PetVet September October 2018 by Barkleigh Productions

WWW. PET VETMAGAZINE .COM

VOL. 1 ED. 2 â&#x20AC;¢ SEPTEMBER / OCTOBER 2018

A Practical Guide for Pet Health Professionals

Dr. Justine Lee

VETGirl ON TOP

HOW INDOOR AIR QUALITY AFFECTS THE FINANCIAL HEALTH OF YOUR BUSINESS

PHOTO BY LESLIE PLESSER SHUTTERSMACK PHOTOGRAPHY

5STRUGGLE

WAYS TO

COMBAT THE

DESSERT

IT’S NOT JUST A BOWL It could shut down your business.

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SEPTEMBER / OCTOBER 2018 A Practical Guide for Pet Health Professionals

CONTENTS 6

Veterinarian Life Advice

PetVet Advisory Board

8 16

LI KE

TH EN

NOW

Combating The Comeback of Canine Flu

22 Low–Level Laser Therapy: Should You

Tailor your Veterinary Practice Marketing to the Way Pet Owners Think

LIKE FATHER,

Offer This Management Technique in Your Practice?

24 Five Ways to Combat the Dessert Struggle for the Busy Vet Professional

SICK BUSINESS

26 Dr. Justine Lee: VETgirl on the TOP

HOW INDOOR AIR QUALIT Y

30 PetVet Top 10: Ten Things to

Do This Month

AFFECTS THE FINANCIAL

WWW. PET VETMAGAZINE .COM

VOL. 1 ED. 2 • SEPTEMBER / OCTOBER 2018

A Practical Guide for Pet Health Professionals

Dr. Justine Lee

VETGirl ON TOP

SICK BUILDING

HEALTH OF YOUR BUSINESS

5STRUGGLE

WAYS TO

COMBAT THE

DESSERT

HOW INDOOR AIR QUALITY AFFECTS THE FINANCIAL HEALTH OF YOUR BUSINESS

PHOTO BY LESLIE PLESSER SHUTTERSMACK PHOTOGRAPHY

ON THE COVER Dr. Justine Lee - VETGirl Photo by Leslie Plesser Shuttersmack Photography

Copyright September 2018. PetVet Magazine is published bimonthly by Barkleigh Productions, Inc, 970 West Trindle Road, Mechanicsburg PA 17055. Postmaster: Send change of address to Pet Vet Magazine c/o Barkleigh Productions, Inc., 970 West Trindle Road, Mechanicsburg PA 17055. No part of this publication may be reproduced without written permission of the publisher. Editorial offices: 970 West Trindle Road, Mechanicsburg PA 17055. (717) 691–3388 FAX (717) 691–3381 Email: info@barkleigh.com

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VETERINARIAN LIFE ADVICE

Your Motivation Starts Here LIFE ADVICE FROM THE COOLEST VETERINARY PROFESSIONALS WE KNOW

“

CONTACT Inquiries: info@barkleigh.com (717) 691-3388 Editorial: rebecca@barkleigh.com (717) 691-3388 (ext. 225) Advertising: james@barkleigh.com (717) 691-3388 (ext. 224)

STAFF Publisher Barkleigh Productions, Inc.

MEDICINE

THE

BEST

President Todd Shelly Vice President Gwen Shelly Chief Operations Officer Adam Lohr Executive Editor Rebecca Shipman

IN the

Art Director Laura Pennington Senior Graphic Designer Jenn Barraclough Junior Designer Jenny Thomas

You get to make a difference every single day. You touch the lives of animals, the people they live with, the people you work with. You can be in practice, but you can go anywhere with this profession: you can be in research, in industry, in rescue, in an NGO, in government, and, my fav, you will ALWAYS be an educator.”

Margie Scherk, DVM, Dip ABVP (Feline Practice)

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Web Master Luke Dumberth Director of Marketing & Client Relations James Severs Administrative / Marketing Assistant Karin Grottola Marketing Coordinator Alyx Robertson Social Media / Pr Coordinator Chelsey Hall

ADVISORY BOARD

Meet our EDITORIAL

ADVISORY BOARD!

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

Michelle Evason BSc, DVM, DACVIM

Jenifer Chatfield DVM, DACZM “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.”

“There are as many diverse, fascinating and impactful career opportunities within this profession as there are exceptional people. Being a veterinarian ensures life stays fun!”

Julie Legred CVT

Alberto Fernandez DVM, DACVECC "The human race will not be possible without the animal kingdom. It is our duty to take care of those that provide to us and to me it is an honor to do so."

Lisa Powell DVM, DACVECC

“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.”

Jill Richardson-López DVM, MBA

“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.”

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“Do something every day to make an animal’s life better.”

CLIENT SERVICES

HOW TO TAILOR YOUR

VETERINARY

PRACTICE

MARKETING TO THE WAY PET OWNERS THINK By Karyn Gavzer

et’s face it. Nobody goes into veterinary practice to become a great marketer. Very few even think about how to market what they do, or realize how much their success in practice depends on it. Back in the 1950’s, it was enough to just hang out a shingle if you wanted to open a veterinary practice. It all but guaranteed success. It doesn’t work that way today. It’s unrealistic and so is the expectation that just doing a good job will be good enough to guarantee clients for a veterinary practice. The “New” Word–of–Mouth Marketing There are some basic truths in marketing that never change, for instance, word–of–mouth advertising is still the best marketing there is. However, what’s different about word–of–mouth advertising today is that it’s on steroids. Now, instead of telling one or two other pet owners about you—for good or for bad—clients can tell hundreds at a time. It is called online reviews. The good news is that veterinary practice teams have a lot of control over online reviews and it starts in their offices, not online.

