Too many new veterinary employees are thrown in to their duties immediately when a staff is shorthanded, resulting in a stressful transition and potential conflicts with team members. Whether they are fresh out of school or highly skilled, shadowing an experienced team member, reviewing all advanced techniques and protocols, covering all policies, training on records systems, locating supplies, and discussing veterinarian and technician pet peeves will create a much smoother transition for new employees. Having a solid orientation also allows your supervisors to clearly assess the training needs of each new staff member. Create a highly positive work environment. Veterinary medicine is definitely a “small world” job market. Word-ofmouth and employee satisfaction can either send applicants your way or drive them away. Being an excellent “boss” and having skilled managers significantly impacts employee retention. Compliment team members, ask what improvements they would appreciate, and truly listen to what they have to say. Work to consistently improve protocols, address safety and compassion fatigue issues, and create a setting where bullying and unprofessional interactions are not acceptable. If your veterinary technicians LOVE working for you, they will let others know.

Actively acknowledge their contributions. Smart employers offer their employees opportunities for additional income for taking on additional responsibilities, upping client retention numbers, bringing in new clients, and otherwise improving the business. Bonuses due to additional profit, thank-you notes and small gifts, and unexpected merit-based rewards will go a long way with keeping experienced technicians in your business, especially your star employees. If your team doesn’t naturally look for ways to improve your business, set a challenge, try out the best ideas raised by the team, and create incentives for success. The current concerns and listed suggestions can be applied to all levels of veterinary staff, from your youngest team member up through your most seasoned veterinarian. Your personal actions will not only make a great impact on your own team’s experience, but will also encourage other veterinary employers to actively address the employment issues inherent in a helping field. The roadblocks are not insurmountable and employers have the power to create a business culture conducive to long, productive veterinary careers! Cynthia Medina, MA, is the Director of Student Services, Bel-Rea Veterinary Technician Training; Director of Product Development, Ready Vet® Emergency Response Plans/Training; and a CATALYST Veterinary Practice Consultant. n

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IN PRACTICE Clearing Up Misinterpretations of Dog Behavior Suzanne Hetts, PhD, CAAB and Daniel Estep, PhD, CAAB Animal Behavior Associates, Inc.

Every month we write a series of articles on a pet behavior theme for members of our Behavior Education Network. A recent theme was mis interpretations of dog behavior. In this article, we share two that you likely run across every day. If Dominance Doesn’t Exist, Let’s Call It Something Else

This misunderstanding has arisen as a reaction to previous beliefs that all (or at least most) aggression directed by dogs to family or other familiar people is dominance aggression. Alternative terms have been created including status aggression or conflict aggression. The definitions are vague and often the terms are used in exactly the same way that “dominance aggression” has been used. The newest re-labeling we’ve encountered is “impulse control aggression.” There is much confusion about what these labels mean and how—or even if—they are useful. Dominance aggression is a construct designed to help us describe certain kinds of agonistic interactions among animals. For animals that fight a lot, it may be helpful to know who’s winning and who’s losing. Dominance hierarchies are constructed by keeping track of who wins and who loses in direct competitions. But sometimes animals don’t fight, and instead avoid or settle their conflicts. In studies of wild species such as baboons, dominance is inferred by measuring which animals get access to resources, such as food; which ones give more threats than they receive; or which ones win the most fights. It is hard to describe a dominance relationship between a dog and family member using such measures, because conflicts usually don’t happen in this way or don’t happen often enough to draw conclusions. But, if you wanted to see if a dominance relationship existed between a dog and family member, you could observe their interactions and take these measures. Some veterinary behaviorists such as Landsberg, Hunthausen, and Ackerman (2013) use dominance aggression to mean aggression delivered by a dog to a family member (or other dog) where the dog shows a confident demeanor, assertive signaling, and threats or aggression in the absence of fearful behavior. This basically means the dog is showing threats and aggression using offensive body postures with little, if any, fearful body postures. This sort of aggression is seen from dogs, but not very often. We’ve observed it more often between dogs instead of a dog directing this behavior pattern to people. Is this sort of aggression related to a dominance relationship as we described it above? Maybe, if you can show that the dog is winning most fights, showing more threats than he receives, and so on—that is, using the traditional measures of social dominance. So dominance isn’t a cause of behavior problems, as in the oftheard phrase “this dog has a dominance problem.” Dominance isn’t a “thing” that dogs have or don’t have. It’s a descriptive term PAG E 3 4 | CV M A Vo ice 2016 : 2

