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    Vtb 20140601 jun_2014 Vtb 20140601 jun_2014 Document Transcript

    • From the publisher of Clinician’s Brief A Peer-Reviewed Journal | June 2014 | Volume 2 Number 5 veterinaryteambrief.com CLINICAL SUITE: MRSP Infections Compassion Fatigue Risks Cyberbullying: Response Techniques Reduce Stress Through Mindfulness Is Proper Nutrition a Fad? Drowning In Difficulties At The Practice? Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • From the publisher of Clinician’s Brief A Peer-Reviewed Journal | June 2014 | Volume 2 Number 5 veterinaryteambrief.com CLINICAL SUITE: MRSP Infections Compassion Fatigue Risks Cyberbullying: Response Techniques Reduce Stress Through Mindfulness Is Proper Nutrition a Fad? Drowning In Difficulties At The Practice? Contents | Zoom in | Zoom out Search Issue | Next PageFor navigation instructions please click here Contents | Zoom in | Zoom out Search Issue | Next PageFor navigation instructions please click here
    • IMPROVING PETS’ LIVES BEGINS WITH A FEW CLICKS. Get the nutrition knowledge you need to help pets live active, healthy lives. Start today and earn up to 15.5 hours of continuing education credit through our free online, self-paced program at DailyNutritionMatters.com. Trademarks owned by Société des Produits Nestlé S.A., Vevey, Switzerland. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • EDITOR’S LETTER Stop. Imagine. I’m scared. I am about to leap off a cliff of my own making. Nine months ago, after another fruitless round of discussing difficult coworkers, frustrating regu- lations, and the desire to experience more creativity in our work, my husband said, “So, let’s do something positive, instead of just talking!” That statement led to where we sit to- day. It opened up our minds and our options. It lifted us up and out of the circular discussions about what wasn’t working in our work life and life in general. We resolved to take a life sab- batical: in July, with 2 suitcases apiece, we will board a plane to Thames, New Zealand, for a year. How did we get from there to here? We decided to do it and we made it happen. It wasn’t easy, and undone details still crowd our to-do list. Yet we continue to march toward our date with Air New Zealand. We have a place to live, my husband has a job, and we have both negotiated leave ar- rangements with our employers. I will leave my university position of 16 years, the programs I’ve built, and the relationships I’ve nurtured. I face leav- ing my aging mother and 2 adult daughters, all of whom I love dearly. My husband will leave 28 years of commitment to a medical practice and patients who count on him. We will leave the home we built and the friends that give structure to our daily lives. When we share our plans with others, the response is inevitably: “Wow! We’d love to do that, but we just can’t “We’d love to do that, but we can’t imagine how we’d rearrange our lives to make it happen.” June 2014 Veterinary Team Brief 1 imagine how we’d rearrange our lives to make it happen.” It hits me that imagine is the operative word. If we cannot imagine taking a step, then it truly is impossible. Wayne and I had to imagine letting go of our current life to begin the work of mov- ing to New Zealand and a year of freedom. Once we realized we could step out of our current life and create a new one, it was as if an ice floe had broken. We found someone to rent our home. Our family and friends stepped in with offers of help, encour- agement, and support. We adjusted our budget. Step by step, what seemed impossible became a reality. This does not mean this move is easy, or free of grief and trepidation. This issue’s theme is “The Hard Stuff,” prompting me to share my upcoming challenge. Whether it is committing to a difficult conversation, facing yet another euthanasia, or taking a stand at work, allow yourself to imagine the outcome you hope to achieve. Then act. You will be surprised where action leads. As leadership pioneer Dale Car- negie said, “Inaction breeds doubt and fear. Action breeds confidence and courage.” I am scared, but I am also exhilarat- ed; I am brimming with the freedom of letting go, of challenging myself to figure out who I am without the trappings of my work and my status quo. The next time I write this col- umn, it will be from a desk in New Zealand! Best wishes, Kathleen Ruby, PhD Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • Kara Burns, MS, MEd, LVT, VTS (Nutrition) Ron Cott, DVM Beth Spencer, DVM Tracy Dowdy, CVPM Fritz Wood, CPA, CFP Veterinary Team Brief is a peer-reviewed journal. To subscribe: veterinaryteambrief.com/subscribe Veterinary Team Brief (ISSN 2324-917X) is published 10 times per year by Brief Media, an Educational Concepts company, 2021 S Lewis Ave, Ste 760, Tulsa, OK 74104-5713. Domestic subscription rate: $50.00 per year. Single copy: $8.00. Payments by check must be in US funds on a US branch of a US bank only; credit cards also accepted. Copyright © 2014 Brief Media. All rights reserved. Reproduction in whole or in part without expressed written permission is prohibited. POSTMASTER: Send address changes to Veterinary Team Brief, PO Box 3617, Northbrook, IL 60065-3617. Periodicals postage paid at Tulsa, OK, and at additional mailing offices. Editors in Chief Kathleen Ruby, PhD Jim Clark, DVM, MBA editor@veterinaryteambrief.com Editor Deborah Stone, MBA, CVPM deb@briefmedia.com Editorial Director Michelle N. Munkres michelle@briefmedia.com Managing Editor Paulette Senior paulette@briefmedia.com Clinical Suite & Capsules Editor Jennifer L. Schori, VMD dr.jen@briefmedia.com Associate Editor Samantha Brulé sam@briefmedia.com Editorial Assistant Amelia Williamson amelia@briefmedia.com Interactive Editor Lindsay Reese lindsayreese@briefmedia.com Medical Consultant Indu Mani, DVM, ScD, FNAP dr.indu@briefmedia.com Advertising John O’Brien john@briefmedia.com Kristen Holder kristen@briefmedia.com Naomi Murray, DVM dr.naomi@briefmedia.com Jillian Smith jillian@briefmedia.com Whitney Hewitt whitney@briefmedia.com Graphic Design + Production Mistretta Design Group, LLC jeanne@mistrettadesigngroup.com President Elizabeth Green beth@briefmedia.com Brief Media 2021 S Lewis Avenue, Suite 760 Tulsa, OK 74104 T: 918.749.0118 | F: 918.749.1987 ISSN 2324-917X (print) ISSN 2324-9188 (online) OUR MISSION Veterinary Team Brief will be the undisputed leading resource for each veterinary team member to optimize patient care and practice success. 2 veterinaryteambrief.com June 2014 Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM ________________ ______________ ________________ __________________ _______________ ________________ ______________ ________________ _________________ _________________ ______________ ____________________ _________________ _______________________ _______________ _____________________
    • June 2014 Veterinary Team Brief 3 TABLE OF CONTENTS 21 37 28 Editor’s Letter IN THE TRENCHES I am an office manager & veterinary assistant…Whitney York TECH TALK Proper Nutrition: Is the New Emphasis a Fad? PUT YOUR MONEY TO WORK Asking for a Raise: 5 Steps PERSONALITY PROFILE ENFP: The Workplace’s Champion SPECIAL FEATURE When Cyberbullies Strike: Best Response Techniques ARE YOU AT RISK FOR COMPASSION FATIGUE? TOP 5 Stress Reducers: Mending Through Mindfulness CLINICAL SUITE The team training series continues. This month’s focus: MRSP INFECTIONS IN DOGS & CATS DIRTY LAUNDRY The Chemically Impaired Colleague THAT SINKING FEELING: Stress & Anxiety in Practice SOCIAL MEDIA CALENDAR CAPSULES Current Literature in Brief THE BUZZ IN BRIEF MIND OVER MATTER Emotional Intelligence & Success: As Easy as Buying a Vowel CRUCIAL CLIENT CONVERSATIONS: Pets with Chronic Conditions Aids & Resources Advertisers Index 28 37 41 44 46 47 49 53 56 56 Handout 35 MRSP & Your Pet 1 7 8 10 12 15 21 24 53 Find more handouts at veterinaryteambrief.com Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • Who’s New at Veterinary Team Brief? Veterinary Team Brief is excited to announce changes in its editorial leadership: Jim Clark, DVM, MBA, is now Co-editor in Chief, joining Kathleen Ruby, PhD. Deborah Stone, MBA, CVPM, is now editor. In other news, Amelia Williamson joins the Veterinary Team Brief team as Editorial Assistant. SPECIAL ANNOUNCEMENT 4 veterinaryteambrief.com June 2014 “The expertise that Clark and Stone bring to Veterinary Team Brief will ensure that our entire network of resources—from social media, to our website, to our print journal— will work synergistically to demonstrate how good medicine, good business, and great leadership intersect to produce exceptional practices and people,” Ruby says. Clark says of his new role: “I’m very pleased and proud to be joining the editorial team. As a veterinarian and practice owner, I became an avid reader of Veterinary Team Brief (then Exceptional Veterinary Team) years ago because I found practical, peer-reviewed information in every issue. I’m committed to continue this tradition, sharing information and ideas that can benefit every member of the veterinary team.” Clark is currently a faculty member at the UC Davis School of Veterinary Medicine in California, where he teaches leadership, communication, and business management. He is also a nationally known author and speaker on veterinary practice management. Stone, owner of Stone Veterinary Practice Management in Austin, Texas, is currently pursuing a PhD in Leadership Studies. “Veterinary practice teams consistently strive to deliver outstanding patient care and client service while developing highly collaborative team relationships. Practice teams are ripe and ready for resources that will help them develop both professionally and personally,” she says. Clark and Stone have been previously involved with the journal, but will now play a more direct role in its content. Williamson recently completed her MA in English at the University of Tulsa. She honed her publishing skills at the James Joyce Quarterly and has worked as both a writing consultant and instructor. Also, Editorial Director Michelle Munkres is currently on maternity leave. Meanwhile, please contact Managing Editor Paulette Senior (paulette@briefmedia.com) or Williamson (amelia@briefmedia.com) with any questions. With this new leadership, Veterinary Team Brief continues to not only embrace its mission—to be the undisputed leading resource for each veterinary team member to optimize patient care and practice success—but also to take its content, including clinical content, to a higher level. Ruby Clark Stone Williamson Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM ________________ _______________
    • 1 Lulich JP, Kruger JM, MacLeay JM, et al. Efficacy of two commercially available, low-magnesium, urine-acidifying dry foods for the dissolution of struvite uroliths in cats. JAmVet MedAssoc. 2013;243:1147-1153.Average 28 days in vivo study in urolith forming cats. 2 Kruger JM, Lulich JP, Merrils J, et al. Proceedings.American College ofVeterinary Internal Medicine Forum 2013. ©2014 Hill’s Pet Nutrition, Inc. ®/™Trademarks owned by Hill’s Pet Nutrition, Inc. HillsVet.com/cdMulticare Help your patients get back to a normal life. CHANGE THEIR FOOD. CHANGE THEIR WORLD. The ONLY nutrition clinically tested to dissolve struvite stones in as little as 7 days1 and reduce the recurrence of FIC signs by 89%. 2 Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • But only 1 Bernie. Insurance plans are offered and administered by Veterinary Pet Insurance Company in California and DVM Insurance Agency in all other states. Underwritten by Veterinary Pet Insurance Company (CA), Brea, CA, an A.M. Best A rated company (2012); National Casualty Company (all other states), Madison, WI, an A.M. Best A+ rated company (2012). ©2014 Veterinary Pet Insurance Company. Veterinary Pet Insurance, VPI, and the VPI logo are service marks of Veterinary Pet Insurance Company. Nationwide Insurance is a service mark of Nationwide Mutual Insurance Company. 14VET2728a_BRIEFMEDIA otitis externa. Today, 4 cases of You’ll probably see your fair share of otitis externa today. Like you probably did yesterday, too. But no matter how common the diagnosis, we know the care you provide is anything but routine. That’s why VPI® covers more of what you treat every day. Our annual deductible and exam fee reimbursement are just two reasons pet owners love VPI. And our client compliance rates and breadth of coverage are why veterinarians love us, too. Recommend VPI and watch your patients—and your practice—grow healthier. (866-838-4874) Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM ________________________
    • June 2014 Veterinary Team Brief 7 IN THE TRENCHES I am an office manager & veterinary assistant... Whitney York HOMETOWN: Greensboro, North Carolina WHERE I WORK: Acadian Oaks Pet Clinic, Baton Rouge, Louisiana I DO WHAT I DO BECAUSE: Helping people to better understand their pets’ needs is the most fulfilling job I can imagine, even on the most difficult days. I enjoy being a part of improving an animal’s quality of life. MY FAVORITE THING ABOUT MY WORKDAY: I learn something new every day! WHAT INSPIRES ME: People with a positive outlook who always treat others well, even when their own lives are difficult. THE PATIENT I WILL NEVER FORGET: About 3 years ago, we worked with a crossbreed puppy that was found in a warehouse dumpster. She was such a loving, happy puppy, despite severe health issues. Watching her progress and heal each day made me feel lucky to be a part of her veterinary team. She had a happy ending in a loving home. I COULD NOT DO MY JOB WITHOUT: The veterinarian I work with on a daily basis, who has taught me more about the ins and outs of veterinary practice during the past 5 years than I could have ever hoped to figure out on my own. SOMETHING MOST PEOPLE DO NOT KNOW ABOUT ME: Five years ago, I lived in England, attended a music conservatory, and earned a postgraduate degree in flute performance. A chance visit to a local veterinary practice inspired me to change my career! Also, I actually enjoy working with fractious cats. I VALUE MOST: The support of my fiancé, Andreas Giger, and my mother, Marsha Lohr, who have both encouraged and believed in me through every step of my transition from musician to veterinary professional. WHAT I DO TO RELAX: I listen to and play music, which still relaxes and regenerates me. I am an avid reader. When time allows, I kayak in the Louisiana bayous to clear my head. WHERE I WILL BE IN 5 YEARS: Recently, I was accepted into Louisiana State University’s School of Veterinary Medicine, so in 5 years I hope to be a veterinarian! Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • 8 veterinaryteambrief.com June 2014 TECH TALK Kara M. Burns, MS, MEd, LVT, VTS (Nutrition) Academy of Veterinary Nutrition Technicians Wamego, Kansas Proper nutrition and its role in health and disease management is receiv- ing increased emphasis. But is the importance of nutrition overstated— could the profession's current focus be just a fad? On the contrary, proper nutrition is integral to patient health and disease management and is now considered the fifth vital assessment following tem- perature, pulse, respiration, and pain.1 As clients become increasingly aware of the importance of nutrition for their own health, they expect a higher stan- dard of nutritional care for their pets. Of the 3 components that affect the life of an animal—genetics, environ- ment, and nutrition—nutrition is the single factor the profession can affect to maximize health, improve performance and longevity, and manage disease. Theveterinaryhealthcareteam should be the best source of information for pets. Clients should be able to take ad- vantage of this expertise, but histori- cally, this has not been the case. The 2003 American Animal Hospital Association (AAHA) compliance study found that patients did not al- ways receive appropriate preventive care despite practice visits, primarily because clients did not think they re- ceived effective recommendations— including specific nutritional advice —from the veterinarian.2 Proper Nutrition: Is the New Emphasis a Fad? Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • PEER REVIEWED Assessment Guidelines To support the veterinary health- care team, AAHA and the World Small Animal Veterinary Associa- tion (WSAVA) have developed nu- tritional assessment guidelines (see Food for Thought) to help ensure that dogs and cats have an ideal nu- trition plan that takes into account each individual’s needs. Good nutrition is integral to optimal healthcare; therefore, it is crucial to incorporate a nutritional assessment and specific nutrition recommenda- tions into each visit.2 Every patient, healthy or ill, that enters the practice should have its nutritional status eval- uated and recommendations based on this evaluation. 3 Easy Steps A nutritional assessment considers the individual patient, diet, feeding management, and environmental factors. The assessment is an itera- tive process, where each factor that affects a patient’s nutritional status is assessed and reassessed as re- quired. Although nutrition’s impact on general health is complicated, Food for Thought Links to information on pet nutrition and veterinary healthcare: • WSAVA Global Nutrition Assessment Guidelines: wsava.org/guidelines/global-nutrition-guidelines • WSAVA Nutrition Toolkit: wsava.org/nutrition-toolkit • 2010 AAHA Nutritional Assessment Guidelines for Dogs and Cats: aahanet.org/Library/NutritionalAsmt.aspx the AAHA and WSAVA nutritional guidelines can be summarized in 3 easy-to-implement steps: 1. Integrateanutritionalassessment and specific dietary recommenda- tions into the physical examination for every patient at every visit. 2. Perform a screening evaluation (nutritional history, activity level, body weight, body condition score [BCS], muscle condition score) for every patient. 3. Implement an extended evalua- tion for patients with abnormal physical examination findings or nutritional risk factors (eg, life stage considerations, abnormal BCS or muscle condition score, poor skin or haircoat, systemic or dental dis- ease, history of snacks or table food >10% of total caloric intake, un- conventional diet, GI upset, inade- quate or inappropriate housing). Clients who understand that pre- ventive care preserves and lengthens their relationship with their pets are more likely to use veterinary ser- vices regularly, so team members should focus on proper nutrition for every patient that presents to their practice. Good nutrition is not a fad—it is good business and good medicine. See Aids & Resources, back page, for references & suggested reading. Good nutrition is integral to optimal healthcare; therefore, it is crucial to incorporate a nutritional assessment and specific nutrition recommendations into each visit. June 2014 Veterinary Team Brief 9 Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • 10 veterinaryteambrief.com June 2014 PUT YOUR MONEY TO WORK Bill Kearley, DVM, MBA Veterinary Practice Success Boise, Idaho Asking for a Raise: 5 Steps Y ou have been working at your current practice long enough to know you have been doing a good job, working up cases, and gaining new clients. Do you think your current salary is reasonable for the dollars you bring into the practice? If not, how do you ask for a raise? Ideally, your contract should state specifically when and how raises will be determined, but often this is not the case. Salary Types There are 2 primary methods of compensating associates: traditional salary or commission-based pay, with various combinations. Salary may be preferred, although all compensation needs to be established primarily by production. The practice should be able to afford a salary while remaining profitable, and team members need to be fairly compensated for time worked and services performed. Most of the time, a raise is requested by an associate on a salary-based sys- tem; a commission-based system al- lows for a raise by increasing gross billing for veterinary services. How- ever, if a graduated percentage sys- temisused,increasingtheproduction percentage may be requested. Step Up Take these 5 steps to ask for a raise: 1Document your progress. Track your production even if on salary. The practice should provide access to this information, but keep a running total yourself. Be able to at least iden- tify income from medical services, pharmacy sales, laboratory services, and imaging. Also, keep a list of non- production projects or activities in which you have participated. 