Here are some things to know: 1. Word–of–mouth marketing is built one client at a time. It depends on how clients feel about their veterinary visit, not just the clinical veterinary care they received. We’ve known since 2007 that clients who trust you and understand the value of your recommendations say ‘yes’ more often and are more accepting of fees.1 This makes warm, personal communication throughout the visit as important as the clinical experience for the client and the pet. Veterinary team members need to be knowledgeable and competent in both clinical and client communication skills to foster a positive client experience. Does your staff training cover both for all staff members, not just the client service representative (CSR)? 2. Avoid Negative Reviews. According to the American Marketing Association, upset customers are the number one reason for bad reviews. Don’t let a client go home angry. Try to solve the problem on the spot. And if that’s not feasible, make a plan to speak with the client as soon as possible to try and resolve it. This takes away the client’s motivation to vent online

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and it decreases the probability of a negative review. And it may also help you identify problems to fix to avoid future client issues. What procedures and training do you have in place for managing an upset client? 3. Encourage Positive Reviews. All medical practices live or die by their online reputation. It’s easy to encourage positive reviews. When a client tells you how pleased they are about something during their visit, thank them and ask them if they would do you a favor and post a review online. Tell the client it would help others like them find your practice and it would mean a lot to you. Then make sure to send a follow up note by e-mail to thank them again for their promise to post an online review. Include a link to click on for the review site on which you want them to post their comments to make it easy for

them to follow through. If you don’t feel comfortable doing this, hire an outside firm to do it for you, because without encouragement of this kind, clients will think they’ve done enough when they thanked you in your office. How Veterinary Marketing Works from the Client Side Your veterinary website and Search Engine Optimization (SEO) are two other key marketing pieces because they are how clients find you. Once they find you, they will use online reviews to decide if they want to choose your practice for their pets. Making a decision on veterinary care today is usually a two-step process, especially for younger pet owners who most practices need to attract. Here’s how it works: Pet owners go online to seek services

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Don’t let a client go home angry. Try to solve the problem on the spot. And if that’s not feasible, make a plan to speak with the client as soon as possible to try and resolve it.

owner behavior is greatly influenced

by the interneT

39% OF PET OWNERS

LOOK ONLINE

FIRST

IF THEIR PET IS

SICK OR INJURED

36%

WOULD NOT

TAKE THEIR PET TO

THE VET EXCEPT FOR SHOTS

and products for their pet to solve a problem or get what they want. They will also try to determine if they even need to work with a veterinarian or if there is a comparable alternative that would be cheaper or more convenient. New findings from the 2011 Bayer Veterinary Usage Study2 of over 2,000 pet owners showed that pet owner behavior is greatly influenced by the internet: • 39% look online first if pet is sick or injured • 36% would not take pet to the vet, except for shots (vaccinations and treatment injections) Pet owners have told us by their online behavior what they believe is important. They care if their pets are sick or hurting and they don’t want to spend a lot on injections that their pets need. Are you talking about the things they care about on your website and social media? For instance, if you educate pet owners about the subtle signs

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and symptoms of some diseases a dog or cat might show if they are sick, it might help more pets to be seen by the veterinarian earlier on. Once you help them with what they care about and build trust, you educate them about the other things theirs pets need—but you may never see them if you don’t start where they are at. Once a pet owner determines that they need to work with a veterinarian, the game changes. Now, they will look for the best veterinarian or practice for their pet—not necessarily the least expensive or the most convenient. These pet owners see selecting a veterinarian as a learning journey. They may decide that the journey isn’t finished yet; they may wait and see how their pet does; they may try an alternative; or they may decide to do more research before making a decision on a veterinary practice. When they finally do come in, they often want to tell you what they think the problem is, based on their research. This is not a sign of disrespect; rather it is an indication of pet owners who really care and are trying to get it right. Connecting with Today’s Pet Owner The point is that your customer has changed. We need to understand them and market to them in the ways that they welcome and act on. Here are some more ideas to better connect with today’s pet owners: 1. Realize that the pet and pet owner relationship has shifted. It’s called the “humanization” of pets and it means that pet owners see their pets more like a child than an animal. They are not expecting rough restraint, or having their pet dragged onto the scale or into the exam room. They expect care, gentleness and expertise in

handling their pets while they are in a veterinary practice. It is similar to the feeling most parents would have about their children at a pediatrician’s practice. Are you working with your team to ensure they have the skills to deliver according to today’s client expectation? 2. Technology has impacted marketing in ways that can be harnessed cheaply and economically to grow a veterinary practice. Today, you can reach and teach pet owners about the care their pets need and you can build stronger relationships with existing clients. At minimum: • Hire a good website designer to ensure that your website is not only attractive, fast–loading and functional, but that it is setup for Search Engine Optimization (SEO) and mobile–compatibility. These last two technology considerations will ensure that your practice can be found online. • Consider allowing pet owners to make their appointments online—be careful with this one, however, and make sure that they can pick an appointment time with their regular veterinarian, lest they be disappointed when they arrive. Also, make sure to confirm the pet’s appointment to decrease the probability of “no-shows.” • If you are not doing this already, start using text to communicate with clients after procedures and surgery at the hospital to let them know how their pets did and when they will be ready to come home. • Collect e–mail addresses and use them responsibly; ONLY to communicate with pet owners on useful, helpful or fun news for their pets. Pet owners will appreciate e-mail contact for: - - Reminders for their pet’s next appointment.

-- Timely pet alerts on new dog or cat diseases reported in your area or other urgent pet news that affects pets in your community. -- Invitation to events at the practice. -- Notification of special promotions at the practice. -- Announcement of practice contests, e.g. best pet selfie/best dressed pet. -- Announcement of changes at the practice, e.g., new doctor; new hours; new services. • Regularly post items on social media that are relevant and interesting to pet owners and true to your veterinary “brand”, such as: -- Stories with pictures or videos* on pets you’ve helped which will educate other pet owners about what you can do for their pets, e.g., the crabby dental patient who changed into a sweet and loving dog after you took away its mouth pain. -- A video showcasing a dog and cat receiving laser therapy or acupuncture and the amazing results they enjoyed after treatment. -- Video tips on helpful topics, such as how to clip a dog’s or cat’s nails without a struggle, or to how socialize your new puppy or play with your new kitten. -- Video clips and pictures of team members and others at community events such as a dog walk or community expo that the practice supported. -- A list of the most popular dog names and cat names (from your practice database) each year. -- A photo of a dog that your practice has DNA tested. Ask viewers to guess the breed, then surprise them with the DNA results.

*In all cases, make sure to have clients and staff members sign a simple release form to allow you to post their and their pets’ pictures online before you use them.

