From the publisher
of Clinician’s Brief
A Peer-Reviewed Journal | July 2014 | Volume 2 Number 6 veterinaryteambrief.com
CL...
It’s a soft chew.
Kills BOTH fleas and ticks.
It’s prescription only.
NexGardTM
(afoxolaner) is the protection you
asked fo...
July 2014 Veterinary Team Brief
1
Researchers have found that altru-
ism—the principle or practice of
concern for the welf...
Kara Burns,
MS, MEd, LVT, VTS
(Nutrition)
Ron Cott,
DVM
Beth Spencer,
DVM
Tracy Dowdy,
CVPM
Fritz Wood,
CPA, CFP
Veterinar...
IMPROVING
PETS’ LIVES
BEGINS WITH
A FEW CLICKS.
Get the nutrition knowledge you need to help pets live active,
healthy liv...
4 veterinaryteambrief.com July 2014
TABLE OF
CONTENTS
Find more handouts at
veterinaryteambrief.com
1
7
9
13
17
20
24
34
5...
NEW
Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q
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®THE WO...
™NexGard and FRONTLINE VET LABS are trademarks of Merial.
©2014 Merial. All rights reserved.
CAUTION: Federal (USA) law re...
July 2014 Veterinary Team Brief
7
IN THE
TRENCHES
I am a
veterinarian...
Martha Smith-Blackmore, DVM
HOMETOWN: Weymouth, M...
ON-SITE DIAGNOSTICS | ABAXIS VETERINARY REFERENCE LABORATORIES
“Iamapeoplepersonbynature,
Iliketalkingtopeople,Ilikethe
in...
July 2014 Veterinary Team Brief
9
5 TOP 5 Douglas Mader, MS, DVM,
DABVP (Canine/Feline & Reptile/Amphibian),
DECZM (Herpet...
10 veterinaryteambrief.com July 2014
the event on a Sunday afternoon and
always get fantastic turnouts. Of
course, the loc...
July 2014 Veterinary Team Brief
11
PEER
REVIEWED
Not Always for the Limelight
Our practice works with the domestic abuse s...
Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q
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q
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qM
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®THE WORLD’...
July 2014 Veterinary Team Brief
13
Katherine Dobbs, RVT, CVPM, PHR
interFace Veterinary HR Systems
Appleton, Wisconsin
“Wh...
14 veterinaryteambrief.com July 2014
A Plan to ACT
If you are distressed about a pattern of
patient care in your practice:...
Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q
M Mq
q
M
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qM
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®THE WORLD’...
Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q
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q
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®THE WORLD’...
TECH
TALK
Carrie Jo Anderson, CVT
Veterinary Technology Program
Hillsborough Community College, Florida
Educating clients ...
18 veterinaryteambrief.com July 2014
PEER
REVIEWED
so stay abreast of incidence, preven-
tion, testing, therapeutics, and
...
Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q
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q
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®THE WORLD’...
SPECIAL
FEATURE
Maureen Anderson, DVM, DVSc, PhD
Animal Health & Welfare Branch
Ontario Ministry of Agriculture & Food
Min...
July 2014 Veterinary Team Brief
21
Methicillin-resistant
Staphylococci
In the past decade, methicillin-resis-
tant Staphyl...
Tastes like
Works like
HillsVet.com
Irresistible new form
Full strength, clinically
proven efficacy
There’s never been
ther...
Introducing the only nutrition clinically tested
to reduce the recurrence of FIC signs by 89%1
now with ingredients to hel...
24 veterinaryteambrief.com July 2014
WHEN SHOULD
LEPTOSPIROSIS BE
SUSPECTED IN A DOG?
• Leptospirosis can cause a variety
...
July 2014 Veterinary Team Brief
25
CLINICAL SUITE | CANINE LEPTOSPIROSIS
STEP 2:
Team Education Primer
Katharine F. Lunn, ...
26 veterinaryteambrief.com July 2014
STEP 2:
Team Education Primer
STEP 3
Communication Keys h
CLINICAL SUITE | CANINE LEP...
July 2014 Veterinary Team Brief
27
Because of the threat of zoonotic transmission, much of our
communication regarding can...
28 veterinaryteambrief.com July 2014
Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Pag...
July 2014 Veterinary Team Brief
29
STEP 5:
Team Roles
Jessie Merritt, CVPM, SPHR
Oswego Veterinary Hospital
Portland, Oreg...
30 veterinaryteambrief.com July 2014
STEP 6:
Team Training Plan
Jessie Merritt, CVPM, SPHR
Oswego Veterinary Hospital
Port...
Katharine F. Lunn, BVMS, MS, PhD, MRCVS, DACVIM
North Carolina State University
College of Veterinary Medicine
July 2014 V...
32 veterinaryteambrief.com July 2014
STEP 7:
Client Handout CLINICAL SUITE | CANINE LEPTOSPIROSIS
What precautions should ...
The TOPICAL ALTERNATIVE for flea and tick control that lasts 8 MONTHS
©2013 Bayer HealthCare LLC, Animal Health Division, ...
PERSONALITY
PROFILE
Lisa Hunter, LSW, & Jane R. Shaw, DVM, PhD
Colorado State University
The Colleague
Who Can’t Say No
34...
OUTCOMES OF
NEVER SAYING NO
• Decreasing self-worth
• Disempowering team members
• Increasing stress
• Lacking balance
• M...
36 veterinaryteambrief.com July 2014
The root of The Carrot Principle is
simple: purpose-based recognition
accelerates a l...
rewarding specific strategically
important actions and behaviors.
Practicing this type of recognition
causes “the trust met...
Previous Page | Contents | Zoom in | Zoom out | Front Cover | Search Issue | Next Page q q
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®THE WORLD’...
COMMUNICATION
CUES
Andra S. Edwards, DVM
Washington State University
Convenience euthanasia refers to a circumstance in wh...
euthanasia. However, a handful of cli-
ents and veterinarians would consider
euthanasia even in the second scenar-
io to b...
July 2014 Veterinary Team Brief
41
DIRTY
LAUNDRY
Charles J. Wayner, DVM
Veterinary Vitality
Topeka, Kansas
“Compliance” in...
DIRTY
LAUNDRY
42 veterinaryteambrief.com July 2014
parasites and do they receive preven-
tives for the appropriate amount ...
does not know the passion that lead-
ership has for maintaining compli-
ance—or the medical rationale
behind the passion—c...
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  1. 1. From the publisher of Clinician’s Brief A Peer-Reviewed Journal | July 2014 | Volume 2 Number 6 veterinaryteambrief.com CLINICAL SUITE: Canine Leptospirosis Busting the Myths of Zoonotic Diseases Ethics of Death for the Sake of Convenience Talking Tough Topics Eyes on the Prize: Thriving in Shelter Medicine DOING WELL DOING GOODby 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 _________________
  2. 2. It’s a soft chew. Kills BOTH fleas and ticks. It’s prescription only. NexGardTM (afoxolaner) is the protection you asked for, and patients will beg for. NexGard is FDA-approved to kill fleas, prevent flea infestations, and kill Black-Legged (deer) ticks, Lone Star ticks and American Dog ticks. NexGard is available only with a veterinarian’s prescription, and features anti-diversion technology monitored by Pinkerton® Consulting & Investigations. TM NexGard and FRONTLINE VET LABS are trademarks of Merial. ®PINKERTON is a registered trademark of Pinkerton Service Corporation. ©2014 Merial Limited, Duluth, GA. All rights reserved. NEX14TTRADEAD (06/14). IMPORTANT SAFETY INFORMATION: For use in dogs only. The most common adverse reaction is vomiting.  Other adverse reactions reported are dry/flaky skin, diarrhea, lethargy, and anorexia.  The safe use of NexGard in pregnant, breeding, or lactating dogs has not been evaluated. Use with caution in dogs with a history of seizures. See product information summary on page 6. Now approvedto kill more ticks! 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. July 2014 Veterinary Team Brief 1 Researchers have found that altru- ism—the principle or practice of concern for the welfare of others2 — favorably impacts our health and happiness, and even our longevity. As a social scientist, I love it when cur- rent research of human behavior proves conventional wisdom. I like it even better when said research sup- ports my personal experience! Our theme this month, “Doing well by do- ing good,” is just such a topic. This phenomenon has long been a subject for armchair, and actual, phi- losophers. Here are the words of a few great thinkers: “The best way to find yourself is to lose yourself in the service of others.” — Mahatma Gandhi “For it is in giving that we receive.” —St. Francis of Assisi “Since you get more joy out of giving joy to others, you should put a good deal of thought into the happiness that you are able to give.” —Eleanor Roosevelt There are caveats, of course. Helpers reap benefits so long as they autono- EDITOR’S LETTER Have You Experienced the Helper’s High? We have all heard the term “runner’s high.” Well, let me introduce you to a new concept—the “helper’s high.”1 “The best way to find yourself is to lose yourself in the service of others.” —Mahatma Gandhi mously enter into their altruistic un- dertaking and are not overwhelmed by their forays into helping others.3 I’ve experienced altruism at my own expense. I have learned the hard way that when my own internal level is off plumb, my body starts sending out the alarm that I need to rein in my busyness, and I need to listen. I have also experienced the afterglow of hours spent volunteering my ser- vices to others. Some of my favorite, albeit painful, memories of my daugh- ters’ early years are of toiling with them in weeklong “work camps” where we joined other parents and children working on home-repair projects for elderly owners who could no longer do the chores themselves. Although these good deeds necessitat- ed sleeping on the floor of an area school each evening, the exhaustion and the good feelings that came from our day of donated labor made that some of the best sleep of my life. Similarly, I have experienced a helper’s high when overseeing a drive to col- lect food for the local food bank, run- ning a blood drive, or taking time out of my day to mentor a new employee. I think this same principle could ap- ply to the approach we take in our everyday work. Smile at a coworker. Reach out and touch the hand of a struggling client. Open the door for a mom wrestling with a toddler and her Great Dane. When we lift others up, we give our- selves a boost both figuratively and literally. We hope you find some great ideas in this month’s articles to help you help others, as well as yourself! Best wishes, Kathleen Ruby, PhD 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
  4. 4. 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 July 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 _____________________ ______________ _________________ _________________ ________________ ______________ ________________ ____________________ ________________ _______________ ________________ __________________ _______________ _________________ ________________________ _______________
  5. 5. 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
  6. 6. 4 veterinaryteambrief.com July 2014 TABLE OF CONTENTS Find more handouts at veterinaryteambrief.com 1 7 9 13 17 20 24 34 53 COVER: Marathon Veterinary Hospital, Florida, team members work on a rare White Pelican's injured wing at a wildlife center where they volunteer. See Top 5, page 9. Photo courtesy of Douglas Mader, DVM. 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 45 57 Editor’s Letter IN THE TRENCHES I am a veterinarian… Martha Smith-Blackmore, DVM TOP 5 Ways to Make Your Practice Part of Your Community SPECIAL FEATURE Following Your Moral Compass TECH TALK Walking the Tightrope: Talking to Clients About Zoonotic Diseases SPECIAL FEATURE Bacterial Pathogens: Busting the Myths of Zoonoses CLINICAL SUITE The team training series continues. This month’s focus: CANINE LEPTOSPIROSIS PERSONALITY PROFILE The Colleague Who Can’t Say No BOOK CLUB Carrot Trumps Stick in Team Building COMMUNICATION CUES The Ethics of Death for Convenience DIRTY LAUNDRY Crystal-Clear Compliance SPECIAL FEATURE We Need to Talk: Tackling Tough Topics CAPSULES Current Literature in Brief SOCIAL MEDIA CALENDAR SPECIAL FEATURE Keeping Our Eyes on the Prize: Thriving in Shelter Medicine THE BUZZ IN BRIEF SPECIAL FEATURE Fighting Disease Outbreaks in Veterinary Practices Aids & Resources Advertisers Index 36 39 41 45 48 50 53 56 57 64 64 Handout 31 Frequently Asked Questions: Canine Leptospirosis
  7. 7. NEW 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 Killer protection with killer new offers. The FRONTLINE® Plus Premium Pack is filled with added value your clients can get only through you. Inside for your clients: * ** ®FRONTLINE is a registered trademark, and ™SATISFACTION PLUS GUARANTEE is a trademark, of Merial. ©2013 Merial Limited, Duluth, GA. All rights reserved. FLE13PLTRADE3 (1/14). * The guarantee offers your choice of a refund, product replacement, or a FREE in-home inspection and treatment, if necessary. Please see full details at www.FRONTLINE.com ** Pet owner pays for shipping & handling.
