PetVet April 2021 by Barkleigh Productions

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VOL. 4 ED.2 • APRIL / MAY 2021

improving ergonomics IN THE VETERINARY WORKPLACE

TURN

overwhelm into confidence

the rise of

Reptiles and What it Means for Veterinary Medicine

APRIL / MAY 2021

A Practical Guide for Pet Health Professionals

CONTENTS I M PROV I N G

V E T E R I N AR Y WORKPLACE 4

PetVet Advisory Board

Veterinarian Life Advice

Are Your Clients Covered? Addressing Pet Insurance

Bringing Feng Shui to Your Spring Cleaning

Turn Overwhelm Into Confidence

Diagnosis of the Diagnostics in Veterinary Medicine

Reptile Vet Dr. Louisa Asseo Shares Her Excitement for “Odd Critters”

32 PetVet 10: 10 Things to Do This Month Inquiries info@barkleigh.com (717) 691-3388

Editorial rebecca@barkleigh.com

Advertising james@barkleigh.com

Copyright March 2021. PetVet Magazine is published bimonthly by Barkleigh Productions, Inc, 970 West Trindle Road, Mechanicsburg PA 17055. Postmaster: Send change of address

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ADVISORY BOARD

Meet our EDITORIAL ADVISORY BOARD!

Courtney A. Campbell DVM, DACVS-SA

PetVet’s advisory board is here to help ensure quality content to motivate & educate Veterinarians and their staff.

Jenifer Chatfield DVM, Dipl. ACZM, Dipl. ACVPM

“My passions ultimately drove me towards becoming a veterinarian, but when I was growing up I briefly flirted with the idea of becoming a magician. As a veterinarian, the ability to save lives, keep animals healthy, and strengthen the human– animal bond makes me realize there’s nothing more magical than that.”

“People should be so lucky as to get to be a veterinarian. The broad-based education empowers us to be successful in multiple fields and affords us the opportunity to choose how we spend our professional time.”

STAFF

Executive Editor Rebecca Shipman

Publisher Barkleigh Productions, Inc.

Art Director Laura Pennington

President Todd Shelly

Senior Graphic Designer Jenn Barraclough

Vice President Gwen Shelly

Web Master Luke Dumberth

Chief Operations Officer Adam Lohr

Marketing Consultant Alex Hammersla

Julie Legred CVT “I have worked in many areas of veterinary medicine and veterinary technology over the last thirty five years, and it is amazing how far our profession has grown and paved the way for the betterment of animals' lives and happiness, as well as improving public health issues. It is an honor for me to be a part of this advisory board to offer additional education and opportunities to grow in our profession.”

Director of Marketing & Client Relations James Severs

Lisa Powell DVM, DACVECC “I have had the privilege of working with a variety of animals in my career and my passion has allowed me to be involved in teaching veterinary students, interns, residents and other veterinarians. I continue to enjoy going to work every day to help critically ill dogs and cats, and love the client interactions as well. I am proud to be a part of this advisory board to help teach and spread my love for this profession to others in the veterinary community.”

Kathryn Primm, DVM, CVPM “Animals mean so much to the human condition. It is my privilege to make lives better every day! I cannot imagine myself in any other career.”

Administrative / Marketing Assistant Karin Grottola Social Media / PR Coordinator Evan Gummo Video Production Becca Tarlo

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VETERINARIAN LIFE ADVICE “Veterinary medicine is an amazing profession. It is also a profession that can be

PHYSICALLY emotionally

draining. Find time to sit down with your family for

dinner. Go on a vacation at least once each year. There will always be deadlines. There will always be messages waiting. But, there won’t always be little league games or dance recitals. Work hard...but play even harder.”

Garret Pachtinger, VMD, DACVECC, Co-Founder, VETgirl and Board Certified Critical Care Specialist

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client services

ARE YOUR CLIENTS

COVERED?

Are Your Clients Covered?

Proactive Conversations Can Save Lives

ADDRESSING PET

INSURANCE By Ricky Walther, DVM

Now, more than ever, we need to talk about pet insurance with our clients. 2020 saw a massive rise in pet adoptions across the country and yet millions of Americans are under enormous economic pressure amid the pandemic. 6

s the authority on pet health, veterinary professionals must advocate for resources that can help new pet parents budget for veterinary treatment—or else we risk seeing a parallel increase in economic euthanasia and a decreasing standard of care.

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While many vet teams do recommend pet insurance, more proactive education is critical to meet the rise in new, inexperienced pet owners. Simply asking, “Do you have pet insurance?” can make clients aware that coverage options exist. In my own experience, clients with pet insurance are more likely to say “yes” to diagnostics that can grant more confidence in treatment plans and improve client compliance. And while none of us got into this profession to talk about finances, the reality is that conversations around treatment costs are frequently a point of contention with pet owners when many Americans don’t even have $2,000 in savings. Our best option is to make sure pet owners are thinking about potential costs and exploring financial tools that can help budget for pet health.

A Positive Impact The biggest impact pet insurance has on the pet parent, the animal, and even the veterinary team, is that the “level of care” conversation doesn’t have to revolve around costs; instead, we can go straight to the best treatment options. Our profession is plagued by

high rates of depression and suicide in large part because of the constant ups and downs of dealing with economic euthanasia. However, one report cited that clients with pet insurance are over 90% less likely to have to opt for economical euthanasia.1 Conversations about euthanasia are always challenging and emotional ones to have with pet owners, and the topic might not be something new pet owners and owners of young pets want to think about. That’s why it’s so important to have a conversation early in the client relationship about the cost of veterinary care over the life of their pet. One study surveyed over 20,000 pet owners and found that less than

20% would be able to afford a major vet bill without pet insurance.2 It’s also important to note that vet practices see greater annual revenue through insured pets versus uninsured pets.3

How to Talk About Pet Insurance (Without a Bias) In the past, vets may have recommended a single provider or just handed clients a bundle of brochures when discussing pet insurance. The truth is, a one-size-fits-all approach doesn’t work for pet insurance, and handing clients a stack of different providers’ marketing materials isn’t a great experience either.