There will always be new marketing ideas and things that you can do. Keeping your customer in mind, and communicating with them in the ways they will expect will always be the key to marketing success.  References: 1 2007 AVMA-BN Research Fee Sensitivity Study 2 Bayer Veterinary Care Usage Study Resources: Free marketing and client communication training videos and other resources are available for veterinary teams at Partners for Healthy Pets, www.partnersforhealthypets.org Karyn is a popular speaker, writer and practice management consultant specializing in marketing, training and customized solutions for veterinary practices. Her mission is to help practices “go and grow” with new ideas and practical plans.She has worked with industry, associations, and veterinary practices for 20 years. She is best known as the former director of marketing for the American Veterinary Medical Association A Practical (AVMA) where Guide she created for public campaigns Pet Health with industry, such as “Pets Need Dentistry, Professionals Too” and training programs to help veterinarians and their teams market their services more effectively. www.karyngavzer.com

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A Novel Therapeutic Approach to Resistant Superficial Infections Author: Michael A. Rossi, DVM, MNS, Dip. ACVD Coastal Veterinary Dermatology & Ear Clinic, Houston, TX What do you tell your clients when their beloved, four-legged

dilute concentrations are low enough to be safely used in children

family member has a superficial, bacterial infection that is not

while showing efficacy against bacteria. A recent report in Veterinary

improving with their oral therapy? Most of us as practicing veterinary

Dermatology showed excellent in vitro antimicrobial effectiveness

professionals have been in a situation where patients do not respond as

of sodium hypochlorite at a dilution of only 0.00156% after 3 and 5

expected with conventional antimicrobials. The worldwide emergence

minutes of contact time! With little to no documented resistance, this

of bacterial strains resistant to virtually all antimicrobials available in

makes this ingredient very effective in managing skin infections. We are

veterinary medicine, namely methicillin-resistant Staphylococcus

very fortunate to have this agent commercially available in Command™

pseudintermedius , has complicated how we clinically manage

shampoo from Vetrimax. This product has shown efficacy against

bacterial infections. While the problem of antimicrobial resistance is

superficial infections caused by Staphylococcal bacteria, as well as

increasing with alarming speed in both animals and humans, there has

those caused by Malassezia yeast. Using this product in conjunction

been a striking reduction in the number of new antimicrobial products

with a sound long-term management plan, such as allergen-specific

in both of these fields. This has shifted focus away from systemic an-

immunotherapy, has the potential to mitigate the number of atopic

timicrobial agents and put more pressure on the development of novel

flares and secondary infections.

topical applications to manage superficial infections. These alternative

In addition to reducing the bacterial colonization on the skin, one

methods are being highly utilized as either monotherapy or as part of

of the other important factors in treating atopic skin disease is cor-

a polytherapy program to prevent or treat superficial infections in the

recting the cutaneous barrier dysfunction. We know through numerous

veterinary community.

studies that the ceramide content within the skin of atopic patients

Some of the most common patients needing help with controlling

is deficient. Many of the topical products that we utilize on a regular

infections are those with atopic dermatitis or atopy. Atopic dermatitis is

basis aim to replenish these crucial moisturizing factors in an attempt

a chronic, immune-mediated disease

to normalize the barrier defect and reduce transepidermal water loss. AtopiCream™ HC Leave-On Lotion from Vetrimax is a rehydrating lotion

of cutaneous inflammation and barrier dysfunction that affects approximately 10-15% of the total canine population. The condition can

that contains a steroid, as well as a ceramide complex and essential

be extremely frustrating and time consuming for both the pet owner

fatty acids to aid in restoring the normal function of the skin. Along

and the veterinarian alike. Factors, such as diverse clinical presenta-

with the moisturizing effects, this product also contains hydrocortisone.

tions, variations in the extent of clinical lesions, and the presence of

The benefits associated with this topical glucocorticoid have been well

secondary infections, including those by Malassezia yeast, complicate

established in both canine and human patients diagnosed with atopic

its treatment and have a significant impact on the human-animal bond.

dermatitis. Some studies have even shown a >50% reduction in clinical

Many recent studies, in both veterinary and human medicine, have

lesions and pruritus scores when this compound was utilized

highlighted the need, not only to address the systemic inflammation,

on lesional skin. This product also comes in a steroid-free version.

but to correct the known skin barrier defect in the atopic patient. There

This could lead to a significant benefit in patients suffering from this

is mounting data that shows that there is marked susceptibility of

condition if used on a routine basis.

individuals with atopic dermatitis to develop infections on the skin with

The field of veterinary dermatology continues to change at a rapid

Staphylococcus aureus in humans and Staphylococcus pseudinter-

pace. As a whole, we a searching for cutting edge treatment options

medius in dogs. These infections are thought to play a significant role

for controlling atopic dermatitis without over medicating patients. Most

in exacerbation of atopic dermatitis lesions. In theory, controlling the

of us are doing this by advancing our knowledge of allergen-specific

bacterial overgrowth in atopic patients could lead to better control of

immunotherapy and though advancements of topical therapies.

their underlying disease.

Incorporating Command™ shampoo and AtopiCream™ HC in a long-

Recently, there has been increased interest in the use of topical sodium hypochlorite (bleach) solutions in the treatment and prevention

term, topical management plan should increase our ability to control superficial infections and increase patient comfort from atopic flares.

of superficial infections in canine and human patients. Most of the 12

PETVET MAGAZINE

VETERINARY PRESCRIBED

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Why It Matters to Me

LI KE FATHER, LIK E

T H EN

NOW

By: Dr. Jill Richardson–López

r. Tim Fleming almost didn’t make it to his interview for the Mississippi State Vet School Class, but he had a great excuse—his six–week–old baby girl, Bailey, was sick with meningitis. But, fortunately, her fever broke and he was able to make it to Starkville just in time. Over the next few years, while daddy studied, Bailey grew up—first learning how to walk and later learning to speak her first words. Classmates were always delighted to see her smiling face when she visited Daddy on campus. She was

the unofficial member of the Class of 1995. After graduation, Dr. Tim relocated his family to northern Mississippi where he later purchased Hernando Animal Clinic. Bailey, a lifelong animal lover, spent her summers working for her father and eventually followed in his footsteps by graduating from MSU’s veterinary college in 2017 and joining her father at Hernando. And if two vets in one family wasn’t enough, Dr. Bailey married her classmate, Dr. Ryan Poling, a week after graduating.