2Seek feedback regularly. Ask for input on how you can im- prove your personal performance in the practice. Do not wait for a formal performance review—constantly seek feedback and work to implement sug- gestions. Document steps you take to improve, and support this improve- ment with actual production num- bers. Have this information readily available when the time comes to share it with your employer. 3Negotiate additional benefits. Consider other benefits in addi- tion to salary. Some fringe benefits can provide tax advantages for both you and the practice (eg, medical in- surance, additional paid time off, an Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • PEER REVIEWED additional allowance for continuing education). Consider pursuing new skills or training that the practice could assist with (eg, time off, ex- penses), or even additional support staff to help increase your personal production. 4Prepare before you ask. Plan your strategy before asking for a conference. Determine whether a raise is financially feasible for the practice. Know your personal pro- duction and the justification for an increased salary. A written proposal for your employer explaining the ra- tionale for seeking a raise will help. 5Ask. This step is often neglected or postponed for too long. The primary reason a raise is not given is that one was never requested. Do not rely on an employer to bring up the issue. As long as every team member is willing to work at his or her current salary, the practice owner or manager often assumes everyone is satisfied. Voice your opinion if you are not. State Your Case Be straightforward and confident. Simply state your case and back it up with facts. Determine beforehand what you truly desire and what you are willing to accept. Your ultimate goal is to agree on a figure somewhere in between. Lastly, consider beforehand if you are willing to walk away if you do not re- ceive a fair compensation figure. See Aids & Resources, back page, for references & suggested reading. Plan your strategy before asking for a raise conference. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM _____________
    • PERSONALITY PROFILE Kathleen Ruby, PhD Washington State University ENFP: The Workplace’s Champion 12 veterinaryteambrief.com June 2014 help others grow and develop. They may be natural coaches, attentive to team members and clients alike. In fact, ENFPs sometimes focus so much on caring for others that they neglect themselves to the point of burnout. And, because they focus more on relationships than details, they may run into conflict with more task-oriented team members. ENFPs are enthusiastic about making things better, so they tend to rally around causes or novel ideas and embrace change, because they see them leading to a better, more positive future. They generally dislike getting mired in details, preferring to see the big picture of how to improve the people aspects of the practice. ENFPs think creatively, and their charismatic enthusiasm wins supporters of their ideas, so they are often the ones who start projects. Another personality type, Veterinary teams work best when comprised of a wide variety of personality temperaments that balance and complement each other. Building successful teams requires members to step back, analyze their own behavioral preferences, and do the same with coworkers. Teams that get into trouble either do not recognize or acknowledge their team members’ different strengths and gifts, or they ignore them when assigning team roles. Although all personality types can accomplish all tasks, expecting team members to do so is like expecting everyone to wear the same size shoe. It is possible, but the ill fit will cause slow-down and complaints. In the April issue, we explored the ISTJ (Introverted, Sensing, Thinking, Judging) personality type, which includes approximately 25% of veterinarians. This month, we examine ENFPs (Extroverted, Intuitive, Feeling, Perceptive), who are commonly regarded as team advocates or champions. Although ENFPs make up only 8% of the general population, veterinary teams tend to include about 15%, most likely because ENFPs itch to “save the world,” and medicine provides a fruitful path for idealists, no matter their role on veterinary teams.1 ENFPs at a Glance ENFPs are among the most optimistic of the 16 personality types.2 They are enthusiastic, people-oriented team members and leaders who appreciate harmony in the workplace and dislike conflict or even mild disagreements. As advocates, they value the opportunity to however, may need to supply the road map and the detailed follow-up to make the project a success. This personality type does not appreciate too much structure and open criticism. ENFPs will respond to the first with frustration and boredom and the second by withdrawing into silence. To ensure the team benefits the most from these idealists, it is best to allow them to juggle several projects at once, develop their own spontaneous systems, and provide positive reinforcement for all that they do well. Because ENFPs are naturally empathetic, warm, and supportive, and they easily identify with others’ thoughts and feelings, they are typically well liked by both clients and patients. See Aids & Resources, back page, for references & suggested reading. THE CHAMPIONS AMONG ENFPs: • Famous ENFPs include: – Bill Clinton – Walt Disney – Ellen DeGeneres – Theodor Seuss Geisel (ie, Dr. Seuss) • ENFPs’ stress-coping strategies are among the best of all the personality types2 • ENFPs are overrepresented in gifted and talented programs in elementary schools.2 Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • ENFPs in General2 : • Are bright and capable • Tend to be warm and interested in people, with great people skills • Are service-oriented and likely to put others’ needs above their own • May be more focused on the future than the present or the past • Dislike performing routine tasks • Think abstractly and understand complex concepts • Long for others’ approval and appreciation • Are creative and energetic • Empower, rather than control, as natural leaders • Resist being controlled by others • Possess strong communication skills • Enjoy fun and spontaneity • Are highly creative • Can seem impatient while others ponder change • Lack strength in their organization and time- management skills. June 2014 Veterinary Team Brief 13 PEER REVIEWED Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM ________________________ ____
    • SPECIAL FEATURE Suzanne Smither Fort Lauderdale, Florida Jurmark’s “lawsuit was frivolous, de- manding a court order to Dr. Koshi to return the cat,” Sarcone said. After Koshi died, he said, New York City Animal Care and Control picked up the animals in her home, including Karl, and took them to a shelter. He does not know where Karl is today, he said, but believes that Jurmark retrieved him with the intention of returning him to the feral cat colony. State Laws Vary In New York, second-degree aggravat- ed harassment, which includes elec- tronic communication with intent to harass, annoy, threaten, or alarm, is a misdemeanor that can land a convict- ed person in jail for as much as a year.2 Sarcone said of his defense in the custody suit: “Gwen Jurmark’s be- havior was reckless and irresponsible and should be punished…monetarily If you’re harassed on the Internet, go to the police immediately and re- port harassment. If nothing happens, complain of aggravated harassment. This advice comes from attorney John Sarcone III, Esq, who represented Shirley Koshi, DVM, a cyberbullying victim who took her own life in Feb- ruary 2014. Filing such a complaint, he said, alerts police to contact the person responsible, order him or her to stop, and put the offender on notice that any further online attacks could result in an arrest. The events leading to Koshi’s death began last summer in New York City when 2 women presented a sick cat they said they had found in a nearby public park. Two weeks later, the cat, Karl, was still recovering from upper respiratory disease when another womandemandedthathebereturned to her. That woman, Gwen Jurmark, said she was Karl’s rightful owner be- cause she had adopted him from a shelter years before and paid to have him neutered. Jurmark had then re- leased him into a park where he lived with other cats. Koshi refused to let Karl go back to the park because of his health and, instead, adopted him and took him home. In October, Jurmark sued Koshi in Bronx Civil Court for Karl’s custody and later led protests outside Koshi’s practice and, with others, launched an aggressive Inter- net campaign against her.1 On February 16, police found Koshi dead in her home, apparently of a drug overdose. “I’m told she left a note referencing that the extreme emotion- al distress she’d been enduring was too much,” Sarcone said, adding that police have the note and are continu- ing to investigate her death. When Cyberbullies Strike: BESTRESPONSE TECHNIQUES June 2014 Veterinary Team Brief 15 Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • 16 veterinaryteambrief.com June 2014 SPECIAL FEATURE and through the criminal justice system.…We were planning to sue Gwen and all the individuals who participatedinthis.”AlthoughKoshi’s suicide left the custody case unre- solved, Sarcone said a wrongful death suit is still possible if one of the veteri- narian’s surviving relatives chooses to initiate it. Each state has different legislation against Internet bullying, says attor- ney John E. Owens, Esq, American Veterinary Medical Law Association president. Owens, who is married to a veterinarian, also has a degree in zoology and previously worked at the University of Florida's College of Veterinary Medicine. In Florida, Owens said, cyberha- rassment or cyberstalking of adults is a third-degree felony carrying a penalty of up to 5 years in prison and a $5,000 fine. However, he said, there must be more than one inci- dent and the offensive electronic communication must be proven to have caused substantial emotional harm and served no legitimate pur- pose. In other states, such as Mary- land, the only cyberbullying law applies to minors, he said. Veterinarians at Risk Koshi’s suicide “has caused a chill through the profession,” said David Carser, BVSc, LLB, CML, president and founder of the Veterinary De- fence Association (VDA), an interna- tional nonprofit organization. TAKING THE BITE OUT OF SOCIAL MEDIA It may seem that clients—or even strangers masquerading as clients—can anony- mously defame veterinarians on social media, then hide behind the First Amendment with impunity. But the tide is beginning to turn, acording to a recent Wall Street Journal article.5 Later this year, the Virginia Supreme Court will examine the case of Joe Hadeed, a carpet cleaner whose business declined 30% in 2012 following a series of negative reviews on the consumer website Yelp.5 Hadeed sued 7 Yelp users for fraudulent reviews; he said he believed some were from competitors and demanded that the site reveal the reviewers’ identities. After the Alexandria Circuit Court and the Virginia Court of Appeals ruled in his favor and held Yelp in contempt for not releasing the names, the company appealed, citing the First Amendment and arguing that the businessman failed to prove the reviews in question were false.5 “They say they have a right to put this information out there. But where’s my right to defend my business?” Hadeed said.5 Many veterinarians may be asking the same question. Exceptions to the Rule Hate speech and defamation are clear exceptions to the constitutional protection generally accorded to free speech. Internet companies such as Yelp, Facebook, Google, and Amazon have a legal protection: Section 230 of the federal Communica- tions Decency Act, enacted in 1996, states, “No provider or user of an interactive computer service shall be treated as the publisher or speaker of any information provided by another information content provider.”6 This relieves website providers of liability for their users’ defamatory statements. Yelp’s content guidelines frown on “threats, harassment, lewdness, hate speech, and other displays of bigotry,” and state, “Your contributions should be unbiased and objective. For example, you shouldn’t write reviews of your own business or employer, your friends’ or relatives’ business, your peers or competitors in your industry...”7 Yelp also counsels reviewers to stick to the facts and avoid misrepresentation and exaggeration, but adds, “We don’t take sides when it comes to factual disputes, so we expect you to stand behind your review.”7 Yelp provides an online support center and allows business owners to flag reviews that clearly violate its guidelines. Facebook’s community standards state, “Facebook does not tolerate bullying or harassment. We allow users to speak freely on matters and people of public interest, but take action on all reports of abusive behavior directed at private individuals. Repeatedly targeting other users with unwanted friend requests or messages is a form of harassment.”8 Facebook’s statement on violence and threats is strong: “Safety is Facebook’s top priority. We remove content and may escalate to law enforcement when we perceive a genuine risk of physical harm, or a direct threat to public safety.”8 However, Facebook’s advice on reporting abuse may not reassure someone who feels bullied, harassed, or threatened: “Please keep in mind that reporting a piece of content does not guarantee that it will be removed from the site. Because of the diversity of our community, it’s possible that something could be disagreeable or disturbing to you without meeting the criteria for being removed or blocked.”8 Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • June 2014 Veterinary Team Brief 17 PEER REVIEWED “I personally get a chill every time I think of the misery Shirley Koshi was subjected to. And all she was doing was looking after the best interests of a stray cat that most certainly was not the property of the person who saw fit to make it her life’s work to destroy Dr. Koshi,” he said. Carser joined veterinarian Craig Greenwood, BVSc, CML, business manager Amber Carser, and legal researcher Debra Parsons in an email interview to discuss how vet- erinarians are particularly suscepti- ble to cyberbullying because they “lean toward being artistic (right brain); they are sensitive, vulnera- ble, and individualistic. The veteri- nary profession is isolated and there is not much support and camarade- rie within the profession. “All these factors (see Veterinarians at Risk) can work together to create the perfect storm,” they noted. “The mix of misunderstanding, emotions, and irrational thoughts leads some people to feel they have to take re- “People have been taking revenge on veterinarians since veterinarians ever existed. But what is new is that they now have the immense power of the media.” venge on veterinarians, often under the guise/excuse/misperception that they should act as advocates to stop the vet harming more animals. “People have been taking revenge on veterinarians since veterinarians ever existed. But what is new is that they now have the immense power of the media, which gives them enormous ability to do massive damage.… (They) think they are immune to re- sponsibility and liability for their ac- tions, because they feel protected by the facelessness and anonymity of the media.…The posts on media of- ten escalate as one derogatory post feeds another…until it blows com- pletely out of proportion.” Attorney Owens said he agrees with the VDA team. “Veterinarians seem to be a little more sensitive to criti- cism” than most professionals, he said. “They’re passionate about what they do and they love it. Negative re- views become very personal.” Since the individuals who complain are passionate about animal rights and protecting their pets, “It makes for a volatile mix sometimes,” he said. In Koshi’s case, he said, “The sad part is, I don’t know that she did anything wrong. You had 2 passionate groups on either side of the issue and she became the battleground.” No Defining Line Owens noted that since there is no bright line marking the point where free speech becomes harassment, proving intent is difficult when it is a question of “a person’s right to ex- press an opinion versus a statement that is harmful, dangerous, and de- liberately false,” and judges often err on the side of free speech. “The big issue is that if it’s an opinion, VETERINARIANS AT RISK Members of the Veterinary Defence Association, an international nonprofit organization, gave these reasons why veterinarians are particularly susceptible to cyberbullying: • Veterinarians are generally isolated with little support. • They are primarily healers and often feel inadequate in the business environment. • The veterinary profession has the highest suicide rate, perhaps 4 times higher than the general population and twice that of doctors and dentists. • The profession is unique in that it deals with the client, not the patient directly, and there can be conflict between the patient’s needs and the client’s wants. • Money is always an issue. Veterinarians rarely, if ever, are able to perform a thorough and complete diagnostic workup because of the owners’ financial constraints. The owners, however, often have human medicine expectations.  • Medicine can be challenging for lay people, who may resort to emotional and subjective reactions. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • 18 veterinaryteambrief.com June 2014 SPECIAL FEATURE it’s probably not defamation, but it can still be harassment,” Owens said. The blog post, "Is This the Worst Vet of 2013?," that one of Koshi's detrac- tors published on December 31, 2013, is one example.3 “The intent was clear- ly beyond animal rights…even ani- mal rights activists are like, ‘This was way overboard,’” he said. The defining line between protected free speech and harassment “is one of reasonableness,” according to the VDA team. “If a media post is factu- ally correct and consists of fair com- ment and is objective, then freedom of expression rules and the author’s right to publish is protected.” While the First Amendment clearly does not protect hate speech, “the Su- preme Court…to our knowledge, has yet to provide clarity in terms of cy- berbullying of the nature faced by Dr. Koshi,” they said. ‘Act Quickly’ If bullied online, “Act quickly. Don’t let it get out of control.” They recom- mended reporting abusive posts to the website manager and asking that they be removed; flooding the same site with positive testimonials; applying for an urgent court injunction or re- straining order to have the post re- moved and further posts blocked, if necessary; and suing for damages. “Veterinarians have to accept that they’re not going to please everybody and there are always going to be de- tractors…no matter what you do, you’re going to be called out by them,” Owens said. “The best thing you can do is step away for a day or so,” he recommend- ed. “If you have a staff member you can trust, have them respond…it sep- arates the situation from the emotion. …If you do respond, take the high road. Do not engage in a war of pas- sion.