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From the growing number of providers, it’s impossible to know which specific plan will best fit a client’s unique breed, age and location. Instead, educate pet parents on breed-specific health risks to keep in mind when considering coverage options. Inform clients of resources that allow them to learn about and compare top providers side-by-side. Many veterinarians choose to have this conversation during a client’s initial visit and during routine care when pets are healthy and perfect candidates for coverage. Simplicity is key to avoiding analysis-paralysis, and such educational resources have recently emerged.

Modern Solutions Marketing materials rarely provide the best information about insurance plans, and most people don’t read the fine print. For motivated clients, it can take hours, days or even weeks to compare plans. For unmotivated clients, many will give up on research. Veterinary teams can help by steering pet parents toward unbiased comparison tools and objective marketplaces. Such resources streamline the volume of information needed to make an informed decision about pet insurance—and can increase the rate at which clients move forward with a coverage option. There is even a free resource that scores top coverage plans based on the user’s breed-specific health risks and shows the expected lifetime costs of each plan (some plans that are cheaper today may be more expensive in the long

run, depending on how the premiums increase over the pet’s lifespan.) Including resources on your practice website can make it easy for clients to find more detailed information and third-party comparison tools. However, proactive in-person (or telehealth) conversation is key to making more pet owners aware of treatment financing protection. We have a window of opportunity to give a larger percentage of the population the resources they need to cover the cost of treatment and ensure their pets live long, happy lives.

References: 1. AVMA’s Market For Veterinary Services 2017 https://www.avma.org/ sites/default/files/resources/2017econ-rpt4-mkt-vet-services.pdf

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2. Fascinating Pet Insurance Statistics from 2019-2020 https://www. pawlicy.com/blog/pet-insurancestatistics-2019-2020/ 3. Insurers Say Pet Care Spending, Visits Increase With Insurance https://www.avma.org/javmanews/2016-10-15/insurers-say-petcare-spending-visits-increase-insurance Ricky Walther, DVM, is a small animal general practitioner at Blue Ravine Animal Hospital in the greater Sacramento, California area. Realizing the positive financial and medical impact that pet insurance can provide for pet parents and the profession, he lends support and advice to companies like Pawlicy Advisor (www. pawlicy.com/vet) that simplify the process of connecting with veterinary financing resources.

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lifestyle

BRINGING

to Your Spring Cleaning By Renee Machel 10

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pring cleaning is a time when you finally wipe the fan blades and deep-clean areas of your house that routinely are missed. It’s also fairly common practice to rid yourself of unused stuff but, most of the time, there isn’t a lot of intention behind “spring cleaning.” Feng shui is the practice of using energy to harmonize an individual with their environment. Your energy and the energy in your home is either positive or negative. You’ve likely felt this before; a stuffy, stagnant energy or tension in the air. And you’ve also probably felt the opposite; light, abundant, flowing, welcoming vibes. You don’t have to be an expert to bring a little light and love into your space this spring. Feng shui can increase the quality of energy—and I’m all about increasing the quality of our lives in any way I can. Veterinary professionals have the “quality of life” conversations with patients day in and day out; it’s okay to take the same approach in your own life. For many, decluttering during spring cleaning can be a difficult project to undertake. Hopefully these tips will help you set new intentions and give you the motivation to make some lasting changes. Who wouldn’t want to activate more balance? Let’s start by removing clutter from corners in your home. Clutter, especially in corners, can drain energy from you, and can even block the flow of energy in multiple areas of your life. Bring awareness to where you tend to pile up clothes, bags, newly–purchased or unused items. Create new systems that will support your natural habits but that will free the clutter. If you drop your items in a pile, this is where a coat rack, key

holder, jewelry dish or quality hamper can come in handy. Consider changing your habits in a feasible way so that you stick with it for the long haul and keep the energy flowing in the right direction. After removing what you can by putting it in its appropriate home, taking it to the trash or donating it to your choice charity, you then create the space for your new system. Pay special attention to closets that harbor large amounts of clothing, coats, bags, hats, etc. Closets are the best places to start.

Here are three key points to keep in mind that align with the feng shui method and will keep indecision at bay:

If it is broken it should go. The message a broken item conveys negatively influences your energy just as the stagnant energy a cluttered mess can bring about.

If there are certain things that you have been holding onto for sentimental reasons, consider “cutting the cord.” If you are holding onto things from a past relationship, it may hinder a new one from beginning. I spent a year and a half grieving my mastiff ’s passing. It was only once I decided to allow his orthopedic beds to find a new home that I created the space for a pup in my life, my home and my heart. One could argue the logic of saving the beds to reduce costs of bringing a new pet into the home, but by holding onto them, it's possible the new pet hadn’t come into my life at all. This could be a metaphor for a new opportunity, job, relationship and so on. Create the space.

or go back to the main principle and remove excess stuff. Next let’s move onto the living room, focusing on the entryway and moving through the room as you would if you entered through the main door. Walk through your home with the intention to remove obstacles in your path, inviting abundance into your space rather than impeding the flow. Over time, you can become gradually unaware of the many things that are in your natural pathway. For your office or clinic, ensure your desk/counter space is clear. In your bedroom, remove what EMF’s (electromagnetic fields) you can live without. Plug your phone in a nearby bathroom or leave it in the living room and replace it with an analog alarm clock (not the kind with red numbers.) Hi-tech equipment can be a cumulative drain on energy. After removing the clutter, consider adding elements that will enhance your wellbeing in certain areas that you desire to rebalance. Natural elements create a natural support system and work together. There can be an excess caused by certain elements and there can also be weakness. Once again, we are reminded it’s all about balance.

