“Talk to the Paw— 27 |Zoom in on Your Annual Review That’S Not My Job” and Other Myths

Home , Dirofilaria immitis

firstline INCLUDES THE Strong veterinary teams, compassionate client and patient care Dermatology ÒTalk to the pawÑ ” p10 thatÕs not my job DENTAL CORNER: Photos of a cat with a fractured mandible

p15 WEIGH IN: What to say when clients diss their dogÕs weight 8

MICROCHIPS: Know your role to help pets get home again 14

FELINE DIABETES: Help cat owners manage their petÕs disease 21

ANNUAL REVIEWS and how to change them for the better 27

SICK OVER WORK? Use these tips to control zoonoses at work 31

June 2013 | Volume 9 | Number 6 | dvm360.com

magentablackcyanyellow ES258542_fl0613_cv1.pgs 05.30.2013 01:15 ADV magentablackcyanyellow ES262711_FL0613_CV2_FP.pgs 06.01.2013 04:30 ADV On the inside

5 | Dear Firstline » Should I ofer discounts?

6 | dvm360.com news » Oklahoma tornado claims countless animal lives

7 | Ask the experts » Ask Shawn: Fighting 5-fnger discounts » When clients diss their dogs

10 | Pearls of practice » Practice life: Te ABCs of a clean team » Te VHMA fles: Overcome hurtles to present your idea 12

» What’s your role? Microchips “Talk to the paw— 27 |Zoom in on your annual review that’s not my job” and other myths

It’s time to make way for service that leaves pet owners purring. Consider this advice to come up to scratch when clients visit your practice. 27 page 15 By Brian Conrad, CVPM

It’s time to embrace a new outlook on client relations employee reviews. Take the sting out of a diabetes diagnosis By Bash Halow, LVT, CVPM Support pet owners by using these tender communication techniques to ease ❯❯ plus Be a great reviewee page 28 the burn of this challenging disease. page 21 By Mandy Stevenson, RVT dvm360 Toolkit: Dermatology team saFety 37 | Marketplace When work makes you sick Sick over work—literally? Use these tips to control zoonoses in the workplace. 40 | By the numbers page 31 By Oriana Scislowicz, BS, LVT Eliminate the spread of gossip ❯❯ plus 5 steps to cleaner hands page 34

dvm360.com | Firstline | June 2013 | 1

magentablackcyanyellow ES258402_fl0613_001.pgs 05.29.2013 23:39 ADV online CONTENT

Join our circle at dvm360.com/community Follow us at twitter.com/ﬁ rstlinemag Like us on facebook.com/FirstlineMag

Team meeting in a BOX

Get the full scoop on how to make strong pet insurance recommendations—as well as a complete set of lesson plans to hold educational team meetings in your practice—at dvm360.com/teammeeting. You’ll ﬁ nd critical tools, including how to select the policies your practice will recommend as well as step-by-step tips to complete claim forms and practice each team member’s role in client communication.

Facebook A spoiled dog ... and a forgotten cat foibles and Steve Dale, CABC, explains why Twitter it’s so important to ask pet own- treats ers if they have cats you’re not Dr. Andy Roark, MS, explains why it seeing. Visit dvm360.com/ really is OK to be funny on your veteri- spoileddog to read nary practice’s social media outlets at how a loving pet dvm360.com/laughatwork. You can owner’s misun- see Dr. Roark speak on social media at derstandings about CVC Aug. 23 to 26 in Kansas City, Mo. her pets’ needs led her to make Visit thecvc.com to learn more. mistakes in the care she didn’t know enough to ask for. Ease clients’ euthanasia pain Subscriber Services: Call (800) 815-3400 in the United States, or (888) It’s never easy to say goodbye, but 527-7008 or (218) 740-6477 in Canada; fax (218) 740-6417; or write to: Dr. Robin Downing says you can Firstline, 131 W. 1st St., Duluth, MN 55802-2065. If you are unable to con- nect with the 800 numbers, e-mail fulfi ll@superfi ll.com. Reprint Services: make things better by empower- Call 1-877-652-5295 ext. 121 or email [email protected]. Outside ing and informing pet owners US, UK, direct dial: 281-419-5725. ext. 121 Back Issues: Individual copies are available for one year; to order, call (800) 598-6008. Permissions/In- throughout the diffi cult event. See ternational Licensing. Call Maureen Cannon at (440) 891-2742. List Sales: her tips at dvm360.com/ Please contact List Account Executive Renée Schuster at (440) 891-2613. Editorial Offi ces: Write to 8033 Flint, Lenexa, KS 66214; or call (913) 871- euthanasiatips. 3800. Visit our websites: dvm360.com; thecvc.com; industrymatter.com.

2 | June 2013 | Firstline | dvm360.com GETTY IMAGES/GEORGE DOYLE & CIARAN GRIFFIN/ ULTRA.F

magentablackcyanyellow ES257582_fl0613_002.pgs 05.29.2013 03:21 ADV THE REAL-BEEF CHEWABLE. REAL EASY PREVENTION.

It’s easy to see how the Real-Beef Chewable supports your recommendation for year-round heartworm disease prevention. HEARTGARD® Plus (ivermectin/pyrantel) is:

• The only heartworm preventive that comes in the Real-Beef Chewable • The heartworm preventive dogs love to take1,2 • The #1 most requested heartworm preventive3 • Backed by the Plus Customer Satisfaction Guarantee4

1 Of dogs showing a preference in three studies, dogs preferred HEARTGARD® Chewables over INTERCEPTOR® (milbemycin oxime) Flavor Tabs® by a margin of 37 to 1; data on file at Merial. 2 Of dogs showing a preference in two studies, all dogs preferred HEARTGARD Plus Chewables to TRIFEXISTM (spinosad + milbemycin oxime) beef-flavored chewable tablets; Executive Summary VS-USA-37807 and VS-USA-37808. 3 Opinion Research Corporation, Heartworm Prevention Medication Study, 2012. Data on file at Merial. 4 Ask your Merial Sales Representative for full guarantee details.

® ®HEARTGARD and the Dog & Hand IMPORTANT SAFETY INFORMATION: HEARTGARD (ivermectin) is logo are registered trademarks of well tolerated. All dogs should be tested for heartworm infection before Merial. All other marks are the property starting a preventive program. Following the use of HEARTGARD, of their respective owners. ©2013 Merial Limited, Duluth, GA. All rights digestive and neurological side effects have rarely been reported. reserved. HGD13TRTRADEAD3 (04/13). For more information, please visit www.HEARTGARD.com. JoinPowerof12.com

See brief summary on page 04.

magentablackcyanyellow ES262695_FL0613_003_FP.pgs 06.01.2013 04:29 ADV CHEWABLES CAUTION: Federal (U.S.A.) law restricts this drug to use by or on the order of a licensed veterinarian. Mission INDICATIONS: For use in dogs to prevent canine heartworm disease by eliminating the tissue stage of heartworm larvae (Diroﬁlaria immitis) for a month (30 days) after infection and for the treatment and control of ascarids (Toxocara To inspire receptionists, credentialed technicians, canis, Toxascaris leonina) and hookworms (Ancylostoma caninum, Uncinaria stenocephala, Ancylostoma braziliense). practice managers and veterinary assistants to build DOSAGE: HEARTGARD® Plus (ivermectin/pyrantel) should be administered orally at monthly intervals at the recommended minimum dose level of 6 mcg of ivermectin per kilogram (2.72 mcg/lb) and 5 mg of pyrantel (as pamoate strong relationships with co-workers, improve their salt) per kg (2.27 mg/lb) of body weight. The recommended dosing schedule for prevention of canine heartworm disease communication skills and educate clients with conﬁdence and for the treatment and control of ascarids and hookworms is as follows: in order to enhance their contributions to a veterinary Color Coding 0n practice and maximize every patient’s well-being. Dog Chewables Ivermectin Pyrantel Foil Backing Weight Per Month Content Content and Carton Up to 25 lb 1 68 mcg 57 mg Blue Content Group 26 to 50 lb 1 136 mcg 114 mg Green Editor/Business Channel Director | Brendan Howard 51 to 100 lb 1 272 mcg 227 mg Brown (913) 871-3823, [email protected]