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“He started taking me on farm calls as a child, so the level of training and support he shared, even from such a young age, was incredible.” – Dr. Bailey

Pet Care Facility DESIGN • BUILD • CONSULTING

IT WORKS Dr. Bailey says, “I think that working with my dad has been so easy because he has this fantastic ability to mentor without being stifling. He started taking me on farm calls as a child, so the level of training and support he shared, even from such a young age, was incredible. Plus he’s hilarious, so when practice brings rough days, which it inevitably does, he’s always there with a joke and a smile to make everything better.”

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IT MATTERS Dr. Tim says “Being in vet school was hard, and when you combine that with juggling the demands of a young family, it’s even more challenging. But, I could not imagine my life any other way.” 

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Industry News

COMBATING THE COMEBACK OF

CANINE FLU

By Steve Dale

Dr. Donna Alexander, administrator of the Cook County Department of Animal and Rabies Control, happened to be on my WGN Radio show talking about the county’s low–cost rabies clinics back in 2015.

t a commercial break, my producer mentioned that she was receiving listener phone calls about coughing dogs. We took one of those calls on the air, cautiously suggesting it’s possible that the canine influenza virus (CIV) had returned to Chicago. One lesson: Don’t assume too much. H3N8 is the flu that spontaneously jumped species, from horses to dogs in Florida in 2005, and outbreaks occurred sporadically across the country, including a limited outbreak in Chicago. We assumed it had returned. The assumption made sense—though on the air, we only cautioned people to visit their veterinarians. Alexander and I had no clue as to what was about to happen. Within days I heard from my own veterinarian, Dr. Natalie Marks at Blum Animal Hospital, and several other clinics also indicated that they were being overwhelmed with coughing dogs. Virologists agreed that the virus appeared to be CIV but realized this wasn’t H3N8. Meanwhile, with

each passing day, the outbreak worsened. I phoned Alexander and suggested she close dog parks/beaches. She said “I’m on it” so fast that I barely had the chance to say goodbye. Together, we formulated signage explaining why dog owners needed to be cautious about socializing with other dogs. Within only two weeks, at least hundreds, if not over a thousand dogs were sickened, and some died. The famed ER clinic, Med Vet Chicago, was filled with some of the sickest dogs. Soon the virologists found the needle in the haystack, pinpointing H3N2 somehow blowing into the Windy City from Southeast Asia, perhaps from dogs rescued from that part of the world. To this day, no one knows for sure how the virus arrived. Protocols and systems were being put into place in clinics on the fly. I’m not exaggerating to suggest some clinics were like war zones, and veterinary technicians, as usual, stepped it up. Veterinarians even saw some clients inside their cars. It was crazy.

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Like so many veterinarians, she was a hero, though her heroics were never publicized. Whatever Alexander did, it wasn’t about her—it was about the animals.

her condo was being repaired after being damaged in a fire. The fire happened only hours after she returned home after appearing with me on the radio to tout those vaccines clinics, which she was so proud of, on the Sunday before she died. She phoned on Monday to tell me about the fire, that her kitchen burned and that there was so much damage, she needed to move out. I expressed concern about her, her things...and she said, “No, no, I am calling to tell you about my neighbors’ cats.” “Neighbors’ cats?”, I wondered. “I trained all my neighbors on how to get their cats into carriers, should something happen,” she said. “They all got out

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Alexander and Marks (and others) continued to inform the general public. For example, they spoke about the risks of boarding dogs or taking them to daycare or groomers. Some daycare/boarding facilities were so flu laden, they had to close. My WGN radio show and my blog became sources of information (even for veterinary professionals). When the H3N2 vaccine became available (or the bivalent combo of H3N8 and H3N2 protection), I was the first to announce it. The Chicago area veterinary community couldn’t have prepared for this, but they came together, and greatly because of Alexander. I am certain her proactive efforts saved lives. I also mention this because Dr. Alexander passed away on June 5th of this year. Like so many veterinarians, she was a hero, though her heroics were never publicized. Whatever Alexander did, it wasn’t about her—it was about the animals. Cook County includes Chicago and many surrounding suburbs. It’s a big place. For years, Alexander gave each and every low-cost rabies vaccine personally, which equated to hundreds. Often she’d somehow remember names of dogs when they returned the next year. Who talks or writes about this sort of dedication? Bad news makes the press, but work ethic doesn’t. Alexander, who as a teenager appeared in the famed Breck Girls ad campaign for the shampoo, opted for veterinary medicine over modeling or show biz. She had been staying at a hotel while

safely. And I knew you would be thrilled.” She was once asked by a listener live on WGN about the dog flu vaccine, “Why vaccinate when most dogs get over the flu and only two to five percent die?” She paused and said, “What if that two to five percent is your dog?” Not one to easily become emotional, she did—I could see it, as she added, “I’ve met owners of that two to five percent. If we have a choice that will benefit our pets—I will always advocate for them. Perhaps, it’s my mission.” Not perhaps—this was Dr. Alexander’s mission. And may I say, ‘mission accomplished.’ 

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Best Practices

he year is 1983. Microsoft releases Word, McDonald’s introduces the McNugget and Tom Cruise’s popularity rises with Risky Business. It was also the year that the World Health Organization first uses the term “sick building syndrome” to describe the adverse health effects on people due to poor indoor air quality.

Decades later, Word, the McNugget, and Tom Cruise are all still with us. As are sick buildings. A sick building can spread outbreaks of upper respiratory infections (e.g. canine influenza), along with dizziness, asthma and allergies related to poor indoor air quality. Any of these can lead to temporary closures and long–term damage to your (and your business’s) reputation, as well as negatively impact staff health and performance. The potential health effects caused by the air in your business can ultimately impact the financial health of your business.