Under furniture is not a storage space. That space should be left open for the flow to continue rather than be blocked.

Under furniture is not a storage space. That space should be left open for the flow to continue rather than be blocked. You could incorporate more wall organization (shelving) that would free up floor space PETVET MAGAZINE

If you choose to add items, choose ones to intentionally enhance the feng shui within the room and throughout the house. The five natural elements and what they represent: • Water: wealth & prosperity • Wood: growth & vitality • Fire: enthusiasm & creativity (excess can bring about restlessness and aggression) • Earth: grounding & balance • Metal: business & strength You can choose to add colors and objects that help balance the energy in the room, as well as your individual

energy, ultimately increasing your vitality or your life force. If you choose to add items, choose ones to intentionally enhance the feng shui within the room and throughout the house. You can add a wooden jewelry bowl, a stone table that is wavy to add a water element or a metallic round mirror. Live green plants can bring ample amounts of positive energy into the space as well. Of course, there are many more

www.rememberapet.org

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ways that you can bring feng shui into your routine cleaning and home or work environment. One of the most important things to embrace when incorporating feng shui into your lifestyle is keeping an open mind and heart. Renee Machel is a nationally recognized wellbeing speaker, certified life coach, CYT 200 yoga instructor, mindfulness and meditation guide. As the co-founder of Get MotiVETed, she aims to provide a positive impact on people’s wellbeing and enhance the culture within organizations of vetmed. She has spent nearly 20 years in the veterinary industry as a hospital leader and technician. She shares her personal story of overcoming wellbeing struggles along with key teachings in managing both personal and professional development.

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Best practices

I M PROV I N G

V E T E R I N AR Y WORKPLACE By Elycia Degenhardt, BA, CVT

pend a day at a typical veterinary clinic and by mid-afternoon you will see people rubbing their own lower backs, necks and shoulders with grimaces on their faces. A morning of lifting, restraining, typing, squatting and kneeling is taking its toll. Everyone who enters the veterinary profession is told it will be physically demanding, but they may not realize the serious implications of these daily aches and pains. Musculoskeletal injuries or disorders may lead to decreased performance, workers compensation claims and even career changes. Understanding the importance of and implementing an ergonomics program is a critical part of reducing the risk veterinary employees face in the workplace.

Risky Business According to the American Veterinary Medical Association, activities common in veterinary medicine that carry a high risk of musculoskeletal injury include awkward postures, high hand force, highly repetitive motions, repeated impact, moderate to high hand-arm vibration and heavy, frequent or awkward lifting. Tasks associated with these risks can be almost anything a veterinary professional does: restraining or lifting a large or uncooperative patient, performing or assisting in surgery, dental prophylaxis and extractions, or kneeling on the floor to accommodate a frightened animal. Veterinary administrative duties such as typing 14

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or talking on the phone can also result in strain and injury. While all parts of the body can be affected by MSD (musculoskeletal disorders), the back, neck and shoulders are frequently noted as sources of pain for those working in veterinary medicine. Some ergonomic tips to alleviate the incidence of these symptoms include:

maintain a neutral spine

1. Maintain a neutral spine This is the core ergonomic principle related to back, neck and shoulder pain. A neutral spine should contain three curves; one in each of the following areas: cervical, thoracic and lumbar spine. The cervical and lumbar spine should curve slightly inward, while the thoracic spine should mirror that curve in an outward fashion. You should not work with your head tilted forward more than 15 degrees from upright or your torso hinged further than 20 degrees forward from the waist. Shoulders should never be “hunched,” meaning curled forward or held in tension toward the ears. Working on a surface that is the proper height—typically the height of the pelvis or higher—greatly increases the likelihood of maintaining a neutral spine position. Ideally, exam and surgical tables should be adjustable to the height of the individual using them. Veterinary receptionists and administrative employees often spend a large portion of their day on the phone, which presents its own ergonomic risks to the cervical spine. As many calls require those answering them to take notes, a handsfree system is a good way to prevent neck strain from cradling a phone between one’s ear and shoulder.

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2. Be mindful of seating We put the most pressure on our spine by sitting, so it is best to avoid sitting for long periods when possible. When seated, be sure to sit facing whatever you are working with straight on, as sitting and twisting is the most stressful position for the spine. This means desks,

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dental and surgical tables, and other areas where employees are often seated should always be designed with room for an individual’s legs to fit comfortably under the work surface. The ideal arm position for working while seated allows forearms to be parallel with the floor, elbows not elevated above forearms and upper arms to rest alongside the torso, maintaining the curve of the thoracic spine and relieving shoulder and wrist strain. An adjustable-height, ergonomically-designed seating surface (a saddle seat is often recommended) encourages proper posture and alleviates spinal and nerve compression. Ideally, alternate sitting and standing tasks to further reduce risk of injury.

3. Practice proper patient handling Many injuries in veterinary practice

occur when interacting with patients. The activity most associated with musculoskeletal risk is lifting large patients. Your practice should have clear guidelines as to what size patients require multi-person lifts. Additionally, patients in the weight range requiring two or more people to safely lift should be scheduled at times when proper staffing ensures this is possible. When lifting any size patient, make sure you have safe footing, take a wide stance and keep your arms as close to your body as possible. Minimize the distance you carry a patient by encouraging conscious patients to stand rather than lie down before lifting them. And, if your work surface is adjustable, lower it before lifting the patient. For sedated or unresponsive animals, use a stretcher to stabilize the weight you are lifting. Patient restraint is also physically

demanding. As with lifting, hold the patient close to your body to brace against sudden movements. Since struggling patients are most likely to cause injury, consider sedation for stressful procedures such as radiographs and ultrasounds. While we often choose to work on the floor as a way to make animals more comfortable, this frequently results in hunched postures and repetitive-use injuries from kneeling or squatting. The ergonomic recommendation is to place patients at the level of the pelvis or higher during physical examination, blood draws, vaccination and other routine procedures. If working on the floor is the best fit for your practice, provide anti-fatigue mats to kneel on and limit the number of floor-level appointments any given employee sees in a day by alternating with other qualified staff.