HEARTGARD Plus is recommended for dogs 6 weeks of age and older. For dogs over 100 lb use the appropriate combination of these chewables. Editorial Consultant | Portia Stewart ADMINISTRATION: Remove only one chewable at a time from the foil-backed blister card. Return the card with the Content Manager | Adrienne Wagner remaining chewables to its box to protect the product from light. Because most dogs find HEARTGARD Plus palatable, Senior Content Specialists | Alison Fulton, Mindy Valcarcel the product can be offered to the dog by hand. Alternatively, it may be added intact to a small amount of dog food. Associate Content Specialist | Ashley Barforoush The chewable should be administered in a manner that encourages the dog to chew, rather than to swallow without Assistant Content Specialists | Heather Biele, dvm | Andrea Hewitt chewing. Chewables may be broken into pieces and fed to dogs that normally swallow treats whole. Medical Editor | Heather Lewellen, dvm Care should be taken that the dog consumes the complete dose, and treated animals should be observed for a few Technical Editor | Jennifer Vossman, rvt minutes after administration to ensure that part of the dose is not lost or rejected. If it is suspected that any of the dose | has been lost, redosing is recommended. Editor, E-media Jessica Zemler Senior Designer/Web Developer | Ryan Kramer HEARTGARD Plus should be given at monthly intervals during the period of the year when mosquitoes (vectors), Art Director | Steph Bentz potentially carrying infective heartworm larvae, are active. The initial dose must be given within a month (30 days) after the dog’s first exposure to mosquitoes. The final dose must be given within a month (30 days) after the dog’s last Multimedia Contributor | Troy Van Horn exposure to mosquitoes. When replacing another heartworm preventive product in a heartworm disease preventive program, the first dose of Editorial Advisory Board HEARTGARD Plus must be given within a month (30 days) of the last dose of the former medication. Our board members provide critical insights into the challenges If the interval between doses exceeds a month (30 days), the efficacy of ivermectin can be reduced. Therefore, for optimal performance, the chewable must be given once a month on or about the same day of the month. If treatment veterinary team members face every day, and they help Firstline provide is delayed, whether by a few days or many, immediate treatment with HEARTGARD Plus and resumption of the content that is relevant and useful to all practice team members. recommended dosing regimen will minimize the opportunity for the development of adult heartworms. Dennis Cloud, dvm | Sharon DeNayer | Debbie Allaben Gair, cvpm Monthly treatment with HEARTGARD Plus also provides effective treatment and control of ascarids (T. canis, T. leonina) Bash Halow, cvpm, lvt | Marianne Mallonee, cvpm and hookworms (A. caninum, U. stenocephala, A. braziliense). Clients should be advised of measures to be taken to Shawn McVey, ma, msw | Ciera Miller, cvt | Julie Mullins prevent reinfection with intestinal parasites. Kyle Palmer, cvt | Nancy Potter | Rachael Simmons EFFICACY: HEARTGARD Plus Chewables, given orally using the recommended dose and regimen, are effective against Mandy Stevenson, rvt | Pam Weakley the tissue larval stage of D.immitis for a month (30 days) after infection and, as a result, prevent the development of the adult stage. HEARTGARD Plus Chewables are also effective against canine ascarids (T. canis, T. leonina) and hookworms (A. caninum, U. stenocephala, A. braziliense). Advanstar Veterinary ACCEPTABILITY: In acceptability and field trials, HEARTGARD Plus was shown to be an acceptable oral dosage form that was consumed at first offering by the majority of dogs. Vice President/General Manager | Becky Turner Chapman PRECAUTIONS: All dogs should be tested for existing heartworm infection before starting treatment with HEARTGARD Group Content Director | Marnette Falley Plus which is not effective against adult D. immitis. Infected dogs must be treated to remove adult heartworms and Medical Director | Theresa Entriken, dvm microfilariae before initiating a program with HEARTGARD Plus. Director, Electronic Communications | Mark Eisler While some microfilariae may be killed by the ivermectin in HEARTGARD Plus at the recommended dose level, Director, The CVC Group | Peggy Shandy Lane HEARTGARD Plus is not effective for microfilariae clearance. A mild hypersensitivity-type reaction, presumably due to dead or dying microfilariae and particularly involving a transient diarrhea, has been observed in clinical trials with ivermectin alone after treatment of some dogs that have circulating microfilariae. Sales Group Keep this and all drugs out of the reach of children. Sales Director | David Doherty In case of ingestion by humans, clients should be advised to contact a physician immediately. Physicians may contact a Poison Control Center for advice concerning cases of ingestion by humans. Senior Account Managers, Advertising Terry Reilly, Chris Larsen Store between 68°F - 77°F (20°C - 25°C). Excursions between 59°F - 86°F (15°C - 30°C) are permitted. Protect product from light. Account Manager, Advertising | Angela Paulovcin Senior Account Manager, Projects | Jed Bean ADVERSE REACTIONS: In clinical field trials with HEARTGARD Plus, vomiting or diarrhea within 24 hours of dosing was rarely observed (1.1% of administered doses). The following adverse reactions have been reported Sales and Projects Coordinator | Anne Belcher following the use of HEARTGARD: Depression/lethargy, vomiting, anorexia, diarrhea, mydriasis, ataxia, staggering, Books/Resource Guides | Maureen Cannon (440) 891-2742 convulsions and hypersalivation. List Rental Sales | Renee Schuster SAFETY: HEARTGARD Plus has been shown to be bioequivalent to HEARTGARD, with respect to the bioavailability of (440) 891-2613 [email protected] ivermectin. The dose regimens of HEARTGARD Plus and HEARTGARD are the same with regard to ivermectin (6 mcg/ kg). Studies with ivermectin indicate that certain dogs of the Collie breed are more sensitive to the effects of ivermectin administered at elevated dose levels (more than 16 times the target use level) than dogs of other breeds. At elevated doses, sensitive dogs showed adverse reactions which included mydriasis, depression, ataxia, tremors, drooling, paresis, recumbency, excitability, stupor, coma and death. HEARTGARD demonstrated no signs of toxicity at 10 times the Chief Executive Officer | Joe Loggia recommended dose (60 mcg/kg) in sensitive Collies. Results of these trials and bioequivalency studies, support the safety Chief Executive Officer Fashion Group, Executive Vice-President | Tom Florio of HEARTGARD products in dogs, including Collies, when used as recommended. Executive Vice-President, Chief Administrative Officer & HEARTGARD Plus has shown a wide margin of safety at the recommended dose level in dogs, including pregnant or Chief Financial Officer | Tom Ehardt breeding bitches, stud dogs and puppies aged 6 or more weeks. In clinical trials, many commonly used flea collars, dips, shampoos, anthelmintics, antibiotics, vaccines and steroid preparations have been administered with HEARTGARD Plus Executive Vice-President | Georgiann DeCenzo in a heartworm disease prevention program. Executive Vice-President | Chris DeMoulin In one trial, where some pups had parvovirus, there was a marginal reduction in efficacy against intestinal nematodes, Executive Vice-President, Business Systems | Rebecca Evangelou possibly due to a change in intestinal transit time. Sr Vice-President | Tracy Harris HOW SUPPLIED: HEARTGARD Plus is available in three dosage strengths (See DOSAGE section) for dogs of different Vice-President, Media Operations | Francis Heid weights. Each strength comes in convenient cartons of 6 and 12 chewables. Vice-President, Legal | Michael Bernstein For customer service, please contact Merial at 1-888-637-4251. Vice-President, Human Resources | Nancy Nugent Vice-President, Electronic Information Technology | J Vaughn