  8. 8. ™NexGard and FRONTLINE VET LABS are trademarks of Merial. ©2014 Merial. All rights reserved. CAUTION: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. Description: NEXGARD™ (afoxolaner) is available in four sizes of beef-flavored, soft chewables for oral administration to dogs and puppies according to their weight. Each chewable is formulated to provide a minimum afoxolaner dosage of 1.14 mg/lb (2.5 mg/kg). Afoxolaner has the chemical composition 1-Naphthalenecarboxamide, 4-[5- [3-chloro-5-(trifluoromethyl)-phenyl]-4, 5-dihydro-5-(trifluoromethyl)-3-isoxazolyl]-N-[2-oxo-2-[(2,2,2-trifluoroethyl)amino]ethyl. Indications: NEXGARD kills adult fleas and is indicated for the treatment and prevention of flea infestations (Ctenocephalides felis), and the treatment and control of Black-legged tick (Ixodes scapularis), American Dog tick (Dermacentor variabilis), and Lone Star tick (Amblyomma americanum) infestations in dogs and puppies 8 weeks of age and older, weighing 4 pounds of body weight or greater, for one month. Dosage and Administration: NEXGARD is given orally once a month, at the minimum dosage of 1.14 mg/lb (2.5 mg/kg). Dosing Schedule: NEXGARD can be administered with or without food. Care should be taken that the dog consumes the complete dose, and treated animals should be observed for a few minutes to ensure that part of the dose is not lost or refused. If it is suspected that any of the dose has been lost or if vomiting occurs within two hours of administration, redose with another full dose. If a dose is missed, administer NEXGARD and resume a monthly dosing schedule. Flea Treatment and Prevention: Treatment with NEXGARD may begin at any time of the year. In areas where fleas are common year-round, monthly treatment with NEXGARD should continue the entire year without interruption. To minimize the likelihood of flea reinfestation, it is important to treat all animals within a household with an approved flea control product. Tick Treatment and Control: Treatment with NEXGARD may begin at any time of the year (see Effectiveness). Contraindications: There are no known contraindications for the use of NEXGARD. Warnings: Not for use in humans. Keep this and all drugs out of the reach of children. In case of accidental ingestion, contact a physician immediately. Precautions: The safe use of NEXGARD in breeding, pregnant or lactating dogs has not been evaluated. Use with caution in dogs with a history of seizures (see Adverse Reactions). Adverse Reactions: In a well-controlled US field study, which included a total of 333 households and 615 treated dogs (415 administered afoxolaner; 200 administered active control), no serious adverse reactions were observed with NEXGARD. Over the 90-day study period, all observations of potential adverse reactions were recorded. The most frequent reactions reported at an incidence of > 1% within any of the three months of observations are presented in the following table. The most frequently reported adverse reaction was vomiting. The occurrence of vomiting was generally self-limiting and of short duration and tended to decrease with subsequent doses in both groups. Five treated dogs experienced anorexia during the study, and two of those dogs experienced anorexia with the first dose but not subsequent doses. Table 1: Dogs With Adverse Reactions. 1 Number of dogs in the afoxolaner treatment group with the identified abnormality. 2 Number of dogs in the control group with the identified abnormality. In the US field study, one dog with a history of seizures experienced a seizure on the same day after receiving the first dose and on the same day after receiving the second dose of NEXGARD. This dog experienced a third seizure one week after receiving the third dose. The dog remained enrolled and completed the study. Another dog with a history of seizures had a seizure 19 days after the third dose of NEXGARD. The dog remained enrolled and completed the study. A third dog with a history of seizures received NEXGARD and experienced no seizures throughout the study. To report suspected adverse events, for technical assistance or to obtain a copy of the MSDS, contact Merial at 1-888-637- 4251 or www.merial.com/nexgard. For additional information about adverse drug experience reporting for animal drugs, contact FDA at 1-888-FDA-VETS or online at http://www.fda.gov/AnimalVeterinary/SafetyHealth. Mode of Action: Afoxolaner is a member of the isoxazoline family, shown to bind at a binding site to inhibit insect and acarine ligand-gated chloride channels, in particular those gated by the neurotransmitter gamma-aminobutyric acid (GABA), thereby blocking pre- and post-synaptic transfer of chloride ions across cell membranes. Prolonged afoxolaner-induced hyperexcitation results in uncontrolled activity of the central nervous system and death of insects and acarines. The selective toxicity of afoxolaner between insects and acarines and mammals may be inferred by the differential sensitivity of the insects and acarines’ GABA receptors versus mammalian GABA receptors. Effectiveness: In a well-controlled laboratory study, NEXGARD began to kill fleas four hours after initial administration and demonstrated >99% effectiveness at eight hours. In a separate well-controlled laboratory study, NEXGARD demonstrated 100% effectiveness against adult fleas 24 hours post-infestation for 35 days, and was ≥ 93% effective at 12 hours post-infestation through Day 21, and on Day 35. On Day 28, NEXGARD was 81.1% effective 12 hours post-infestation. Dogs in both the treated and control groups that were infested with fleas on Day -1 generated flea eggs at 12- and 24-hours post-treatment (0-11 eggs and 1-17 eggs in the NEXGARD treated dogs, and 4-90 eggs and 0-118 eggs in the control dogs, at 12- and 24-hours, respectively). At subsequent evaluations post-infestation, fleas from dogs in the treated group were essentially unable to produce any eggs (0-1 eggs) while fleas from dogs in the control group continued to produce eggs (1-141 eggs). In a 90-day US field study conducted in households with existing flea infestations of varying severity, the effectiveness of NEXGARD against fleas on the Day 30, 60 and 90 visits compared with baseline was 98.0%, 99.7%, and 99.9%, respectively. Collectively, the data from the three studies (two laboratory and one field) demonstrate that NEXGARD kills fleas before they can lay eggs, thus preventing subsequent flea infestations after the start of treatment of existing flea infestations. In well-controlled laboratory studies, NEXGARD demonstrated >94% effectiveness against Dermacentor variabilis and Ixodes scapularis, 48 hours post-infestation, and against Amblyomma americanum 72 hours post-infestation, for 30 days. Animal Safety: In a margin of safety study, NEXGARD was administered orally to 8- to 9-week-old Beagle puppies at 1, 3, and 5 times the maximum exposure dose (6.3 mg/kg) for three treatments every 28 days, followed by three treatments every 14 days, for a total of six treatments. Dogs in the control group were sham-dosed. There were no clinically-relevant effects related to treatment on physical examination, body weight, food consumption, clinical pathology (hematology, clinical chemistries, or coagulation tests), gross pathology, histopathology or organ weights. Vomiting occurred throughout the study, with a similar incidence in the treated and control groups, including one dog in the 5x group that vomited four hours after treatment. In a well-controlled field study, NEXGARD was used concomitantly with other medications, such as vaccines, anthelmintics, antibiotics (including topicals), steroids, NSAIDS, anesthetics, and antihistamines. No adverse reactions were observed from the concomitant use of NEXGARD with other medications. Storage Information: Store at or below 30°C (86°F) with excursions permitted up to 40°C (104°F). How Supplied: NEXGARD is available in four sizes of beef-flavored soft chewables: 11.3, 28.3, 68 or 136 mg afoxolaner. Each chewable size is available in color-coded packages of 1, 3 or 6 beef-flavored chewables. NADA 141-406, Approved by FDA Marketed by: Frontline Vet Labs™, a Division of Merial Limited. Duluth, GA 30096-4640 USA Made in Brazil. 1050-4493-02 Rev. 4/2014 Body Afoxolaner Per Chewables Weight Chewable (mg) Administered 4.0 to 10.0 lbs. 11.3 One 10.1 to 24.0 lbs. 28.3 One 24.1 to 60.0 lbs. 68 One 60.1 to 121.0 lbs. 136 One Over 121.0 lbs. Administer the appropriate combination of chewables N1 % (n=415) N2 % (n=200) Vomiting (with and without blood) 17 4.1 25 12.5 Dry/Flaky Skin 13 3.1 2 1.0 Diarrhea (with and without blood) 13 3.1 7 3.5 Lethargy 7 1.7 4 2.0 Anorexia 5 1.2 9 4.5 Treatment Group Afoxolaner Oral active control THERE’S MORE GREAT CONTENT ONLINE! Visit veterinaryteambrief.com for the following articles and more: ‘MY DOG IS JUST GETTING OLDER’ Clients who make such comments often do not realize that their pet may be suffering with arthritis pain. Veterinary team members should educate their clients about treatment options for degenerative diseases and let them know they can improve the quality of life of their pets. veterinaryteambrief.com/arthritis IS WORKPLACE LOYALTY EXTINCT? Today’s average worker stays at a job for 4.4 years. Young team members often leave a job after half that time. But, it is possible to create an atmosphere that revives and sustains team loyalty in your practice. Learn the essential elements of team member engagement. veterinaryteambrief.com/workplace-loyalty BE SURE YOUR ROUNDS START THE DAY RIGHT Daily rounds can assure better communication inside and outside your practice, improve collaboration among team members, and streamline vital procedures. Learn how to get the most out of your regular rounds, including who should participate and what questions to ask. veterinaryteambrief.com/daily-rounds FEAR ON THE JOB: FIGHT OR FLIGHT? One-third of Americans reported being targets of workplace bullying and 49% reported fearing colleagues in a 2007 survey. If you are afraid at work, learn how to overcome the fear, take the offensive and assert yourself, and change the culture of your practice. veterinaryteambrief.com/fight-or-flight 6 veterinaryteambrief.com July 2014 WATCH FOR THESE ARTICLES IN FUTURE ISSUES! HEARD ANY GOOD GOSSIP? Can you cure this insidious "disease" in your practice? It is possible. GOOD DR. GOOGLE: Our new technology column will teach you how to turn this villain into your best friend. 