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Employer Guidelines Employers are responsible for the safety and welfare of their team. Fortunately, embracing this responsibility benefits everyone in the veterinary setting—including practice owners—by reducing workplace compensation claims, increasing employee satisfaction and improving productivity. The following are steps employers can take to establish and maintain an ergonomically-friendly veterinary work environment: 1. Provide ergonomic training: New employees at a veterinary practice should receive ergonomic training covering all daily duties. Training should be refreshed for all staff on a regular schedule determined by practice owners or managers. Visual reminders of proper postures and technique should be posted in work areas. 2. Invest in prevention: There are a number of products specifically designed to make a workplace ergonomically friendly, including seating, work surfaces/tables, specialized keyboards, braces and belts, and hand tools for surgery and dentistry. Practice owners or managers should stay well informed on the most effective products and make selections that fit employee needs. If a practice is being built or remodeled, an ergonomics consultant can be a useful resource for making design choices that reduce physical strain and injury. 3. Schedule thoughtfully: Scheduling greatly influences the physical stress put on veterinary employees. Try not to place large, physically-demanding patients backto-back; for example, alternate small and large dogs, or dogs and cats. Make sure staffing meets demands when scheduling so team members are not coerced into performing tasks alone, compromising their safety. When scheduling multiple surgeries, alternate surgeons if possible. And, if a single surgeon is working, aim to provide a mix of procedures that do not require the same posture or movements. Finally, give enough breathing room in the schedule for staff to feel comfortable taking “micropauses”— breaks of 20 seconds every 20 to 40 minutes to change position, stretch or perform any movement that reduces fatigue. 4. Encourage team involvement: The Occupational Safety and Health Administration advocates for a participatory approach to ergonomics, meaning all team members are encouraged to provide regular feedback about their working conditions, including identifying problem areas and suggesting solutions. Staff should also feel safe reporting any physical concerns as early as possible. Employers should ask team members to evaluate any ergonomic changes made to the practice for effectiveness.

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Veterinary work will never be easy, but understanding and implementing healthy ergonomic practices increases worker safety and career longevity. Ergonomic planning creates an environment where veterinary professionals are able to provide care to patients while being kinder to their own bodies, ultimately leading to a more sustainable and healthier future for veterinary medicine. 

Resources: 1. Altier B. Comfort and Participatory Ergonomics in Veterinary Dentistry. DVM360. https://www.dvm360. com/view/comfort-and-participatory-ergonomics-veterinarydentistry-proceedings-pdf. Published August 31, 2019. Accessed June 11, 2020. 2. Ergonomics. Occupational Safety and Health Administration. https://www.osha.gov/SLTC/ ergonomics/. Accessed July 1, 2020. 3. Hawn R. Strains, Sprains, and Pain in Veterinary Professionals. Trends Magazine. June 2020:37-40. 4. Veterinary Ergonomic Guidelines. American Veterinary Medical Association. https://www.avma.org/resourcestools/avma-policies/veterinary-ergonomic-guidelines. Accessed June 11, 2020. 5. White SC. Ergonomics in veterinary medicine. Innovative Veterinary Care Journal. https://ivcjournal. com/ergonomics/. Published January 3, 2020. Accessed June 11, 2020. Elycia Degenhardt is a certified veterinary technician working at an internal medicine practice in Savannah, Georgia. She joined the veterinary profession after 4 years as a high school teacher and remains passionate about education. Elycia earned degrees from the University of Wisconsin- Madison and Madison College and continues to learn new things every day through her career and life experiences.

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business trends

the rise of

Reptiles and What it Means for Veterinary Medicine By Mike Corcoran, DVM, DABVP (R/A), CertAqV

eptiles have been increasing greatly in popularity as pets in the United States over the past several years. According to surveys, in 2007 reptiles were kept as pets in 2% of US households. That has more than doubled to 4.5% of households in 2020. There are several reasons for this increase, relating both to changing human demographics in the country and changing perceptions of the animals themselves. These two factors are also leading to a demand for better quality veterinary care in reptile species. This presents revenue opportunities for veterinarians as well as opportunity to improve the lives of these unique animals.

The Effect of Demographics Many aspects of the demographic changes related to increased reptile ownership appear to be based in economics. Compared to decades ago, there has been an increased wealth gap. The cost of a college education has risen far more drastically than starting salaries and the minimum wage has not changed at the federal level in more than 10 years. This has led to far more young people living with parents for a longer time and living in smaller apartments rather than buying a single-family dwelling. In situations like that, ownership of an animal like a dog is more difficult. In turn, this has led to increased ownership of exotic pets overall. Most new jobs have been in more urban areas, leading to an urbanization of the population during 18

this time as well. Reptiles can be some of the least demanding exotic animals in terms of space requirements, tendency to have destructive behavior and tendency to create noise. The wealth gap has led to many people working longer hours or working multiple jobs. This leads to less time at home and more sporadic schedules that leave less predictability. Trying to keep a feeding and care schedule for a pet becomes more difficult. Most reptiles are lower maintenance in terms of care and schedules since they will often require feeding with far less frequency and tolerate more time in the enclosure so long as the enclosure meets their need for exercise and enrichment. While many reptiles tolerate (and may even enjoy) human interaction, they are far less demanding of that attention than small mammals or birds. That helps increase the appeal of reptiles as companion animals as well.