4 | June 2013 | Firstline | dvm360.com

magentablackcyanyellow ES256786_fl0613_004.pgs 05.28.2013 23:07 ADV Dear Firstline

Question of the month: What tasks do team members tackle that make you grateful?

facebook facebook.com/ﬁrstlinemag

Brent D. Taking over doing anything when things get busy. Sara G. Helping with the doctor if I’m in the middle of Help this reader: something else. A question from amanda M. I’ve got a couple of girls who are amazing dvm360.com/community organizers. Everything gets put away and then labeled The dos and don’ts of so we can ﬁnd it fast. They are a godsend. discounts Has anyone tried this—offering money Liz H. Restocking all the drawers, cabinets and bedding discounts to clients who refer new so I don’t have to go running for something when I clients to the practice? We’ve sent refer- really need it. That’s so incredibly helpful. ring clients different gifts over the years, Jennifer S. Making up syringes of pain medication to but lately with declining visits in general go home with cats after surgeries. At 44 I can’t read the I’m looking for a way to increase client lines on the TB syringes. It’s time for reading glasses. visits and attract new clients. What’s your opinion on giving a $10 or $20 Thank you to my team members for helping. credit to existing clients for each new Brandy S. Just being on time. After working 13 hours, referral that schedules an appointment? I’m ready to leave. And knowing that the next people I don’t know what else to do. on shift will be on time and ready to work makes it —Doctor Buzzy much easier for me to leave on time with some sanity. Share your answer: Debbi J. Working as a team. I can always count on my Visit dvm360.com/ girls to know what to do and when to do it. discount to answer this question and read other responses. Jennipher B. Keeping the fecal loops clean. While you’re there, ﬁnd out what ex- amy D. Callbacks. perts say about discounts at dvm360 .com/discounttips.

Getty ImaGe/stockcam dvm360.com | Firstline | June 2013 | 5

magentablackcyanyellow ES257180_fl0613_005.pgs 05.29.2013 00:20 ADV dvm360 news

Fatal Oklahoma tornado claims countless animal lives Veterinary community responds in the twister’s wake. By Julie Scheidegger wenty minutes from Moore, Okla., Dr. Dustin TBrown and the staf at the Animal Medical Center— Midwest City took cover as the deadly EF4 tornado carved a line of destruction around them. “Tat tornado lifted right before it got to our clinic,” Dr. Brown says. After it passed, “we came back and started trying to do what we can.” Dr. Brown headed to Moore, and he attended to horses injured in the storm. He says they An 85-foot-by-200-foot indoor arena once stood in this bare space at Celestial Acres equine saved as many as they could. sports facility in Moore, Okla. There were also four barns with stalls, horse walkers, turnouts and paddocks. A spokesman with the property that included Orr Family Farms conﬁrmed that all employees and 34 horses survived the deadly tornado that devastated Moore on May 20. The aftermath But the number of equine fatalities from the storm may be more than 50. Te Orr Family Farm, an agricultural tourism destination of care as well. Brown’s staf Dr. Rod Hall, Oklahoma’s and home to Celestial Acres, at Animal Medical has treated state veterinarian, managed an a large sports training facility, a few. “It’s basically just triage incident command team that sustained heavy and help the ones we can,” coordinated eforts between damage from he says. Scores of animals the triage workers and emer- the tornado. A are missing. gency shelters. “Te place the spokesman for tornado hit had a lot of horse the property says Counting the toll farms,” Dr. Hall says. What you can do there were animal Dr. Brown says huge metal An overwhelming number Learn the latest on casualties. electricity towers “just snapped of people from across the donation sites to support Dr. Brown saw in half—vehicles just twisted country ofered their assistance. the inﬂux of animals and countless num- around trees. Even the grass “It’s been great to have so many provide medical services bers of fatally and everything was gone,” he volunteers—way more than we for injured animals injured horses. says. “It was a very powerful could use,” Dr. Hall says. “I wish at dvm360.com/ He says there tornado that went through. I could just thank every one of tornadorelief. are a lot of dogs Tere’s not much that could them individually—even the and cats in need survive something like that.” ones that didn’t get to come.”

6 | June 2013 | Firstline | dvm360.com Photo courtesy of orr family farm

magentablackcyanyellow ES258066_fl0613_006.pgs 05.29.2013 22:05 ADV ASK the experts

Ask Shawn Fighting a f ve-f nger discount e have an inventory item that has repeatedly been short when counted. It’s a very specif c eye Wmedication ordered in limited quantities, and only a handful of clients use the medication. One of the clients has recently been sent to collections, and she happens to be related to a team member. I fear that the missing medication is walking out of the clinic in the hands of an employee. How would you recommend that I approach this employee? We are prepared to f re her for the crime, but we have no proof that she’s the culprit. Help! —Suspicious of sticky fi ngers uch! T is is a tough items are indeed walking out Need one, but if you don’t the door. Also of er the culprit help nowow Ohave proof that the a chance to confess and keep team member is stealing, there’s his or her job if he or she Get an answer—fast—with? not much you can do. makes restitution. Firstline Hotline. Text your problem to 913-732- Right now it looks as though I also recommend that your 1465. We’ll send you the evidence is circumstantial at practice treats the drug as a an answer in 48 hours best. I see two choices: controlled substance. Make (business days only). Stan- 1. Put cameras in your prac- all employees sign for use dard text messaging rates tice, and explain exactly what’s of the medication until the apply. You can also email us at fi rstline@advanstar happening at a staf meeting. incident passes or the suspect .com or direct message us 2. Of er a minimal reward leaves the practice. on Facebook at facebook to anyone with proof that the —Shawn .com/FirstlineMag or Twitter at @fi rstlinemag.

Got a question? Ask Shawn. Maybe you’re tired of babysitting your team members. Perhaps you’re looking for strategies to beat a bully. Shawn can help. Shawn McVey, MA, MSW, is a member of the Firstline and Veterinary Economics Editorial Advisory boards and CEO of McVey Management Solutions in Chicago. Email your questions for him to ﬁ [email protected]. Then visit dvm360.com/mcvey to read McVey’s advice on other hot topics. And catch Shawn live Aug. 23 at CVC in Kansas City. Visit thecvc.com to learn more.

GETTY IMAGE/DAVID SUTHERLAND dvm360.com | Firstline | June 2013 | 7

magentablackcyanyellow ES257311_fl0613_007.pgs 05.29.2013 01:52 ADV OroCAMª(meloxicam) Transmucosal Oral Spray Non-Steroidal Anti-Inﬂammatory Drug for oral use in dogs only. ASK the experts Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian.

BRIEF SUMMARY: This summary does not include all the information needed to use OroCAM safely and effectively. See the Package Insert and Client Information Sheet for complete prescribing and other information.

For Animal Use Only For Oral Use in Dogs Only

WARNING Repeated use of meloxicam in cats has been associated with acute renal failure and death. When clients Do not administer meloxicam transmucosal oral spray to cats. See Contraindications for detailed information. DISS THEIR DOGS Description: Meloxicam belongs to the oxicam class of non- narcotic, Non-Steroidal Anti-Inﬂammatory Drugs (NSAID). Each milliliter of OroCAM contains 5 mg meloxicam. Sometimes when we mention a you’re likely to f nd common ground. Indication: OroCAM (meloxicam) Transmucosal Oral Spray is Q pet needs to lose weight, clients So whatever pet owners say, listen and indicated for the control of pain and inﬂammation associated with osteoarthritis in dogs. blame the animals. How do we keep of er f rst steps, Dr. Ward says.