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. July 2014 Veterinary Team Brief 7 IN THE TRENCHES I am a veterinarian... Martha Smith-Blackmore, DVM HOMETOWN: Weymouth, Massachusetts WHERE I WORK: Animal Rescue League of Boston (and anywhere an animal control officer/law enforcement officer/prosecutor seeks my expertise) I DO WHAT I DO BECAUSE: My passion drives me to seek answers and justice for animals that may have suffered non- accidental injury at the hands of a human being, or through negligent inaction. When I help an investigatory team and prosecutors uncover the truth about what happened to an animal, I am helping society be a safer place for all of us. MY FAVORITE THING ABOUT MY WORKDAY: Collaborating with like-minded professionals who are animal welfare oriented—it is such a good feeling when volunteers, colleagues, investigators, and the whole law enforcement community comes together with one goal in mind: keeping the world safe for animals. WHAT INSPIRES ME: People who are driven by a moral passion for justice and who adhere to strict scientific principles. What is right is the truth, and not simply a conviction. THE ANIMAL I WILL NEVER FORGET: Beatrice, a lovely collie/shepherd mix whose owner kept her captive and sexually abused her over a long period of time. He was found guilty, and she found peace and love in a wonderful foster home. It was a tough case, but Beatrice was able to lead a normal dog life, including hiking and swimming, for the last couple of years of her life. I COULD NOT DO MY JOB WITHOUT: Coffee! Also, my marvelous team that has a wonderful sense of humor. We see the darkest of things in the darkest hours, but our tight working relationships help us thrive despite the challenges of our work. I VALUE MOST: Peace. Calm. Joy. I am tremendously blessed to have a very supportive and understanding husband who helps make my personal world safe. SOMETHING MOST PEOPLE DO NOT KNOW ABOUT ME: I am a very spiritual person, and I give my fears and apprehension up to a higher power. WHAT I DO TO RELAX: I play ice hockey! It is a great way to get out my pent-up aggression in an appropriate way. IN 5 YEARS I WILL BE: Solving crime, saving animals, and improving the world! Beatrice CourtesyofBostonBusinessJournal 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. ON-SITE DIAGNOSTICS | ABAXIS VETERINARY REFERENCE LABORATORIES “Iamapeoplepersonbynature, Iliketalkingtopeople,Ilikethe interaction.Ilovemyjob.” BonnyKyamugabirwa|Technical Support Representative | Union City, CA. BeenwithAbaxisfor7years To watch Bonny’s story, visit vet.abaxis.com/beinspired Abaxis, VetScan, Abaxis Veterinary Reference Laboratories and AVRL are registered trademarks of Abaxis, Inc. ©Abaxis 2014. Learn more about all of our products and services at www.abaxis.com #beinspired B E T T E R + B E T T E R 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. July 2014 Veterinary Team Brief 9 5 TOP 5 Douglas Mader, MS, DVM, DABVP (Canine/Feline & Reptile/Amphibian), DECZM (Herpetology) Marathon Veterinary Hospital Marathon, Florida Competition today is fierce. Veterinary practices find themselves com- peting with each other and with the internet for every pet health dollar. When times get tough, you want the people to come to you for their pet healthcare needs, and there is no better way to engender loyalty to your practice than to give back to your community. ents. Instead, each of our veterinarians volunteers at the wildlife center help- ing the injured birds, turtles, and other animals. Instead of limiting our re- sources to helping only one or 2 cli- ents, we help the wild animals, which benefits not only the wildlife, but also the entire community.” Whenever we go to the wildlife cen- ters we take lots of photos. Pictures of team members removing a fish hook from a pelican, repairing a broken wing on a hawk, or doing an MRI on a sea turtle are sure to show up in the local paper, and people are immedi- ately impressed and happy about the story. They realize that veterinarians really do care about animals and not just money. It also brings much-need- ed publicity to the wildlife centers and helps them bring in donations for their noble efforts. TOP WAYS TO MAKEYOUR PRACTICE PART OF YOUR COMMUNITY Top 5 Ways to Give Back to Your Community • Volunteer at a shelter • Hold a dog wash • Blood drives—for pets, too • Teach • Run a cancer relay. People are not going to know what you do unless you tell them. It’s not bragging—it’s a way to share informa- tion. Almost all towns, big or small, have a newspaper and/or newsletter. If nothing else, they have websites or blogs. People like “feel good” stories. People love animals. Put the 2 togeth- er and you can be an instant winner in making your presence felt in your community. Volunteer at a Wildlife Center Not a day goes by in our prac- tice that a client does not ask for a discount. I love what I do and I would love to be able to help every patient and every client for free, but the reality is that I have bills to pay and I just cannot give away services. So, do I pick and choose who gets a discount? As soon as you give one, the word gets out, and everybody wants a price break. A client will say, “You gave Ms. Peabody a discount. Why can’t I get one?” All the veterinarians in my practice volunteer at the 2 wildlife centers in town. We assign “volunteer days” at our monthly meetings. Now, when a client asks for a discount, I can say, “I’m sorry, Ms. Smith. We are just not able to give discounts to individual cli- 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. 10 veterinaryteambrief.com July 2014 the event on a Sunday afternoon and always get fantastic turnouts. Of course, the local papers are called and great photos are always published. Multispecies Blood Drive As in most communities, the local blood bank is always in need of human donors. Similarly, our small animal practice is in constant need of pet blood donors. This year, Dog Wash Once a year, our practice sponsors a dog wash that al- ways has a theme—support- ing homeless pets, the local animal shelter, our Companion Care Fund (money to help indigent pet owners), and more. Product representatives from the larger veterinary supply companies are asked to donate the shampoo, and the practice team members donate the labor. We hold we combined the 2 needs into one event. On Sunday afternoons, the lo- cal blood bank sets up in our practice parking lot. We advertise the pet and human blood drive in the paper and on our Facebook page. Anyone in the community (pet owners or not) can donate blood. Pets volunteered to be- come a “pet donor” are screened for inclusion on our donor list while the owner gives blood. Even owners who do not want to donate blood them- 5 TOP 5 The Marathon Veterinary Hospital, Florida, team works on the wing of a rare White Pelican (top). When an injured sea turtle, shown with veterinarian Kristin Hall (second from right), needed an MRI, the media coverage included the human hospital that donated its MRI services, the local Turtle Hospital, and Marathon Veterinary Hospital. Educating local citizens keeps your practice top of mind. Here, Doug Mader, DVM, (third from right), and his team present show-and-tell special guest Pink, a 14-foot Burmese python, at Mader’s lecture, "Invasive Pythons in the Everglades." Marathon Veterinary Hospital sponsors a booth at the annual “Relay for Life,” as well as the “Bark for Life” event, where people put photos of their pets on the large ribbon and make donations. This brings awareness that pets get cancer, too. Photos courtesy of Douglas Mader, DVM, Marathon Veterinary Hospital Doing Good for Your Community is Good for Your 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
  13. 13. July 2014 Veterinary Team Brief 11 PEER REVIEWED Not Always for the Limelight Our practice works with the domestic abuse shelter, the police, and the fire department to help shelter animals caught in the middle of bad situations. Whether it is a pet that has been confiscated from a violent family situation or one whose owners were in an auto accident or a house fire, we always offer to board the animal at no charge until the crisis is over. This is not done for the sake of getting press coverage, but because we care and want to be there in the time of need. selves can bring their pets in for donor screening. It’s a win-win for the hu- man hospital and our practice. Talk of the Town Animal health issues that worry pet owners always arise. What better source of pet health information than the local veterinarian? Whether it is melamine in pet foods or the avian flu, people always have questions and concerns. Be proactive and offer community lectures on current topics. Most local libraries welcome such events and provide free classroom space. If your practice is large enough, offer the lec- ture on-site, which not only shows the community that you care enough to educate, but also shows off your facility. Pets Get Cancer, Too Almost every community celebrates the American Can- cer Society’s “Relay for Life” event—a 24-hour marathon to raise money for cancer research. It amazes me how many people have no idea that pets get cancer, too. Our practice team includes cancer survivors, so every year we support the American Cancer Society’s event. In the last few years, we have also included a “Bark for Life” event by helping sponsor a parallel celebration of pets that have lost their battles with the disease, as well as survivors. Our tent has several displays—the most impressive is the board where owners can sponsor “Paws” with the names and photos of their pets. Conclusion These are just a few ideas that have worked well for our practice. There are no rules, minimums, or maxi- mums. There are no limits to what you can do to help your community. You don’t need to be fancy or high- tech; for example, sponsoring a ga- rage sale in your parking lot with the proceeds going to local animal shel- ters or other charities is one simple way to give back. Not only are you helping your com- munity, but you are also creating the “warm, fuzzy, feel good” component that cannot be quantified. Working together as a healthcare team does not have to be limited to the exam- ination or operating rooms. Is your veterinary practice just an- other business in town or is it inte- grated into the community? 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. 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. July 2014 Veterinary Team Brief 13 Katherine Dobbs, RVT, CVPM, PHR interFace Veterinary HR Systems Appleton, Wisconsin “Whether it is from unsafe systems of care, insufficient staffing to provide the care patients and families need, or being constrained from advocating for patients as our conscience dictates and our heart demands, too many nurses lose their compassion and move from embracing their work as heroic and profound to viewing it as a job they just need to get through each day. Far too many remain in practice but have lost the compassion that is central to excellent nursing care.” —Compassion Fatigue and Burnout in Nursing1 As the veterinary profession embraces the concept of compassion fatigue and continues to battle burnout, another difficult issue has surfaced: moral distress. The American Association of Critical-Care Nurses (AACN) recognizes this concept of moral distress in human healthcare and has developed a protocol to address the issue.2 The AACN defines moral distress as when you know the ethically appropriate action to take but are unable to act upon it, and you act in a manner contrary to your personal and professional values, which undermines your integrity and authenticity. Addressing Moral Distress The protocol is summarized as the 4 A’s: 1 ASK: Reflect on your present feelings and ask yourself if moral distress is present. 2 AFFIRM: Commit to address the moral distress. 3 ASSESS: Contemplate your readiness to act, considering the risks and benefits. 