The Changing Perception of Reptiles Even a superficial examination of reptiles in the media and popular culture shows a shift in perception during recent years. Television shows like The Crocodile Hunter depict them as animals that are important to their ecosystems and animals that are loved by their

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owners in captivity. There are more reptile cartoon characters in children’s shows, and no longer universally as the “bad guys.” This can be compared to less than a generation ago when the most common presentation of reptiles in film or television was as scary, evil, mindless beings. There has been increased research into the mental and emotional needs of reptiles that has also led to a better understanding of the complexities of their minds. There are studies that clearly show stereotypic behaviors in reptiles housed improperly and more normal behaviors in captive reptiles housed in naturalistic habitats. Other studies show the more social nature of reptiles that has been previously unknown. Reptiles have been increasingly trained for desired behaviors and the training has been used to decrease stress. Studies of sentience in reptiles have supported the capability of reptiles to experience anxiety, stress, excitement, fear, pain and suffering. There has also been suggestion of more positive emotions and recognition of human caretakers in a pleasant way. The information from these studies has been increasingly disseminated to people who keep them as pets. The need for enrichment of captive reptiles has been seen far more in zoos, research facilities and in homes of pet owners. Unique food items, naturalistic habitats, puzzle boxes, human interaction and novel activities have been used in all these settings to improve the quality of life for reptiles. In the pet trade, more products are being marketed for reptile owners that are directed at enrichment and improvement of the human-animal bond. Social media is also connecting reptile owners, and the posts are full of people sharing enrichment ideas, pictures of pet reptiles being cuddled in front of the TV and reptiles wearing sweaters.

PHOTO BY Anna-Marie Ruoff

PHOTO BY Mike Corcoran

In the pet trade, more products are being marketed for reptile owners that are directed at enrichment and improvement of the human-animal bond. 20

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What Does This Mean for Veterinary Medicine? Naturally, reptile owners are becoming more common with the growing popularity of these species as pets. With the increased awareness of complexities of the reptile cognition and emotion, the demand for improved veterinary care has also been increasing in this demographic. More than 75% of pet reptiles are owned by people in Gen X and Gen Y. These generations have also been found to be more likely to humanize their pets and are therefore more likely to seek veterinary care for their animals. For veterinarians, this means that not only are

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you more likely to encounter reptiles in private practice, but you are more likely to have owners who place importance on their care—and are more likely to pursue diagnostics and treatments that are recommended for the welfare of their animal. In current reptile practice, the use of advanced diagnostic tools is not unusual. Ultrasound, CT, digital radiography, blood testing, cytology and histopathology are all commonplace in the current environment. Hospitalization, endoscopy and surgery are also frequently pursued in order to improve the health of the pet reptile. Increasingly, wellness and routine care are being sought after by the newer generation of people who keep reptiles as pets. This trend places veterinarians in a good position to have a positive influence over the health and wellbeing of these animals. It also provides a good potential revenue stream for veterinary clinics. Treatment of these animals can not only be done out of the interest of the individual veterinarian, but can also be a good fiscal decision for a veterinary practice. For the veterinarian seeing reptiles in practice, there are also ever-increasing opportunities to continue acquiring the education needed to accurately diagnose and treat conditions for reptile patients and increasing numbers of referral locations for cases that require more advanced care. Numerous online educational opportunities exist and many of the larger veterinary conferences now routinely present reptile tracks as a

regular part of their annual schedule. For more ongoing support of practice, there are great opportunities for continuing education, access to journal articles and peer support or mentoring through the Association of Reptile and Amphibian Veterinarians. This group also has an annual conference at ExoticsCon in collaboration with the Association of Exotic Mammal Veterinarians and the Association of Avian Veterinarians. Meeting the demands of reptile owners for good care of their animals can be an interesting, challenging and rewarding part of any practice. With the increased opportunity for learning the latest in reptile medicine and the willingness of reptile owners to seek good care for their pets, the possibilities are almost limitless.  For more information on the Association of Reptilian and Amphibian Veterinarians, visit: arav.org

Dr. Mike Corcoran is a 2008 graduate of Washington State University. His practice history has included small animal emergency medicine and exotic animal-exclusive practice. Dr. Corcoran is a certified aquatic veterinarian and a Diplomate in Reptile and Amphibian Practice with the American Board of Veterinary Practitioners. He has served on the board of the Association of Reptile and Amphibian Veterinarians (ARAV) for more than five years, including one year as President, and is currently the chair of the ARAV’s Legislation and Animal Welfare Committee. Dr. Corcoran currently resides in sunny Southern California and is practicing part-time while acting as a consultant for numerous practices and remains active in teaching and lecturing. 22

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BEYOND THE STETHOSCOPE

Angela Demaree, DVM, MPH, CHPC

We are now a few months into the new year, and many of us may start to feel overwhelmed, guilty or upset with ourselves when we realize our New Year's resolutions and good intentions have slowly faded away.

hen we are rushing through our days, just trying to get everything accomplished and not forget to check on our patients or pick our kids up from practice, it's easy to lose sight of our goals, our dreams and the priorities we had hoped to accomplish. This is also how overwhelm creeps in, and you suddenly realize there isn't enough time, money or energy to accomplish everything you had promised…or is there? After years of self-reflection and coaching clients in various disciplines ranging from veterinary medicine to the campaign trail, I noticed that being overwhelmed is often the indicator that we are not living in alignment with our values or haven't maintained a boundary. In other words, we are not consistently living in alignment or congruent with the best of who we are and who we know we can be. 24

The keyword here is consistent. Our brains are silently keeping score of when we show up and follow through— and those times when we either forget to show up or don’t follow through. We need more checks in the “win” column to feel more confident in our abilities. So, how do we get more wins when much of what we do in the practice of medicine is simply outside of our control? When I start to feel overwhelmed, like a failure or just in a funk, here's how I break it down to get back on the path towards living my best, most confident life and how many of my clients do the same.1 First, write down everything that is stressing you out and make a list. I'm not a to-do list person, but it doesn't look as scary or overwhelming as it may feel when I can see that stress in black and white on the page in front of me. Next, think about your priorities in the five areas of life: health (physical and emotional), relationships (connection with others), finance, mission (personal and professional) and spirit (hobbies, adventure, fun). Are any of these on the list, and what are they? Maybe we've forgotten about them entirely, or perhaps they are masquerading as not urgent or important in light of the other shiny worries clamoring for our attention. Then make a grid. Yes, I'm the math and data geek, but I won't make you determine the slope of a line on this x-y axis. In the top left quadrant, write "urgent + important," the top right quadrant write "not important

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what are my

what is currently

Stressful

Priorities HEALTH RELATIONSHIPS FINANCE MISSION SPIRIT

NOT IMPORTANT

Tackle

Delegate

Plan

Remove

not URGENT

URGENT

IMPORTANT

The goal here is to identify what is both urgent and important and do those items first. Friendly hint: Not everything is both urgent and important.