SICK BUILDING

SICK BUSINESS HOW INDOOR

AIR QUALIT Y AFFECTS THE FINANCIAL HEALTH OF YOUR BUSINESS

By Annette Uda

How Do Buildings Get Sick? Historically, the 1973 oil embargo and consequent energy crisis led to an effort by builders and regulatory agencies to make buildings air tight and more energy efficient. Making buildings “tighter” meant reducing the amount of outdoor air provided for ventilation. Bitter cold and brutal heat were managed, and pleasant indoor temperatures maintained—all thanks to heating, ventilation and air conditioning (HVAC) systems. However, tighter buildings also meant that the occupants breathed the same air, day in and day out. Just consider the quality of that air. This led to what was described by the Environmental Protection Agency (EPA) as, “Indoor Air Facts No. 4: Sick Building Syndrome”: “Most indoor air pollution comes from sources inside the building. For example, adhesives, carpeting, upholstery, manufactured wood products, copy machines, pesticides and cleaning agents may emit volatile organic compounds (VOCs), including formaldehyde. Environmental tobacco smoke contributes high levels of VOCs, other toxic compounds and respirable particulate matter. Research shows that some VOCs can cause chronic and acute health effects at high concentrations, and some are known carcinogens. Low to moderate levels of multiple VOCs may also produce acute reactions.” The EPA also points to chemical contaminants from outdoor sources, such as motor vehicle exhausts, biological contaminants such as bacteria, molds, pollen and viruses as contributing factors to sick buildings—and potentially sick occupants.

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What may be less obvious when it comes to the indoor air quality is the negative effect on staff performance. This can be due to simple decision–making impairment (e.g. headaches) or high rates of absenteeism thanks to the spread of colds or flu. What Does This Mean for Your Veterinary Hospital? Translating the EPA’s description to veterinary medicine, here are a few common biologic contaminant examples: A dog infected with canine influenza coughs, a cat infected with feline calicivirus sneezes and both shed dander. Chemical contaminant examples could include: VOC emission from your freshly painted reception area and “fragranced” surface cleaners. In veterinary hospitals, airborne contaminants may be heavy enough to eventually fall to the surface but most (including the aerosolized droplet nuclei from infected animals) will remain in the air and move throughout your building on air currents. These are generated by

your HVAC system as it works to keep your business warm in the winter and cool in the summer. Simply put, your building’s HVAC is the “lungs” of your business, recirculating that same air, breathing in and breathing out...and potentially leading to sick business syndrome in your own hospital. How Sick Buildings Can Impact the Financial Health of a Business The negative, if not potentially catastrophic, impact to an animal care business that suffers from an infectious disease outbreak among animals is obvious. Temporary closures of the clinic or business for the cleaning of a room, area or building equal a financial hit. However, the potential for long-term damage to

your or your business’s reputation can be even more devastating. What may be less obvious when it comes to the indoor air quality is the negative effect on staff performance. This can be due to simple decision– making impairment (e.g. headaches) or high rates of absenteeism thanks to the spread of colds or flu. Published March 21, 2017 for Harvard Business Review, author and researcher Joseph G. Allen tackles the impact of unhealthy building air on the

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The workers’ decision– making performances were evaluated using a standardized cognitive function test that researchers have used for decades. The results? Breathing better air led to better decision–making performance and higher test scores.

decision–making performance of office employees, in his article “Research: Stale Office Air Is Making You Less Productive”. Allen notes that, “While sick building syndrome is decades old, its associated set of symptoms such as eye irritation, headaches, coughing and chest tightness is still an issue today.” He continues to say, “Study after study has shown that the amount of ventilation, or fresh outdoor air brought inside, is a critical determinant of health. Good ventilation has been shown to reduce sick building syndrome symptoms, cut absenteeism and even reduce infectious disease transmission.” For his own study, Allen measured workers’ decision-making by altering air quality conditions of a highly controlled work environment from a conventional environment, which merely

met minimally acceptable standards, to an optimized one. The levels of VOCs in the space were changed by controlling the number of common materials that emit these chemicals–e.g., surface cleaners, dry erase markers, dry cleaned clothing and building materials. The workers’ decision–making performances were evaluated using a standardized cognitive function test that researchers have used for decades. The results? Breathing better air led to better decision–making performance and higher test scores. Further, the biggest improvements were in areas that tested how workers used information to make strategic decisions and how they plan, stay prepared and strategize during crises. Without even addressing the specifics of other potential health benefits, such

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as reduced sick building syndrome and absenteeism as a reason for improving indoor air quality, Allen concludes, based on his study that, “Ultimately, managers would be wise to routinely incorporate health impacts into all of their cost–benefit calculations. When health is accounted for, the costs for enhancing the indoor environment can be properly weighed against the health and productivity benefits. For example, an executive will clearly see that an enhanced facilities budget will reduce human resource costs. This makes buildings, in essence, a human resource tool.” Maintaining Optimal Indoor Air Quality in Your Business While most of us would prefer to throw open the windows and rely solely on fresh air, increasingly record–topping hot and cold temperatures make HVAC systems a necessity for operating an animal care business. As the lungs of your building and, ultimately your business, your HVAC system must be cared for to reduce the spread of disease, improve cognitive function and decrease absenteeism. Here are a few ways to improve your air quality and reduce sick building syndrome: 1. Improve the Functionality of Your HVAC System with Regular Maintenance

• Change the filters. For most buildings, HVAC filters should be changed at least every three months, but animal care can be an entirely different animal. Depending on how dirty or plugged the filters get, filters should be changed as often as every two weeks and certainly at least once a month. Be sure to check your HVAC manual to see what kind of filter you need to buy and recommendations for filter change. • Clean the coils. An integral part of your HVAC system are evaporator coils that absorb heat from the indoor air as it is blows over them. These coils become

dirty as dust and dander settle on them along with “biofilm”, a build–up of microorganisms that creates an impenetrable layer over the coils. Not only do dirty coils prevent the HVAC system from working efficiently by demanding increased electricity to function and decreasing air flow, but they can also create breeding grounds for bacteria. Cleaning the coils should be part of your regular routine. Again, be sure to consult your HVAC manual for more information specific to your system, but be aware of this important caveat: if you wait too long to clean your coils, not only will the biofilm be more difficult to remove, but aggressive cleaning to try to do so can result in damage to coils. 2. Utilizing Ultraviolet Germicidal Irradiation (UVGI) to Improve Air Quality, Enhance HVAC Performance & Reduce Maintenance Time