4 ACT: Implement strategies to initiate changes, manage any setbacks, and preserve your integrity and authenticity. If you are still not ready to ACT, consider the 4 R’s: 1 RELEVANCE: Imagine the impact your action could have (eg, improved patient care, enhanced relationships, enhanced personal well-being, professional satisfaction). 2 RISK: Consider the risk of not acting (eg, personal suffering, dissatisfaction with practice environment, decreased quality of patient care). 3 REWARDS: Recall situations where you succeeded in effecting positive change. Imagine how you would feel at work after you act and the changes are in place. 4 ROADBLOCKS: Identify the roadblocks that you should avoid (eg, resistance to change, criticism, retaliation, alienation). Following Your Moral Compass SPECIAL FEATURE 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. 14 veterinaryteambrief.com July 2014 A Plan to ACT If you are distressed about a pattern of patient care in your practice: • Identify a patient care situation that is typical of the pattern you find distressing. • Request that a manager or the practice owner discuss the case with team members. • Study outside resources to find a similar situation and identify other ways to manage this kind of problem. • Formulate a case study as a teaching tool. Sonnya Dennis, DVM, DABVP, in her presentation on Ethics Exhaustion at the 2013 Veterinary Social Work Summit, defined “ethics” as a code of moral conduct or rules, following duty and not convenience, and doing the thing “I should do.”3 The definitions of “wrong” and “right” do vary from person to person; however, when we accept a position in a practice that provides a service we personally feel is immoral or PEER REVIEWED unethical, we compromise our own ethics. Dennis describes ethics exhaustion as fatigue, emotional distress, and the lack of will to continue to act in a way that is consistent with what we believe is ethical. “Ethics exhaustion is not a loss of compassion, but being prevented from acting on what you believe is the compassionate, caring thing to do,” she said.3 How do we continue our work but manage our moral compass? We need to ask ourselves one question: Is what I am doing or about to do in the best interest of my patient?3 If we use this as our guiding star, we can never go wrong, because we will always know we are doing the right thing for those that matter most—our patients. See Aids & Resources, back page, for references & suggested reading. Pointing the Practice’s Compass Every practice plans to hire team members whose moral compass points in the same direction to help avoid moral distress and ethics exhaustion. These tips can help: • Talk about morals and ethics when interviewing potential new team members. Does the candidate have a “no tolerance” policy toward any specific activities? • Maintain an open-book policy so that team members are comfortable expressing their concerns about moral and ethical issues. • Address such issues when they occur (eg, a particularly difficult case or client). • Always follow up with team members when a case has clearly stretched their moral and ethical beliefs. Ethics are personal, but always strive to reach a consensus that benefits both the practice and the team member. SPECIAL FEATURE For Example: Your caseload is overwhelming and the practice is understaffed, and you believe your patients are not receiving the level of care they deserve. Here’s how you could apply the 4 A’s. ASK: Reflect on your feelings and ask yourself questions to determine if moral distress is present. You need to deter- mine that you are not the only one who is too busy and that patients are indeed suffering because of the overwhelming caseload or the shortage of team members. AFFIRM: Make a commitment to address the moral distress. Typically a certain situation—a particular case, a terrible shift—will be the last straw, and you decide to speak up. ASSESS: Consider the pros and cons. Then, make a decision to, for example, speak to your supervisor about hiring part-time help. Risks: • No one listens to you. • Management may see it as complain- ing about your personal workload. • Other team members may not back you up on your assessment of patient care. • You may be paid less, or receive no more raises, to pay for new hires. Benefits: • Patients will receive quality medical care rather than barely adequate treatment. • Your team members may be grateful that you spoke up. • More team members will share the caseload. • Your moral distress concerning this issue will be relieved. ACT: You may be ready, willing, and able to tackle your moral distress. 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. 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. TECH TALK Carrie Jo Anderson, CVT Veterinary Technology Program Hillsborough Community College, Florida Educating clients is seldom easy. Educating them about zoonoses (ie, diseases that are communicable from animals to humans under nat- ural conditions) is always a challenge. Veterinary technicians walk a fine line between raising client awareness so the veterinarian’s recommen- dations are followed and pets remain healthy, and overly alarming clients about potential risk to the family’s health. Veterinary technicians are the key to client communication; they are the team members who can take time to explain disease transmission principles, educate clients about preventing transmission, and help cli- ents implement the veterinarian’s recommendations at home. Use the following blueprint to develop a zoonoses education plan for clients. Establish, Educate, Equip 1Establish the veterinary practice and, in turn, the veterinary tech- nician as authorities on zoonotic and vector-borne disease potential. Technicians should reinforce the vet- erinarian–client–patient relationship. It is necessary to have a firm grasp of the subject in order to educate clients, Walking the Tightrope: Talking to Clients About Zoonotic Diseases July 2014 Veterinary Team Brief 17 See related stories, Bacterial Pathogens: Busting the Myths of Zoonoses, page 20, & Clinical Suite: Canine Leptospirosis, page 24, of this issue. 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. 18 veterinaryteambrief.com July 2014 PEER REVIEWED so stay abreast of incidence, preven- tion, testing, therapeutics, and products related to zoonotic and vector-borne diseases. For the sake of both animal and human health, clients must develop a respect for zoo- noses without developing unwarrant- ed fears about diseases, in their pets or themselves. 2Educate clients about universal precautions and zoonotic and vector-borne diseases prevalent in your area. First, clients must know that regular veterinary visits, animal waste cleanup, and simple hand wash- ing will prevent a great deal of poten- tial zoonotic disease transmission (see Client Education About Zoonoses). As clients become familiar with zoo- noses and the ease of prevention, they are less likely to become alarmed when they hear reports of “outbreaks” from friends or the media. Next, help the entire veterinary team stay atop zoonotic and vector-borne diseases prevalent in your region or state by monitoring updates from your Reputable Resources Steer clients to reputable internet sources for information on zoonotic diseases, including: • Companion Animal Parasite Council Recommendations: capcvet.org/capc-recommendations • Keeping Pets Healthy Keeps People Healthy Too. U.S. Centers for Disease Control and Prevention: cdc.gov/healthypets/ • Promoting Safe Pet Ownership. Worms & Germs Blog, University of Guelph & Centre for Public Health and Zoonoses: wormsandgermsblog.com state Department of Health (DOH). Most state DOH websites maintain a page with an overview of animal con- tact and human health or zoonotic disease reporting; your practice can periodically check this site to monitor diseases showing up in your area. 3Equip clients with the ability to locate additional reliable resources about zoonotic and vec- tor-borne diseases. Every great vet- erinary technician knows that half the battle is having the answers and com- municating effectively with clients. The other half is knowing when to say, “I’m not sure, but I will find that answer for you.” Take this a step fur- ther; teach the client to have a discern- ing eye when it comes to using the internet (see Reputable Resources). Because clients will never stop looking things up online, we should instead help them find appropriate resources. Again, the state DOH website is an excellent place to start. Print out client handouts or pull up the website on an examination room computer to show the client directly. Unique Opportunity The technician’s confidence level can directly impact client acceptance of the message. Be familiar with zoo- notic disease prevalence, transmis- sion, prevention, and treatment to better ensure client compliance. While educating clients about zoo- noses, veterinary technicians have a unique opportunity to reinforce the veterinarian–client–patient re- lationship through client commu- nication. See Aids & Resources, back page, for references & suggested reading. Client Education About Zoonoses • New puppy or kitten visits are ideal times to communicate with clients about zoonotic diseases. Incorporate the topic as you review internal and external parasite control, the benefits of neutering animals, and the practice’s protocol for annual or semiannual visits. • Annual or semiannual visits provide an opportunity for the technician to review current disease outbreaks, address client concerns, or point out updated medications and disease prevention methods. • Current events boards in the waiting room or screen savers in examination rooms can offer timely information about different zoonotic disease risks. If the client sees an unfamiliar zoonosis, take the opportunity to educate him or her. TECH TALK 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. 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. SPECIAL FEATURE Maureen Anderson, DVM, DVSc, PhD Animal Health & Welfare Branch Ontario Ministry of Agriculture & Food Ministry of Rural Affairs Guelph, Ontario, Canada Bacterial Pathogens: Busting the Myths of Zoonoses 20 veterinaryteambrief.com July 2014 It is important that the veterinary team pro- vides sound information to clients about zoonotic diseases and ways to reduce the risk of disease transmission between them and their pets. Here is a brief overview of a few common zoonotic bacterial pathogens. 