of one type of relationship. And if you take the right behavioral measures, you can infer whether dominance best describes a particular human-dog or dog-dog relationship or not. Dominance aggression is an identifiable kind of aggression that dogs sometimes show to familiar people, and to other dogs, but it isn’t necessarily associated with dominance relationships. The trend has been to change the label, not based on scientific observations, but instead in order to create “terminology separation” from harmful “dominance based” training techniques. To avoid confusion, perhaps it is better to avoid the label dominance aggression and just describe the behavior patterns, body postures, and contexts in which the aggression occurs. And second, avoid concluding a dominance relationship exists without taking the behavioral measures described above. Just because a dog resists having something done to him, or having something taken away from him, does not necessarily mean the animal is assuming a dominant role in the interaction. Displacement Behaviors Are “Cries for Help”

Displacement behaviors are normal behaviors that are displaced, or occur out of their normal context, hence their name. In popular dog training literature, they are sometimes referred to as “calming signals” (a term not found in the scientific literature). “Calming signals” are claimed to function as communication signals. The sender of such a signal is purportedly doing so in an effort to “calm” the receiver or prevent the interaction from escalating into a conflict or display of aggression. Unfortunately, there seem to be many examples of people making the assumption that displacement behaviors are communicative behaviors despite the lack of any evidence supporting this assumption. We read the following recently in a local online magazine: “Often beginning with subtle signals, such as licking their lips, yawning, or turning their heads, they are asking to be removed from a situation they see as threatening. They are ostensibly saying ‘help me’.” (May, L., 2015. “Transforming Your Scared and Scary Dog.” Mile High Dog. Oct/Nov 2015, pp. 16-18.) Displacement behaviors occur when animals are undecided, or uncertain about how to respond in the moment, to the situations in which they find themselves. This means dogs may yawn or lip lick as a result of their indecision about how to respond to a given stimulus, but with no intent to have an effect on another individual’s behavior. The above article seems to take that even one step further by saying fearful dogs show displacement behaviors in an effort to motivate someone to essentially intervene on their behalf. That’s way beyond how displacement behaviors are described in the ethological literature. The classic example of a displacement behavior that every student taking an introductory course in animal behavior learns about is lesser black-backed gulls (described by Niko Tinbergen). During a conflict at a territorial boundary, the male rivals will intersperse bouts of threats or outright fighting with episodes of grass pulling. The gulls grab the grass or turf and tug at it dramatically. Continued on next page

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IN PRACTICE Continued from previous page If we apply the over-interpretation about displacement behaviors to gulls, we would say that the gull is asking someone— even another gull—to come save him from this predicament he’s gotten himself into with this other male. No gulls rush to his aid, however, so observations do not support this interpretation. And certainly gulls cannot depend on human intervention! Don’t forget as well that displacement behaviors are normal behaviors. In a recent “Animal Behavior Case of the Month” in JAVMA (2015, Vol 247(4): 354-5) the authors state the possibility that a variety of behaviors—such as flank sucking, tail chasing, and light or shadow chasing that fall under “compulsive disorders” —could be displacement behaviors and should not be ruled out. Because displacement behaviors are normal behaviors and flank sucking and tail chasing or not, by definition they cannot be considered displacement behaviors and the possibility should be ruled out. Displacement behaviors, however, have been demonstrated to be a reaction to frustration in addition to occurring in conflict situations. Thirsty doves prevented from getting to water by a