Dosage and Administration: Always provide the Client these conversations positive? Information Sheet when prescribing and dispensing OroCAM. Use the lowest effective dose for the shortest duration consistent Keep your message fresh with individual response. Due to the pump sizes, dogs weighing et owners can be pretty sensitive Being creative about how you deliver less than 5.5 pounds (2.5 kg) cannot be accurately dosed. OroCAM should be administered once daily at a dose of Pabout their pets’ weight, espe- your message is important, Dr. Ward 0.1 mg/kg (0.045 mg/lb). See Bottle/Pump Assembly Instructions for Veterinarians and Administration Instructions for Owners. cially if they recognize they feed too says. His practice has used seasonal Contraindications: OroCAM (meloxicam) Transmucosal Oral many cookies or dish up too many themes, such as holding of holiday Spray should not be used in dogs that have a hypersensitivity to meloxicam or known intolerance to NSAIDs. Do not use OroCAM desserts for their furry friends, says weight gain and springing forward in cats. Dr. Ernie Ward, founder of the As- into f tness, to give a fresh spin on Do not use OroCAM in cats. Acute renal failure and death have been associated with the use of meloxicam in cats. sociation for Pet Obesity Prevention. weight loss programs.

Human Warnings: Not for use in humans. Keep this and all Instead of trying to curb these doggy It’s important to stay positive, he medications out of reach of children. Consult a physician in case of accidental ingestion by humans or contact with mucous disses and feline smack downs, think says. Maybe only 30 of your 3,000 membranes. Direct contact with skin, eyes, and mucous of this as a conversation opener. Con- active clients participated in your pro- membranes should be avoided. If contact occurs with skin, the area should be washed immediately with soap and water for at sider this example: gram this time around. Just remember least 20 seconds. In case of contact with eyes, ﬂush immediately with water. Women in late pregnancy should avoid contact with these people are involved—and they’re this product. Mrs. Jones: “Scooter, you garbage probably on social media sites, where Other Precautions: The use of OroCAM (meloxicam) Transmu- cosal Oral Spray has not been evaluated in dogs younger than six gut! You ate too many cookies, and they just might brag about Mittens’ months of age, dogs weighing less than 5.5 lbs (2.5 kg), dogs used for breeding, or in pregnant or lactating dogs. Meloxicam now you’ve got me in trouble.” success on the scale. is not recommended for use in dogs with bleeding disorders, as safety has not been established in dogs with these disorders. Concurrent administration of potentially nephrotoxic drugs should You: “Mrs. Jones, that’s one of Offer food advice be carefully approached. Please refer to the full Package Insert for more complete information on possible interactions and other the things I want to talk to you about “Clients’ No. 1 question is, ‘What pertinent information. Scooter. Like most dogs, he likes to should I feed my pet?’ and everyone Common Side Effects: The most common adverse reactions involved the gastrointestinal system (see the Table in the Package eat. Maybe we can f nd some should have a good answer to Insert). Non-gastrointestinal adverse reactions were rare and included increased liver enzymes, hematuria, lethargy, polydipsia, healthier snacks to keep this question,” Dr. Ward advis- and dehydration. him happy.” es. “T e most important deci- The incidence of adverse reactions observed in a clinical study sion pet owners make each is tabulated in the Package Insert. The pattern suggests some gastrointestinal effects (vomiting, diarrhea) are associated with While it may be chal- day is what they choose to OroCAM. The clinical signs were generally mild, transient (lasted 1-4 days during the 28-day study period), and resulted in complete lenging to convince Mrs. feed their pets, so we have recovery. There were no clinical signs related to the increased liver enzymes. Jones to stop giving to give good answers.”

Effectiveness: Effectiveness was demonstrated using OroCAM treats, of ering an alter- Catch Dr. Ward live Aug. 23 in a masked, placebo-controlled, multi-site ﬁeld study involving client-owned dogs. In this study, 280 dogs diagnosed with native—giving a piece at CVC Kansas City, where osteoarthritis were randomly administered OroCAM, or a placebo. Dogs received a daily meloxicam dose or placebo for 28 days. of carrot as a snack in- he’ll of er tips to stay positive, Effectiveness was evaluated in 258 dogs and ﬁeld safety was stead—is a much easier ditch the practice drama and evaluated in 280 dogs. After 28 days the treatment group showed a success rate (improvement of clinical signs) of approximately change in the begin- improve your client com- 73% and the placebo group showed a success rate of about 47%. ning. If you can get munication. Visit thecvc See full Package Insert for more details, as well as for results of safety studies. pet owners talking, .com to learn more.

ORO-061 March 2013 © Abbott Laboratories

8 | June 2013 | Firstline | dvm360.com GETTY IMAGE/TERRY J ALCORN

magentablackcyanyellow ES257310_fl0613_008.pgs 05.29.2013 01:52 ADV Spray and Go The ﬁ rst and only veterinary NSAID with transmucosal oral delivery for canine osteoarthritis.

Quick and reliable delivery1,2

• Administered with a quick spray

• Consistent and accurate dose 2

• Absorbed directly into the systemic circulation 1

• Nothing to swallow or digest

See how it works at OroCAM.com

quick and reliable delivery 1, 2

Indication: OroCAM (meloxicam) Transmucosal Oral Spray is indicated for the control of pain and inﬂ ammation associated with osteoarthritis in dogs. Important OroCAM (meloxicam) Safety Information: WARNING: Repeated use of meloxicam in cats has been associated with acute renal failure and death. Do not administer meloxicam transmucosal oral spray to cats. See Contraindications for detailed information. Warnings, Precautions, and Contraindications: For oral use in dogs only. OroCAM should not be used in dogs with known hypersensitivity to meloxicam or other NSAIDs, dogs weighing less than 5.5 pounds (2.5 kg), or dogs younger than six months of age. It has not been evaluated for safety in breeding dogs, lactating dogs, or dogs with bleeding disorders. Adverse Reactions: Common adverse reactions include vomiting, diarrhea, increased liver enzyme values, and loss of appetite. In clinical studies, the clinical signs were generally mild, transient (lasted 1-4 days during the 28-day study period), and resulted in complete recovery. There were no clinical signs related to the increased liver enzymes. Kidney or liver damage has been reported with other NSAIDs. Other Recommendations: All dogs should undergo a thorough history and physical examination before the initiation of NSAID therapy. Appropriate laboratory testing to establish hematological and serum biochemical baseline data is recommended prior to and periodically during administration of any NSAID. See Brief Summary of Prescribing Information on adjacent page.08. To learn more about OroCAM, contact Abbott Animal Health Customer Service at

888-299-7416. Promist is a trademark of Velcera, Inc. OroCAM is a trademark of Delivered by Technology Abbott Laboratories. ORO-061 March 2013 © Abbott Laboratories. 1. Placebo-Controlled Field Efﬁ cacy Trial of Meloxicam Administered Orally Via Transmucosal Oral Mist (Promist™ Technology), in Client-Owned Dogs with Osteoarthritis, Abbott Study 09-17-MC-D-CT-MP, 2011. 2. OroCAM Spray Studies Summary, Abbott Study 11-11-MC-N-DC-MC, 2011.

magentablackcyanyellow ES262721_FL0613_009_FP.pgs 06.01.2013 04:30 ADV Pearls of practice

