From the publisher
of Clinician’s Brief
A Peer-Reviewed Journal | June 2014 | Volume 2 Number 5 veterinaryteambrief.com
CL...
Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q
M Mq
q
M
M
qM
Qmags
®THE WORLD’...
From the publisher
of Clinician’s Brief
A Peer-Reviewed Journal | June 2014 | Volume 2 Number 5 veterinaryteambrief.com
CL...
IMPROVING
PETS’ LIVES
BEGINS WITH
A FEW CLICKS.
Get the nutrition knowledge you need to help pets live active,
healthy liv...
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...
Kara Burns,
MS, MEd, LVT, VTS
(Nutrition)
Ron Cott,
DVM
Beth Spencer,
DVM
Tracy Dowdy,
CVPM
Fritz Wood,
CPA, CFP
Veterinar...
June 2014 Veterinary Team Brief
3
TABLE OF
CONTENTS
21
37
28
Editor’s Letter
IN THE TRENCHES
I am an office manager & veter...
Who’s New at Veterinary Team Brief?
Veterinary Team Brief is excited to announce changes in its editorial leadership:
Jim ...
1
Lulich JP, Kruger JM, MacLeay JM, et al. Efficacy of two commercially available, low-magnesium, urine-acidifying dry food...
But only
1 Bernie.
Insurance plans are offered and administered by Veterinary Pet Insurance Company in California and
DVM ...
June 2014 Veterinary Team Brief
7
IN THE
TRENCHES
I am an
office manager
& veterinary
assistant...
Whitney York
HOMETOWN: G...
8 veterinaryteambrief.com June 2014
TECH
TALK
Kara M. Burns, MS, MEd, LVT, VTS (Nutrition)
Academy of Veterinary Nutrition...
PEER
REVIEWED
Assessment Guidelines
To support the veterinary health-
care team, AAHA and the World
Small Animal Veterinar...
10 veterinaryteambrief.com June 2014
PUT YOUR
MONEY TO WORK
Bill Kearley, DVM, MBA
Veterinary Practice Success
Boise, Idah...
PEER
REVIEWED
additional allowance for continuing
education). Consider pursuing new
skills or training that the practice
c...
PERSONALITY
PROFILE
Kathleen Ruby, PhD
Washington State University
ENFP:
The Workplace’s Champion
12 veterinaryteambrief.c...
ENFPs in General2
:
• Are bright and capable
• Tend to be warm and interested
in people, with great people
skills
• Are se...
Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q
M Mq
q
M
M
qM
Qmags
®THE WORLD’...
SPECIAL
FEATURE
Suzanne Smither
Fort Lauderdale, Florida
Jurmark’s “lawsuit was frivolous, de-
manding a court order to Dr...
16 veterinaryteambrief.com June 2014
SPECIAL
FEATURE
and through the criminal justice
system.…We were planning to sue
Gwen...
June 2014 Veterinary Team Brief
17
PEER
REVIEWED
“I personally get a chill every time I
think of the misery Shirley Koshi ...
18 veterinaryteambrief.com June 2014
SPECIAL
FEATURE
it’s probably not defamation, but it
can still be harassment,” Owens ...
© ROYAL CANIN SAS 2014. All Rights Reserved.
In an eight- to twelve-week diet elimination trial, Royal Canin Anallergenic™...
Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q
M Mq
q
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qM
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®THE WORLD’...
SPECIAL
FEATURE
Sharon DeNayer, ME
Windsor Veterinary Clinic
& The Downing Center for Animal Pain Management
Windsor, Colo...
SPECIAL
FEATURE
As veterinary professionals, we work
in the only medical field where we
see our patients from womb to
tomb....
PEER
REVIEWED
Compassion Fatigue Symptoms
Compassion fatigue can elicit a wide variety of
symptoms.1
Be aware that it is g...