…It never works out for the vet- erinarian. Be professional, be succinct, and then just leave it at that.” Owens is “a big fan of mediation” if disputes do not involve criminal be- havior, but, he said, “if it does get to harassment, contact local law enforce- ment, and make a complaint.” Reach out to the local veterinary com- munity during a cyberbullying crisis, especially when feeling isolated, Ow- ens said. “Look at the closest veteri- narian or the person you worked for previously. Find a mentor and ask them how to deal with it.…Typically, local VMAs are really good for that. “The AVLMA offers a free e-newslet- ter, webinars, and an annual continu- ing education session to educate veterinarians and attorneys on the state of the law.” A future webinar will likely deal with bad reviews, including cyberbullying issues, he said. “Stand together.…This needs to hap- pen on a national scale,” the VDA team advises. Joining associations like the VDA is easy and effective; the VDA helps members by compil- ing responses to cyber, newspaper, and other defamatory articles that explain the facts and limit any damage to the member’s professional reputation. ‘A National Crisis’ New York attorney Sarcone is now crusading for tougher laws against cy- berbullying. In a video on the website Ban the Veterinary Abuse Network,4 he said, “My message is to any politi- cian that’s out there, federal or state, that this is a great opportunity for you to get ahead of the curve on some- thing that is a national crisis.” See Aids & Resources, back page, for references & suggested reading. Suzanne Smither has 30 years of journalism, editing, management, and research experience. Her writing has been published in numerous newspapers and periodicals, and she has written 6 books about cats. Editor’s note: This is a follow-up to A Disturbing Trend: Veterinary Cyberbullying in the April issue. WHERE TO GO FOR ADVICE: • American Veterinary Medical Law Association: 202-449-3818, info@avmla.org • Cyberbullying Research Center: cyberbullying.us • Veterinary Defence Association: 773-944-0386 (U.S.), 1-877-883-2201 (Canada), veterinary-defence-association.org • Wired Safety: wiredsafety.org Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM ___________ ____________ _______
    • © ROYAL CANIN SAS 2014. All Rights Reserved. In an eight- to twelve-week diet elimination trial, Royal Canin Anallergenic™ can help you confidently identify if food allergens are the cause of severe skin reactions in your canine patients. Using breakthrough technology, the proteins in Anallergenic are broken down into amino acids and very small chain peptides to significantly reduce the possibility of an adverse food reaction. And with exceptional palatability and digestibility, Anallergenic is the first choice for both food allergy detection and long-term therapeutic feeding of patients with confirmed food allergy. To learn more about the science behind Anallergenic and to start your diet elimination trial, call your Royal Canin District Manager or 1-800-592-6687. Take diet off the suspect list. Veterinary Exclusive Formulas Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM ___________________
    • SPECIAL FEATURE Sharon DeNayer, ME Windsor Veterinary Clinic & The Downing Center for Animal Pain Management Windsor, Colorado Are You at Risk for Compassion June 2014 Veterinary Team Brief 21 Fatigue? Compassion fatigue translates to cumulative stress and can cause a variety of symptoms, but we can develop coping strategies. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • SPECIAL FEATURE As veterinary professionals, we work in the only medical field where we see our patients from womb to tomb. Over time, a close bond is created with both clients and pa- tients, allowing us to embrace their joys and sorrows. Veterinarians are also the only doctors who have the privilege of legally per- forming euthanasia when they can no longer prevent their patients’ suffering. Although we are fortunate to be able to provide euthanasia, it is our most difficult task and may bring heaviness to our souls. As veterinary healthcare team members, we must continue to support the veterinarian, patient, and client through this process. The Cost of Caring Compassion fatigue is described as the cost of caring. It is also known as secondary traumatic stress and vicari- ous traumatization. Whatever its name, compassion fatigue translates to cumulative stress and can cause a variety of symptoms (see Compas- sion Fatigue Symptoms). Some of the stressors we experience as care- givers are the demands of animal care, the balance of work and home, and those caused by management. We cannot always control the stress- ors; however, we can make changes in our attitude and our reactions. We can increase our stress tolerance. We can develop coping strategies. Self-Care is Key Self-care is the key to both surviving and preventing compassion fatigue. We cannot continually help clients and patients if we do not take care of ourselves. In each of his training sessions, Alan Wolfelt, PhD, found- er of the Center for Loss and Life Transition (centerforloss.com), asks participants questions about them- selves and invites them to talk about the activities they enjoy when away from work. If you cannot list any such activities, or if you cannot re- member when you last did any of these activities, you are not taking care of yourself. Compassion Fatigue or Burnout? Some team members are more compassionate than others by nature and some may struggle with burnout rather than compassion fatigue. Many of the suggestions given here for dealing with compassion fatigue may also be helpful for those struggling with burnout. The team member should first focus on self-care, although it may be necessary to consider taking a sabbatical, working elsewhere, or finding a new profession. “All of us who attempt to heal the wounds of others will ourselves be wounded; it is, after all, inherent in the relationship.”— David Hilfiker, MD Following is a list of simple self-care activities: Find a Support Network • Seek the support of people you care about. • Speak honestly with those in your support network. • Spend time every day with people you enjoy. 22 veterinaryteambrief.com June 2014 Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM ____________
    • PEER REVIEWED Compassion Fatigue Symptoms Compassion fatigue can elicit a wide variety of symptoms.1 Be aware that it is generally easier to recognize the symptoms in others than in ourselves. • Absenteeism • Anxiety, fear, shame • Change in weight, appetite, eating habits • Diminished morale, poor self-esteem • Dread or horror • Feelings and thoughts of inadequacy • Flashbacks of thoughts and images • Frustration, anger, resentment, rage • Grief, numbness, fear of death • Inability to let go of work-related issues • Loss of hope, loss of enjoyment • Obsessive, compulsive desire to help • Physical illness, lack of energy, constant fatigue • Poor work performance, decreased work interest • Sadness, depression • Secretive self-medication, addiction • Sleep disturbance, nightmares • Withdrawal from social contacts, isolation, avoidance. Create a Healthy Work Environment • Promote a healthy sense of humor in the practice. • Create a safe space at work. • Take a break/time out/vacation when you need it. Take Care of Yourself • Eat a balanced diet. • Do some physical activity every day. • Create quiet time for yourself every day. • Reward yourself with a treat now and then. • Get adequate rest. Find Meaning in Your Work • Define and pursue your life mission. • Create and work toward your personal goals. • Reward yourself for accomplishing these goals. These self-care activities can be incorporated into our daily lives to bring more balance and to cope with stress. See Aids & Resources, back page, for references & suggested reading. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM _________
    • 24 veterinaryteambrief.com June 2014 5 TOP 5 Lydia Gerber, PhD Washington State University “Mindfulness means paying attention in a particular way; on purpose, in the present moment, and nonjudgmentally.”—Jon Kabat-Zinn, PhD Since it was developed in 1979, Jon Kabat-Zinn’s 8-week mindfulness- based stress reduction (MBSR) program has proved effective in decreasing stress and anxiety and enhancing a sense of well-being and purpose among its participants.1 Mindfulness in Routine Activities Extra time required: None We often perform routine tasks auto- matically. This practice asks us to do the opposite and bring our full atten- tion to the experience of, for instance, washing our hands—noticing the sensation of water and soap on our skin, the temperature of the water, the sense of touch as one hand brush- es the other. Using this time to fully connect to physical sensations can become a means of connecting to our moment-to-moment experience. TOP STRESS REDUCERS: MENDING THROUGH Mindfulness Top 5 Stress Reducers Through MBSR • Mindfulness in Routine Activities • Mindful Walking • The STOP Exercise • Mindful Eating • Awareness of Breath Exercise Through 30- to 45-minute guided daily exercises, which include medita- tion, yoga, and body scans (ie, focus- ing on different body regions, one at a time, while lying down), participants are able to connect with their mo- ment-to-moment experiences, sensa- tions, emotions, and thoughts, and observe them without judgment. Over time, participants experience re- duced work-related stress, less anxiety, fewer negative symptoms from condi- tions such as chronic pain, and an in- creased sense of joy in being alive. Brain imaging reveals that practicing MBSR causes a shift in activity in the prefrontal cortex toward the left— hard evidence that supports the im- pression among practitioners that they feel more emotionally stable, op- timistic, and connected to others.2 MBSR Practice With such positive results, very limit- ed cautions, and virtually no side ef- fects, MBSR has surged in popularity. Yet the greatest challenge may be finding the time to learn and practice MBSR. For a sense of the benefits of mindfulness practice, here are 5 quick exercises that can be incorporated into a busy day of veterinary practice. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • June 2014 Veterinary Team Brief 25 PEER REVIEWED puter tasks, or as we sit in the car between errands. During very busy days, it allows us to reconnect with our own physical needs, such as the need to eat, drink, or stretch. It also offers an opportunity to acknowl- edge our emotions as we make diffi- cult decisions. Try to do this exercise 3 to 4 times daily so that it becomes an automatic reponse during stress- ful times. Mindful Eating Extra time required: A few minutes This exercise asks us to pay attention while eating a snack, or possibly an entire meal, noticing the textures and flavors of food as we eat, the chewing and swallowing sensations, and the feeling as food passes through the esophagus into the stomach. We often use mealtimes to catch up on text messages or reading, but this exercise not only connects us with the present moment, but often helps us discover Mindful Walking Extra time required: None This is a practice my veteri- nary students find particularly bene- ficial to clear their heads during a busy day. Using the time it takes to move from one room to the next, fo- cus your full attention on the actual process of walking: What is the sen- sation in the foot as the heel touches the ground, weight is shifted from one foot to the other, the foot rolls onto and off the floor, and the toes touch? This can be done at a slow or normal pace. The STOP Exercise Extra time required: ≤1 minute Kabat-Zinn developed this practice; each letter of STOP represents one step1 : 1. Stop whatever you are doing at the moment. 2. Take a deep breath, inhaling and exhaling fully, paying attention to your breath. 3. Observe your sensations, emotions, thoughts, and surroundings in this moment. 4. Proceed with your life. This simple practice offers immedi- ate present-moment awareness and can be done unobtrusively in the presence of others. The exercise of- fers a quick break as we move from one activity to another, such as be- tween phone conversations or com- that with mindful eating, we feel more satisfied with less food. Awareness of Breath Exercise Extra time required: >5 minutes This is a short version of the formal mindfulness practice. To focus fully on the experience, use a timer to alert you when the 5 minutes are up. To reap the most benefit, do the exercise as part of a daily routine. Sitting in a comfortable but attentive posture, or lying down, focus on ob- serving your breath as you inhale and exhale, wherever the experience of breath is most vivid—in the nostrils, the throat, the chest, or the abdo- men—without trying to change your breathing pattern. You may repeated- ly find that your mind wanders during this activity, like a puppy in training. Being patient and nonjudgmental as you return to breathing is key. When nagging thoughts keep coming to your attention, it helps to label those thoughts as “thinking” and to return to breathing as one’s anchor of aware- ness. Meeting the Challenge Taking the time to learn and practice MBSR will be time well spent, and being mindful of these quick, simple exercises will be rewarding personally and professionally. See Aids & Resources, back page, for references & suggested reading. Read All About It For more information about managing stress through mindfulness: • A Mindfulness-Based Stress Reduction Workbook. Stahl B, Goldstein E—Oakland, California: New Harbinger Publications, 2010. • Full Catastrophe Living. Kabat-Zinn J—New York: Bantam Books, 2013. • Mindfulness : An Eight-Week Plan for Finding Peace in a Frantic World. Williams M, Penman D—New York: Rodale, 2011. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • 26 veterinaryteambrief.com June 2014 THERE’S MORE GREAT CONTENT ONLINE! Visit veterinaryteambrief.com for the following articles and more: TO DECLAW OR NOT TO DECLAW? Whether you are for or against it, this procedure is now frequently requested, and your practice will need to take a position. Here’s how to develop your stance. veterinaryteambrief.com/ declawing WHEN TEAM MEMBERS BRING THEIR PROBLEMS TO WORK We can damage a practice when we bring personal problems to work. Leaders should develop relationships with team members so they can recognize these problems and resolve them with empathy. veterinaryteambrief.com/ personal-problems-to-work CULTURAL COMPETENCE IN PRACTICE As our clients become more diverse, team members need to demonstrate respect for different cultural attitudes toward animals. veterinaryteambrief.com/ cultural-competence IS DISCOUNTING A GOOD BUSINESS STRATEGY? Veterinarians typically say no to discounts because they imply that their prices are overstated—but in a world of connected, informed clients, they need to reconsider. veterinaryteambrief.com/ discounting-good-strategy Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM ________ _____________________ ________________ _____________________ ________________ ________ ______ ________________ ________ ______
    • Starts killing fleas in just 30 minutes Lasts a full month More than 50 million doses sold worldwide Prevents infestations Important Safety Information Cats: The most common adverse reaction recorded in clinical trials was vomiting. Other adverse reactions were lethargy, anorexia, weight loss, and diarrhea. Use with caution with concomitant extra-label use of ivermectin. Dogs: The most common adverse reaction reported is vomiting. Other adverse reactions reported include lethargy, anorexia, ataxia, diarrhea, and seizures. Serious adverse reactions have been reported following concomitant extra-label use of ivermectin with Comfortis. Post-approval experience continues to support the safety of Comfortis when used concurrently with heartworm preventatives according to label directions. For product label, including complete safety information, visit comfortis.com or see page . Thefaces offast flea relief comfortis.com 888-545-5973 ©2014 Elanco CF00998 Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM ________