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. July 2014 Veterinary Team Brief 21 Methicillin-resistant Staphylococci In the past decade, methicillin-resis- tant Staphylococcus aureus (MRSA) has appeared in companion animals. A well-recognized and troublesome pathogen in humans for decades, this antibiotic-resistant “superbug” can be problematic, especially in individuals (both animal and human) with com- promised immune systems, skin wounds, or surgical incisions. It is also relatively easily transmitted between people and pets—it likely originally spread to animals from humans. MRSA typically circulates at a low level in the population; however, its “cousin,” methicillin-resistant S pseudintermedius (MRSP), is be- coming more common, especially among dogs. Both the methicillin- and nonmethicillin-resistant ver- sions of S pseudintermedius are well adapted to living on dogs, whereas MRSA and nonmethicillin-resistant S aureus are better adapted to living on humans.1 mised, the elderly, and very young children, need to be particularly dil- igent about these measures and should not put themselves at in- creased risk by performing proce- dures such as bandage changes, if possible. However, an MRSA or MRSP infection by itself is not an indication for surrendering a pet. Capnocytophaga canimorsus Capnocyto-what? Many are unfamil- iar with this bacterium, which healthy dogs and cats often carry in their mouths. C canimorsus occasionally makes dramatic news when it causes a devastating or even fatal infection af- ter seemingly innocuous contact with a dog, but the bacterium actually pos- es little risk to healthy, immunocom- petent humans. Factors such as immunosuppression, alcoholism, and lack of a functional spleen can in- crease the risk in humans.4 Infection has been associated with minor bites or a pet licking an area of broken skin, MRSP infection is rare in humans, even in clients with dogs, so the risk of MRSP transmission from pet to client appears to be much lower than with MRSA.2 Nonetheless, MRSP infection does sometimes occur in humans,3 so if an animal is MRSP- or MRSA-positive, clients should be advised to avoid high-risk contacts (eg, with the mouth, nose, infected skin lesions), practice good hand hygiene after handling the pet, and keep their wounds and skin lesions covered. High-risk individu- als, including the immunocompro- These resources offer a wealth of information about zoonotic diseases: • Zoonotic Diseases. Center for Food Security & Public Health: cfsph.iastate.edu/Zoonoses/index.php • Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel (2010). National Association of State Public Health Veterinarians: avmajournals.avma.org/doi/pdf/10.2460/ javma.237.12.1403 • Infection Prevention and Control Best Practices for Small Animal Veterinary Clinics (2008). Canadian Committee on Antibiotic Resistance: wormsandgermsblog.com/uploads/file/CCAR%20Guidelines%20 Final%282%29.pdf • Worms & Germs Blog: Promoting Safe Pet Ownership. University of Guelph & Centre for Public Health and Zoonoses: wormsandgermsblog.com MRSA MRSP Primary reservoir Humans Dogs Zoonotic potential High Low Carriage potential in pets Generally short-term Long-term or possibly lifelong Common types of infection Skin, wounds, surgical sites Skin, wounds, surgical sites Comparison of MRSA & MRSP as Zoonotic Pathogens of Companion Animals 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 _____________ ___________________________ _____________
  24. 24. Tastes like Works like HillsVet.com Irresistible new form Full strength, clinically proven efficacy There’s never been therapeutic nutrition like this. CLINICAL NUTRITION TO IMPROVE QUALITY OF LIFE™ ©2014 Hill’s Pet Nutrition, Inc. ®/™ Trademarks owned by Hill’s Pet Nutrition, Inc. 22 veterinaryteambrief.com July 2014 and has even been reported after just “close contact” with a dog.5 The infec- tion can progress quickly, and delay in treatment may result in gangrene of the digits or limbs, or even death. It is therefore crucial that clients tell their physicians about contact with pets or other animals so that zoonotic patho- gens like C canimorsus are given early consideration. In cases of animal bites or scratches, a client should always immediately and thoroughly wash the affected area with soap and water. Al- ways protect broken skin from contact with pets. Strep throat Strep throat (streptococcal pharyn- gitis) is caused by the bacterium Streptococcus pyogenes, also known as Group A Streptococcus (GAS). Hu- mans are sometimes prone to recur- rent strep throat episodes, and some may eventually try to blame their dog. Researchers decades ago impli- cated dogs as a potential source of GAS,6 but their culture methods did not differentiate GAS from Group G streptococci, which in- clude the common canine commen- sal S canis. More recent studies have failed to find GAS in dogs or cats, even those living with children suf- fering from strep throat.7,8 When humans have recurrent infec- tions, the Infectious Disease Society of America recommends testing their human contacts, not their pets, be- cause no current evidence shows pets as a source of GAS.9 If a client wants his or her pet tested for a particular SPECIAL FEATURE pathogen at a physician’s request, the veterinarian should discuss the re- quest with the physician to ensure that testing will provide meaningful results that can be used for the man- agement or treatment of the client, the pet, or both. Communication is always key. The entire veterinary team must be knowledgeable about the myths and realities of these bacteria. For more information, use the resources pro- vided (see Read All About It, page 21) to both inform clients and initi- ate conversations about this import- ant topic. See Aids & Resources, back page, for references & suggested reading. Editor's note: Part 2 will be published in an upcoming issue. In cases of animal bites or scratches, a client should immediately and thoroughly wash the affected area with soap and water. 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. Introducing the only nutrition clinically tested to reduce the recurrence of FIC signs by 89%1 now with ingredients to help manage stress. HillsVet.com NE W Break the cycle with c/d® Multicare Urinary Stress 1 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. CHANGE THEIR FOOD. CHANGE THEIR WORLD. 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. 24 veterinaryteambrief.com July 2014 WHEN SHOULD LEPTOSPIROSIS BE SUSPECTED IN A DOG? • Leptospirosis can cause a variety of clinical problems in dogs, ranging from subclinical infections to sudden death with no preceding clinical signs. The most common problem is acute renal failure (also called acute kidney injury [AKI]), but leptospirosis can also cause liver disease, ocular disease (uveitis), vasculitis, abnormal bleeding, muscle pain, polyuria, or polydipsia. • Leptospirosis should always be considered in any dog that is presented with AKI, including dogs that previously had chronic kidney disease (CKD), sometimes called “acute-on-chronic” kidney disease. Leptospirosis should be suspected in dogs with AKI until testing has proved that something else caused the kidney damage. STEP 1: Comprehensive Overview Katharine F. Lunn, BVMS, MS, PhD, MRCVS, DACVIM North Carolina State University College of Veterinary Medicine Canine Leptospirosis STEP 2 Team Education Primer h Because of the possibility of zoonotic transmission, clients need to be aware of the potential risks of leptospirosis while receiving appropriate support to keep the risks in perspective. WHICH TEST RESULTS INCREASE SUSPICION OF LEPTOSPIROSIS? • In addition to AKI manifesting as increased serum concentrations of creatinine and blood urea nitrogen, canine leptospirosis can also cause mild decreases in platelet counts (thrombocytopenia); increased liver enzymes, particularly alkaline phosphatase; and increased bilirubin concentrations. Urinalysis may show a low urine specific gravity, the presence of blood or casts, and sometimes glucosuria despite a normal serum blood glucose concentration. WHICH TESTS CAN DIAGNOSE LEPTOSPIROSIS IN DOGS? • The disease can be diagnosed by either finding evidence of the organism in the blood or urine, or by detecting an antibody response in the blood. Many tests, including dark-field microscopy, immunofluorescent antibody tests, and polymerase chain reaction (PCR), can potentially detect leptospires in urine; however, because none of these tests are perfect, it is important to bear in mind that a negative test (eg, a PCR) does not rule out the diagnosis of leptospirosis; a very low number of leptospires may be present, or the organisms may not have been present in the blood or urine at the time of sampling. Although false positives are possible with any test, a positive result for leptospirosis on a PCR should be taken seriously, as this is a zoonotic disease. • The most common test for antibodies is the microscopic agglutination test (MAT). This is a simple blood test that can confirm whether the dog has been exposed to Leptospira spp bacteria. It is important to consider vaccination history when interpreting results of this test. Be sure to perform acute and convalescent MAT tests, which involve 2 samples taken approximately 2 weeks apart, particularly if the first sample is negative. A negative first sample does not rule out leptospirosis. Leptospires are primarily transmitted through direct or indirect contact with urine. The organism can also be present in other bodily fluids, but these are a less common source of exposure. CLINICAL SUITE | CANINE LEPTOSPIROSIS 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. July 2014 Veterinary Team Brief 25 CLINICAL SUITE | CANINE LEPTOSPIROSIS STEP 2: Team Education Primer Katharine F. Lunn, BVMS, MS, PhD, MRCVS, DACVIM North Carolina State University College of Veterinary Medicine What to Do When Leptospirosis Is Suspected Leptospires are killed by most routine disinfectants, including bleach, ethanol, and quaternary ammonium compounds. They are also killed by many detergents, sunlight, dessication, and freezing. MANAGE THE PATIENT • Any dog with AKI should be a suspected leptospirosis patient until an alternate diagnosis has been proven, bearing in mind that not all dogs with leptospirosis have AKI. • If hospitalized, the patient should be housed in a low-traffic area of the practice, preferably in a floor-level cage. If necessary, use a gurney or cart to move the patient. • Identify the patient with a clearly visible cage card or warning sign that alerts team members to the presence of a patient suspected to have leptospirosis. • Dogs with AKI often require urinary catheterization with a closed collection system to manage their renal failure. Wear protective clothing when placing or manipulating the catheter or emptying the urine bags. The urine should be mixed with bleach before disposal in the drain; use a 1:1 mixture of urine with a 10% bleach solution. If the dog urinates in its cage or urine cannot be contained, consider placing an indwelling urinary catheter with a closed collection system. If this is not an option, consider using absorbent pads. Wear protective equipment when disposing of the pads. • Dogs that are not catheterized should urinate only in a designated area that can be disinfected after use. A hard, nonpermeable surface is preferred. • If any urine spills occur, immediately clean and disinfect the area while wearing protective equipment. • Consider bathing dogs that have urine-soaked fur. Wear protective equipment when bathing, particularly eye and mouth protection. (continued) h 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 Make sure that the veterinary healthcare team is familiar with the common and uncommon manifestations of leptospirosis so that potential cases are recognized. Educate the team about the precautions necessary to avoid spreading the disease to humans.