sheet of glass will begin grooming themselves. We’ve all seen dogs do the same when prevented from getting something they want. Our dog Coral, for example, will often yawn while waiting for us to get ready to take her for a walk. The trend also seems to be to assume that dogs showing displacement behaviors are stressed and experiencing unpleasant emotional states. Displacement behaviors are a manifestation of uncertainty. When we are uncertain about whether to turn left or right while driving, we might experience some mild anxiety. Uncertainty over more significant behavioral choices could produce a correspondingly greater degree of stress and anxiety. We can infer the same for dogs. Manifestation of a yawn or two is unlikely to mean the dog is experiencing a high level of distress. However, it’s important to pay attention to the displacement behaviors dogs display, particularly if they occur at high frequencies or for long durations. Uncertainty is a stressor that should not be ignored in the dog’s environment. Providing a behavior choice the dog is more certain he wants to do (take a treat, go for a walk, or play with a toy for example) should decrease the frequency of displacement behaviors and lessen any anxiety. n

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CVMA Voice 201 6: 2 | PAGE 35

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IN PRACTICE Staying Afloat: Self Care Strategies to Help Improve Your Overall Wellness Katherine Garcia, MA, LAC, Veterinarian Peer Health Assistance Program Liaison

Years ago while doing research for a self-care presentation, I came across one of the best quotes about the importance of selfcare I had ever seen. “Place your own oxygen mask first. If we cannot first extend compassion and care to ourselves, we cannot extend it to those we have vowed to help through our work” (La Jeunesse). It’s no secret that work in the animal care field is stressful. Veterinarians, technicians, assistants, and other animal care workers spend their days seeing patients, communicating with owners, performing surgeries, providing end of life care, and cleaning kennels. With these tasks often happening back to back, it can be hard to find time for a break. As I visit veterinary practices around the state talking with staff about wellness issues, I often hear the same things: “It’s so busy, I don’t have time for a break; sometimes I don’t even have time to eat or go to the bathroom my entire shift,” or “I can’t turn down a patient in need so if I’m called to go back into work after hours, I’ll stop what I’m doing and head back to the clinic.” It can be a common belief that the more you work, the more you help your patients. However, if you are not first compassionate towards yourself by providing much needed self-care, you cannot extend compassion to the patients you are working so hard to help. Here are some self-care strategies for you to consider applying to help protect yourself against symptoms of burnout, compassion fatigue, and to improve your overall wellness. • Assess yourself. Ask yourself some questions and be honest in your answers. How am I feeling? How are things going at work and at home? Have I taken a break today? Have I eaten today? How much sleep am I getting? When is the last time I did something fun? • Create a plan. If you find areas to improve upon during your self-assessment, create a plan for change. Set S.M.A.R.T. (Specific, Measurable, Attainable, Realistic, Time-based) goals. If you are not taking breaks at work, set a goal to take some time for yourself. It is realistic and attainable to set a few minutes aside daily to eat, stretch, or to debrief with your coworkers. Remember to also create a plan for your personal life. Lack of self-care in your personal life can infiltrate into your professional life and vice versa. • Implement your plan and re-evaluate if necessary. Test out your plan and if you find it’s not working, re-evaluate and adjust your strategy. Don’t just throw in the towel because it didn’t work perfectly. • Remember to eat. Nutritious food and adequate hydration are essential to sustain the energy and focus needed to perform throughout the day. Even on your busiest days having a snack in between appointments can be critical. • Get adequate sleep. Lack of sleep can have dramatic effects on our functioning. Numerous studies conducted have PAG E 3 6 | CV M A Vo ice 2016 : 2