    • 28 veterinaryteambrief.com June 2014 TREATMENT Treatment of pyoderma caused by methicillin-resistant S pseudintermedius (MRSP) differs little from that for methicillin- sensitive S pseudintermedius (MSSP) infection, except for the need to correctly identify the appropriate antibiotic that should be prescribed. STEP 1: Comprehensive Overview Alexander Werner, VMD, DACVD Animal Dermatology Center Studio City, California MRSP is Not MRSA Superficial bacterial folliculitis, or pyoderma, is common in dogs, uncommon in cats, and most often a secondary disease. Signs vary widely and reflect the underlying cause (eg, allergic skin disease, endocrinopathy). The initial lesion of pyoderma is the pustule leading to the crusted papule. Similar in appearance to a pebble cast into calm water, individual lesions increase into ever-expanding circular areas with peripheral crusts, erythema, and central clearing (ie, the epidermal collarette). Multiple crusted patches with erythema and malodor eventually develop. Staphylococcus pseudintermedius is the primary bacterium isolated in superficial bacterial folliculitis. It is frequently a resident of the nares, lip folds, and anal region of dogs, and a transient on the haircoat. Infection by S schleiferi and S aureus is less common. Canine infection with S aureus—particularly methicillin-resistant S aureus (MRSA)—is often associated with exposure to a human in the household with MRSA or frequent visits to healthcare facilities. S aureus and S pseudintermedius are cultured with similar frequency from the skin of healthy cats and cats with inflammatory skin disease, although the frequency of culturing methicillin-resistant strains is low. Culture and sensitivity testing are recommended in cases of pyoderma that fail to respond to empiric choice antibiotics. Treatment for MRSP-related pyoderma must include topical antibacterial therapy, systemic antimicrobials, and identification and management of any underlying process that permitted infection from MRSP colonization. Patients with pyoderma that fail to respond to initial therapy with antibiotics should not be assumed to have MRSP. Empiric choice of a so-called stronger antibiotic, particularly a drug reserved for proven MRSP, is strongly discouraged, as this may result in a multidrug-resistant infection. Antibiotic choice should be based on results of culture and sensitivity testing. Samples for culture are best obtained when previous antibiotic therapy (and topical antiseptic therapy) has been discontinued for several days. Exudate from within a pustule or from beneath the peeling edge of an epidermal collarette is preferred for culture. Based on culture and sensitivity testing results, potentiated sulfonamides at 15–30 mg/kg n Antibiotic choice should be based on results of culture and sensitivity testing. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • June 2014 Veterinary Team Brief 29 CLINICAL SUITE | MRSP INFECTIONS IN DOGS & CATS q12–24h and chloramphenicol at 30–50 mg/kg q8–12h are common treatment options. Additional choices—if reported effective— may include clindamycin at 11 mg/ kg q24h or doxycycline at 5–10 mg/kg q12–24h. In cases with multi-drug resistance, amikacin at 20 mg/kg q24h or rifampin at 10 mg/kg q12–24h may be required. However, these antibiotics are associated with potentially life-threatening effects; clients should be counseled on adverse reactions and the need for proper laboratory monitoring. Treatment should continue until one week past clinical resolution of all regions. Topical antiseptic therapy is critical. Patients with MRSP should be bathed twice weekly, even daily if possible. Shampoos containing 2%–4% chlorhexidine or 2.5%–3% benzoyl-peroxide have demonstrated excellent efficacy. Conditioners and sprays containing chlorhexidine and dilute (5%) household bleach solution rinses provide excellent residual antiseptic effects. Environmental decontamination may help reduce recolonization with MRSP. Household bleach at a 1:32 dilution is bactericidal for MRSP. SPECIAL CONSIDERATIONS When treating MRSP, clients should avoid contact with the infected area of the patient, and especially discourage licking of the face or any area of damaged STEP 2 Team Education Primer h skin. Avoidance of areas most commonly colonized by MRSP (lips, nose, anus) is advised. Contact with the patient should be followed by hand washing or the use of an alcohol-based hand sanitizer, especially for an immune- compromised individual. Infected patients should not be in contact with other animals, and should not go to day care, groomers, or dog parks. While concurrent colonization of humans and pets with MRSP has been reported, transmission of infection is rare. MRSP may not be contagious, but exposure of potentially susceptible individuals should be avoided. Feces can be colonized by MRSP. Prompt removal of waste and frequent cleaning of litter boxes reduce environmental contamination. Environmental clean-up should include frequent washing of bedding, toys, and bowls. Pets should not sleep in the client's bed until the infection has resolved. When treating MRSP, clients should avoid contact with the infected area of the patient, and especially discourage licking of the face or any area of damaged skin. Figure 1. Bacterial infection by MRSP in a 10-month-old male springer spaniel CourtesyofAlexanderWerner Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • 30 veterinaryteambrief.com June 2014 MRSA & MRSP BY THE NUMBERS • S pseudintermedius can be cultured from the skin of many healthy dogs and some cats.1 • Approximately 20%–30% of humans are either intermittently or persistently colonized STEP 2: Team Education Primer Alexander Werner, VMD, DACVD Animal Dermatology Center Studio City, California MRSA & MRSP at a Glance THE TERMINOLOGY • COLONIZATION: The presence of bacteria on a body surface that does not cause invasion or damage. • COMMUNITY-ASSOCIATED (OR ACQUIRED) INFECTION (CAI): An infection not associated with the risk factors of HAI (see below), and acquired from normal social interactions. Note: CAI and HAI are terms to describe MRSA in humans but are not applicable to MRSP or used in veterinary medicine. • HOSPITAL-ASSOCIATED (OR ACQUIRED) INFECTION (HAI): An infection associated with risk factors including recent hospitalization or surgery, or among healthcare workers; also called a nosocomial infection. • INFECTION: The invasion of tissues by bacteria, producing harm. Infection is often multifactorial, requiring both the presence of the organism and an abnormality that causes skin damage (eg, a wound) or immune compromise (eg, an endocrinopathy, concurrent disease process). • METHICILLIN-RESISTANT (MR): Indicates nonsusceptibility of a bacterium to the action of methicillin (oxacillin). Methicillin-resistant staphylococcal infections are called MRSP or MRSA and considered resistant to all -lactam antibiotics, including amoxicillin and cephalexin. Resistance in MRSA and MRSP is mediated by the the mecA gene. • METHICILLIN-SUSCEPTIBLE (MS): Indicates susceptibility of a bacterium to the action of methicillin. In some laboratories, methicillin has been replaced by the more stable oxacillin. Methicillin-resistant and oxacillin-resistant are synonymous terms. An infection with S pseudintermedius that is susceptible to oxacillin is called an MSSP. • STAPHYLOCOCCUS AUREUS (SA): A normal commensal bacterium of humans and cats. • STAPHYLOCOCCUS PSEUDINTERMEDIUS (SP): A normal commensal bacterium of dogs and cats. Previously reported as S intermedius (SI), recent molecular tests have identified 3 distinct species within the SI group, with SP being the bacterial pathogen most frequently isolated from canine skin. STEP 3 Communication Keys h CLINICAL SUITE | MRSP INFECTIONS IN DOGS & CATS (subclinically) with S aureus in the nares.2 • The frequency of isolating MRSP from infections, especially from pyoderma, has changed dramatically in the past 15 years. Studies of isolates from as recently as 2000 demonstrated little resistance to either cephalexin or fluoroquinoles, whereas in a 2009 follow-up study, resistance increased to 10% and 30%–40%, respectively.1 • The greatest risk for MRSP development is prior treatment (within one year) with antibiotics. • MRSP is reported to colonize 4.5% of healthy dogs and 1.2% of healthy cats.3 • Nasal carriage of MRSP in veterinary professionals was reported in one study to be 3%–5.3%.4,5 Owners of pets with MRSP had a carriage rate of 4%–13%.6,7 Repeat cultures from 2 owners were negative following treatment of their pets.5 • MRSA is reported to colonize up to 3.5% of the general human population.8 • MRSP can contaminate the environment. MRSP can be isolated in samples from 5%– 10% of veterinary practices and from the environment 6 months after clinical resolution of an infected animal.8 • S pseudintermedius typically colonizes dogs and cats and is transient in humans; S aureus typically colonizes humans and colonizes (and infects) dogs poorly. Decolonizing dogs and cats of staphylococci is likely impossible. • Canine pyoderma caused by MRSA is almost always associated with human MRSA infection in the immediate environment. Colonization by MRSA in dogs is rapidly lost following treatment of the human source for infection and/ or removal from potentially contaminated environments (eg, hospital, nursing home). Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • June 2014 Veterinary Team Brief 31 A key to resolving MRSP infections is client compliance. While treatment may seem demanding initially, the quickest way to resolve the infection is to follow all recommendations. Christopher Keller Animal Dermatology Center Studio City, California Overcoming Resistance to Treating Resistant Infections STEP 4 Team Workflow h Pets should not sleep in the client’s bed until the infection has resolved. STEP 3: Communication Keys CLINICAL SUITE | MRSP INFECTIONS IN DOGS & CATS DISCUSS ORAL ANTIBIOTICS Appropriate antibiotics will be prescribed to resolve the infection and may need to be continued for extended periods of time. Team members should remind clients to give the medication as directed, and for the entire period prescribed, to avoid developing more resistance. As with any new medication, clients should be advised of possible adverse effects and instructed to call with any questions or concerns. Technician Mrs. Smith, the veterinarian is starting Lucy on oral antibiotics to clear the infection. It is very important that you give these medications as directed. You will be continuing the antibiotics even after all the signs of the infection have resolved, so don’t discontinue the medications just because Lucy looks healed, which could lead to an even more resistant infection. The veterinarian may request a recheck examination before completing the antibiotics. DISCUSS TOPICAL THERAPY Treatment will also include frequent topical therapy (eg, antiseptic shampoos, conditioners, rinses, sprays). The team should review these products and stress their importance in the treatment plan. Technician You will need to bathe Lucy once to twice a week. I know sometimes that can be difficult, but bathing can be very helpful and may decrease the amount of time you need to treat her. You will first wet her coat, then apply and lather the shampoo. Make sure you massage all the way down to the skin. The lather will need to stay on Lucy for 5–10 minutes, so you may want to keep a toy or a few treats handy to help her pass the time. Rinse her well, then apply the conditioner (and rinse, if prescribed). DISCUSS CLEANING While it is unlikely a healthy human will acquire an MRSP infection from his or her pet, cleaning the pet’s environment is important. A 1:32 dilute bleach solution is an effective cleanser, where possible. Clients should also be advised to wash their hands frequently, especially after handling their pet. Technician Cleaning Lucy’s living areas would be very helpful. Wash her bedding, food and water bowls, and toys often. Use a dilute bleach solution (a 1:32 ratio, or 1/2 cup per gallon of water). While it would be very unlikely for this infection to spread to a healthy human, you should wash your hands after contact with Lucy (bathing, medicating, playing). Finally, you should keep her away from social activities (dog parks, groomers, day care) until the infection has cleared. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • TECHNICIAN/ASSISTANT ✔ Make follow-up calls to the client, discuss any new laboratory results, and answer any new questions the client may have.STEP 5 Team Roles h Make follow-up calls to the client discuss any new laboratory results and answer any new questions RECEPTIONIST ✔ Provide the client with an invoice. ✔ Schedule a recheck examination. Provide the client with an invoice STEP 4: Team Workflow Christopher Keller Animal Dermatology Center Studio City, California Team Workflow VETERINARIAN ✔ Devise a formal infection-control program that will guide team members on how to address concerns when a patient known to have MRSP comes into the practice. Collect input from all members of the team (veterinarians, technicians, assistants, receptionists) because they all will see this from different aspects according to their roles. ✔ Review the patient’s history, discuss current problems, and perform a complete physical examination. ✔ Discuss diagnostic testing, steps taken after testing, a tentative diagnosis, and a treatment plan with the client. ✔ Advise the client of the recommended recheck schedule. ✔ Make sure all of the client’s questions are answered. ✔ Wash hands after handling the patient. TECHNICIAN/ASSISTANT ✔ Keep the MRSP patient separated from other patients. ✔ Collect necessary laboratory samples (skin smears, cultures, blood samples). ✔ Prepare medications, shampoos, conditioners, rinses, and/or sprays. ✔ Discuss treatment with the client, stressing the importance of following recommended protocols. ✔ Discuss environmental cleaning and the need for good hygiene. ✔ Answer any additional client questions. ✔ Clean areas the patient has contacted with antiseptic cleanser. ✔ Wash hands after handling the patient. CLINICAL SUITE | MRSP INFECTIONS IN DOGS & CATS Devise a formal infection-control program that will guide team members on how to address concerns RECEPTIONIST ✔ Welcome the client. ✔ Separate a patient with previously diagnosed MRSP from other patients, possibly by moving them immediately into an examination room. ✔ Clean areas the patient has contacted with antiseptic cleanser. ✔ Wash hands after handling the patient. ✔ 32 veterinaryteambrief.com June 2014 ✔ ✔ Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • June 2014 Veterinary Team Brief 33 STEP 5: Team Roles Christopher Keller Animal Dermatology Center Studio City, California Team Roles STEP 6 Team Training Plan h CLINICAL SUITE | MRSP INFECTIONS IN DOGS & CATS TEAM MEMBER ROLE RESPONSIBILITIES RECEPTIONIST Patient/client bonding expert and educator ✔ Clean contaminated areas with antiseptic solutions (ie, dilute bleach). ✔ Make staff aware of the patient’s presence to maintain separation and proper infection control. ✔ Follow all contact with the patient with hand washing and/or the use of an alcohol-based hand sanitizer. TECHNICIAN/ ASSISTANT Client educator ✔ Separate the patient as much as possible to avoid contact with other patients. ✔ Disinfect all equipment used to treat or evaluate the patient with dilute bleach or an alcohol-containing cleanser. ✔ Clean contaminated areas (including the examination room) with antiseptic solutions (eg, dilute bleach). ✔ Change clothing prior to contact with other patients, if possible; wearing disposable gloves while handling the infected patient is useful. VETERINARIAN Medical expert and client educator ✔ Treat the patient as completely as you would MSSP cases. ✔ Emphasize the need for client compliance with all aspects of treatment, including topical therapy. ✔ Advise the client of the need for good hand and environmental hygiene, but do not make him or her panic. ✔ Clean all equipment used to treat or evaluate the patient. ✔ Follow all contact with the patient with hand washing and/or the use of an alcohol-based hand sanitizer. Follow all contact with the patient with hand washing and/or the use of an alcohol-based hand sanitizer. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • 34 veterinaryteambrief.com June 2014 STEP 6: Team Training Plan Christopher Keller Animal Dermatology Center Studio City, California Communicating on Communicables With the increasing number of MRSP infections, veterinary practices will be answering more client questions about MRSP. Make sure each team member knows the appropriate answers. The entire team should be well versed on standard treatments for MRSP to educate clients on therapies. CLINICAL SUITE | MRSP INFECTIONS IN DOGS & CATS STEP 7 Client Handout h KEYS TO SUCCESSFUL INFECTION CONTROL • Wash hands frequently with soap and water. • Use an alcohol-based hand sanitizer, if available. • Change uniforms after restraining an MRSP patient. • Clean and disinfect all areas and instruments that MRSP patients contact. A dilute bleach solution (1:32) is a good sanitizer; however, other commercially available products may be available. Be sure to check the label for necessary concentration and contact time. • Keep known MRSP patients separated from other patients. ADDRESSING COMMON CLIENT QUESTIONS Q: What is MRSP? A: MRSP, or methicillin-resistant Staphylococcus pseudintermedius, is a bacterial infection that can cause skin infections in dogs and sometimes cats, and is resistant to many common antibiotics. It is important to keep in mind that MRSP is not methicillin-resistant Staphylococcus aureus (MRSA). MRSP rarely becomes systemic; its effects are limited primarily to infections on the skin. Q: Can I get MRSP? A: It is unlikely that a healthy adult will get an MRSP infection from a pet. If individuals in the household have a compromised immune system, keeping the pet separated as a precaution is recommended. Q: Is MRSP contagious to my other pets? A: Healthy pets may carry the bacteria, but they should not become infected. Q: Can this infection be cured? Will it come back? A: The veterinarian will prescribe antibiotics based on skin culture results. You will also need to do a lot of bathing and keep your pet’s environment clean. It may be necessary to look for an underlying cause of the infection to prevent it from returning. REVIEW OF MRSP THERAPY The entire team should be well versed on standard treatments for MRSP to educate clients on therapies. Review and discuss the following topics at a team meeting about MRSP: • Adverse effects of common antibiotics used to treat MRSP infections • Procedures for therapeutic bathing and use of topical treatments • Household hygiene techniques. See Aids & Resources, back page, for references & suggested reading. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • Alexander Werner, VMD, DACVD Animal Dermatology Center Studio City, California June 2014 Veterinary Team Brief 35 STEP 7: Client Handout MRSP & Your Pet CLINICAL SUITE | MRSP INFECTIONS IN DOGS & CATS You are likely aware of MRSA, a type of staph infection that has become resistant to treatment with commonly used antibiotics. You may be confused, then, if you hear your dog or cat has been infected with MRSP. Do not worry—although the 2 bacteria have similar names, they are different organisms and MRSP does not pose the threat to human—or pet—health that MRSA does. While multiple antibiotic-resistant bacterial infections are becoming more of a problem in both human and animal medicine, they are treatable. Staphylococcus pseudintermedius (SP), the most common cause of bacterial skin infection in dogs, may temporarily colonize (remain without causing harm) human skin, but should not cause problems in healthy individuals. CAN HUMANS CATCH MRSP? CAN OTHER PETS? Other than from dog bites, MRSP infection in humans is very uncommon. The zoonotic risk (the chance of transmission of an infection from animal to human) is low, but individuals with compromised immune systems may be at higher risk. Other dogs can be colonized with MRSP from an infected or colonized dog. However, for infection to develop, skin damage and/or immune compromise must be present in the exposed animal. Still, it is prudent not to expose other animals to dogs known to be infected. Quarantine of the animal entirely is probably not necessary, but avoiding dog parks, day care, and grooming shops during treatment is advisable. LISTEN TO YOUR VETERINARIAN As for treatment of all diseases in companion animals, strict adherence to the veterinarian’s recommendations is very important. This is especially true for treatment of MRSP. Discontinuing antibiotics before finishing the full course prescribed only encourages the return of infection, possibly with resistance to a previously effective drug. In addition, the search for and control of any underlying problem (such as an allergy) that encouraged the development of MRSP is necessary. Treatment must include topical therapy for the skin irritation, such as bathing with an antiseptic shampoo and the application of antiseptic rinses. This not only increases patient comfort and hastens healing, but also decreases environmental contamination and the potential exposure of noninfected individuals in the household (including animals and humans). Environmental decontamination may be helpful to reduce reinfection. Pet bedding, toys, and bowls should be cleaned frequently with antiseptic solutions. Household bleach at a dilution of 1:32 with water (1/2 cup per gallon of water) is an excellent bactericidal choice. During active infection with MRSP, your pet should be discouraged from licking your face or any area of damaged skin, and should not sleep in your bed. You should avoid contact with infected lesions as well as areas most likely to be colonized with MRSP, such as the lips, nose, and anus. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • October 15, 2014 Pre-Surgery Summit Laboratories & Workshops October 16-18, 2014 Surgery Summit Seminars & Scientific Abstracts SAN DIEGO, CA Registration opens May 19th Sharpen your diagnostic and surgical skills at the 2014 American College of Veterinary Surgeons (ACVS) Surgery Summit. Attend hands-on laboratories on canine sports medicine, urethral stenting, regional analgesia, and more. It’s the ONE meeting where you can choose from 309 hours of veterinary CE taught by internationally recognized surgical and allied medicine specialists for all primary care veterinarians and veterinary technicians. For more details, visit www.acvssurgerysummit.org We’ve reserved a table for you Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • DIRTY LAUNDRY Charles Meredith, MD, & Amanda Shaw, MPH Washington Physicians Health Program Seattle, Washington Veterinarians face a plethora of exter- nal stressors that may put them at increased risk of developing sub- stance use disorders compared with the general population, including an increased potential for financial problems,professionalisolation,staff- ing shortages (particularly for the solo practitioner), and the emotional toll of performing frequent euthana- sias. Veterinarians also have relatively easy access to controlled substances. The Washington Physicians Health Program (wphp.org), an intervention, monitoring, and advocacy program for doctoral-level healthcare provid- ers, recommends using the “Six I’s” when considering early warning signs that a veterinarian may be at risk for impairment: • Irritability: A team member exhibits mood swings and a gradual personality change. He or she becomes a different person, terse and angry with other team members, patients, and clients, and may overreact to the smallest perceived insult. • Irresponsibility: The team member begins taking shortcuts or shifting work to others to minimize time in the practice. He or she may develop a new pattern of unwitnessed medication spillage or breakage, justifying his or her need to check out more. • Inaccessibility and Isolation: Once a team member becomes chemically dependent, he or she may try to minimize THE CHEMICALLY IMPAIRED COLLEAGUE It can be incredibly hard to determine whether a team member is mis- using drugs or alcohol, and the development of true impairment can be insidious. Because veterinary training selects for highly functioning and gifted individuals, it can be more difficult to identify their “impairment.” June 2014 Veterinary Team Brief 37 Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM ______