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+ urgent, the bottom left is “not urgent + important," and the bottom right is "not urgent + not important." You may recognize this as the Eisenhower matrix.2 President Eisenhower made this famous when deciding which items to tackle, which to delegate and which could just be ignored or removed from his plate. If not doing something adds stress to your life, then grab your calendar and schedule it three months from now. In ninety days, you'll have a better perspective of if it's necessary or if you can just not do it. The goal here is to identify what is both urgent and important and do those items first. Friendly hint: Not everything is both urgent and important. So how do we determine what is really important? Remember that exercise we just did with the five areas of life? Is it essential to one of those five areas and is it of high importance or low importance? Then for the items that are urgent but not important, can you delegate them? Here's where we get tripped up; we do the urgent items that are not important before we do the important projects that are not urgent. That's where we experience the negative emotions because our brains know that we aren't congruent or living in alignment with what we said was most important to us (our values). A simple hack to trick our brains and get us back on track to experiencing more joy, happiness and confidence with less overwhelm and stress focuses on what is important but not urgent. Are there a few items that are easy that we can quickly close the loop on? Check the important boxes first and then the urgent ones. Just get something, anything, accomplished and off of your plate, then celebrate how good that feels. If we can get only one or two simple things moved forward, we are telling our brains a new story; "I am capable, I followed through with integrity on what I promised—I got this!" With this new-found confidence, make a plan for those important projects that aren't urgent. The ones that take hours, days or even weeks of uninterrupted time that we've been procrastinating

on, because who has a three-hour block of uninterrupted time these days? What are the three to five big pieces of the puzzle that will get this project moved forward to completion? Grab a clean sheet of paper and write those across the top. Under each one, write what the two or three needle-moving activities are; the bare minimum to get this piece of the project accomplished. Do you know how to do it? Have you done it before? Do you need to learn something? What can you do first? Often, once we break those big projects down into smaller sections and subsections, they aren't so big or overwhelming and we learn that it doesn't have to be done in just one order. Can you knock off some of the more manageable parts and pieces to gain momentum and confidence towards the more complex or time-consuming details? Make a plan. When are you going to do these needle-moving activities? Where do you have pockets of 5, 15 or 30 minutes to start to knock this off your plate? We often don't have the confidence when we don't feel competent, which is why we talk about the confidence-competence loop in high performance and positive psychology. It's a self-perpetuating or infinite loop. When you feel more competent or capable, you have more confidence so you can and will perform that next task with excellence. We need to practice those skillsets to become both more competent and confident.3 As veterinary professionals, we are smart, strategic people who can devise a plan and reasoning as to why something can't be done that will be airtight. So, today, I'm challenging you to ask yourself, how can I do this? Where can I find the time? Finally, go with the flow. Be grateful for all of your successes, wins, challenges and the times you were a hot mess but you showed up fully and did your very best to push yourself to learn and grow along the way. The more we celebrate the little wins and fully integrate those into our identities, the happier and more confident we will feel. Allow yourself to ride

the wave of momentum you are creating by accomplishing these tasks. That simple act of appreciating yourself for a job well done puts more points in the “win” column and tells your brain that you have the clarity around what's important because you showed up and followed through. You are capable and competent, and therefore, you feel less overwhelmed and have more confidence in your abilities. This is one tangible formula for how we can hack our brains and put the competence-confidence loop into action and convert that overwhelm into confidence.  Dr. Angela Demaree is the CEO and Principal Consultant for PAWS Consulting, a public health and political consulting firm. Angela recently retired as a Major in the United States Army Reserves, is a Certified High Performance CoachTM and the host of Beyond the Stethoscope, the podcast for

veterinarians and busy professionals who want actionable, implementable solutions surrounding work-life balance, accomplishing your goals and living your dreams. She spends her free time with her horse, Tommy and teaching her Quaker Parrot the Purdue Fight Song. You can connect with Angela on Twitter and LinkedIn @ DemareeDVM.

REFERENCES: 1. Demaree, A. (2020, March 27). Quick Tips to Overcome COVID19 Overwhelm [Video blog post]. Retrieved February 15, 2021, from https://youtu.be/WNSm0ctEFcA 2. Clear, J. (2020, June 09). How to be more productive by using the “eisenhower box”. Retrieved February 15, 2021, from https:// jamesclear.com/eisenhower-box 3. Dehmer, J. J., Amos, K. D., Farrell, T. M., Meyer, A. A., Newton, W. P., & Meyers, M. O. (2013). Competence and confidence with basic procedural skills. Academic Medicine, 88(5), 682-687. doi:10.1097/ acm.0b013e31828b0007