PRACTiCe liFe: The ABCs of a clean team By Brent Dickinson

Editor’s note: Practice Life is a new column A secret trick to help stop odors is to tape dryer designed to off er tools to help your practice manage sheets under desks, behind cabinets and inside daily challenges, big or small, more effi ciently. drawers. T ey give off the pleasant fragrance of clean laundry, which can help cut the many n our profession, there’s really no way to plan odors our practices generate every day. Also, don’t cleaning, and sometimes a can of air freshener hesitate to load up on air fresheners. Gel-type Ijust doesn’t cut it. Follow the ABC rule: Always fresheners hide easily behind counter displays so Be Cleaning. If you’re headed to another room your team sees them, but customers don’t. All in your practice, take something with you that they notice is the smell of spring fl owers or an belongs there. Keep surfaces cleared and wiped island breeze, which they most likely didn’t expect down. Mop around the perimeter of rooms to when walking into a veterinary facility. avoid slip injuries but freshen odors. Take a mo- Don’t forget to make cleaning part of your daily ment to step back and see a room as your custom- routine. If you walk an elderly client and her pet to er does. If something looks out of place or dirty, the car and notice three cigarette butts and a dog take care of it. Remember, clients are more likely mess on the way back, pick them up! T ey aren’t to notice when a facility isn’t clean. For example, going to jump into the trash can by themselves, and consider these easy-to-overlook places: clients will see them as your uncleaned mess. > Make sure to check the bathroom daily to Team tip: Keep a waste pick-up bag and a latex restock towels and ensure that the fl oor, toilet and glove in your back pocket every day. It takes a sink areas are clean. while to get into the habit, but it will make your > Pet hair tends to fl oat under elevated objects day easier and your practice cleaner. like refrigerators, surgical units and cabinets, so get the vacuum hose under there at least weekly. Brent Dickinson is the practice manager at Dickinson-McNeill Veterinary Clinic in Chester- T is hair can give off odors and also collects dust fi eld, N.J. Share your tips to keep your practice and allergens. clean at dvm360.com/community.

Dental corner in pictures scan the Qr code to see a photo gallery of how a veterinary team worked together to help a cat with a fractured mandible from a car accident, or check it out at dvm360.com/dentalphotos. Then hear Pat March, CVT, VTs (Dentistry), speak at CVC Kansas City aug. 23 to 26. she’ll lead the Focus on Dentistry: Dental Techniques for Technicians course and the Focus on Dentistry: Nerve Blocks for Dental Procedures lab. Visit thecvc.com to learn more.

10 | June 2013 | Firstline | dvm360.com Getty ImaGe/FLyFLoor/PhotoS coPyrIGht oF the UnIVerSIty oF PennSyLVanIa

magentablackcyanyellow ES259382_fl0613_010.pgs 05.30.2013 19:06 ADV Introducing the new blueprint for easy, effective treatment of otitis externa.

Flexible Nozzle: Unique Airless Delivery System: Gentle on sensitive • One pump delivers canine ears. an exact 1 mL dose every time. • No messy drops to count. No more mystery.

Precise dosing in any position. No more wrestling matches. One pump, once daily, for 5 days for any size dog. Eliminates dosing frustration.

Three Powerful Actives including Hydrocortisone Aceponate (HCA) – A potent new-generation glucocorticoid. If you could design the ideal treatment for otitis externa in ® dogs, it might just be EASOTIC (hydrocortisone aceponate, miconazole nitrate, gentamicin sulfate) Otic Suspension for Dogs. It makes treating otitis so easy (hydrocortisone aceponate, miconazole and accurate your clients will happily nitrate, gentamicin sulfate) comply, and the novel formulation Otic Suspension For Dogs makes short work of inmammation, bacteria, and yeast. To learn more, Ease and otic together at last. visit www.virbacvet.com.

EASOTIC Otic Suspension for Dogs is contraindicated in dogs with known or suspected hypersensitivity to corticosteroids, imidazole antifungals, or aminoglycoside antibiotics. Do not use in dogs with known tympanic membrane perforation. The safe use of EASOTIC Otic Suspension for Dogs in dogs used for breeding purposes, during pregnancy, or in lactating bitches has not been evaluated. See brief summary for additional product information.

magentablackcyanyellow ES263104_FL0613_011_FP.pgs 06.03.2013 18:36 ADV Pearls of practice

® EASOTIC Otic suspension (hydrocortisone aceponate, miconazole nitrate, gentamicin sulfate) Anti-inflammatory, antifungal, and antibacterial The VhMA For Otic Use in Dogs Only CAUTION Federal law restricts this drug to use by or on the order of a licensed veterinarian. Files: BRIEF SUMMARY: Please consult package insert for complete product information. INDICATIONS Got an idea? EASOTIC® suspension is indicated for the treatment of otitis externa in dogs associated with susceptible strains of yeast (Malassezia pachydermatis) and bacteria (Staphylococcus pseudintermedius). Run with it! CONTRAINDICATIONS Do not use in dogs with known tympanic membrane perforation. On the road to practice EASOTIC® suspension is contraindicated in dogs with known or suspected hypersensitivity to corticosteroids, imidazole antifungals, or aminoglycoside antibiotics. improvement, carefully crafted solutions that WARNINGS Human Warnings: Not for use in humans. Keep this and all drugs out of reach of children. involve the team win the race. Humans with known or suspected hypersensitivity to hydrocortisone, aminoglycoside By Christine Shupe, Executive Director, VHMA antibiotics, or azole antifungals should not handle this product. Animal Warnings: As a class, aminoglycoside antibiotics are associated with ototoxicity, vestibular dysfunction and renal toxicity. The use of EASOTIC® suspension in a dog with a damaged tympanic membrane can result in damage to the structures of the ear associated with hearing and balance or in transmission of the infection to the middle or inner ear. re you ready to step up at on to find out what she learned in Immediately discontinue use of EASOTIC® suspension if hearing loss or signs of vestibular your practice? Te Vet- the process. dysfunction are observed during treatment (see ADVERSE REACTIONS). PRECAUTIONS erinary Hospital Managers Do not administer orally. A Concurrent administration of potentially ototoxic drugs should be avoided. Association (VHMA) recognizes The back story Use with caution in dogs with impaired hepatic or renal function (see ANIMAL SAFETY). excellence and innovation among Nancy was hired as a practice man- Long-term use of topical otic corticosteroids has been associated with adrenocortical suppression and iatrogenic hyperadrenocorticism in dogs (see ANIMAL SAFETY). veterinary hospital managers ager when the economy was growing The safe use of EASOTIC® suspension in dogs used for breeding purposes, during pregnancy, through success stories that inspire and the hospital’s client base was or in lactating bitches, has not been evaluated. ADVERSE REACTIONS others to reach further. Consider strong. As economic conditions In a field study conducted in the United States, there were no adverse reactions reported in 145 dogs administered EASOTIC® suspension. Nancy Hay, CVPM, RVT, a practice deteriorated, she noticed client visits In foreign market experience, reports of hearing loss and application site erythema have been manager with a veterinary hospital declined. To improve the health of received. In most reported cases, the hearing loss and erythema were transient and resolved with discontinuation of EASOTIC® suspension. in North Ogden, Utah. She recently patients and increase client visits, To report suspected adverse drug events, or for technical assistance contact Virbac at devised and implemented a strategy Nancy and her colleagues outlined 800-338-3659. ANIMAL SAFETY for addressing a decline in patient a strategy to get clients to commit Aural administration of EASOTIC® suspension to 12 week old Beagle dogs at 1, 3, and 5 times the recommended dose (1 mL/ear/day) for 15 days (three times the treatment length) visits at her veterinary practice. Read to preventive care. Within a few was associated with alterations of the hypothalamic-pituitary-adrenal axis as evidenced by the ACTH stimulation results. Other findings considered to be related to treatment include the development of aural hyperemia; the presence of renal tubular crystals and possibly renal tubular basophilia and atrophy; elevated liver weights; the development of otitis externa and media; and elevations in alanine aminotransferase, alkaline phosphatase, total protein, albumin, and cholesterol levels. STORAGE INFORMATION: Store at temperatures between 20º C-25º C (68º F-77º F), with excursions permitted between 15º C-30º C (59º F-86º F). HOW SUPPLIED: EASOTIC® suspension is supplied in a polyethylene canister, with a soft applicator canula. Distributed by: Virbac AH, Inc. Fort Worth, TX 76137 USA NADA 141-330, Approved by FDA. © 2013 Virbac Corporation. All Rights Reserved. Rev 8/2011