  28. 28. 26 veterinaryteambrief.com July 2014 STEP 2: Team Education Primer STEP 3 Communication Keys h CLINICAL SUITE | CANINE LEPTOSPIROSIS Any team member handling the patient should wear a disposable gown and gloves. PROTECT THE TEAM • Leptospirosis patients do not need to be isolated. Protecting team members who handle the dog or any bodily fluid is the main concern, which can be achieved without isolation. These patients are also often critically ill, and are better served by being readily visible to the team. • Any team member handling the patient should wear a disposable gown and gloves. Protective eyewear and a face mask are recommended whenever there is a risk of splashing of urine or other bodily fluids (eg, when handling wet bedding, bathing the patient). Wash hands thoroughly after removing protective clothing. The organisms are transmitted through cuts and abrasions on the skin, or through mucous membranes of the eyes or mouth. • Avoid needlestick injuries and direct contact with the patient’s blood. • Wear protective equipment, particularly for the eyes and mouth, when cleaning cages, runs, and soiled bedding. Avoid pressure-washing runs, which will aerosolize the organisms. • Team members who are pregnant or immunosuppressed should not handle patients suspected to have leptospirosis, their urine, or other bodily fluids. • Educate all team members and laboratory technicians who may handle blood, urine, or other bodily fluid samples from the patient. • Be aware that clinically healthy dogs have the potential to shed leptospires in urine; team members and laboratory technicians should therefore always wear gloves and cover bare skin when handling any dog wastes. 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. July 2014 Veterinary Team Brief 27 Because of the threat of zoonotic transmission, much of our communication regarding canine leptospirosis should center on protection for team members and clients. The role of every team member is to educate, support, and provide written resources that will offer balance between caution and overreaction. Jessie Merritt, CVPM, SPHR Oswego Veterinary Hospital Portland, Oregon Providing Balance Through Conversations STEP 4 Team Workflow h STEP 3: Communication Keys CLINICAL SUITE | CANINE LEPTOSPIROSIS a safe comfort level for the client. Consider including these points in discharge instructions: • Symptoms that indicate the patient is not responding to treatment as well as expected, and when to call your office • Directions for when to return for a follow-up visit for the second MAT (antibody) test if necessary • Diet and exercise instructions • Medication information, including the warning to give as directed and to complete the entire course • Direction that the patient should, if possible, urinate on a surface that can be disinfected using a 3%–10% (1:30 or 1:10) dilution of bleach, until directed otherwise • Phone numbers of the emergency practice in your area if your practice does not provide 24-hour services • Recommendations for protective equipment for home care, as well as a home-care kit. CLIENTS WITH LEPTOSPIROSIS- POSITIVE DOGS Advise clients whose dogs have leptospirosis to take the following steps to avoid the spread of the disease: • Avoid direct contact with the dog’s urine until the course of antibiotics is completed, because bacteria are spread mainly through the urine of infected animals. • Always wear gloves or wash hands thoroughly after touching the infected dog or anything that might have urine on it. • To prevent spread of the disease and reinfection, keep the patient away from vegetable gardens, wading pools, playgrounds, and groundwater. WRITTEN DISCHARGE INSTRUCTIONS Leptospirosis can be intimidating for the client. Provide a client handout (see Frequently Asked Questions: Canine Leptospirosis, page 31) along with written patient discharge instructions to create Keep the patient away from vegetable gardens, wading pools, playgrounds, and groundwater. 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. 28 veterinaryteambrief.com July 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 STEP 4: Team Workflow Jessie Merritt, CVPM, SPHR Oswego Veterinary Hospital Portland, Oregon Team Workflow RECEPTIONIST ✔ Immediately welcome the client and patient, and escort them into an examination room. TECHNICIAN/ASSISTANT ✔ Review the patient’s status or progress. ✔ Take the patient’s vital signs using the appropriate protective equipment, such as gloves, goggles, and a mask. ✔ Restrain and document in the medical record according to practice procedures. CLINICAL SUITE | CANINE LEPTOSPIROSIS VETERINARIAN ✔ Perform the physical examination using the appropriate protective equipment. ✔ Discuss treatment options with the client. ✔ Counsel the client on health risks to anyone who has been in contact with the patient or the patient’s environment. ✔ Confirm that all the client’s questions have been answered. TECHNICIAN/ASSISTANT ✔ Provide and review all written handouts and treatment plans. ✔ Prepare the cage area if the patient is being admitted, and choose the patient team. ✔ Thoroughly disinfect the examination room and equipment used on the patient. STEP 5 Team Roles h VETERINARIAN OR TECHNICIAN/ASSISTANT ✔ Provide daily patient updates to the client. ✔ Supervise any patient visits by the client and his or her family for proper infection control. ✔ Schedule a recheck appointment following discharge. ALL TEAM MEMBERS ✔ Always greet clients warmly, introduce yourself, and acknowledge the patient by name. ✔ If leptospirosis is suspected, limit hands-on interaction to members of the patient's care team. ✔ If leptospirosis is included on the list of diseases to be ruled out, ensure that the team is notified.
  31. 31. July 2014 Veterinary Team Brief 29 STEP 5: Team Roles Jessie Merritt, CVPM, SPHR Oswego Veterinary Hospital Portland, Oregon Team Roles STEP 6 Team Training Plan h CLINICAL SUITE | CANINE LEPTOSPIROSIS TEAM MEMBER ROLE RESPONSIBILITIES RECEPTIONIST Ambassador of the practice and master of organization ✔ Create a bonding experience for clients by welcoming, interacting, listening, and assuring them your entire team is there to help. ✔ Guide the client through the process of the visit, making sure he or she knows what to expect while minimizing potential exposure or contamination to other clients, patients, or environments. TECHNICIAN/ ASSISTANT Client educator and patient caregiver ✔ Instill clients with trust and confidence by demonstrating professionalism and compassion. ✔ Anticipate the needs of the veterinarian regarding equipment, supplies, and restraint. VETERINARIAN Educator, medical expert, and team mentor ✔ Provide clients access to knowledge and treatment options. ✔ Lead the team on how to offer guidance, and be accountable for appropriate patient care and zoonotic protocols. All team members should be aware of a likely zoonotic patient to manage the appointment and protect other clients, patients, and each other. This is not the time to play “Pass the Puppy” (even though she may be incredibly cute). 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. 30 veterinaryteambrief.com July 2014 STEP 6: Team Training Plan Jessie Merritt, CVPM, SPHR Oswego Veterinary Hospital Portland, Oregon Your Zoonotic Protocol Reducing the risk of exposure when handling a suspected or confirmed leptospirosis patient begins with a solid zoonotic protocol and team training, even before the patient walks in the door. CLINICAL SUITE | CANINE LEPTOSPIROSIS STEP 7 Client Handout h WORDS FROM THE WISE Suggested resources for learning more about leptospirosis: • Leptospirosis Zoonotic Infection in a Veterinary Technician in North County: sdcvma.org/leptospirosis-zoonotic-infection-veterinary-technician- north-county • 2010 ACVIM Small Animal Consensus Statement on Leptospirosis: Diagnosis, Epidemiology, and Treatment: acvim.org/publications/ consensusstatements.aspx TEAM • Which team members handled this patient before the potential diagnosis of leptospirosis? Consider them exposed and counsel accordingly. There should be specific team members assigned to each patient; only they handle treatments, supplies, and cleanup. • These team members should be required to wear gloves and gowns when handling the patient, and face masks, goggles, or shields whenever there is a risk of exposure to urine or bodily fluids. This should be for the duration of hospitalization or until an alternate diagnosis is confirmed. • If these team members must also treat other patients, they should treat the leptospirosis patient last. • Pregnant and immunosuppressed team members should be discouraged from being part of this patient care team. PATIENT • If possible, place the dog in a floor-level cage without direct neighbors. • The cage should be clearly marked as a patient with suspected leptospirosis. • Dedicate specific floor space in front or to the side of the patient cage for supplies. Use newspaper or disposable puppy pads to place supplies (eg, fluids, sharps, urine collection bags). These supplies should never reach the general population area. All supplies brought into the patient’s area should be disinfected or sealed in a biohazard bag before leaving the area. Sealed bags should be turned over to a hazardous waste company. ENVIRONMENT • Clean all nonporous surfaces with dilute (3%–10%) bleach or disinfectant. • Clean lawn, gravel, pavement, or wood with dilute bleach when possible, and section off until completely dry. CLIENT • Educate the client about the risk of exposure. Has the patient been to daycare, a boarding or grooming facility, or a neighbor's house recently? Any human exposed to the patient needs to be counseled about the risk and encouraged to contact his or her medical care provider for advice. • If clients are permitted to visit their pet, gloves and gowns should be required. • Identify all laboratory samples as high risk for zoonosis. 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. Katharine F. Lunn, BVMS, MS, PhD, MRCVS, DACVIM North Carolina State University College of Veterinary Medicine July 2014 Veterinary Team Brief 31 STEP 7: Client Handout Frequently Asked Questions: Canine Leptospirosis CLINICAL SUITE | CANINE LEPTOSPIROSIS How did my dog get leptospirosis? The exact source of infection cannot be determined in a specific patient, but the infection usually comes from contact with infected urine from wild animals. This could be from a contaminated water source such as a pond or stream, or just from wild animals passing through the backyard. My dog never swims or goes in the water and only goes outside to eliminate. How could he possibly get exposed to leptospirosis? Unfortunately, your dog was probably just in the wrong place at the wrong time. If an infected wild animal happened to urinate in your backyard, and your dog later sniffed or licked that area, then he could have been infected at that time. But I always thought this was mainly a disease of outdoor and hunting dogs? No. Any dog is susceptible, and many veterinarians see cases in small breed dogs, indoor dogs, and “lap dogs” that rarely go outside. Which wild animals carry leptospirosis? Many animals can carry the infection, including those that we commonly see in our backyards and neighborhoods. Examples include skunks, opossums, raccoons, foxes, moles, mice, rats, deer, and squirrels. Can people get leptospirosis? Yes, it is a zoonotic disease, meaning that it can be transmitted to people from animals. Can I catch leptospirosis from my dog? There is a risk, but it is decreased once your dog starts antibiotic therapy. Humans can also catch leptospirosis from contaminated water sources, from non-companion domestic animals, and from wild rodents. Because of the potential risk, it is important to take precautions once your pet comes home. 1 2 3 4 5 6 (continued) h 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. 