    • DIRTY LAUNDRY 38 veterinaryteambrief.com June 2014 physical contact with others to continue hiding the illness or to reduce the hours between chemical use and avoid withdrawal symptoms. He or she may volunteer for the graveyard shift, frequently skip team meetings, consistently be late, call in sick on Monday mornings (a common time for extended hangovers from weekend drinking), or take extended lunch or bathroom breaks, returning in a calmer, less inhibited mood. • Inability: This sign can be manifested through a new pattern of inappropriate or inadequate care, bizarre medication orders, dosage miscalculations, sloppy or delayed charting, or deviation from standard procedures. • Incidentals: Colleagues may see, hear, and smell signs in the practice. It may only be in the late stages of alcohol dependence or drug addiction that a team member reaches the threshold of impairment and his or her illness becomes visible to colleagues. Individuals concealing their illness will go to great lengths to mask questionable behavior, chronic use, or withdrawal symptoms, and may show new patterns such as wearing long sleeves or sunglasses, or constantly using mouthwash, heavy cologne, or breath mints to hide the alcohol odor. Medication counts may frequently be incorrect when controlled substances are checked out for procedures. Team members may also show physi- ologic signs of chronic use or with- drawal. Signs suggestive of alcohol use include puffy or frequently bloodshot eyes and an “orange peel” or ruddy nose, whereas chronic irritability or tremor can suggest withdrawal. The smell of alcohol on the breath or slurred speech should not be ig- nored. Opioid use can lead to pupil- lary miosis and “nodding off” during meetings, while withdrawal may be marked by irritability, fre- quent bathroom trips for diarrhea, yawning, and a runny nose and tear- ing eyes. Intravenous substance use can result in track marks on the ex- tremities. Benzodiazepine use can also lead to “nodding off,” with with- drawal symptoms similar to those of alcohol dependence. Cannabis use can lead to chronically injected con- junctivae, while cocaine or amphet- amine intoxication is marked by pupillary dilation, tachycardia, ele- vated energy, hypersexuality, and perhaps even psychosis. These illnesses often develop gradu- ally and can be difficult to identify. Substance dependence can result in varying levels of impairment; thus, the frequency of these behaviors and visible signs may be episodic. How- ever, the medical literature has con- sistentlydemonstratedthatuntreated alcohol or drug dependence can sig- nificantly increase the frequency of The 6 I’s Be alert to these 6 indicators that a team member may be at risk of impairment: 1. Irritability 2. Irresponsibility 3. Inaccessibility 4. Isolation 5. Inability 6. Incidentals In a situation where a veterinarian or other practice team member may be chemically impaired, early intervention and evaluation offer the best opportunity for a successful outcome and help to protect patient safety. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • Behavior Management: Canine Separation Anxiety Canine Dermatology and Parasitology Feline Dermatology and Parasitology Feline Behavior Easy enrollment — register today at elancopetprogram.com Earn free continuing education (CE) credits Enables you to help screen patients Makes it easier to discuss some of the latest developments in veterinary medicine RACE-approved CE credits upon completion of each learning module Unique incentives and rewards upon completion of each learning module Motivate Educate Reward Continuing education is just a click awaywith the Elanco PET Program Professional Education and Training ©2012 Elanco CAH1044 edthattreatmentisextremelyeffective for doctoral-level healthcare provid- ers. In one study of more than 900 healthcare providers recovering from substance use disorders, relapse rates following 5 years of monitoring were less than 20%.2 In a situation where a veterinarian or other practice team member may be chemically impaired, early interven- tion and evaluation offer the best op- portunity for a successful outcome and help to protect patient safety. See Aids & Resources, back page, for references & suggested reading. errors made by individual health- care providers, and in the veterinary field, untreated addiction can easily be fatal.1 When you question a team member’s safety after observing any of the de- scribed signs, consider consulting with your state’s confidential veteri- nary wellness program. In states with- out a confidential crisis intervention and support program for veterinari- ans, the state veterinary medical asso- ciation or board of veterinary medical examiners may be able to offer sup- port and resources. Reporting con- cerns about an impaired colleague, while difficult, is a proactive and com- passionate act that will help protect the individual’s professional status and personal well-being. Although addiction is a chronic dis- ease, several studies have demonstrat- PEER REVIEWED Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM ___________
    • Miconazole and chlorhexidine aid in the treatment of moderate to severe fungal and/or bacterial skin infections Potentiated with the antibacterial activity of TrizEDTA Plus epidermal barrier repair therapy with the addition of ceramides Pleasing scent of lavender and lemon grass oil in a lush, lathering shampoo, along with convenient, easy-to-use spray and wipes. A unique combination of 2% miconazole, 2% chlorhexidine, patented USP TrizEDTA, and ceramides. MICONAHEX+Triz TM Shampoo, Spray & Wipes ANTIMICROBIAL THERAPY JUST GOT STRONGER! Wipes Shampoo Spray Formulated for use in dogs, cats and horses. To find out more about MICONAHEX+Triz Products, contact your Dechra Sales Manager or Distributor Representative. Contact us for 24-Hour Technical Support (866) 933-2472, www.dechra-us.com Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • STRESS & ANXIETY IN PRACTICEWho has not pulled into the parking lot at work with tight neck muscles, a racing heart, or a sinking feeling in the pit of the stomach? Life is stressful, and part of that stress* shows up at the practice. SPECIAL FEATURE Carl Bello, DVM, LMHC Seattle, Washington *For simplicity, the author uses the terms stress and anxiety interchangeably to refer to various states of agitation, tension, pressure, worry, frustration, and other feelings of uneasiness. That Sinking Feeling: June 2014 Veterinary Team Brief 41 Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • 42 veterinaryteambrief.com June 2014 SPECIAL FEATURE Every day we handle the stress of working with illness, suffering, death, strong emotional attachments, finan- cial issues, and time pressure. We must also address the emotional and psychological health and stability of ourselves and our clients. No matter how excellent our stress management and coping skills, we still have mo- ments that can emotionally knock us off our feet. Part of the individuality of stress and anxiety in veterinary medicine is that various practice team mem- bers may have drastically different experiences of the same event. Five dentals with extractions, 3 spays, and 2 tumor removals on the same day may make the practice owner happy, give the technician and veterinarian nightmares, and be a nonissue for the receptionist and kennel team. 3 Categories of Workplace Stress In my experience, causes for work- place stress can generally be divided into 3 categories—structural, individ- ual, and interpersonal. Following is an overview of each category that will provide a framework to identify what causes stress and ways to manage it. 1. Structural Factors Structural factors refer to things thatprobablycannotbechanged— ie, the bigger picture issues in any given practice. One of the most powerful, and potentially insidi- ous, structural factors is practice philosophy or ethos. I have been they voice complaints? Do they feel that management treats them fairly and equally? Are changes made or are reasons provided when change cannot be made? My expe- rience has been that if practice management cannot handle these issues professionally and sensitive- ly, higher levels of stress and anxi- ety result, leading to lower team member morale and greater turn- over. Only the practice owner or office manager can address these struc- tural issues, and they truly have a profound effect on how well the team functions. 2. Individual Factors This category includes “the voices inside our heads” that may contrib- ute to anxiety and stress in the practice. Are you the type of per- son who needs to be liked by oth- ers? When holding a patient for Dr. Jones, do you take it personally if he does not thank you? When Mr. Starbuck is annoyed because he was kept on hold for a moment, do you feel guilty (even though around my share of practices that seem to encourage, for lack of a better term, “martyrdom” among team members. This means the longer hours members work, the more lunches they miss, and the less money they charge, the “better” they are. An associate, technician, kennel staff member—anyone ex- cept the owner—will have little or no power to correct the practice structure and likely will feel stress and anxiety. Another structural issue is the ex- tent to which practice leadership has a sense of its vision and mission and whether that has been clearly communicated to the team. Lack of clarity of purpose often leads to everybody pulling in opposite di- rections, which causes stress and anxiety. A subset of structural factors is whether management has policies in place to handle team concerns. Is it clear what one team member should do to handle a conflict with another? Is confidentiality assured? Do team members feel heard when HELP IS AVAILABLE These resources may be helpful if you are feeling stressed and anxious at work: • Nonviolent Communication: A Language of Life. Rosenberg MB—Encinitas, California: PuddleDancer Press, 2003; nonviolentcommunication.com. • Full Catastrophe Living. Kabat-Zinn J—New York: Bantam Books, 2013. • The Relaxation and Stress Reduction Workbook. Davis M, Eshelman ER, McKay M—Oakland, CA: New Harbinger Publications, 2008. • The Stress of Life. Selye H—New York: McGraw-Hill, 1984. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • June 2014 Veterinary Team Brief 43 you are trying to get 10 other things done at the front desk and Dr. Jones is being crabby)? To help determine your individual factors, try listening to your self- talk. Developing awareness can help you realize how much you may be contributing to your own stress. Take a few minutes at the end of the day to check in with yourself. Do you think, I’m such a failure or I should be a faster worker? Such self-talk can dramatically in- crease feelings of stress and anxiety. Unless you are aware of your own beliefs and self-judgments, they will forever plague you. A trusted friend, counselor, or support group can help sort through these issues. Once you are aware of your inter- nal factors, you will know how much you need to change as op- posed to how much the job needs to change. This will not be a quick fix, but important changes rarely are. 3. Interpersonal Factors Think of interpersonal factors as Can’t we all just get along? Veteri- nary medicine is a people-oriented business as much as it is animal- oriented. Stress results when you cannot get along with people. We all have unique personalities, and certain people may rub us the wrong way (and vice versa). Some- times just accepting this truth relieves some stress. Focusing on Interpersonal issues among prac- tice team members can be one of the biggest challenges. Healthy in- terpersonal relationships at work start at the top, and if you are a manager or owner constantly struggling with these issues, seek help. Without strong yet empathic leadership, the team can end up being a dysfunctional unit. Now What? Getting to the root cause of stress in the practice is a difficult process that takes time and self-reflection. Learn- ing about our own personality and listening to our self-talk can be pain- ful, yet ultimately extremely helpful (especially considering how much of our life we spend at work). Talk things over with someone who has a level of detachment or objectivity—not another team member. Finally, if you find yourself working in a practice that has significant struc- tural issues with no indication of changing, the best plan may be to find a position better suited to you. See Aids & Resources, back page, for references & suggested reading. PEER REVIEWED treating your team members with professionalism and respect with- out needing them to like you— and you to like them—can be a big step in the right direction. If there are multiple personalities at work who cause you stress, take a look at the constant in the equa- tion: you. If more than one team member says you contribute to re- lationship problems, consider this an opportunity to grow both per- sonally and professionally. Seek constructive feedback from a su- pervisor, counselor, or mentor. Conversely, if through self-reflec- tion and counsel you conclude that you are not the problem, you are possibly in a mix of people who are not a good fit for you. An important caveat: If a superior (eg, supervisor, manager, veteri- narian) treats you disrespectfully or abusively, you have a problem. Then, consider the structural issues mentioned earlier. Will manage- ment handle this issue profession- ally,respectfully,andconfidentially? If not, you will need to evaluate whether the situation is tolerable.1 Part of the individuality of stress and anxiety in veterinary medicine is that various practice team members may have drastically different experiences of the same event. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • 2014 SOCIAL MEDIA CALENDAR Social Media Made Easy Want to grow your social media presence and share information with your clients? Need quick ideas on what to post every day? Veterinary Team Brief can help. Follow the steps below to start sharing today. DAY-BY-DAY STEPS STEP 1 Visit veterinaryteambrief.com/easysocialmedia STEP 2 Copy the text and link provided by Veterinary Team Brief STEP 3 Paste the text and link to your social media accounts (eg, Facebook, Twitter) STEP 4 Click Post or Tweet to share with your clients 44 veterinaryteambrief.com June 2014 TIP! The days of Facebook as a free marketing tool for businesses seem to be coming to an end. Set aside a monthly budget for paid impressions and use the Promote Page and Boost Post  features to increase page likes and the reach of your posts. *Full posts and URLs available at veterinaryteambrief.com/easysocialmedia Sunday Monday 6 The journey of life is sweeter when traveled with a dog.—Anonymous 7 Groom Your Cat* 13 What shampoo do you like to use on your pet? 14 7 Reasons Your Cat Keeps Meowing* 20 Post an image of an animal up for adoption. Include details about how he or she can be adopted. 21 Feline Infectious Peritonitis* 27 Post about a pet-friendly location in your area. 28 Traveling and Moving with Your Cat* Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • June 2014 Veterinary Team Brief 45 Social Media Calendar: July 2014 Dermatology Focus Tuesday Wednesday Thursday Friday Saturday 1 Post about a product or service your practice provides. Share an image of the product if you have one handy. 2 Summer Safety Tips* 3 Ringworm in Dogs* 4 Celebrating the 4th of July with Your Pets: Firework Safety* 5 SEE IT: Retired Soldier from Florida Reunites with an Army Buddy Dog a Year After Being Separated* 8 Cancer: Now What?* 9 Clipping a Dog's Claws (Toenails)* 10 Pyoderma in Cats (Bacterial Skin Infection, Pus in the Skin)* 11 Highlight something wonderful that a team member did for a patient this week. 12 Cat Unrolls Toilet Paper, Then Politely Puts It Back* 15 Chewing* 16 Great Tips to Help You Give Your Dog Medications* 17 Allergy Testing* 18 Highlight a service that you offer, such as boarding. 19 Lounging Cats* 22 Top 10 Plants Poisonous to Pets* 23 10 Strange Dog Behaviors Explained* 24 Botflies (Maggots) in Dogs* 25 Highlight something wonderful that a team member did for a patient this week. 26 Bow-WOW! Double-Dutch Dog Breaks Guinness Jump Rope Record* 29 Addison's Disease in Dogs* 30 Glaucoma in Dogs: An Eye Emergency* Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM 31 Canine Acne*