12 | June 2013 | Firstline | dvm360.com Getty ImaGe/technotr

magentablackcyanyellow ES259381_fl0613_012.pgs 05.30.2013 19:05 ADV Pearls of practice

months, the hospital made sig- household as well as coupons ness plans, but for the plans to nificant strides toward success- for discounted visits to pass help patients and the business, fully implementing this plan. along to new clients. she needed to spread the word. Nancy is quick to credit her With a tight budget, she relied Overcome hurdles team members for their role on creative marketing. Tis Nancy has worked since 2005 in making the plans a suc- included grassroots advertising at the full-service hospital, cess. Veterinarians and team through community groups, re- which provides preventive, members must believe in a wards and incentives and men- urgent and emergency care. program to work as a team and tions on the practice’s website. In recent years, the number of meet goals. > When the rules change, gravely ill pets arriving at the change your plan. Nancy hospital had increased dra- A win-win situation understood that the rules of matically. She attributed this Nancy’s efforts benefited the veterinary medicine were to the economy: Clients were hospital, patients and clients. changing. Rather than play by deferring preventive and rou- In the process, she learned the old rules, she had to come tine care because they couldn’t valuable professional lessons: up with a game plan that was afford it. Her goal was to > Look for problems, but responsive to the new reality. identify strategies to encourage craft solutions. Disturbed > Don’t allow challenges to patients to commit to preven- by the number of critically ill halt progress. Nancy admits tive pet care by introducing patients, Nancy acted on her that at times the design work to wellness plans. concerns. develop the plans was mind- Wellness plans at veteri- > Don’t be deterred numbing, but the final monthly nary practices are sometimes by problems that appear payment plans had a positive administered by companies, but overwhelming. Nancy knew effect on the practice’s viabil- Nancy suggested offering plans the problems she was seeing ity. Te wellness plans were with three distinct levels of care were due to factors outside her first offered in January 2012. that would be provided through control. Although she couldn’t During the first year, gross the hospital. Each plan allowed fix the economy, she could still sales increased by 5.4 percent. a predetermined menu of an- make a difference. Wellness plans accounted for nual medical services as well as > Focus on rewarding 4.6 percent of income. installment payment options. good work. Nancy is a firm Are you ready to join the Nancy encouraged the team believer in incentives to inspire race? Te first step is to gain to promote the plans. Team colleagues. She also believes in acceptance for your idea. Visit members received training offering incentives to clients dvm360.com/VhMA for tips and incentives. As an example, whose efforts improve the to get off the starting line. for each pet they sign up, practice’s well-being. team members are offered > Involve the team. Nancy Christine Shupe is executive director of $20, which is added to a team credits team members for their the Veterinary Hospital fund and divided among team willingness to contribute to the Managers Associa- members. Clients received success of the new initiative. tion. Te association is incentives, too, such as half > Let your creativity flow. dedicated to serving professionals in veterinary manage- priced initial memberships for Nancy was on the right track ment through education, certification additional pets in the same when she proposed the well- and networking.

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magentablackcyanyellow ES259380_fl0613_013.pgs 05.30.2013 19:05 ADV Pearls of practice

help make sure you’re spreading the MicROchips: microchip message and improve the What’s your role? chances lost pets will ﬁnd their way home:

>>Receptionist: >>Practice manager: When pet owners call to schedule Ofer training at team meetings. Review an appointment, ask if their pets are how microchips can save the day at microchipped. When clients visit, dvm360.com/microresist. Ten ofer them a handout, such as “FAQs about learn how to market microchips with Microchipping” at dvm360.com/microFAQ. tips from dvm360.com/micromarket.

>>Technicians and assistants: >>Veterinarian: When you’re taking the pet’s history, Reinforce the microchipping mes- ask if Flufy or Bowser ever strays sage by sharing success stories of pets from the house. You can use the reunited with their families. You may sample script at dvm360.com/ also share microchip statistics from microscript to guide your conversation. dvm360.com/microstats.

magentablackcyanyellow ES260060_fl0613_014.pgs 05.30.2013 22:26 ADV CommuniCation strategies

“Talk to the paw— Tweet this Where are the service bottlenecks at your practice? that’s not my job” Share where you get blocked on Twit- and other myths ter @FirstlineMag #bottleneck. It’s time to adjust your cat-titude to make way for service that leaves pet owners purring. Consider this advice to come up to scratch when clients visit your practice. By Brian Conrad, CVPM

ave you ever gotten your hackles up clinic you’d fnd a veterinarian, a veterinary because someone asked you to do assistant and maybe someone up front answer- Hsomething that wasn’t in your job ing phones. Often it was a slower pace and description? It used to be when you visited a everyone was responsible for everything. ➤

thinkstock/istockphoto dvm360.com | Firstline | June 2013 | 15

magentablackcyanyellow ES259356_fl0613_015.pgs 05.30.2013 19:01 ADV CommuniCation strategies

We now walk into clinics and f nd much my job!” T ese are just some of the attitudes more specif c job titles: client service that distract us from our goal of working representatives, exam room as- together to serve clients. sistants, pharmacy technicians, nutrition advisers and even Separate the credentialed technicians lazy daisies with accredited specialties. Let’s talk about the glaring T e idea of one person do- answer f rst: pure laziness. ing everything in the clinic While a coworker may be doesn’t really make sense lazy, often this behavior is anymore, nor is it possible a symptom of something in most circumstances. greater. True, there are some Unfortunately, with these of us working in veterinary changes we also see a familiar clinics who are here just for a problem set in: “T is is my area of paycheck. If that sounds like you, responsibility and I don’t stray from it.” I encourage you to rethink your career Or worse, “T is is my area of responsibility— choice and look for something that stirs your pas- keep out!” sion. You aren’t going to f nd happiness in “just T is can be frustrating for team members a job,” and it’s going to be obvious to you and and managers but even more frustrating for everyone else that you don’t really care. clients. T ink of the last time you went grocery shopping and waited a long time to check Tame the turf wars out. You were tired, short on time and getting “T ey don’t help me. Why should I help them?” angrier by the minute. Worse, as you scanned Before you say this, let me remind you we aren’t the front of the store, you saw two to three in grade school, and you’re not going to be hear- employees standing around talking. T is took ing the third period bell ringing anytime soon. your anger to another level of infuriation. Why So it’s time to grow up. If you make a concerted in the heck couldn’t they be doing something ef ort to help others, over time most people will to help? Imagine how you’d have felt to see reciprocate. Don’t become those employees bag groceries, guide shoppers frustrated when you put forth to shorter lines and even of er to help place the ef ort and it isn’t immedi- items on the checkout counter for you? ately returned. Human behavior So what caused those grocery store changes over time, so have employees to think it was OK to stand some patience. Put the there and chat as you waited in line scorecard away. A feeling miserable, thinking, “I’m never cohesive team doesn’t going to get home for dinner”? What keep track to make causes our team members to think it’s OK sure everything’s even to hang out in the back while the phone Steven. If a month goes rings of the hook and our appointments by and there seems to are running 45 minutes behind? Let’s take be one or two people who a look at a couple of the common situations hold back, meet with them that tend to trigger the phrase, “T at’s not and share your thoughts.