Ultraviolet Germicidal Irradiation (UVGI) offers an opportunity to dramatically improve the air quality of your business to prevent the spread of disease, reduce VOCs and other contaminants and keep your HVAC system working efficiently. UVGI has been used for 100 years to disinfect, sanitize and control infection in hospitals and other highly sensitive environments where maintaining sanitary air circulation, as well as surface areas, are critical. Briefly, UVGI works as a mutagen to bacteria, viruses and other microorganisms on a cellular level, penetrating the cell wall. This disrupts the microorganism’s DNA, breaking the carbon bond which causes the death of the cell and/or renders it helpless. Additionally, the right UVGI unit used in conjunction with photocatalytic oxidation can reduce VOCs and foul smells by breaking down the odors into carbon dioxide (CO2) and H2O. Portable and upper air UVGI products can target specific areas of your business, but UVGI can also be

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integrated with your HVAC system to disinfect the air throughout your business. The UVGI unit, when placed in your HVAC system, works as the indoor air passes through it, killing pathogens and breaking down VOCs. Further, UVGI placed by HVAC coils automatically cleans the coils, eliminating the need for, and cost of, regular coil cleaning maintenance and the use of harsh cleaning chemicals, all while increasing efficiency. The right amount of UVGI, along with correct installation of UVGI for HVAC systems, can provide both coil cleaning efficiency as well as air sanitization. Healthy Building, Healthy Business The impact of sick buildings has been recognized and studied for decades, and the evidence continues to mount. Unhealthy air can have a wide range of negative impacts on a business, from infectious disease outbreaks to staff absenteeism and cognitive impairment, all of which can impact your financial bottom line. Maintaining healthy indoor air quality by taking care of your HVAC system and considering the use of UVGI will help keep the rest of your business healthy as well.  Annette Uda is the founder of PetAirapy, the animal care industry’s leading manufacturer of UVGI surface and air sanitation equipment celebrating its tenth anniversary in 2018. Annette has a passion for animal health and educating animal care providers on reliable, non-toxic ways to create clean, healthy environments for your animal clients and your staff that are protected from airborne pathogens, infectious disease, and noxious VOCs. To learn more about her company, visit petairapy.com.

Business Trends Photos By Dr. Angela Dodd (Animal Wellness Center of Athens, GA)

SHOULD YOU OFFER THIS MANAGEMENT TECHNIQUE

IN YOUR PRACTICE? By Natalie Stilwell, DVM, MS, PhD

Laser therapy is an increasingly popular tool used to help manage a variety of veterinary patient concerns, including postoperative pain, arthritis and slow wound healing. Laser therapy is performed on companion animals, horses and even exotic species, and is widely accessible to general practitioners. How Laser Therapy Works Low–level laser therapy (LLLT), also known as photobiomodulation therapy, uses light emitted at a specific wavelength to stimulate cellular processes. Another term for LLLT is “cold laser therapy”, as the laser produces only a minimal amount of heat and energy compared to surgical lasers. The depth of light penetration is determined by the light’s wavelength, with superficial tissues absorbing light at lower wavelengths compared to deep tissues. Use of different wavelengths, light doses and intensities can greatly influence how LLLT interacts with target tissues. All lasers are classified by the amount of power they deliver, and therapeutic lasers in veterinary medicine belong to either class 3B (LLLT) or class 4 (high-power laser), with

the latter having a higher risk of side effects including thermal tissue damage. The rest of this article will focus on LLLT (class 3B). The many benefits of LLLT are not yet fully understood. At a cellular level, molecules known as “photoacceptors” use photon energy emitted by the laser light to enter an excited state. Certain cellular activities, including increased mitochondrial ATP and cell membrane permeability, as well as reduced cellular apoptosis and proinflammatory cytokine release are stimulated. These cellular activities promote formation of granulation tissue, collagen, bone and blood vessels, leading to increased delivery of oxygen and immune cells to the target tissues.

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The use of standardized eye protection is essential for humans and animals in the treatment room to avoid retinal damage from the laser. Applications in Veterinary Medicine LLLT has been studied extensively in human medicine; however, there is a relative lack of research-based literature examining LLLT for veterinary use. Currently, there are no standard protocols for laser therapy in veterinary medicine, and the optimal parameters for different animal species are still unknown. Therefore, dosage settings are typically based on manufacturer-specific recommendations, rather than on established guidelines for best practices. Most experts agree this area needs more research before we can understand laser therapy’s full potential in veterinary medicine. However, a safe starting point is to use parameters that have exhibited positive effects in the same species in peer–reviewed literature. Then, adjust doses according to the individual patient’s response to treatment. Many newer, veterinary–specific laser units also contain software to alter dosing parameters according to patient species, size, weight and coat color. LLLT performs best when used as one part of a multimodal treatment program utilizing pharmaceutical and non–pharmaceutical components. Potential applications for LLLT use include adjunct treatment of IVDD, surgical incisions, slow-healing wounds, laminitis, anterior cruciate ligament rupture, edema and other acute and chronic issues. Safety Considerations While LLLT is generally considered a safe therapy, its use is contraindicated

over areas of neoplastic tissue, endocrine tissue, active hemorrhage, open epiphyseal plates and gonads. The use of standardized eye protection is essential for humans and animals in the treatment room to avoid retinal damage from the laser. What to Know Before Buying A good–quality laser unit is not inexpensive, so it’s best to do your homework before purchasing one. Start by researching units that meet international laser safety standards and are made by manufacturers offering training and technical support for veterinary use. Laser therapy typically offers an excellent return on investment. A trained veterinary technician or nurse can perform treatments, and most patients tolerate the short, painless sessions well with minimal restraint. Sessions typically occur frequently at first and then are gradually spaced out for chronic conditions. Pricing can be based on treatment site or appointment time length, with pre–paid packages for multiple sessions. As many clients are unfamiliar with laser therapy, they will appreciate educational materials, as well as individualized progress reports via pictures and videos. In conclusion, laser therapy is a promising modality to incorporate into general practice. While continued research is needed to establish standardized protocols for different species and applications, LLLT has a wide safety

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margin, is relatively non–invasive, and offers a variety of potential applications from patient rehabilitation to management of geriatric pain. Purchase of a unit, together with appropriate training of staff and patient selection, can provide a benefit to patient care and also improve your bottom–line. Reference: Riegel RJ, Godbold Jr JC, eds. Laser Therapy in Veterinary Medicine: Photobiomodulation. West Sussex, UK: Wiley Blackwell, 2017. Natalie Stilwell combined her love of animal health and writing to create Seastar Communications and Consulting, a veterinary writing and consulting business based in Athens, Georgia. Through her business, “Dr. Nat” practices aquatic animal medicine and provides veterinary and scientific materials for a variety of clients. She lives with her husband (a fellow fish vet) and their furry, feathered, finned, and shelled “kids”.