32 veterinaryteambrief.com July 2014 STEP 7: Client Handout CLINICAL SUITE | CANINE LEPTOSPIROSIS What precautions should I take? Until the course of antibiotics is finished, wash your hands thoroughly after handling your pet and his or her bedding, food, and water bowls. Do not allow your dog to lick your face. Wear gloves and use bleach or other household disinfectants to clean up any urine accidents in the house. Minimize contact between your pet and anyone who is pregnant or immunosuppressed (eg, receiving immunosuppressive drugs, infected with HIV) until the course of antibiotics is finished. You should also consult with your family physician. Can I safely pet my dog? Yes, just petting your dog should not put you at great risk if you are otherwise healthy, but wash your hands afterward, and always avoid direct contact with urine. What should I do to make my backyard safer? It is not really possible to eliminate infection from the backyard. If you see your dog urinate on a hard surface outside, spray the area with a disinfectant or bleach, and continue to spray until the antibiotics are finished. The organisms are killed by sunlight and by freezing temperatures, so depending on your climate, they may not survive for long. You should not encourage wildlife to visit your yard by feeding them, although it is not possible to eliminate all animal visitors that may pass through the neighborhood. What about my other dogs? They are not sick, but could they get leptospirosis also? Provided your affected dog completes the antibiotic course, your other dogs probably will not get leptospirosis. However, if all your dogs spend time in the same environment, others may have been exposed. Depending on the risk of infection, your veterinarian may elect to treat these dogs preventively. How will I know if I have leptospirosis? People with leptospirosis exhibit a variety of symptoms, including flu-like symptoms and liver or kidney disease. A veterinarian cannot make the diagnosis or give you medical advice, but may strongly recommend you consult your physician if you have any symptoms of illness, particularly if you are pregnant or have a suppressed immune system. Should all dogs be vaccinated against leptospirosis? All dogs are potentially susceptible to leptospirosis, and the risks and benefits of vaccination should be discussed with your veterinarian. There is evidence that vaccines provide protection for at least one year. What else should I know? You must complete the course of prescribed antibiotics to ensure that the infection is properly eliminated. Bring your dog back for follow-up testing, which may help prove or disprove that your dog has leptospirosis and allow his or her recovery to be monitored. 7 8 9 10 11 12 13 Frequently Asked Questions: Canine Leptospirosis (continued) 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. The TOPICAL ALTERNATIVE for flea and tick control that lasts 8 MONTHS ©2013 Bayer HealthCare LLC, Animal Health Division, Shawnee Mission, Kansas 66201 Bayer, the Bayer Cross and Seresto are registered trademarks of Bayer. S14222 » Bayer’s sustained release technology combines two effective active ingredients, IMIDACLOPRID + FLUMETHRIN » Kills ticks on DOGS OR CATS within 48 hours and repels and kills reinfesting ticks on dogs in as quickly as 6 hours » Quickly kills fleas on DOGS OR CATS within 24 hours and reinfesting fleas within 2 hours www.BayerDVM.com 1 Data on file. THE PERFORMANCE YOU EXPECT FROM A TOPICAL, IN AN EASY-TO-USE COLLAR. *Achieves100%efficacyagainstfleaswithin2daysoftreatmentandmaintainsefficacy above90%forover7months. Afterday2,97.7–100%efficacyagainst I.scapularis(dog) and A.americanum(cat)wasachievedfor8months.1 * 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. PERSONALITY PROFILE Lisa Hunter, LSW, & Jane R. Shaw, DVM, PhD Colorado State University The Colleague Who Can’t Say No 34 veterinaryteambrief.com July 2014 be devoted to current responsibilities. Follow these tips2 : • Take time to answer. I am interested, and I will need some time to look it over before I decide. • Use “I” statements. I am sorry to say No, as it is such a great opportunity. • Say it with kindness and make it clear. I am going to have to say No on this one, even though I wish I could help. • Decline the task, not the team member. Although I admire the work you are doing, I wouldn’t be able to give the project the attention it deserves and need to say No this time around. • Avoid using Maybe. Maybe can be taken as a potential Yes and lead to false hopes and expectations. • Offer an alternative. I cannot participate in this initiative. I’m wondering if we could delegate the tasks among the whole team, which would allow all of us to contribute. When to Say Yes Yes can be the right answer. Team members who know when to say Yes help create a healthy balance between It is such a small word, yet No has the power to cause big problems in the workplace. We’ve all worked with—or perhaps recognize in the mirror—some- one who struggles with turning down a request or delegating a task. Having good intentions and wanting to be the best at our job make it difficult to say No to requests. Still, when we accept more responsibility than we can handle, Yes turns into Maybe—and when the task is not completed, projects, client interactions, and even patient outcomes are negatively impacted. One team member’s inability to say No is exhausting, frustrating, and disempowering for the entire team. Declining a request when our intention is to provide the highest standard of patient care can be difficult. Work is a reflection of who we are, and no one wants to be seen as unhelpful, negative, or uncaring. We may also feel that we are the only one who can do a particular task well; for example, we may think, No one can handle complaint calls as well as I can. The downside, in addition to being stretched too thin, is that we may be depriving other team members of an opportunity to take on a new task, grow, or be recognized. When to Say No Always saying Yes is often an attempt to avoid guilt.1 Help yourself or a team member see that accepting every request may lead to constant struggling, and that saying No when it is appropriate allows more attention to accepting new proposals on top of their existing workloads.3 Before responding, take time to examine roles, responsibilities, objectives, and purpose. Ask yourself: • Will taking on this task help or hinder my current efforts? • What are my current priorities? • How does this request align with my role? • Who else has the skill set to address this task? • What will be gained if I complete the task? • What will be lost if I decline the task? Say Yes when a request falls directly within the scope of your role and job duties and can be accomplished in a timely manner based on all the other tasks on your plate. Yes or No? Next time you feel about to say Yes when you need to say No, think first whether a negative response would be a positive outcome for you, the rest of your team, your patients, and your practice. See Aids & Resources, back page, for references & suggested reading. One team member’s inability to say No is exhausting, frustrating, and disempowering for the entire team. 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. OUTCOMES OF NEVER SAYING NO • Decreasing self-worth • Disempowering team members • Increasing stress • Lacking balance • Missing deadlines • Mounting resentment • Reducing work performance • Stretching yourself too thin. July 2014 Veterinary Team Brief 35 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
  38. 38. 36 veterinaryteambrief.com July 2014 The root of The Carrot Principle is simple: purpose-based recognition accelerates a leader’s effectiveness, and an effective leader who makes team members feel appreciated and understood on a personal and professional level will achieve improved business results. Of course, the devil is in the details, and Gostick and Elton provide guidance on the specifics throughout the book. The authors begin by citing data that demonstrate a strong correlation BOOK CLUB Jessica Goodman Lee, CVPM Brakke Consulting Dallas, Texas Title: The Carrot Principle Authors: Adrian Gostick and Chester Elton Topics: Leadership, employee motivation, productivity Highlights: • An important book for leaders seeking to improve their skills at effectively motivating their teams while achieving greater satisfaction in life and work. • The last chapter is extremely helpful and lists 125 great ways to recognize team members, dividing them into categories: day-to-day, above and beyond, career recognition, and celebration events. • This bestselling book, first published in 2007, offers up new “aha” moments for anyone in a leadership role, no matter how many times it has been read. Carrot Trumps Stick in Team Building between appreciation, engagement, and productivity in business. Gostick and Elton insist that the best place to find talent is right under your nose: “Recognition has an accelerating impact on the workplace. It gives coworkers a vision of the possible and the desire to garner the rewards.” They also offer the interesting premise that when great managers intertwine a team member’s goals with those of the company, the result is the ultimate level of satisfaction. So what exactly is purpose-based recognition? It involves publicly The Veterinary Connection The average small animal practice experiences 32% turnover on an annual basis, according to the 2013 edition of the AVMA Report on Practice Business Measures.1 This is often due to the lack of experience and formal training of those put in leadership roles. Inexperienced managers may not understand the connection between leadership, recognition, and team members’ organizational commitment and job satisfaction. Practice owners would benefit by adopting a “carrot culture” when asking someone to take on a management role—openly and publicly recognizing the individual’s potential and then accelerating that person’s effectiveness by providing training and educational opportunities. The investment will pay for itself 100-fold. Many practice owners and managers may not openly communicate with their team members. The Carrot Principle suggests that adopting a culture of open sharing has far-reaching benefits. As the authors explain, “…when a leader fails to constantly and openly communicate ‘who we are and what’s important,’ the conversation doesn’t stop. The dialog among employees just goes in a different direction, and the company culture develops away from the leader’s influence, goals, and priorities.” Practice owners and managers who do not currently practice open communication should rethink their policy. 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. rewarding specific strategically important actions and behaviors. Practicing this type of recognition causes “the trust meter to shoot off the scale,” because team members recognize that their leader values the Adopting a culture of open sharing has far-reaching benefits. ideas and efforts of others who are committed to the same cause. Recognition can take many forms, “but whatever it is, the best reward is always personal and tailored to employee interests and lifestyle, given by a manager who cares enough to find out what motivates each individual.… Managers who invest in choosing relevant awards suddenly find themselves becoming much more relevant as well.” The second half of The Carrot Principle is a how-to manual for creating a “carrot culture.” The authors address things such as “carrotphobia”—the many excuses a manager may make for not recognizing his or her team members. Tools are provided to implement a carrot culture, such as a recognition frequency log and a “carrot calculator” to gauge the team’s perception of recognition in the workplace. Twenty pages are dedicated to a variety of recognition ideas broken down by type and circumstance. Based on its statistics and logical information, this book would benefit both seasoned and new business leaders, who should grab a copy and put it to use. 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 _______________ ______________________