16 | June 2013 | Firstline | dvm360.com Getty imaGe/aJphoto.GRaphic/spXchRome

magentablackcyanyellow ES259354_fl0613_016.pgs 05.30.2013 19:01 ADV feeling confident in your protection.

Dogs should be tested for heartworm prior to use. In a small percentage of treated dogs, digestive, neurologic and skin side effects may occur. For more information, please see product insert on page 17.

magentablackcyanyellow ES263868_FL0613_NOVARTIS1_FP.pgs 06.04.2013 03:24 ADV protection against 5 parasites for the price of 3.

Sentinel® (milbemycin oxime/lufenuron) Flavor Tabs® are now available at a price comparable to Heartgard® Plus

so you can offer your clients a wider spectrum of protection — all in one monthly tablet.

magentablackcyanyellow ES263867_FL0613_NOVARTIS2_FP.pgs 06.04.2013 03:24 ADV CommuniCation strategies

NADA 141-084, Approved by FDA Brief Summary—For full product information see product insert. Caution: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. Description: SENTINEL® (milbemycin oxime/lufenuron) Flavor Tabs® are available in four tablet sizes in color-coded packages for oral administration to dogs and puppies according to their weight. Milbemycin oxime consists of the oxime derivatives of

5-didehydromilbemycins in the ratio of approximately 80% A4 (C32H45NO7, MW 555.71) and 20% A3 (C31H43NO7, MW 541.68). Milbemycin oxime is Let them know what your plan is to one that we can do it or take it on. classiﬁed as a macrocyclic anthelmintic. help out and describe how their help Remember, as you take on new Lufenuron is a benzoylphenylurea derivative with the following chemical composition: N-[2,5-dichloro-4-(1,1,2,3,3,3, -hexaﬂuoropropoxy)-

would not only beneft you but also challenges and projects in the clinic, phenylaminocarbonyl]-2,6- difluorobenzamide (C17H8CI2F8N2O3, MW 511.15). Benzoylphenylurea compounds, including lufenuron, are classified as insect clients and pets. You might start with you must delegate some of your old development inhibitors (IDIs). a gentle prompt, like this: ones. If you’re struggling with this, Indications and Usage: SENTINEL Flavor Tabs are indicated for use in dogs and puppies, four weeks of age and older, and two pounds body weight sit down with your practice manager or greater. SENTINEL Flavor Tabs are also indicated for the prevention of heartworm disease caused by Dirofilaria immitis, for the prevention and You: “In the past few months, I’ve or owner and come up with a plan. control of flea populations, the control of adult Ancylostoma caninum (hookworm), and the removal and control of adult Toxocara canis and been trying to improve how I work Consider this example of how you Toxascaris leonina (roundworm) and Trichuris vulpis (whipworm) infection. Lufenuron controls flea populations by preventing the development of flea by pitching in when I see ways I can might approach your manager: eggs and does not kill adult fleas. Concurrent use of an adulticide product may be necessary for adequate control of adult fleas. help. What can I do to help you?” Dosage and Administration: SENTINEL Flavor Tabs are given orally, once You: a month, at the recommended minimum dosage of 0.23 mg/lb (0.5 mg/kg) “I appreciate the chance to milbemycin oxime and 4.55 mg/lb (10mg/kg) lufenuron. Dogs over 100 lbs. In many cases, this will encourage talk with you. I’ve been feeling a are provided the appropriate combination of tablets. SENTINEL Flavor Tabs are palatable and most dogs will consume the others to reciprocate and ask what little overwhelmed recently, and tablet when offered by the owner. As an alternative to direct dosing, the tablets can be hidden in food. Administer SENTINEL Flavor Tabs to dogs, they can do to help you, too. I wondered if you could help me immediately after or in conjunction with a normal meal. Food is essential for identify your top three priorities for adequate absorption of lufenuron. SENTINEL Flavor Tabs must be administered monthly, preferably on the Address the grumpy cats me. I want to focus on those areas same date each month. In geographic areas where mosquitoes and fleas are seasonal, the treatment schedule should begin one month prior to the Burnout and the phrase “It’s not my frst and make sure you’re getting expected onset and should continue until the end of “mosquito and flea season.” In areas with year-round infestations, treatment should continue job” go hand in hand. If you fnd what you need.” through the entire year without interruption. yourself muttering those very words If a dose is missed and a 30-day interval between dosing is exceeded, administer SENTINEL Flavor Tabs immediately and resume the monthly dosing schedule. under your breath, it’s time to give Or you may ofer a solution: Warnings: Not for use in humans. Keep this and all drugs out of the reach yourself a time out and re-evaluate of children. Precautions: Do not use SENTINEL Flavor Tabs in puppies less than what’s going on. Has the leader- You: “I appreciate the chance to four weeks of age and less than two pounds of body weight. Prior to administration of SENTINEL Flavor Tabs, dogs should be tested for existing ship team placed too much on your talk with you. I’ve been feeling a heartworm infections. Mild, transient hypersensitivity reactions manifested as labored respiration, vomiting, salivation, and lethargy have been noted in plate? Tis can easily happen when little overwhelmed recently, and some treated dogs carrying a high number of circulating microfilariae. we become the “yes” man or the I hope you can help me choose Adverse Reactions: The following adverse reactions have been reported in dogs after giving milbemycin oxime or lufenuron: vomiting, depression/ “yes” woman—we always tell every- which tasks to delegate so I can lethargy, pruritus, urticaria, diarrhea, anorexia, skin congestion, ataxia, convulsions, hypersalivation, and weakness. concentrate on new responsibili- Efficacy: Milbemycin Oxime Milbemycin oxime provided complete protection against heartworm ties. I’ve noticed our new techni- infection in both controlled laboratory and clinical trials. cian is looking for more responsi- In laboratory studies, a single dose of milbemycin oxime at 0.5 mg/kg was effective in removing roundworm, hookworm, and whipworm. In well- bilities, and I thought this might controlled clinical trials, milbemycin oxime was also effective in removing be an opportunity for both of us roundworms and whipworms and in controlling hookworms. Efficacy: Lufenuron to grow in our positions. What are Lufenuron provided a 99% control of flea egg development for 32 days following a single dose of lufenuron at 10 mg/kg in studies using experimental your thoughts on this?” flea infestations. In well-controlled clinical trials, when treatment with lufenuron tablets was initiated prior to the flea season, mean flea counts were lower in lufenuron-treated dogs versus placebo-treated dogs. After 6 monthly treatments, the mean number of fleas on lufenuron-treated dogs Maybe your personal life was approximately 4 compared to 230 on placebo-treated dogs. When treatment was initiated during the flea season, lufenuron tablets were has become overwhelming effective in controlling flea infestations on dogs that completed the study. The mean for the moment and is carrying flea count per lufenuron-treated dog was approximately 74 prior to treatment but had decreased to 4 after six monthly doses of lufenuron. A topical adulticide was over into the workplace. Only you used in the first eight weeks of the study to kill the pre-existing adult fleas. For technical assistance or to report suspected adverse events, call can self-diagnose, so do it. Burnout 1-800-332-2761. symptoms are real, and it isn’t that Manufactured for: Novartis Animal Health US, Inc. Greensboro, NC 27408, USA you’ve done something wrong. But ©2008 Novartis Animal Health US, Inc. without corrective action, it will only SENTINEL and Flavor Tabs are registered trademarks of Novartis AG. get worse. You will eventually cross a NAH/SEN-FCT/BS/6 06/08