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industry news

Diagnosis of the Diagnostics in Veterinary Medicine By Jenifer Chatfield, DVM, DACZM, DACVPM

he last 18 months have truly been a watershed period in the land of science and medicine. Obviously, SARS-CoV-2 must be mentioned at least once, and this sentence serves as that obligatory acknowledgment. Moving beyond the superficial, the global accomplishment of recognizing a novel pathogen emergence, identifying the pathogen, retarding the pathogen’s progress through the human population, developing a vaccine, and finally manufacturing and distributing that vaccine on a global scale is an amazing accomplishment. When one then considers that all these significant tasks were accomplished in 12-14 months from pathogen emergence to effective vaccine distribution, the past year in science and medicine was simply incredible. In the age of warp-speed vaccine development (and manufacture and distribution), one wonders if other components of the healthcare system are progressing as quickly. Despite the truly awe-inspiring response from the health sciences in the face of SARS-CoV-2, the testing available proved less than ideal. In fact, depending on which test was employed and the community prevalence, the results were often equivocal at best—even in the face of fairly sophisticated interpretation. Have clinical diagnostics kept pace with other areas of healthcare? And how about veterinary medical care? What is the current state of veterinary diagnostics for 28

infectious diseases? And, furthermore, what is the prognosis for diagnostics in the veterinary practice? Diagnostic tests to determine health—or causes for the lack thereof—are not new. Diagnostic testing by physicians and veterinarians alike was not always the sophisticated practice of today. Prior to 400 BC, the oldest known test on bodily fluids was pretty straight forward. The patient’s urine was poured on the ground, and if the urine drew insects, then the patient was diagnosed with boils. Progress was made around 300 BC when Hippocrates performed a full diagnostic work-up by tasting the urine, listening to the lungs, observing skin color and other outward appearances. Bubbles on the surface of urine was readily tied to kidney disease, and chronic illness and hematuria was first documented as indicative of kidney failure circa 50 AD. In early times, urine was certainly the key to a diagnosis; so much so that failure to examine the patient’s urine allowed for a public beating of a physician, according to the Jerusalem code of 1090. While medical advancement suffered from a severe paralysis for centuries due to the hubris of Galen, by the time the 1600’s and 1700’s rolled around, health experts had “graduated” to assessing a patient’s urine…still! Then, in the 1800’s, came the “Golden Age” wherein the shape of a patient’s skull could predict mental health and magnets were used to treat all manners

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of illness. At least improvements in hygiene led to dramatic increase in survival rates overall. Indeed, the late 1800’s produced Koch’s postulates and an epiphany regarding infectious diseases. The concept of producing a pure culture of the disease-causing pathogen is still prevalent today. While we no longer rely on horses, wagons or even steam engines for transportation, we still refer to culture as a diagnostic gold standard for many infectious agents. And while candles and lanterns are now reserved for austere and temporary events, culture remains a routine diagnostic method for many clinical conditions. What?! Why?! Why has clinical identification of a pathologic agent not kept pace with other facets of society and medicine? Oh, but it has! In the early 1990’s, the world atlarge was introduced to a cutting-edge laboratory process called polymerase chain reaction (PCR) via the US judicial system. Thirty years later, even PCR has evolved and advanced. But what bearing might any of this have on veterinary practice? While culture and sensitivity remain readily available, quantitative PCR (qPCR) has now become available to veterinary practitioners, a mere five to six years after appearing in human medicine. While qPCR is certainly more sophisticated than a culture, is qPCR advantageous? Less prone to error? More sensitive and specific? The short answer is “yes” to all of these. Consider that culture of a pathogen (bacterial, fungal or viral), at its most basic, provides the most welcoming environment and watching for the pathogen to appear. Any number of imperceptible errors can impact the results of a culture; a small temperature excursion, incorrect nutrients provided, incorrect nutrient ratio or a random contaminant that may

simply outpace the growth of the actual disease-causing organism. Quantitative PCR amplifies any known pathogen present in a sample and does so in such a way as to provide relative population comparison. Thus, if a normal component of an animal’s microbiome is present in extreme numbers so as to produce pathology, that circumstance is reflected in qPCR while such growth might be routinely dismissed on interpretation of sample culture. Therefore, the huge gap in traditional PCR appears to be bridged as qPCR can determine whether the organism detected is viable. Accurate assessment of the pathogen in question is not the only factor in effective treatment and diagnostics. In an effort to avoid a “post-antibiotic” era, veterinary medicine must begin to acknowledge the value of more routine sensitivity evaluation prior to administration. If qPCR is the cutting-edge for pathogen determination, then how is antibiotic resistance to be determined without growing a culture? Enter the era of PCR-determined antibiotic resistance. The ability of a pathogen to resist antibiotics is based on possession of genetic codes. PCR technology can be used to determine whether or not a microbe population has the capability to express resistance. It is true that just because the gene for resistance is present, the microbe is not necessarily resistant. However, if resistance is a possibility, the engaged practitioner simply chooses an antibiotic where resistance is not known to be likely. While the practice of veterinary medicine remains a practice, in a world of warp-speed vaccine development and administration, it seems that clinical diagnostics for infectious diseases are poised to exceed impulse power. The next big step since the introduction of antibiotics seems to have arrived. PETVET MAGAZINE

With the introduction of molecular determination of pathogens combined with molecular determination of antibiotic sensitivity into the arsenal of the general practitioner, veterinary medicine is ready to truly enter the war on antimicrobial resistance. This veterinarian’s prognosis for diagnostics in practice is positive!  Dr. Chatfield is board-certified in both zoological medicine and preventive medicine. She has been a practice owner, worked in zoos and completed international fieldwork. Dr. Chatfield’s peer-reviewed publications include pharmacokinetics, wild animal behavior, infectious disease, and assisted reproduction in endangered species. Additionally, Dr. Chatfield loves French bulldogs, Himalayan cats, the dirtiest of vodka martinis and basking in the sun on any Caribbean beach.