  40. 40. 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. COMMUNICATION CUES Andra S. Edwards, DVM Washington State University Convenience euthanasia refers to a circumstance in which the care of a pet, for whatever reason, reaches a level of incon- venience that is no longer tolerable for a client. Veterinarians of- ten consider convenience euthanasia unjustifiable and unethical, but like many situations the veterinary profession faces, this is not a black-and-white issue. A Spectrum of Scenarios The level of inconvenience tolerated before making the decision to eutha- nize a pet is unique to each client. Consider a client who purchases new furniture and asks that her aging poodle be euthanized because the dog no longer matches the couch. Consider also a client who chooses to care for a patient with a severe spi- nal injury that requires medical ad- ministration and attention to bodily functions several times a day. The first story, though far-fetched, il- lustrates an extremely low threshold of inconvenience that one would hope to never see in practice. The majority of clients would not euthanize a pet over such a trivial issue, and most of us would agree that this is an example of an unjustified convenience euthanasia. A much greater number of clients would reach the threshold of incon- venience with the care of the patient in the second scenario and choose The Ethics of Death for Convenience July 2014 Veterinary Team Brief 39 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. euthanasia. However, a handful of cli- ents and veterinarians would consider euthanasia even in the second scenar- io to be unethical, because they would determine that the patient could still have a life worth living with proper care.1 Full Context When confronted with the prospect of performing any euthanasia, it is im- portant to consider the entire situa- tion, and communication with the client is key. If a client requests a eu- thanasia that is ethically uncomfort- able, consider offering an alternative. Perhaps the client believes that he or she has no other option and simply needs some guidance in how to pursue treatment, or could be directed to a local rescue organization that could help find the patient a new home. Af- ter truly listening to the client, the best choice may indeed be euthanasia, even if it did not seem so at the start. As veterinarians, each of us must de- velop our own definition of what we consider an unethical euthanasia of convenience, and we must use our best judgment to make ethical choices that consider the well-being of both our patients and clients. See Aids & Resources, back page, for references & suggested reading. Jorgensen Laboratories, Inc. Loveland, CO 80538 | (800) 525-5614 www.jorvet.com | Info@jorvet.com ACCURATE, EASY-TO-USE TONOMETER IS Silicon Grip + box of probes free of charge when you buy a TONOVETe by August 29th, 2014. SUMMER CAMPAIGN When confronted with the prospect of performing any euthanasia, it is important to consider the entire situation, and communication with the client is key. 40 veterinaryteambrief.com July 2014 PEER REVIEWED COMMUNICATION CUES 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. July 2014 Veterinary Team Brief 41 DIRTY LAUNDRY Charles J. Wayner, DVM Veterinary Vitality Topeka, Kansas “Compliance” in veterinary medicine is defined as, “The pet receives the care you believe is best for the pet.”1 This is nicely conveyed in the acro- nym CRAFT, where Compliance = Recommendation + Acceptance + Follow-Through. Wonderful details on this concept are available.1-3 The exciting thing about “compli- ance” is that it takes a team approach to deliver and achieve. The crucial, initial element of maintaining client compliance is the belief system of your practice’s healthcare team. The veterinarian, the client, and the healthcare team are responsible for de- livering the best care for the patient. Examine Your Own House You know from studies and from practical experience that a significant number of pets are not receiving the care you believe is best for the pet. From my observation, that includes many veterinary team members’ pets. Be honest: Among your pets and those of your team, are any over- weight? Are any in need of periodon- tal therapy? Do they have their teeth brushed daily? Are they checked con- sistently for heartworm and internal COMPLIANCE After visiting more than 2,500 veterinary practices around the world and being involved with the American Animal Hospital Association’s initial 2002 study on compliance in veterinary medicine, "The Path to High Quality Care," I would like to share the concept of Crystal-Clear Compliance.1 Have you ever explored, experiment- ed with, emulated, or encouraged your team to adopt some of the many great ideas to improve client compli- ance put forth in publications and at conferences? If you have, are they still in place and being continually im- proved, or were they tried for a time and then discarded as too time-con- suming, complicated, or contrived? 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. DIRTY LAUNDRY 42 veterinaryteambrief.com July 2014 parasites and do they receive preven- tives for the appropriate amount of time? Are your pets devoid of anxi- ety, well-trained, and well-groomed? Are they receiving proper nutritional products that your practice endorses to clients? Do they receive regular laboratory tests to minimize poten- tial medical problems? What about the pets of your family members and friends? Ouch! My contention is that we cannot be true stewards of compliance if we ourselves are not compliant. Do as I say, not as I do is not an appropriate way to practice. The Cold, Hard Truth The unfortunate reality is that some clients likely believe that your fees are too high, you do not convey “care,” and their pets do not need to come into the practice at the inter- vals you determine for each specific medical need. This is not exclusive to veterinary medicine. Do you ever feel that you can see through the ve- neer of a business pitch because the offer does not seem genuine or sin- cere? Your clients are just the same, and since a beloved pet is involved, they may be even more cautious. Crystal-Clear Concept To change this reality and convert clients to truly believe, trust, endorse, and utilize your practices’ products, services, and talents on a consistent basis, I propose the concept of Crys- tal-Clear Compliance (CCC). Please contemplate for a moment the word “crystal.” It is a solid material, whose constituent parts, (scientifically, atoms,molecules,orions),arearranged in an ordered, consistent pattern ex- tending in all 3 spatial dimensions. Crystals are transparent and brilliant. Your veterinary healthcare team can share such crystal-like characteris- tics (see Crystal-Clear Team). When a team has these characteris- tics, clients, regardless of external fac- tors, will likely enthusiastically use and support your practice. Said an- other way, it is important to demon- strate your team’s unified belief system, and to walk the walk. Practice Culture Promoting CCC can be the product of a positive practice culture (ie, the attitudes, customs, and beliefs that distinguishes one group of people from another). If a practice culture is not explicitly established, articulat- ed, and lived, especially by the prin- cipals, subcultures will develop—but they probably won’t be conducive to exceptional compliance. It is also important that practice own- ers and leaders are dedicated to ongo- ing team skill-set development on compliance. If every team member It is important that practice owners and leaders are dedicated to ongoing team skill-set development on compliance. 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. does not know the passion that lead- ership has for maintaining compli- ance—or the medical rationale behind the passion—compliance will always break down or not exist at all. You’re only as strong as your weakest link, as the saying goes, and if just one team member is not on the same page with improving com- pliance, the patients, the clients you serve, and the practice may suffer. Yes, practices can be distinguished by the kinds of equipment they have or their veterinarians’ medical and surgical skills. That’s how we within the profession tend to “evaluate” one another. But clients more often critique us on how our unified cultures (or disparate subcultures) are revealed. People don’t care how much you know until they know how much you care has never been more relevant in veterinary practice. Please strive to enhance your practice’s culture, and therefore your compas- sion, care, and compliance. The results will likely be palpable to the patients and clients you serve. Make CCC a Priority Remember, clients want to trust your recommendations. Make it easy for them to do so by making Crys- tal-Clear Compliance a priority. You should not have to defend the cost of veterinary care, but rather promote its incredible value by living it, then delivering it. I encourage you to take advantage of the substantial and valuable resourc- es Veterinary Team Brief makes avail- able to you! See Aids & Resources, back page, for references & suggested reading. You should promote the incredible value of veterinary care by living it, then delivering it. CRYSTAL-CLEAR TEAM Clients will likely use and support a veterinary practice whose team has these rock-solid characteristics of a crystal: • Solid: Unified as parts of the team • Consistent: Reinforcing • Radiating out: Positively promoting your practice • Transparent: Easily noticed and understood • Brilliant: Unique, vivid PEER REVIEWED July 2014 Veterinary Team Brief 43 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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