found cognitive deficits due to lack of sleep comparable to impairment due to alcohol consumption. These studies found impairment of individuals lacking one night of sleep to be equivalent to a .05 Blood Alcohol Content (BAC) and 28 hours of sleep deprivation to be equivalent to .10 BAC. • Engage in exercise. Exercise is important for overall wellness. Most individuals working in the animal care community affirm, “I don’t have time to exercise.” However, you actually do have the time and you do exercise. All that time you spend walking your dogs is exercise. Keep it up and assess if you can increase the frequency, pace, and/or duration. Incorporate one or two of these suggestions into your life. Once you have a routine, you can add another wellness strategy to help you “stay afloat.” Peer Assistance Services, Inc. (PAS) authors a regular column in the CVMA VOICE. PAS contracts with the Department of Regulatory Agencies to prove the statewide Veterinarian Peer Health Assistance Program (VPHAP). For more information or to schedule a presentation on wellness issues a ffecting the animal care community for your practice, please go to our website PeerAssistanceServices .org or call 1-800-369-0039. We invite your comments and suggestions for future article content. Email: info@peerassist.org.

References Durmer, J., & Dinges, D. (2005). Neurocognitive Consequences of Sleep. Seminars in Neurology, 25, 117-129. Retrieved from University of Pennsylvania Documents: http://faculty.vet.upenn.edu/uep /user_documents/dfd3.pdf La Jeunesse, C. (2014). Staying Afloat: Professional Stress andWellbeing Resources. Retrieved from American Veterinary Medical Association: https://www.avma.org/ProfessionalDevelopment/Career /Documents/AVMA_Staying_Afloat_Notes.pdf n

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CVMA NEWS

Welcome to your CVMA Chapter and District update page in the CVMA VOICE! Here you will find items of importance and interest for your chapter or district. If you have anything you would like to see included here, please send your items, information, or articles to camicacciatore@colovma.org. CVMA DISTRICT 2 | LARIMER

CVMA is pleased to welcome Dr. Wayne Jensen as the newly appointed District 2 Representative. A 1984 CSU graduate, he has more than 30 years of experience in the animal health industry, including veterinary medical practice, research, product development, business development, and research grant funding. In addition to his responsibilities as Professor and Interim Head in the Department of Clinical Sciences at CSU, Dr. Jensen and his wife, Dr. Tracey Jensen, own Wellington Veterinary Hospital, an AAHA-accredited hospital that was selected as a 2012 AAHA Practice of the Year. Dr. Jensen took on the District 2 Representative role because, he says, “Our profession is facing significant challenges that will require us to collectively work together to identify viable solutions. If we are to be successful in addressing these challenges, local (e.g., LCVMA), state (e.g., CVMA) and national (e.g., AVMA) organizations must work together to facilitate the process and implement the solutions. Through my participation as the District 2 Representative, I hope to help in these efforts.” CVMA CHAPTER 6 | DENVER AREA

August 16 | CE Impaction Dermatology Toolbox: An Interactive Case Discussion and Diagnostic Approach to the Pruritic Pet Jackie Campbell, DVM, Diplomate American College of Veterinary Dermatology This combination two-hour CE will give the clinician a practical and thorough approach to diagnosing and managing pruritic dogs. The first hour will focus on the four main causes of pruritus in dogs including atopy, food allergy, parasite, and dermatophyte, with clinically applicable diagnostic and treatment plans provided. The second hour will be an interactive case discussion for application of knowledge in diagnosing pruritic disease, understanding the treatment options available, and providing clients with treatment expectations.