LIFESTYLE

TO combat the

STRUGGLE FOR THE BUSY VET PROFESSIONAL By Caitlin Kiarie

More often than not, parents are struggling with when to offer dessert, what to offer for dessert and how frequently to offer it. And, if you are a very busy veterinary professional struggling with maintaining a good work/life balance, you have even less time to argue.

llow me to guide you along what I believe to be the easiest and most effective ways to combat the “dessert struggle” so that mealtimes can be pleasant for all of you. Don’t label your food. A friend of mine told me that, when she was in vet school, she was obsessed with maintaining her weight. She decided to stop eating carbs completely and focused more on high protein foods, like steak and eggs. However, when she got stressed at school, she would find herself sitting on the couch eating an entire bag of cookies or a pint of ice cream and then feeling miserable afterwards. She defined carbs as “bad” and tried to avoid them. When we label a food as “unhealthy”, “bad” or too high in sugar, it causes us to

want to restrict that type of food from our household so it won’t be over–consumed. However, we all know that restriction is the bigger cause of eventual overconsumption. We need to stop labeling foods as good or bad and remember that ALL foods have a place in a healthy diet. All things in moderation. Children who aren’t offered the opportunity to learn moderation at home can become the ones who can’t stop indulging at birthday parties or social gatherings. In fact, it becomes a vicious cycle where kids feel restricted, go to a party and get the chance to indulge, inevitably over-consume and then parents think, “See, this is why I don’t have cookies in my house, she can’t control herself ”. In reality, for most children, the opposite would be true. If cookies, for

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example, were offered on a more regular basis and not restricted, they wouldn’t feel the need to overdo it because they aren’t “taboo”. The icing on the cake (pun intended) is for you to regularly consume dessert with your child to role model this goal of moderation. Let them have the cake! Not only do children need to have exposure to sweets more regularly to learn moderation, but they also need to learn that food is not contingent on behavior. When dessert is used as a punishment in any way, whether it’s because they haven’t eaten a good enough meal or because they acted out behaviorally earlier that day, they begin to learn that the dessert is a special treat which further increases desire and allure for that supposed “unhealthy food”. This in turn makes it harder for them to practice moderation as the dessert becomes higher on the hierarchy of foods. A DVM Mom confessed to me that she would threaten her four year old daughter that she wouldn’t get a piece of chocolate if she didn’t pick up her toys. By doing this, she was actually teaching her daughter that chocolate withholding was punishment and making chocolate into a very special reward. Food is not a reward. Likewise, when we use dessert as a reward for positive behavior, as is commonly done with potty training, getting good grades or eating everything on their plate, children learn the habit of using food as a way to reward themselves later in life. I think most people can relate to this issue as adults when we feel we have earned that chocolate brownie after working hard, dealing with an especially nasty pet owner or for being so “good” on our diet. Somewhere in our subconscious we foolishly believe that food will make us feel better or

All things in moderation If cookies, for example, were offered on a more regular basis and not restricted, they wouldn’t feel the need to overdo it because they aren’t “taboo”. should be part of celebrating our own achievements. So while there is nothing wrong with having delicious food as part of holiday or party celebrations, it shouldn’t be the routine way in which we congratulate ourselves. Dessert with dinner. Now that we have established the need for dessert as a learning opportunity for moderation and eliminated using it as a way to punish or reward children, we can talk about how to incorporate it into your family’s lifestyle. Enter...dessert with dinner. Remember the saying, “Life is short, eat dessert first”? Well there’s something to be said for that when feeding children. When they are given the opportunity to see all the options on the table including dessert, they can eat the right amount for their bodies. If instead they had eaten all their dinner until feeling full (which is the goal to eat until we feel full, not to please others), and were then offered the dessert, it would entice them to eat past their fullness. Over time, eating past fullness will lead to deregulation of their appetite, eventual weight gain and possible decline in their health. Wasn’t this exactly what we were trying to avoid to begin with? Wasn’t our goal as the parent to protect their health, which is why we weren’t giving too many sweets to begin with? When they can equally view their chicken or sweet

potatoes on the same level, at the same time as their cookie, you might find that they end up eating less of the sweets. Above all, you are your child’s greatest role model. They need more of us to “walk the walk” and do less of the “talk” in order to continue developing a healthy relationship with food!  Caitlin Kiarie is a Registered Dietitian Nutritionist and founder of Mom-N-Tot Nutrition who believes creating a lifetime of healthy habits starts with the proper foundation. She helps families create healthy habits from pregnancy cravings through childhood food fights by way of private counseling, large workshops, small group lectures, kids cooking classes, and grocery store tours. For more information, visit MomNTotNutrition.com or learn A Practical for more great tips Guide by following Caitlin on Pet Health Facebook at https://www.facebook.com/ Professionals momntotnutrition or on Instagram @MomNTotNutrition

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Dr. Justine LEE

ON TOP!

By Steve Dale

At 45, Justine Lee is now a superstar in veterinary medicine, having co-created (with Dr. Garret Pachtinger) what is arguably the leading online platform for continuing education for veterinary professionals, called VETgirl, which is now celebrating its fifth anniversary.