24 veterinaryteambrief.com June 2014
5 TOP 5 Lydia Gerber, PhD
Washington State University
“Mindfulness means paying atten...
June 2014 Veterinary Team Brief
25
PEER
REVIEWED
puter tasks, or as we sit in the car
between errands. During very busy
da...
26 veterinaryteambrief.com June 2014
THERE’S
MORE GREAT
CONTENT
ONLINE!
Visit veterinaryteambrief.com
for the following ar...
Starts killing fleas
in just 30 minutes
Lasts a full month
More than 50 million doses sold worldwide
Prevents infestations
...
28 veterinaryteambrief.com June 2014
TREATMENT
Treatment of pyoderma
caused by methicillin-resistant
S pseudintermedius (M...
June 2014 Veterinary Team Brief
29
CLINICAL SUITE | MRSP INFECTIONS IN DOGS & CATS
q12–24h and chloramphenicol at
30–50 mg...
30 veterinaryteambrief.com June 2014
MRSA & MRSP
BY THE NUMBERS
• S pseudintermedius can be
cultured from the skin of many...
June 2014 Veterinary Team Brief
31
A key to resolving MRSP infections is client compliance. While
treatment may seem deman...
TECHNICIAN/ASSISTANT
✔ Make follow-up calls to the client, discuss any new laboratory results, and answer any new question...
June 2014 Veterinary Team Brief
33
STEP 5:
Team Roles
Christopher Keller
Animal Dermatology Center
Studio City, California...
34 veterinaryteambrief.com June 2014
STEP 6:
Team Training Plan
Christopher Keller
Animal Dermatology Center
Studio City, ...
Alexander Werner, VMD, DACVD
Animal Dermatology Center
Studio City, California
June 2014 Veterinary Team Brief
35
STEP 7:
...
October 15, 2014
Pre-Surgery Summit
Laboratories & Workshops
October 16-18, 2014
Surgery Summit Seminars
& Scientific Abst...
DIRTY
LAUNDRY
Charles Meredith, MD,
& Amanda Shaw, MPH
Washington Physicians Health Program
Seattle, Washington
Veterinari...
DIRTY
LAUNDRY
38 veterinaryteambrief.com June 2014
physical contact with others to
continue hiding the illness or to
reduc...
Behavior Management:
Canine Separation Anxiety
Canine Dermatology and Parasitology
Feline Dermatology and Parasitology
Fel...
Miconazole and chlorhexidine aid
in the treatment of moderate to
severe fungal and/or bacterial skin
infections
Potentiate...
STRESS & ANXIETY
IN PRACTICEWho has not pulled into the parking lot at work with tight neck
muscles, a racing heart, or a ...
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  1. 1. 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
  2. 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
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. 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 ________________ ______________ ________________ __________________ _______________ ________________ ______________ ________________ _________________ _________________ ______________ ____________________ _________________ _______________________ _______________ _____________________
  7. 7. 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
  8. 8. 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 ________________ _______________
  9. 9. 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
  10. 10. 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 ________________________
  11. 11. 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
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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 _____________
  16. 16. 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
  17. 17. 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
  18. 18. 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 ________________________ ____
  19. 19. 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
  20. 20. 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
  21. 21. 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
  22. 22. 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 ___________ ____________ _______
  23. 23. © 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
  24. 24. 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 ___________________
  25. 25. 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
  26. 26. 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 ____________
  27. 27. 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 _________
  28. 28. 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
  29. 29. 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
  30. 30. 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 ________ _____________________ ________________ _____________________ ________________ ________ ______ ________________ ________ ______
  31. 31. 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 ________
  32. 32. 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
  33. 33. 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
  34. 34. 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
  35. 35. 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
  36. 36. 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
  37. 37. 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
  38. 38. 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
  39. 39. 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
  40. 40. 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
  41. 41. 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 ______
  42. 42. 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
  43. 43. 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 ___________
  44. 44. 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
  45. 45. 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

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