PAG E 3 8 | CV M A Vo ice 2016 : 2

Lulu’s Classroom DFL Tours | 6:00-7:00 PM Dumb Friends League CE Session | 7:00-9:00 PM 2080 S. Quebec Street Box dinner included. Denver CO 80231 Generously sponsored by Zoetis Look to your email for registration information or call the CVMA office at 303.318.0447. Upcoming Impactions and Meetings

Below you will find a list of upcoming Impactions for the second half of 2016. Please understand that these events are subject to change. So add them to your calendar, but be sure to check the Chapter 6 | Denver Area page at colovma.org, where you’ll find a calendar of events and any updates or changes. Also look to your monthly chapter communication email from CVMA. Please come join us, meet other members, and make connections in 2016! Finding Meaning in Veterinary Medicine Meetings are held at 6:30 PM on the third week of each month alternating between Tuesdays and Wednesdays as follows, and will be hosted by Dr. H. Howells. Monday, July 18 Wednesday, September 21 Wednesday, November 16

Tuesday, August 16 Tuesday, October 18 Tuesday, December 20

Trivia Impactions Wednesday, July 27 (7:30 PM) World of Beer 7260 W Alaska Dr. (Belmar) Lakewood, CO 80226 Tuesday, August 23 (8:00 PM) Lowry Beer Garden 7577 E Academy Blvd. Denver, CO 80230 Tuesday, November 22 (7:00 PM) Glass Half Full 7301 S Santa Fe Dr. Littleton, CO 80120

CV M A VO ICE

CVMA NEWS CVMA CVA Program

2016 CVA Graduates

Grow Your Team—While Growing Your Bottom Line!

Please join us in congratulating the newest graduates of the CVMA Certified Veterinary Assistant program!

CVMA is proud to recognize and certify the designation of CVMA Certified Veterinary Assistant (CVA). The CVMA CVA program provides continuing education for veterinary medical personnel, enabling them to become more informed, skilled, and trusted members of the veterinary medical team. This program was designed to help staff to pursue veterinary medicine as a career, not just a job. Investing in your employees saves your practice from having to deal with less turnover for your practice and costly replacement and re-training efforts! To learn more and to enroll today, visit www.colovma.4act.com. And coming soon: CVA Levels II and III. Contact Katie Koch, CVMA’s manager of membership engagement, at 303.539.7275 for more information. Did you know? If you are a CVMA Premium or Core member, the $325 enrollment fee for the CVA program is waived as part of your membership level!

Alexis Gibson, CVA I Lamar Community College Lamar, CO Justina Mundell, CVA I Lamar Community College Lamar, CO Katryna Miller, CVA I Lamar Community College Lamar, CO

MEET Oscar Oscar is a 5-year-old neutered male orange tabby CliniCal SignS:

• Oscar developed acute vomiting, lethargy, and anorexia

DiagnOStiCS:

• Blood work revealed severe azotemia (creatinine was 8.4 mg/dl) • abdominal ultrasound revealed ureteral obstruction with stones on his right side

treatment:

• IV fluid therapy, electrolyte management, antibiotics, pain medications, prazosin • intervention with placement of subcutaneous ureteral bypass devices (SUB)

OUtCOme:

• Oscar recovered well from his surgery • Oscar’s creatinine was 2.1 mg/dL with a urine specific gravity of 1.042 at his recheck 4 months after the procedure • Oscar is home and feeling great!

advanced diagnostics, such as sUB placement in cats with ureteral obstruction, can save lives of dogs and cats like Oscar. Our team of veterinary specialists is here seven days a week to provide care for pets with acute kidney injury…and more!

S p e c i a l i S t S 7 d ay s a w e e k specialty Line: 720.975.2804 | vcaaevhspecialty.com www.facebook.com/vcaaevh | 688.referrals@vca.com CVMA Voice 201 6 : 2 | PAGE 39

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PAID Jefferson City, MO Permit 210

Ready to enjoy the dog’s life?

It’s Time.

Most veterinarians only buy or sell a practice once. We have specialized in veterinary practice sales for over 39 years. The Simmons team consists of Brokers, Lawyers, CPA’s, Business Experts and Credited Valuation Analysts who are involved in hundreds of veterinary practice transactions every year.

Kathy Morris, CPA, CVA & David King, DVM, CVA Simmons Intermountain 303-805-7627 | kathy@simmonsintermountain.com