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petvet profile

Dr. Louisa Asseo shares her excitement for

By Jen Phillips April

s a kid, I was always bringing home bugs and lizards, much to my mother’s dismay,” shares Veterinarian Dr. Louisa Asseo who has always had an affinity for reptiles. Far from being a passing childhood phase, she continued her interest in college. “I’ve had a Blue Tongue Skink since 1994. His name is Dude. He was my start in reptile medicine. When I got him in 1994, the prognosis for his health was poor. The literature says they live to around 15 years, but here he is, going on 27. He taught me how much we still needed to learn about captive reptiles and inspired my desire to improve their health and happiness while in our care.” Dr. Asseo serves as the medical director at Oasis Veterinary Hospital in Martinez, California. She’s also active in the Association of Reptilian and Amphibian Veterinarians (ARAV) and currently serving as the President-elect. Dr. Asseo says there is a common misconception that reptiles and amphibians don’t need veterinary care: “That’s not correct. Our goal with ARAV is to bring public awareness to the need for professional care for these animals.” Reptiles as pets are growing in popularity. According to a recent report,1 reptile product sales are in growth mode from $495 million in 2019 to reach between $550-$650 million in 2024. “We’re here to help. Each reptile you get is a

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“I’ve had a Blue Tongue Skink since 1994. His name is Dude. He was my start in reptile medicine. When I got him in 1994, the prognosis for his health was poor. The literature says they live to around 15 years, but here he is, going on 27.”

– Dr. Louisa Asseo commitment. It’s a long-term commitment, and we want to help people take care of these animals and make sure that it’s for more than the ‘cool’ factor,” Dr. Asseo continues. “We make sure to ask the right questions to match a reptile with a good home. Questions like, ‘Are you going to have the space for that tortoise or monitor lizard? If you have a long-lived animal, put them in your will.’ We want to make sure we’re doing our due diligence to set them up for success.” There are practical reasons for people welcoming reptiles into their homes as pets. As Dr. Asseo says, “Many require less space than a dog or cat, and once their habitat is set up well, they can require less daily maintenance. You can leave them for a night or two if you have to travel.” Dr. Asseo sees both experienced reptile owners, like breeders and long-time collectors, as well as inexperienced people. “Some just inherit a bearded dragon and have no idea what to do with it.” One of her goals as a veterinarian is to educate

people on the importance of husbandry. “What’s good for an iguana is not the same for a bearded dragon. For example, an iguana needs 80-95 degrees and 70-90% year-round humidity. They also like to climb, so they need height to be happy. A bearded dragon needs it between 80-110 degrees, but 20-30% humidity. We want to mimic their natural habitat.” Dr. Asseo doesn’t work exclusively with “companion exotics” or “odd critters;” as a veterinarian, she knows them all. She does work with cats and dogs, too. “One of my biggest mentors said to me, ‘To be excellent in reptile medicine, you have to be a great dog and cat veterinarian. That’s where the most cutting-edge medicine is happening,’” she shares. When she’s not working, she keeps a full schedule. “I get bored if I’m not either learning or working on something,” Dr. Asseo says. She has a husband, three cats, two dogs, several reptiles and a Meyer Parrot at home. She also scuba dives, kickboxes, runs and tastes wine. 

References 1. https://www.businesswire.com/news/home/20200513005335/en/Sale-of-Reptile-Products-Forecast-to-Grow-from-495-million-in2019-to-Reach-Between-550-million-and-650-million-by-2024-COVID-19-Adjusted-Forecasts---ResearchAndMarkets.com A web writer since 2005, Jen’s written over 1,000 articles on pet-related topics. She works with veterinarians and pet professionals around the world to help them attract and retain customers through effective content marketing practices. Passionate about both pets and digital marketing, you can find out more at jenphillipsapril.com. When not working with her fabulous clients, you can find her eating tacos and practicing her Spanish in her adopted home of the Riviera Maya.

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PETVET TOp 10

Ten things to DO

2 GIVE Flexitarianism a try.

Instead of clearcut rules of the vegetarian or vegan diets, the flexitarian way of eating is mostly plant-based, but doesn’t require a full-time meat-free commitment.

24th is world 1 April veterinary day. The theme for 2021 is “Veterinarian Response to the COVID-19 Crisis.” Share how you’ve helped the world respond to COVID-19 for a chance to win the WVD award and a $3,500 prize! For more info, visit www.worldvet.org

Keep clients away from “DR. Google” & direct them TO AMC’S

online Pet Health Library! The AMC’s Usdan Institute for Animal Health Education launched an innovative, user-friendly Pet Health Library on its website (amcny.org/pet-health-library/) which provides information on common illnesses and conditions, wellness and prevention tips, and downloadable resources.

May 8th iS NATIONAL

find THE BEST dog services near you

ANIMAL Disaster

Preparedness Day.

Put together some resources to share with your clients to encourage them to create a plan for their pet in the event of a disaster.

Make new friends, setup playdates &

with the new app Canoodle. This social media platform lets dog lovers talk, blog and explore with no boundaries. Find the best match for you and your special companion!

PETVET MAGAZINE

this month

May is Lyme Disease Prevention Month. With cases of Lyme disease now seen in dogs in every U.S. state, it is more important than ever to talk to clients about prevention of this deadly disease.

NOT COMFORTABLE WITH AIR TRAVEL yet?

8 Keep tabs on the state of

the veterinary industry Plan a road trip to a national park!

with VetSuccess’ Veterinary Industry Tracker, now avail-

To find the closest natural treasure

able on AMVA’s website and in their monthly newsletter,

to you, visit www.nps.gov

“AVMA Practice Pulse.” This tracker provides veterinary professionals with the most current and insightful data so they can monitor key veterinary indicators and make more informed business decisions.

young veterinarian? photo viA vetsetgo.com

9 Healthy(ish)

10 Know an aspiring

cocktails

are all the rage! More people are reaching for alcohol-free spirits, low-calorie alcoholic beverages and boozy versions of popular healthy beverages. And, homemade craft cocktails continue to be popular with the work-from-home crowd. See what you can create today!

Encourage them to enter Vet Set Go’s (www. vetsetgo.com) annual “Become a Veterinarian Camp Contest 2021.” This online essay contest will award three students camp tuition and room and board at the Auburn Junior Veterinary Camp in Auburn, Alabama. 

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