    • 46 veterinaryteambrief.com June 2014 Although functional workplaces encourage team members to interact positively, hostile behaviors may still arise. These hostile behaviors may be associated with abusive supervision, which can adversely impact job performance. This study examined the process through which personality mediates the effects of abu- sive supervision, or verbal and nonverbal—but not physical—an- tagonistic behaviors, and the effects of coping strategies and conscientiousness on abusive supervision and job performance. Conscientious workers are considered reliable, hardworking, self-disciplined, and persevering, and are more likely to be thoughtful and deliberate in their reactions to stress while main- taining high performance levels. The study hypothesized that this trait would consequently reduce the negative effects of abusive supervision, and that conscientious team members would use more active coping strategies. The relationship between abusive supervision and lowered job performance was weaker when team members were more conscientious. While avoidance cop- ing, manifested as mental, emotional, or physical disengage- ment, indicated a negative relationship between abusive supervision and performance, active coping did not predict pos- itive performance. The results indicated that even when a team Abusive Supervisors & Conscientious Team Members Keeping the Team in the Dark CAPSULES Current Literature in Brief member was highly conscientious, avoidance coping negated any potential benefits. The study also suggested that hiring high- ly conscientious individuals may lessen the negative impact of abusive supervision, as well as implementation of managerial strategies to reduce inclination toward avoidance coping. As a business owner, I consider it far more vital to mitigate and prevent abusive supervision than to understand coping strate- gies of any unfortunately subjected team members. Hiring con- scientious workers means that they will handle stress more adaptably, but abusive supervision is absolutely not inevitable. Practice owners must be aware of these dynamics so appropri- ate changes can be made, ideally via regular one-on-one meet- ings in which honest feedback and input will not be punished. Team meetings can help, but many team members will not feel comfortable naming an abusive supervisor in such a public set- ting.—Carl Bello, DVM, LMHC SOURCE: Surviving an abusive supervisor: The joint roles of conscientiousness and coping strategies. Nandkeolyar AK, Shaffer JA, Li A, et al. J Appl Psychol 99:138-150, 2014. COMMENTARY COMMENTARY Communicating and staying on top of developments within the team is a constant challenge. This study offered advice for staying in tune with the chaos of manage- ment. The timing and content of team meetings is essential; it is im- portant to convey yearly, quarterly, and weekly messages at an appropriately staggered pace, and the content should be tai- lored to goals that are achievable within this timeframe. The substance of meetings should be noted regardless of informa- tion conveyed and audience size, and any protocols, group decisions, or standard of practice documents should be filed in an accessible, secure, flexible, and economic manner. Com- munication with individual team members should be in person and limited in time, except under special circumstances or during annual reviews. Team members are not only a cost to a business, but also a great resource—never forget to use all opportunities to incorporate their ideas and advice. This article reminds us that effective communication within practices involves more than the one-on-one communication skills we utilize among team members or clients. Organiza- tional communication, especially important in planning and executing effective meetings, needs careful planning to ad- dress questions related to who, what, where, when, and how. When the right people are brought together at the right time, the potential for creative problem solving is immense, but only if the meeting is structured the right way. Also, effective com- munication lasts long after the meeting is over—when deci- sions are made or new policies and protocols are created, we need to follow through by keeping good records and ensuring that information is easily and quickly accessible to those who need it.—Darcy H. Shaw, DVM, MVSc, MBA, DACVIM SOURCE: Effective team communication. Crick J. In Pract 36:96-98, 2014. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • June 2014 Veterinary Team Brief 47 THE BUZZ IN BRIEF To improve client compliance and patient care, Vets First Choice now offers free shipping on all prescription and maintenance veterinary diets when customers sign up for automatic deliveries. For more information about the service and the brands available, visit vetsfirstchoice.com. —Press release 5/2014 OPTIMIZERx Corporation has launched VoucherDVM to assist veterinary practices in offering savings on the products and medications prescribed to their clients. VoucherDVM, powered by OPTIMIZERx’s SampleMD platform, integrates into veterinary practice management software or is a downloadable desktop application. Learn more at voucherdvm.net.—Press release 4/2014 H3 Veterinary CreditPlans has introduced the H3 WellnessPlus Credit Card, which provides revolving credit to pet owners that can be used to purchase products and services at a participating veterinary practice. The card also features promotional credit plans ranging from 6 to 60 months, with no sign-up fees, upfront costs, monthly minimums, or equipment purchase requirement for the practice. For more information, visit veterinarycreditplans.com. —Press release 4/2014 IDEXX Laboratories has released the IDEXX VetConnect PLUS mobile app for iPhones. The new app instantly presents and notifies veterinarians of available diagnostic results either from IDEXX in-house analyzers or IDEXX Reference Laboratories, allowing practitioners to closely monitor their cases and make timely medical decisions. Visit idexx.com for details. —Press release 4/2014 Weight management that works in the real world. 1 Data on file. Hill’s Pet Nutrition, Inc. ©2014 Hill’s Pet Nutrition, Inc. ®/™ Trademarks owned by Hill’s Pet Nutrition, Inc. [CANNED + DRY + TREATS] Available in canine and feline formulas EXPECT SOMETHING DIFFERENT 88% of pets lost weight in two months at home1 Now with our most advanced antioxidant formula ever to help combat the inflammation associated with obesity (dry only) Now with our most advanced antioxidant formula ever! Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • June 2014 Veterinary Team Brief 49 W hat is your IQ (intelli- gence quotient)? Unless you are a member of Mensa (those who score in the up- permost ranges of any IQ instru- ment), IQ is a relatively insignificant measure, especially in adulthood. What about your EQ (emotional quotient)? EQ and Emotional Intelli- gence (EI) have been researched and MIND OVER MATTER Sally Starbuck Stamp & Jeff Thoren, DVM Gifted Leaders, LLC Phoenix, Arizona written about extensively for more than 30 years, beginning with How- ard Gardner’s book on multiple in- telligences in 1983 through Daniel Goleman’s significant work in the 1990s. EQ is having "intelligence," or information about how our emotions, and those of others, affect our inter- actions and relationships. In addition, EI includes the element of respond- ing to and managing emotions.1 EQ is now thought to be as import- ant as IQ—or even more so—when determining personal and profession- al success. Having emotional intelli- gence means that you are confident, good at working toward your goals, adaptable, flexible, and resilient, and you recover quickly from stressful sit- uations, according to Goleman.2 Emotional Intelligence & Success: As Easy as Buying a Vowel Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • 50 veterinaryteambrief.com June 2014 we choose to respond to situations, including stress. 3. Social awareness is understand- ing others’ emotional states and responses—what some call our ability to “read” people accurately. It includes empathy, which is the ability to experience, to some de- gree, what is going on for others without actually having the expe- rience ourselves. 4. Relationship management is the MIND OVER MATTER EQ Quadrants Goleman's is perhaps the most easily understood of the many EQ models. He outlines 4 main competencies: 1. Self-awareness is having insight into our individual emotional makeup, how we express emo- tions, what triggers them, and what sensations accompany them. 2. Self-management is the ability to act on or use our emotions, and how ability to use all 3 competencies so that interaction with others is mutually satisfying. It includes effective communication, conflict competency, and respectfully ap- preciating differences. What does EQ have to do with posi- tivity and happiness? Susan Scott, author of Fierce Conversations,3 sug- gests that everything we say or do leaves a wake that is rarely neutral. Our words and actions can impact people negatively, which, in turn, af- fects the success of our interactions and relationships. Being emotionally aware of ourselves and others allows us to more accurately assess the wake we create. Managing the emotions can make the difference between a wake that rocks all the boats in the water and one that is an almost im- perceptible ripple. Choosing positivi- ty is a way to more consistently create a positive wake. Improving Your EQ While there is not much opportuni- ty to change your IQ, there are many ways to develop and improve your EQ. Using a model can help translate learning into action. The 4 Corners of Empathetic Assertive- ness model by Marcia Hughes of Collaborative Growth will help: • Identify where you are with respect to specific EQ competencies • Provide a common language for discussion • Provide a framework for action for the desired behavioral change. Think about the vowels in the alphabet to remember these 4 areas of EQ skills: A = Assertiveness, E = Empathy, I = Impulse control, O = Optimism, U = Yo(U) Source: Four Corners of Empathetic Assertiveness. Hughes M. Collaborative Growth; http://www. cgrowth.com/articles/Leadership_4_corners.pdf; accessed May 2014. Used by permission. 4 Corners of Empathetic Assertiveness Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Assertiveness: The ability to communicate what is needed, including expected accountability. Empathy: The ability to feel compassion and concern for the circumstances of others. Impulse Control: The ability to manage emotions and actions, especially when things go wrong. Optimism: The belief that things can be resolved; a sense of hopefulness that can inspire others.
    • PEER REVIEWED do this, and we can work together to make it a great day!” Develop the habit of assessing the wake that you create. Strive for bal- ance among the model’s 4 quad- rants. Intentionally practice the EQ skills that you want to improve. If you do, you’ll be rewarded with a higher level of happiness for yourself and those around you. Remember—it's as easy as buying a vowel! See Aids & Resources, back page, for references & suggested reading. How can you improve your own EQ? First, look at the 4 corners of empathetic assertiveness and ask yourself how well you perform in these areas. It often helps to recall a specific recent experience where you interacted with a team member or client. For example, as a front-line adminis- trator in a busy small animal prac- tice, you may need to ask others to do something that they may not re- ally want to do. Think about the vowels and ask yourself: • Am I assertive? • Do I demonstrate empathy? • How well do I control impulsive language and behavior? • What level of optimism do I convey? Consider the difference between these responses: “Mary, I would like you to do what I ask without hearing all of your excuses for why you can’t do something. You make me really mad! I wonder if you’re really capable of doing this job.” “Mary, I need your help with answer- ing phone calls today in addition to your other duties. I know you’re really busy and I wouldn’t ask this if there were other solutions. I know you can Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM __________
    • Subscribe to Clinician’s Brief for FREE to receive: • Brief, concise formats for the practicing veterinarian • The publication small animal veterinarians have ranked #1 most essential for 7 years!* SUBSCRIBE FOR FREE AT CLINICIANSBRIEF.COM/SUBSCRIBE OR CALL 855-229-4956. From the publisher of Veterinary Team Brief *2007-2013 PER and Essential Media Studies Essential tips for diagnosis and treatment • Q Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM ____________________________ NO TIME TO SIFT THROUGH A STACK OF JOURNALS? NO PROBLEM.
    • June 2014 Veterinary Team Brief 53 Sky, Mrs. Larson’s 6-year-old Yorkshire terrier, suffers from alopecia, increased appetite, polyuria/polydipsia, and a pot-bellied appear- ance. Mrs. Larson agrees to blood and urine testing, and the results confirm the suspicion: pituitary-dependent Cushing’s disease. Delivering the news that a patient has a chronic disease can be challenging and fraught with frustration. It is a long road; expectations become mud- dled, challenges arise, and compliance often falls by the wayside, leaving the patient to suffer. Thankfully, there are tools to ensure proper treatment and clear communication and to promote client understanding, commitment, and adherence to the treatment plan. Chunking & Checking Chances are this is not the first time, nor will it be the last, that you have talked about Cushing’s disease, mak- ing it is easy to resort to a spiel. In- stead, employ chunk and check to tailor the explanation to the specific situation and individual client. In its most basic form, chunk and check in- volves giving information in small, easily understood phrases (1–3 sen- tences) [chunk] and checking for client understanding using pauses, open- ended questions, reflective listening, or empathy [check] before moving on. “Testing has confirmed that Sky has Cushing’s disease. We can help manage SPECIAL FEATURE Lisa Hunter, LSW, & Jane Shaw, DVM, PhD Colorado State University Crucial Client Conversations: Pets with Chronic Conditions his signs with a good quality of life. The disease will never go away, and it will require your commitment [chunk and pause]. What initial questions do you have at this point [check: open-ended question]?” Chronic conditions require consider- able client effort to manage, so simply checking for base understanding is not enough. Use chunk and check to ascertain what the clients’ goals are, elicit their concerns, and determine their level of commitment. A client who is actively engaged develops a deeper understanding and is more likely to adhere to recommendations.1 Eliciting the Client’s Perspectives Identify the client’s perspectives to determine his or her expectations, investment, willingness, and capa- bilities. By accounting for worries, ideas, and feelings, promoters or barriers can be identified for imple- menting the plan of care. Invite an open discussion regarding financial resources, recent life events (eg, mov- ing, new job, birth, death), support system, family structure, profession, and schedule. The client’s answers to these questions will directly affect whether he or she will adhere to the treatment plan. For example, Mrs. Larson travels ex- tensively for work. Is her dog sitter able and willing to give medications, monitor for adverse reactions, and bring Sky in for rechecks? In addition, Mrs. Larson is unsure of the finances, Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • 54 veterinaryteambrief.com June 2014 as she is struggling with medical debt and going through a divorce. How can the expenditures be spread out? Enhancing Compliance Eliciting the client’s perspectives pro- motes partnership and client partic- ipation, a strong foundation for compliance.2 With any chronic ill- ness, compliance with the care plan is instrumental in successfully man- aging the patient’s problems. The 2002 American Animal Hospital As- sociation’s (AAHA) Compliance Study used the acronym CRAFT as a framework for how compliance and communication lead to optimum pa- tient care3,4 : Compliance (C) = Recommendation (R) + Acceptance (A) + Follow-through (FT) When engaging in a crucial conver- sation concerning chronic disease, the recommendation equates to the chunk, while acceptance parallels the check method of communication. Follow-through involves putting the mutual agreement into action, with the roles of both the veterinarian and the client [partnership] in caring for the pet clearly defined and accepted [summary, contracts for next steps, and final check]. “Let me make sure that we are all on the same page with Sky’s care plan [sum- mary]. You will be giving Sky his medi- cation every other day for the next week. If you have to travel, his sitter will pro- vide care and can call us with any ques- tions. After a week, we will reassess Sky and determine his medication schedule [contract for next steps]. “I want to make sure we are working together on this [partnership]. How does this plan fit into your schedule, budget, and care plan for Sky [final check]?” Clients often feel frightened and frus- trated when confronted with treating a pet’s chronic illness. By delivering the news in manageable portions via chunk and check, eliciting the client’s perspectives, expectations, and goals, and tailoring a treatment plan that works for the client, client compliance is improved, client–veterinary team satisfaction is enhanced, and—most importantly—the patient receives the best veterinary care possible. See Aids & Resources, back page, for references & suggested reading. PEER REVIEWED SPECIAL FEATURE AIDS & RESOURCES produced by mindfulness meditation. Davidson RJ, Kabat-Zinn J, Schumacher J, et al. Psychosom Med 65:564-570, 2003. 2.Attending to the present: Mindfulness meditation reveals distict neural modes of self- reference. Farb NAS, Segal ZV, Mayberg H, et al. Soc Cogn Affect Neurosci 2:313-322, 2007. When Cyberbullies Strike References 1. New York veterinarian driven to suicide after cat custody battle ruins clinic. New York Daily News; http://www.nydailynews.com/new-york/ nyc-veterinarian-driven-suicide-cat-custody-fight- article-1.1701820; accessed Apr 2014. 2. New York Penal - Article 240 - § 240.30 Aggravated Harassment in the Second Degree. Onecle; http://law.onecle.com/new-york/penal/ PEN0240.30_240.30.html; accessed Apr 2014. Keys to the Client’s Perspectives • Ability to provide care • Barriers to providing care • Challenges • Family structure • Finances • Goals and expectations • Profession • Recent life events • Strengths • Stressors • Support system • Thoughts and feelings • Time and schedule. 3. Is This the Worst Vet of 2013? Shirley Sara Koshi of Gentle Hands Veterinary Strikes Back with Bizarre Version Regarding Her “Theft” of Karl the Cat, Claims She Has “Sold Karl.” Suki’s Safe Haven: The Veterinary Abuse Network Blog; http:// vetabusenetwork.blogspot.com/2013/12/is-this- worst-vet-of-2013-shirley-sara.html; accessed Apr 2014. 4. John Sarcone III bombshell: Koshi’s suicide note addressed harassment. Ban the Veterinary Abuse Network; http://banvetabuse.blogspot.com/2014/03/ john-sarcone-iii-bombshell-koshis.html; accessed Apr 2014. 5. Yelp reviews brew a fight over free speech vs. fairness. The Wall Street Journal; http://online. wsj.com/news/articles/SB1000142405270230384 7804579477633444768964?mod=trending_now_3; accessed Apr 2014. 6. Communications Decency Act: An h Continued from page 56 Overview. Communications Decency Act; http:// communicationsdecencyact.com/; accessed Apr 2014. 7. Content guidelines. Yelp; http://www.yelp.com/ guidelines; accessed Apr 2014. 8. Facebook community standards. Facebook; https://www.facebook.com/communitystandards; accessed Apr 2014. Suggested Reading How to stop bullying on Facebook. wikiHow; http:// www.wikihow.com/Stop-Bullying-on-Facebook; accessed Apr 2014. State cyberstalking and cyberharassment laws. National Conference of State Legislatures; http:// www.ncsl.org/research/telecommunications- and-information-technology/cyberstalking-and- cyberharassment-laws.aspx; accessed Mar 2014. Support center: Responding to reviews. Yelp; https://biz.yelp.com/support/responding_to_reviews; accessed Apr 2014. Wrongful death claims: An overview. Nolo; http://www.nolo.com/legal-encyclopedia/wrongful- death-claims-overview-30141.html; accessed Apr 2014. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM ______________________ ____________ ___ ______________________ ________________ ___ _______________ ___ _____________________ ___ ____________________ _____________________ _____________ _______________________ ________________ __________________ ____________________ ____ ________