ETgirl (vetgirlontherun.com) offers webinars, educational videos and podcasts. While Lee won’t disclose exact numbers, nearly two million have downloaded the free podcasts, from 170 countries. Sponsored webinars are also offered at no charge. And on Facebook, the VETgirl page has grown organically to nearly 157,000 followers. “Our goal was kind of simple and that hasn’t changed,” says Lee. “For busy veterinarians and technicians, we felt there isn’t always a need to travel

for CE and to read those journals that pile up can be impossible. CE can be as close as your phone, iPad and may happen in the comfort of your home.” And the CE itself isn’t extravagantly theoretical. “It’s all about what people can really use in practice,” Lee says. One example is that when the H3N2 strain of canine influenza virus (CIV) hit, Lee was one of the first to work hard to sort fact from fiction when little was really known about how quickly the virus may spread, how it might spread (such as on objects, fomites), and

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what clients might do to avoid flu, and has been a proponent of vaccination. Lee notes that CIV is likely underdiagnosed, maybe significantly so. Most clients don’t want to pay for the lab work, and veterinarians know how to treat upper respiratory. Often based on symptoms, the assumption is CIV. So, the lab work isn’t “pushed.” “I wish more veterinarians would then diagnose as canine infectious disease complex—not bordetella, or even CIV if it’s really unknown. And we’ve learned that many dogs, or some dogs, have two ideologies: H3N2 and parainfluenza, for example,” Lee continues. These are more reasons to vaccinate for H3N2, or arguably the vaccine for H3N2 and H3N8. Lee also supports the notion that dog flu should be added to the list of mandated vaccines for dog kennels and dog daycare. And encourages veterinary practices that board dogs to think about it as well. “Bottom line, dogs should be protected,” she says. Lee is a great teacher—and teaches countless thousands in her online classroom annually. But she doesn’t consider herself as such. After all, she’s Minnesota modest, and Minnesota nice. Lee isn’t originally from Minnesota. She spent most of her life in the East, growing up in New Jersey, going to vet school at Cornell University College of Veterinary Medicine in Ithaca, NY, interning at Angell Animal Medical Center near Boston, MA and then heading back to Cornell to teach for a year. She taught anatomy and emergency medicine. “I’ll be honest,” she says. “It’s totally ironic I taught subjects that I once got a C in. I was a total C student.” But even C students can reach for excellence—once they find their niche, which Lee finally found in emergency medicine and critical care. And she did

Lee is a great teacher—and teaches countless thousands in her online classroom annually. But she doesn’t consider herself as such.

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her residency for just that at the University Of Pennsylvania School Of Veterinary Medicine. St. Paul, Minnesota seemed an odd place for her to land. But she’s thrived there with her husband, Jason and her 1½ year old son. For those who have known Lee it’s no surprise that she’s athletic; a runner (of shorter distance events—no marathons for “vet girl”), kick boxing and ultimate Frisbee—but morel mushroom hunting? “It makes senses,” she argues. “I’m a foodie; I love mushrooms. I love to hunt for mushrooms.” Sadly, she gets no help from her dog, who is not a mushroom hunting hound, but instead a pitbull–mix named Milo. Her cat is a domestic shorthair, who she and her husband adopted after losing both of their elderly cats last year within days of one another. Lee, herself, loves to learn and has grown into her role as a teacher, which she takes very seriously. And she has thousands of admirers worldwide. Back in the day, Prince tickets might be easier to come by than the first ever VETgirl U conference, which took place in

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August in Minneapolis. It sold out as soon as word got out. So, what makes this mushroom hunter a veterinary rock star? She answers, “I’m no rock star, but our success is clinical relevance and sticking to science,” she says. Her model works, in part, because so many veterinary professionals are just like Lee, a busy mom with outside interests (though few likely hunt for mushrooms), and the CE is practical and convenient. Steve Dale, CABC is a certified animal behavior consultant. He’s host of three radio shows about pets, and is editor of “Decoding Your Dog,” authored by members of the American College of Veterinary Behaviorists. He’s authored/contributed to many books, including several veterinary textbooks. He’s on the Board of the Winn Feline Foundation and Human Animal Bond Association. His blog is www.stevedale.tv

How do you protect the pets in your care from airborne disease? PetAirapy KILLS more than 99.9% airborne and surface pathogens, and controls odors 24/7 Infectious pathogens can live in the air for up to two weeks. Our proprietary Ultraviolet Germicidal Irradiation (UVGI aka UV-C) technology disinfects and sanitizes everywhere germs are found. PetAirapy PREVENTS AND DESTROYS DOG FLU, CANINE COUGH, DISTEMPER, PARVOVIRUS, AND MORE. Our products are manufactured exclusively for the animal care industry and custom designed for your particular needs.

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PETVET TEN SEPTEMBER 4TH IS NATIONAL

1 DAY

MACADAMIA

Update yourself on the potential macadamia nut dangers for dogs here: https://aspcapro.org/sites/ pro/files/x-toxbrief_0402_0.pdf

3 Just because you work with anal glands doesn’t mean you have to smell like them! Pamper yourself with a new fragrance. Discount department stores, like Marshall’s carry name brand perfumes at bargain prices.

While rabies is a 100% preventable disease, each year, over 59,000 people die from this horrible disease, most occurring in Africa and Asia. Take time to learn more about how you can help causes like Mission Rabies and Rabies Free Africa.

PETVET top 10

Ten things to do this month see how many you can do!

NAB A NEW SCENT

September 28th is World Rabies Day

Habla Espa Ñol

Did you know that more than 13% of Americans are native Spanish speakers? Show your Spanishspeaking clients your love by sharing these great pet care podcasts from Dr. Marta Sanchez https://www.petliferadio.com/ hablandodeperrosygatos.html

This is a great time to get organized at home. That means make three piles; keep, donate and trash. The Disabled Veterans of America offers free pickup of your unwanted items, including clothes, toys and small appliances. For info on how to donate, visit www.donatedav.org

ORGANIZE AND

DONATE

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FOR THE KIDS

NATIONAL

Veterinary

Kidsfresh is an easy option for moms on the move. These tasty microwavable lunches take two minutes to prepare and are packed with pureed vegetables that your kids will never see coming. Check them out at www.kidsfresh.com

Technician

Everyone loves

free stuff! Throughout September and October, vets can register for free diabetes management kits (that include insulin, diabetic food, and glucometer) at www.Petdiabetesmonth.com

10 FRESH

WEEK

7 The third week in October is

MAKING LUNCHES

Show your team that you care and splurge on a fun party. Our suggestion is a movie night in the clinic with “Isle of Dogs”—which has pet humor that will be appreciated by all.

Halloween

Means

CHOCOLATE Halloween is coming and that means lots of dogs ingesting chocolate. Keep the ASPCA Animal Poison Control Center’s number handy (888-426-4435).

FAST AND

MEALS

Looking for some easy, healthy recipes to make for your entire family? Check out Weelicious by Catherine McCord. Meals are available for around $17 on Amazon.

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