    • June 2014 Veterinary Team Brief 55 PRACTICE MARKETPLACE Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM _______________ _____________________
    • Activyl................................................back cover us.activyl.com Merck ACVS Surgery Summit........................page 36 acvssurgerysummit.org American College of Veterinary Surgeons CitraVet..................................................page 51 prnpharmacal.com PRN Pharmacal Clinical Brief: Bacterial Pyoderma Patient Pearls.....insert veterinaryteambrief.com/bacterial-pyoderma Dechra Comfortis...................................... pages 27, 26 comfortis.com Elanco CranMate..............................................page 23 prnpharmacal.com PRN Pharmacal Elanco PET Program...........................page 39 elancopetprogram.com Elanco Hill’s Prescription Diet Metabolic..pages 47,48 HillsVet.com/Metabolic Hill’s Pet Nutrition Hill's Prescription Diet Urinary Tract Health.......................... pages 4,5 HillsVet.com/cdMulticare Hill’s Pet Nutrition Leba III...................................................page 55 lebalab.com Leba Lab MiconaHex+Triz ...................................page 40 dechra-us.com Dechra NAVC Conference 2015.........inside back cover NAVC.com The North American Veterinary Community Nestlé Purina Daily Nutrition Matters.......... inside front cover DailyNutritionMatters.com Nestlé Purina Royal Canin Anallergenic....................page 19 royalcanin.us Royal Canin Strengthen the Bonds.........................page 14 idexx.com/strengthenthebonds IDEXX Laboratories Vetadryl .................................................page 11 prnpharmacal.com PRN Pharmacal Veterinary Pet Insurance.......................page 6 vpihealthypractice.com Veterinary Pet Insurance WSAVA 2014 .........................................page 20 wsava2014.com World Small Animal Veterinary Association AIDS & RESOURCES ADVERTISERS INDEX 56 veterinaryteambrief.com June 2014 Are You at Risk for Compassion Fatigue? Reference 1. Certification Training for Compassion Fatigue Professionals. Gentry JE—Eau Claire, Wisconsin: Premier Publishing and Media, 2013. Suggested Reading Companioning You!: A Soulful Guide to Caring for Yourself While You Care for the Dying and the Bereaved. Wolfelt AD—Fort Collins, Colorado: Companion Press, 2012. Compassion Fatigue in the Animal-Care Community. Figley CR, Roop RG—Washington, DC: Humane Society Press, 2006. Healing Your Grieving Body: 100 Physical Practices for Mourners. Wolfelt AD, Duvall KJ—Fort Collins, Colorado: Companion Press, 2009. Healing Your Grieving Soul: 100 Spiritual Practices for Mourners. Wolfelt AD—Fort Collins, Colorado: Companion Press, 2009. Treating Compassion Fatigue. Figley CR (ed)— New York; Brunner-Routledge, 2002. When Caring Hurts: Managing Compassion Fatigue. VetMedTeam; http://www.vetmedteam. com/class.aspx?ci=376; accessed May 2014. When Helping Hurts: Compassion Fatigue in the Veterinary Profession. Ayl K—Lakewood, Colorado: AAHA Press, 2013. Clinical Suite: MRSP in Dogs & Cats References 1. Antimicrobial resistance of Staphylococcus pseudintermedius isolates from healthy dogs and dogs affected with pyoderma in Japan. Onuma K, Tanabe T, Sato H. Vet Dermatol 23:17-22, 2012. 2. Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001-2002. Kuehnert MJ, Kruszon-Moran D, Hill HA, et al. J Infect Dis 193:172-179, 2006. 3. Coagulase positive staphylococcal colonization of humans and their household pets. Hanselman BA, Kruth SA, Rousseau J, Weese JS. Can Vet J 50:954-958, 2009. 4. Carriage of Methicillin-Resistant Staphylo- coccus pseudintermedius in Small Animal Veterinarians: Indirect Evidence of Zoonotic Transmission. Paul NC, Moodley A, Ghibaudo G, et al. Zoonoses and Public Health 58: 533–539, 2011. 5. The prevalence of carriage of meticillin-resis- tant staphylococci by veterinary dermatology practice staff and their respective pets. Morris DO, Boston RC, O’Shea K, et al. Vet Dermatol 21:400-407, 2010. 6. Risk of colonization or gene transfer to owners of dogs with methicillin-resistant Staphylo- coccus pseudintermedius. Frank LA, Kania SA, Kirzeder EM, et al. Vet Dermatol 20:496-501, 2009. 7. Review on methicillin-resistant Staphylococcus pseudintermedius. van Duijkeren E, Catry B, Greko C, et al. J Antimicrob Chemother 66:2705- 2714, 2011. 8. Staphylococcal control in the veterinary hospital. Weese S. Vet Dermatol 23:292-298, 2012. Suggested Reading An in vitro study to determine the minimal bac- tericidal concentration of sodium hypochlorite (bleach) required to inhibit meticillin-resistant Staphylococcus pseudintermedius strains isolated from canine skin. Pariser M, Gard S, Gram D, et al. Vet Dermatol 24:632-634, 2013. Meticillin-resistant Staphylococcus pseudin- termedius: clinical challenge and treatment options. Frank LA, Loeffler A. Vet Dermatol 23:283-291, 2012. Special Issue on Staphylococci and the Skin. Vet Dermatol 23(4), 2012: 251-385. Crucial Client Conversations References 1. Skills for Communicating with Patients. 2nd ed. Silverman J, Kurtz S, Draper J—Abingdon UK: h Continued on page 54 Radcliffe Medical Press, 2005. 2. Compliance: Crafting quality care. Wayner CJ, Heinke ML. Vet Clin North Am Small Anim Pract 36:419-436, 2006. 3. Compliance: Taking Quality Care to the Next Level. American Animal Hospital Association; https://www.aahanet.org/Library/QualityCare.aspx; accessed Apr 2014. 4. Six Steps to Higher Quality Patient Care, American Animal Hospital Association. Lakewood, Colorado: AAHA Press, 2009. Dirty Laundry References 1. Prevalence of alcohol use disorders among American surgeons. Oreskovich MR, Kaups KL, Balch CM, et al. Arch Surg 147:168-174, 2012. 2. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. McLellan AT, Skipper GS, Campbell M, DuPont RL. BMJ 337:a2038, 2008. Mind Over Matter References 1. What is Emotional Intelligence? Mayer JD, Salovey P. In Salovey P & Sluyter DJ (eds): Emotional Development and Emotional Intelligence: Educational Implications—New York: BasicBooks, 1997. 2. Emotional Intelligence: Why It Can Matter More Than IQ. Goleman D—New York City: Bantam Books, 1995. 3. Fierce Conversations: Achieving Success at Work & Life, One Conversation at a Time. Scott S—New York: Berkley, 2002. Suggested Reading Emotional intelligence. Goleman D; http://www. danielgoleman.info/topics/emotional-intelligence/; accessed Apr 2014. Personality Profile References 1. MBTI Temperament Types and the Veterinary Team. Ruby K. Unpublished study by Educational Concepts for Merial, 2011. 2. Creative You: Using Your Personality Type to Thrive. Kroeger O, Goldstein DB—New York: Atria, 2013, pp 158-162. Put Your Money to Work Suggested Reading Compensating Doctors by Salary Still Works! Kearley B. Veterinary Team Brief; http://www. veterinaryteambrief.com/article/compensating- doctors-salary-still-works; accessed Feb 2014. Publication 15-B, Employer’s Tax Guide to Fringe Benefits. Department of the Treasury, Internal Revenue Service; http://www.irs.gov/pub/irs-pdf/ p15b.pdf; accessed Feb 2014. Tech Talk References 1. Global Nutrition Guidelines. World Small Animal Veterinary Association; http://www.wsava.org/ guidelines/global-nutrition-guidelines; accessed Apr 2014. 2. The Path to High Quality Care: Practical Tips for Improving Compliance. American Animal Hospital Association—Lakewood, Colorado: AAHA Press, 2003. Suggested Reading Owner Education and Adherence. Burns KM, Towell TL. In Towell TL (ed): Practical Weight Management in Dogs and Cats—Ames, Iowa: Wiley-Blackwell, 2011. That Sinking Feeling Reference 1. Nonviolent Communication: A Language of Life. Rosenberg MB—Encinitas, California: PuddleDancer Press, 2003. Top 5 References 1.Alterations in brain and immune function Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM ______________________ _____________________ ___________ _________________ ____ ______
    • to better care every day. LEAD THE WAY 2015 JANUARY 17-21 ORLANDO, FLEXHIBITS 18 - 21 For all you true leaders out there, Early Registration starts now. FOR MORE INFORMATION, VISIT NAVC.COM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM _____________________
    • If you were a dog, what would you do about ticks and fleas? with indoxacarb Drives fleas to extinction Both patients and clients want a product that really gets rid of fleas. Activyl® , the latest innovation in monthly spot-on flea control, features indoxacarb and bioactivation — a mode of action that uses enzymes inside the flea to activate Activyl® ’s full flea-killing power. Copyright © 2014 Intervet Inc., a subsidiary of Merck & Co., Inc. All rights reserved. Intervet Inc. d/b/a Merck Animal Health, Summit, NJ 07901 US/ACT/0214/0012 Available strictly through veterinarians. Protected by Merck Animal Health Track & Trace™ technology. Quick-Drying • Fragrance-Free • Waterproof us.activyl.com Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • Bacterial Pyoderma Patient Pearls Clinical Brief 1 STEP 1: Overview Sponsored by Dechra Veterinary Products CLINICAL BRIEF BACTERIAL PYODERMA PATIENT PEARLS A Supplement to Veterinary Team Brief Canine Bacterial Pyoderma: What You Need to Know Kimberly Coyner, DVM, DACVD Dermatology Clinic for Animals, Tacoma and Olympia, Washington Bacterial skin infections (bacterial pyoderma) in dogs are a very common clinical problem usually caused by Staphylococcus pseudintermedius. A gram-positive coccoid bacteria that is considered normal flora in dogs,1 S pseudintermedius can also be an opportunistic pathogen in dogs with underlying conditions that compromise the skin barrier or immune function including2 : • Hypersensitivity dermatitis (atopy, food allergy, flea allergy) • Parasitic skin infestations (Demodex mites, scabies, fleas) • Endocrinopathies (hypothyroidism, Cushing’s disease) • Follicular dysplasia disorders • Keratinization disorders (sebaceous adenitis, zinc-responsive dermatosis) An underlying cause was found in 28 of 30 dogs in a study of recurrent bacterial pyoderma.3 In otherwise healthy dogs, treatment of bacterial pyoderma will result in complete cure. Common causes of rapid recurrence (within 1–2 weeks) include inadequate duration of anti- biotic therapy or bacterial resistance. In recurrent cases in which infections KEY POINTS • Dogs with chronic or recurring bacterial pyoderma typically have an underlying condition that compromises the normal skin barrier or immune function. • New understanding of the role of epidermal barrier dysfunction as well as the emergence of multidrug-resistant, methicillin-resistant Staphylococcus pseudintermedius (MRSP) has led to increased emphasis on management of bacterial pyoderma with topical therapy, rather than systemic antibiotics. • Barriers to owner compliance with topical therapy can often be overcome with client education and tailoring the regimen to the owner’s ability to successfully apply treatments. resolve and then recur within 2 to 3 months, it is important to identify and treat the underlying cause.3 Recurrent bacterial pyoderma occurs more commonly in atopic dogs due to increased adherence of staphylo- coccal bacteria to atopic canine skin cells,4 altered skin immune system function,5 and abnormalities of skin barrier function.6 ABNORMAL SKIN BARRIER The epidermis acts as a functional and immunologic barrier to prevent desic- cation and penetration of the skin by infectious organisms and allergens. The stratum corneum, the outermost layer of the epidermis, is composed of cornified keratinocytes (corneocytes) sur- continues on page 2 FOR MORE ON CANINE BACTERIAL PYODERMA VISIT veterinaryteambrief.com/ bacterial-pyoderma Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM ________________ ___________________ _________
    • 2 Clinical Brief Bacterial Pyoderma Patient Pearls STEP 2: Recognizing Pyoderma Clinical Appearance & Diagnostics Kimberly Coyner, DVM, DACVD Dermatology Clinic for Animals, Tacoma and Olympia, Washington CLINICAL APPEARANCE Theappearanceofcaninebacterialpyodermacanvarydependingoninfection location and length of surrounding hair. In a superficial bacterial folliculitis, initial primary lesions are papules and pustules (Figures 1 & 2), which can crust and then progress into expanding areas of alopecia and surrounding scaling (epidermal collarettes), hyperpigmentation, and lichenification (sometimes appears similar to Malassezia/yeast dermatitis) (Figures 3, 4, & 5). Papules can appear similar to hives in short-coated dogs (Figure 6), whereas long-coated dogs with superficial bacterial pyoderma may have just a dull coat with scaling +/- odor and easily epilated hair coat (Figure 7). Deep bacterial pyoderma may appear as areas of thick crusting, alopecia, inflamed bullae, and/or ulcerative draining skin lesions (Figure 8). Figure 1BFigure 1A Figure 1. A, Inguinal pustule (left) and papule (right); B, neutrophils with intracellular cocci found on pustule. Figure 2A Figure 3. Patchy truncal hair loss and scaling due to bacterial folliculitis in an atopic miniature pinscher. Figure 2B Figure 4. Epidermal collarettes. Figure 2. A, This atopic cocker spaniel was very pruritic but only slight fine scaling was visible on external examination. B, When the dog was shaved for intradermal allergy testing, numerous tiny bacterial papules were identified; papules, scaling, and pruritus quickly resolved with antibiotics and topical antimicrobial therapy. rounded by complex lipid lamellae that are manufactured by keratinocytes deeper in the skin layers.7 The lipids consist of ceramides (fatty acids linked to a long-chain sphingosine base). The “outside in” theory of atopic der- matitis is that a genetic abnormality of skin protein manufacture leads to bar- rier dysfunction and increased pene- tration of allergens.7 Ultrastructural evaluation of skin samples in dogs with atopic dermatitis showed wide spaces between corneocytes, intracor- neocyte retention of lamellar bodies, and intercellular areas with lipid lamellae absence and disorganization.8 Allergenic challenge caused further disorganization of corneocytes and lipid lamellae arrangement, as well as widening of intracellular spaces.8 In atopic dogs there is also a quantita- tive reduction in ceramides, which increases transepidermal water loss (TEWL).9 While studies in atopic dogs are limited, application of topi- cal products containing ceramides in atopic humans helps to reduce in- flammation and TEWL.10, 11 continued from page 1 The “outside in” theory of atopic dermatitis is that a genetic abnormality leads to barrier dysfunction and increased penetration of allergens. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • Bacterial Pyoderma Patient Pearls Clinical Brief 3 DIAGNOSTICS Bacterial pyoderma is diagnosed by clinical appearance and cytology as well as by ruling out other infectious causes of folliculitis with deep skin scrapings for mites +/- dermatophyte culture. Samples can be collected us- ing the following techniques: • If pustules are present, rupture with a needle and impress the contents onto a slide. • For moist, exudative, or lichenified lesions, press a slide directly onto affected areas to obtain impression cytology. • For dry scaly areas, collect skin debris with a dull, dry scalpel blade or spatula; smear onto the slide, and stain with Diff-Quik or a similar stain. • Press a piece of clear acetate tape onto the area of interest, then place the tape onto a slide over a drop of blue stain. Slides are first scanned under 10 and then examined under 40 to 100 . Neutrophils with intracellular cocci +/- Figure 7. This long-coated dog with superficial bacterial pyoderma has a dull coat with greasy scaling; when the hair is parted, bacterial crusts are visible. Figure 8. Deep bacterial pyoderma. The Shift Toward Topical Therapy & Home Management John Angus, DVM, DACVD Animal Dermatology Clinic, Pasadena, California Three major developments during the last decade have led to increased emphasis on home management with topical therapy in treatment of staphylococcal pyoderma: 1. Understanding of the role of epidermal barrier dysfunction in pathogenesis of atopic dermatitis 2. Understanding that bacterial overgrowth as a consequence of epidermal barrier dysfunction contributes to progression of clinical disease, pruritus, and dermatitis 3. The emergence of multidrug-resistant, methicillin-resistant Staphylococcus pseudintermedius (MRSP) As a result, veterinarians are now more often asking owners to utilize shampoo and other topical therapeutic protocols for both short- and long-term management of common dermatologic diseases. Frequent bathing is a critical tool in managing atopic patients from an early age—not just when they are dirty, infected, itchy, seborrheic, or malodorous— but as a constant therapy to 1) remove irritants/debris, 2) remove allergens, 3) reduce bacteria/yeast, and 4) moisturize and repair the defective epidermal barrier. Atopic dermatitis is a chronic, progressive disease and these patients may always be prone to relapse or recurrence of bacterial and yeast overgrowth. Frequent bathing with products that are both restorative of epidermal function but also reduce recolonization by native bacteria and yeast is essential. Home care with veterinary-directed topical protocols can be viewed as both steroid- and antibiotic-sparing over the lifetime of the patient. macrophages are found in superficial and deep bacterial pyoderma. In bac- terial overgrowth syndrome, numer- ous extracellular bacteria are seen and may include cocci as well as rods +/- Malassezia. Aerobic bacteria culture is indicated if bacteria persist on cytology despite em- piric antibiotic therapy (especially in recurrent cases that have already been treated with multiple antibiotics), if pri- marily rod-shaped bacteria are found, and in cases of deep bacterial pyoder- ma.3 Culture can be performed by swabbing a freshly ruptured pustule, by rubbing the culturette swab under an intact crust or under the rim of an epi- dermal collarette, or by obtaining a 4- to 6-mm punch biopsy of a papule or pustule for tissue culture. Figure 6. Hypotrichosis, easily epilated fur, and raised tufts of fur are caused by a bacterial folliculitis in this atopic dog. Figure 5A Figure 5B Figure 5. After several weeks of ketoconazole for suspected Malassezia dermatitis of the neck (A) and axillae, impression cytology of the affected areas in this dog revealed only bacterial infection with no yeast (B). Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • 4 Clinical Brief Bacterial Pyoderma Patient Pearls STEP 3: Selecting the Correct Treatment Keys to Successful Staphylococcal Pyoderma Management John Angus, DVM, DACVD Animal Dermatology Clinic, Pasadena, California When managing a single episode of bacterial skin infection, veterinarians have one goal: successful resolution of the infection. When managing chronic or relapsing infection, however, there are two goals: 1) successful resolution of the current infection, and 2) diagnosis and management of the underlying cause. Failure in one or the other will ultimately result in disease progression and perception of treatment failure by owners. fecting safety of antibiotics they use. For example, aminoglycosides are rarely chosen to manage superficial bacterial pyoderma due to safety concerns. Efficacy • Cephalosporins are the first choice for staphylococcal pyoderma (except for cases of MRSP; see box below). They are safe, effective, encounter low levels of resistance, and have easy-to-administer options by multiple routes. • Variable resistance is reported to clindamycin, lincomycin, erythromycin, doxycycline, potentiated sulfa, and chloramphenicol; reserve these for cases with specific culture and susceptibility profiles. • Poor choices include penicillin, ampicillin, amoxicillin, and tetracycline. • Fluoroquinolones should be reserved for gram-negative pathogens or rare cases where they exceed beta-lactams in efficacy. TOPICAL TREATMENT The benefits of topical therapy are sum- marized in the box at bottom of page 5. SYSTEMIC TREATMENT Rapid, complete resolution is often achieved by combining systemic and topical treatment. The major risk fac- tor for acquiring MRSP, however, is being on antibiotics. Thus, clinicians must evaluate whether an antibiotic is needed. If so, the selection should be based on: Safety Veterinarians should be familiar with common side effects, adverse events, drug interactions, and other factors af- TREATING PYODERMA IN PATIENTS THAT ALREADY HAVE MRSP Antibiotic selection in these cases should be based solely on susceptibility specific to the cultured isolate. The MRSP antimicrobial susceptibility pattern includes resistance to beta-lactams, fluoroquinolones, sulfonamides, macrolides, and tetracyclines, which leaves less desirable choices such as chloramphenicol, rifampin, and amikacin. Consult with your local dermatologist for current recommendations for using these antibiotics to manage MRSP. Fortunately, while MRSP is resistant to many antibiotics it is not resistant to topical antiseptics. Protocol with Topical Therapy Alone 1. Deep soak, whirlpool, or pulsating hydrotherapy prior to medicated bath. Clip hair if necessary. 2. Benzoyl peroxide shampoo: Focus on problem area first, then the rest of the body. Deep massage for 5–10 minutes then rinse thoroughly, beginning with unaffected areas and then proceeding to those with lesions. 3. 3–4% Chlorhexidine shampoo: Same process as benzoyl peroxide. 4. Accelerated hydrogen peroxide or Dakin’s solution rinse. Soak to skin. Do not rinse. 5. Repeat DAILY for 10–14 days then reassess. If resolved, then repeat two times per week for 4 weeks. If not resolved, continue DAILY therapy switching up topical products as needed. FOR MORE ON CANINE BACTERIAL PYODERMA VISIT veterinaryteambrief.com/ bacterial-pyoderma Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM ________________
    • Bacterial Pyoderma Patient Pearls Clinical Brief 5 Shampoos Common antiseptic ingredients in vet- erinary shampoos are listed in the box at right. Regardless of product, the active ingredient must contact the target— that means frequent AND correct use by the owner. As an adjunct to systemic antibiotics or to prevent bacterial over- growth syndrome and relapsing infec- tion, “frequent” may mean one to two times per week. In active MRSP, “fre- quent” may mean daily or every other day. With a long, thick coat, a groom- ing length clip may be useful. If there is obstructive debris, dirt, crust, adherent scale, or seborrhea, try a prebath with an antiseborrheic shampoo followed by antiseptic shampoo. For deep bacterial pyoderma, prolonged hydrotherapy with pulsatile action, whirlpool, or sim- ple warm water soak is highly benefi- cial. Direct the owner to “treat the problem area first, then the rest of the body, rinse in reverse order” (unaffected areas first) so that the majority of time/product/ attention is spent treating the affected skin (see Client Handout on page 7). Rinses After shampooing, skin is clean, hy- drated, free of debris, and the hair fol- licles are open: an ideal time to lock in hydration and apply a product with residual antimicrobial action. Multiple conditioners and lotions are available to provide moisturizing, antipruritic, or antiseptic action—including prod- ucts effective against MRSP (see box above). Other Topical Therapies Augmental therapies are available for specific situations: • For owners unable/unwilling to bathe their dogs frequently, many of the same antiseptic ingredients can be found in sprays, lotions, or mousse products designed to be applied and left on the skin. • Antiseptic wipes/pads/ointment/gel can be used for fold pyoderma or localized dermatitis. Chlorhexidine/ tris-EDTA wipes are easy to use daily between baths. Chlorhexidine + imidazole and/or acidifying agent are appropriate if yeast is present. Nisin is particularly effective against staphylococci, including MRSP. • 2% Mupirocin ointment is recommended for staphylococcal lip fold pyoderma or focal deep pyoderma but has little action against gram-negative bacteria. • Chlorhexidine with tris-EDTA or silver sulfadiazine is a good choice for Pseudomonas. • Hyperosmolar honey/sugar are highly effective in managing deep wounds, burns, or otherwise severely compromised skin with secondary bacterial contamination. BENEFITS OF TOPICAL THERAPY • Physical removal of scale, crust, debris, irritants • Physical removal of allergens • Moisturize, restore, repair dysfunctional epidermal barrier • Reduce active infection • Reduce recolonization by pathogens • Provide temporary relief from pruritus • Decrease odor • Reduce reliance on systemic antibiotics as sole therapy • May reduce selection of resistant bacterial strains during antibiotic therapy MAINTENANCE THERAPY OF DOGS WITH HIGH PROBABILITY OF RELAPSE 1. 3–4% chlorhexidine shampoo: Focus on past problem areas first, then the rest of the body. Rinse in reverse order— unaffected followed by lesional areas 2. Apply rinse of choice: Antiseptic, antipruritic, or intensive moisturizing 3. Repeat 1 to 2 times per week 4. If unable to bathe weekly, then bathe a minimum of every 2–3 weeks and use topical spray or mousse with chlorhexidine 2–3 days per week ACTIVE INGREDIENTS IN TOPICAL AGENTS Shampoos • Most common antiseptic ingredients – Benzoyl peroxide – Chlorhexidine – Ethyl lactate – Acids: Acetic, boric, malic, glycolic • Imidazoles––for management of concurrent Malassezia dermatitis • Additional ingredients to enhance antimicrobial therapy – A carbohydrate, such as mannose, d-galactose, or l-rhamnose––to inhibit bacterial adherence to keratinocytes – Tris-EDTA: May have a synergistic antimicrobial action by damaging bacterial cell walls – Phytosphingosine: A pro-ceramide, to increase epidermal barrier function – Sulfur-salicylic acid: Enhances keratolysis and debris removal Rinses Effective Against MRSP • Sodium hypochlorite (Dakin’s solution): Caution––May stain fabrics and light-colored hair • Accelerated hydrogen peroxide • Stabilized oxychlorine Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • 6 Clinical Brief Bacterial Pyoderma Patient Pearls STEP 4: Client Communication Breaking Down the Barriers to Client Compliance Chantelle Tebaldi, BS, CVT Animal Dermatology South, Port Richey, Florida There are many things we can do as a team to help ensure our clients are ready, able, and willing to undertake the tasks we set before them. At every step, we can help set ourselves, our clients, and our patients up for success. • Discuss oral medications in detail. Show them the pills and call them by name. Clients should have a clear understanding of what each medication is and what it is for. • Demonstrate proper techniques for bathing, ear cleaning, or ear medicating; then have the owner attempt it so you can troubleshoot. • Handouts and written instructions are useful to help ensure compliance. Keep them simple and short. AFTER THE APPOINTMENT Preventing compliance issues extends beyond the appointment. A follow-up call can often head off problems before they start or go too far. • Set follow-up call reminders starting 2 to 3 days after the initial visit and continuing at set intervals. • Ask owners how they feel the pet is doing. Clients with unreal expectations may feel their pet should be dramatically better by this point and could be getting frustrated. • Confirm dosing of oral medications and make sure there are no difficulties medicating the pet. Offer tips to ease administration and avoid missed doses. • After receiving a wealth of information clients need a chance to ask questions. Reiterate the hospital’s availability should they have any questions at home. BEFORE THE APPOINTMENT The initial phone conversation is an ex- cellent place to start setting expectations for the visit as well as the approach the team will take. • Discuss the time clients should be prepared to spend during their visit. • Discuss preparing for the appointment including when to stop current topicals and fasting for possible procedures. • Discuss the flow of an appointment, basic diagnostics, and estimated costs. • Email a “welcome letter” to new clients with pertinent information. A template personalized to each client and patient makes this an efficient strategy. DURING THE APPOINTMENT In the exam room: • Get owners involved in the exam. Most owners will appreciate efforts to make them integral to their pet’s care. Teach what the lesions are and what their presence means. • Explain diagnostic results and show them pictures. It is not difficult in this age to take a photo of microscopic findings and show the owner what it means to have a skin infection. Often, this gives owners an appreciation for why it is important to return for progress exams and follow-up cytology. CLIENT TALKING POINTS Differences Between Human Skin & Pet Skin Clients should understand that their pet’s skin is different in structure and microbiome from their own and that products designed for our use are often not ideal for our pets. • Staphylococcus pseudintermedius is the most common cause of bacterial pyoderma in dogs, whereas S aureus infections are more common in human medicine. • Bacterial pyoderma is more common in pets, especially dogs, than in people. Owner’s Ability to Administer Topical Therapy Topical therapy, especially bathing, can be a daunting task. Asking owners what they can reasonably do will help the veterinary team better tailor an individualized treatment plan. An ideal topical therapy regimen should incorporate more than one product to increase the effectiveness of the treatment. If bathing frequency is an issue, sprays, wipes, and mousses can be used in conjunction with or in place of bathing. Methicillin-Resistant & Multidrug- Resistant Staphylococcal Infections As discussed earlier, topical antimicrobial therapy often is our best or only option after consideration of culture and sensitivity results in conjunction with the risk associated with certain systemic therapies.12 When MRSP is cultured, clients will often ask about risk to themselves or other pets. Colonization can occur in pets and people who are in contact with an infected pet with active lesions.12 CLIENT HANDOUTS Client handouts can reinforce information shared during the visit and improve compliance. In practices using electronic records, prewritten templates allow the technician to choose the relevant information for each case and insert it into the discharge instructions. Clients feel empowered when they have the knowledge and skills they need to help their pet and are less likely to discontinue treatment. Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • Client Handout Pyoderma & Your Pet WHAT IS PYODERMA? Pyoderma is a bacterial infection of the skin and is usually caused by a bacterium called Staphylococcus pseudintermedius. The bacterium is normally present in most dogs but typically doesn’t cause disease in healthy skin. When the immune system and normal barrier function are compromised due to an underlying condition, the skin becomes susceptible to infection. Common underlying causes of pyoderma include allergic diseases (food allergy, atopy, flea allergy), parasites (mange), and hormonal imbalances. It is important to diagnose and begin treatment of the underlying problem in order to help prevent recurrence. Treatment of the pyoderma may involve oral antibiotics and/or antibacterial ointments, shampoos, sprays, or mousses. KEY POINTS IN TREATING PYODERMA: • Do not stop your pet’s antibiotics before they are finished without consulting your pet’s veterinarian—no matter how good the skin looks—because this may lead to antibacterial resistance. • Topical treatment, such as a strict bathing regimen or application of leave-in products such as spray or mousse, is essential to resolving current infections and preventing future ones, especially in cases of antibiotic resistance. • A recheck examination (usually after 3–4 weeks of treatment) is necessary to evaluate your pet’s skin. • The diagnosis and management of the primary problem is the key to preventing recurrences of a skin infection. BATHING TIPS: Remember that bathing is a therapeutic tool, not just a grooming tool. • Saturate the pet’s coat and skin with water. Begin in affected areas, then move to remainder of body. • Apply the shampoo to the palms and then spread onto the pet. • Do not apply the shampoo directly to the pet in a stripe down the back. • Work the shampoo into the coat and ensure it contacts the skin. • Do not scrub against the growth pattern of the coat; this can worsen infection. • Allow 10 minutes of contact time with the skin (not just the coat). • Pets can be fed or taken on walks during this time. • Rinse extremely well with tepid water. Begin with unaffected areas, then move to areas with lesions. • Towel from head to tail, top to bottom with gentle pressure or with a hair dryer on a cool setting. It is very important to keep your pet’s recheck appointment. The oral medications and topical treatments may need to be modified based on your pet’s progress. Topical treatment, such as a strict bathing regimen or application of leave-in products such as spray or mousse, is essential to resolving current infections and preventing future ones, especially in cases of antibiotic resistance. Bacterial Pyoderma Patient Pearls Clinical Brief 7 Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM
    • 8 Clinical Brief Bacterial Pyoderma Patient Pearls Team Training & Work Flow Chantelle Tebaldi, BS, CVT Animal Dermatology South, Port Richey, Florida Bacterial pyoderma cases can be time consuming and there are many factors the team must consider before, during, and after the appointment. Each member of the team needs to be on the same page when it comes to the recommendations of the practice, and good communication between team members,includingthereceptionist,thetechnician,andthedoctor,isessential. Receptionists are often where good case management begins. They can set client expectations for the visit as well as ensure records from any referring veterinarian are received prior to the appointment. A well-trained technician can manage the flow of an appointment from beginning to end. PYODERMA CASE MANAGEMENT 1 PRIOR TO APPOINTMENT 2 DURING APPOINTMENT Review records, paying special attention to: • Dates of previous visits for similar issues: To help establish a pattern for chronicity • Cytology or culture and sensitivity results: A history of MRSP affects the choice of treatment • Previous antibiotic use and response will help establish whether a culture and sensitivity may be warranted at this visit • Response to therapy: Were previous treatments tolerated? Any drug reactions? Were previous medications effective? • Proper disinfection of the exam room • Postappointment follow-up calls • Confirm medication and topical therapy compliance and adjust as necessary • Relay test results and their implications • Answer questions HISTORY: Beyond the signalment of the pet: • Age at first occurrence of bacterial pyoderma and frequency of recurrence • Progression of clinical signs: Pruritus before lesions, lesions before pruritus, or lesions without pruritus • Medications and response, past and present • Ectoparasite control for pet and other pets in household • Diet and response, past and present (client adherence to diet exclusivity) • Concurrent clinical signs: Change in activity level, appetite, water consumption, or elimination habits • Change in environment PHYSICAL EXAM • Lesion type and distribution • Discussion of findings with the owner during the process DIAGNOSTICS • Cytology will help direct therapy • Culture and sensitivity if warranted • Blood tests for endocrine diseases, serum allergy testing, etc • Biopsy • Intradermal allergy testing TREATMENT COURSE • Oral medications • Topical therapies • Combination of systemic and topical therapy • Ectoparasite program CLIENT EDUCATION • Demonstrate proper techniques for topical application • Client handouts 3 AFTER APPOINTMENT 1 3 2 REFERENCES 1. Staphylococcal colonization of mucosal and lesional skin sites in atopic and healthy dogs. Fazakerley J, Nuttall T, Sales D, et al. Vet Dermatol 20:179-184, 2009. 2. Muller and Kirk’s Small Animal Dermatology, 6th ed. Scott DW, Miller WH, Griffin CE—Philadelphia: Saunders, 2001, pp 291-296. 3. Canine recurrent pyoderma: A multicenter prospective study. Bensignor E, Germain PA. Vet Dermatol 15 Suppl S1:42, 2004. 4. Adherence by Staphylococcus intermedius to canine corneocytes: A preliminary study comparing noninflamed and inflamed atopic skin. McEwan NA, Mellor D, Kalna G. Vet Dermatol 17:151-154, 2006. 5. Atopic dermatitis: A disease caused by innate immune defects? De Benedetto A, Agnihothri R, McGirt LY, et al. J Invest Dermatol 129:14-30, 2009. 6. Is the skin barrier abnormal in dogs with atopic dermatitis? Olivry T. Vet Immunol Immunopathol 144:11-16, 2011. 7. Abnormal skin barrier in the etiopathogenesis of atopic dermatitis. Elias PM, Schmuth M. Curr Opin Allergy Clin Immunol 9:437-446, 2009. 8. Transmission electron microscopic studies in an experimental model of canine atopic dermatitis. Marsella R, Samuelson D, Doerr K, et al. Vet Dermatol 21:81-88, 2010. 9. Increased transepidermal water loss and decreased ceramide content in lesional and non-lesional skin of dogs with atopic dermatitis. Shimada K, Yoon JS, Yoshihara T, et al. Vet Dermatol 20:541-546, 2009. 10. Evaluating clinical use of a ceramide-dominant, physiologic lipid-based topical emulsion for atopic dermatitis. Kircik LH, Del Rosso JQ, Aversa D. J Clin Aesthet Dermatol 4(3):34-40, 2011. 11. Clinical use of a ceramide-based moisturizer for treating dogs with atopic dermatitis. Jung JY, Nam EH, Parks SH, et al. J Vet Sci 14(2):199-205, 2013. 12. Recognizing pyoderma: More difficult than it may seem. Gortel K. Vet Clin Small Anim 43:1-18, 2013. © Copyright 2014, Educational Concepts, LLC, dba Brief Media STEP 5: Putting It All Together Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q M Mq q M M qM Qmags ®THE WORLD’S NEWSSTAND TM