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magentablackcyanyellow ES259985_fl0613_017.pgs 05.30.2013 22:20 ADV CommuniCation strategies

line, and then there’s no you don’t know. going back for a posi- Recently one of tive outcome. our incredible team members was work- Calm the ing hard to stay ’fraidy cats busy during an Fear is another appointment lull reason we fail one afternoon. She to pitch in. You noticed multiple might be scared boxes of inventory to try something had arrived. Tough new and embarrass it isn’t her job to un- yourself in front of a pack the supplies, she client—or worse a co- wanted to help—especial- worker—and wind up be- ly since some of the boxes ing the butt of the clinic jokes appeared to be on ice. Te third for the next week. You worry box she unpacked was from a you’ll step on someone’s And they often respond, “I company she recognized, but toes if you venture outside don’t need help,” because it she didn’t know how to store your comfort zone. In both just seems easier to fnish the the item inside. Knowing other cases, communicate with your work themselves rather than products manufactured from team. Ask them for help. Tis explain how to do the task. this company are kept in the can-do attitude will go far. So take a few minutes to freezer, she placed the items A positive approach sounds think about the education in the freezer with the other something like this: you can pursue on your own lab supplies. In fact, this item to help your team members belonged in the refrigerator You: “I looked on the schedule more around the practice. and not the freezer. About 30 and I see Rex needs blood work Many websites ofer free team products were ruined at a cost and radiographs. I’ve done blood training from topics that of more than $500. An expen- work but I’ve never done radio- range from pet restraint to sive lesson to remember: Know graphs. Can you show me how client communication. When what you’re doing before doing to do this task this time and next coworkers see you’re making it. Ask for help. When you have time I can do it for you?” efort to learn, they respond in the attitude, “Tis task needs to positive ways. be completed and I’m willing A lukewarm approach sounds to do it—can you show me like this: Paws to consider how?” this will open the door As you fnd yourself starting to with your coworkers. It will also You: “How can I help?” want to take on more respon- teach you for the next time so sibility, I applaud you. But you won’t need to ask how. When you say this, the other tread lightly. Do be proactive in Finally, make sure you’re all person often thinks, “I don’t helping team members in other in. Don’t try to fake it or fnd have time to stop what I’m do- areas of the hospital. But also yourself taking shortcuts to ing to show you what to do.” realize you don’t know what temporarily appease your clients

18 | June 2013 | Firstline | dvm360.com Getty imaGe/hulya ozkok

magentablackcyanyellow ES259357_fl0613_018.pgs 05.30.2013 19:01 ADV isn’t as scary as it sounds.

VPI® helps put your clients at ease when discussing their pets’ health.

VPI gives your clients the conﬁ dence that comes with knowing their pets are getting the best possible care you can provide. Maybe that’s why 4 out of 5 vets who recommend insurance recommend VPI.*

Recommend VPI for Healthy Pets and Happy Owners. Call 866-Vet-4VPI (866-838-4874) or visit vets.petinsurance.com

*2012 Veterinary A&U study Underwritten by Veterinary Pet Insurance Company (CA) Brea, CA. National Casualty Company (all other states), Madison, WI and A+15 rated company. © 2013 Veterinary Pet Insurance Company. Nationwide Insurance is a service mark of Nationwide Mutual Insurance Company.

magentablackcyanyellow ES263099_FL0613_019_FP.pgs 06.03.2013 18:35 ADV CommuniCation strategies

“Our goal must be to work together to make each other look good and keep clients happy at our practices. After all, that’s why we’re here.”

fault the body wasn’t correctly each other look good and keep labeled,” you’re right. But if clients happy at our practices. you’re also telling yourself, After all, that’s why we’re here. “T e receptionist didn’t have an obligation to research the Easier than concern,” you’re part of the herding cats problem. We’re all going to At your next team meeting, or fellow team members. It will make mistakes. Our goal must split into small groups with a literally bite you in the butt. We be to work together to make representative from dif erent once had a receptionist tell parts of the hospital in each a client that her pet’s ashes group. Talk about what you hadn’t returned and to come appreciate about each other back in next week to pick them and f nds helpful that others up. T e client responded: “But do for you. Come together it’s already been three weeks.” and summarize for each other. T e receptionist could have And when you see someone taken ownership of the client’s helping you out, make sure concerns but instead took the to notice and say something. easy way out and instilled false When we feel appreciated, hope. She asked the client to we’re much more likely to come back a week later only to repeat the behavior. Your goal: again f nd no urn and no ashes. eliminate “T at’s not my job” Had the receptionist taken con- from your practice. trol of the situation and done a Bust your Brian Conrad, CVPM, little extra leg-work, she would bottlenecks has been the practice have found the body still in the Visit dvm360.com/ manager for Meadow Hills Veterinary Centers freezer awaiting further direc- myjobtool for a free tion. You can only imagine the in Kennewick, Wash., activity to help your team since 1999. He earned client’s reaction. It’s very hard identify and open up his CVPM designation in 2003 and has served on the VHMA Board of to instill any client conf dence the areas where service at this point. Directors since 2009. Conrad will speak bottlenecks at your at CVC Kansas City Aug. 23 to 26. To If you’re telling yourself, practice. learn more or to register, visit “It’s not the receptionist’s thecvc.com.

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magentablackcyanyellow ES263092_fl0613_020.pgs 06.03.2013 18:18 ADV Sponsored by:

June 2013 | dvm360.com/toolkit

dermatology A special monthly package designed to help boost client compliance and make it easy for your team to educate pet owners about regular pet wellness care.

Your dermatology tools: Videos >> How to set realistic expectations with a dermatology diagnosis >> How to have a great p06 dermatology visit Social Media Tweets and posts to educate clients about dermatology p09

iPad module Spark your clients interest in dermatology with this handy exam room module p10

GETTY IMAGES / LUIS ALVAREZ Handouts Ready-to-use team and WHAT’S YOUR DIAGNOSIS? client handouts >> The facts about One bulldog’s pemphigus foliaceus >> Tips for diet trials serious skin condition p7 >> Environmental control of infectious disease >> 20 questions to ask Sample script: clients p14

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PLUS p19 DERMATOPHYTE p2 technicians p13 >> A ﬁ nal tip CULTURES

magentablackcyanyellow ES252369_dvmtoolkit0613_cv1.pgs 05.21.2013 00:55 ADV DERMATOLOGY

How to perform and interpret DERMATOphYTE By Kimberly S. Coyner, cuLTuREs DVM, DACVD Use this guide to maximize fungal culture media (Figure 2), taking care not to embed the bristles too deeply, which risks your success with this displacing the culture media when the bristles are indispensable in-house test. removed. Use a sterile hemostat to remove hair and debris caught among the bristles, and place ermatophyte cultures can be challeng- the material on the culture medium surface. ing to perform and interpret. However, Te Mackenzie brush technique is helpful to Dknowing how to best collect samples for screen for asymptomatic carriers and to obtain culture, select and incubate culture media, and samples from animals undergoing antifungal identify media culture changes and fungal colony treatment in which skin lesions have clinically re- morphology will help you avoid a misdiagnosis. solved. In these cases, stroke the toothbrush over the entire body, concentrating especially on areas COLLECTING CULTURE SAMPLES with prior lesions and, in cats, on the face, ears, and paws. It is recommended to brush for one Hair pluck To obtain samples for minute or to brush the length of the animal 10 dermatophyte culture, use a sterile hemostat to times.2 In animals undergoing antifungal therapy, pluck hairs from around the periphery of a newly repeat cultures every two or three weeks, and formed or expanding skin lesion, avoiding areas continue treatment until two negative culture that may have been recently medicated. Ideal results are obtained.2 hairs to select are those in areas of active crusting In cases of suspected onychomycosis, the and hairs that appear damaged or misshapen.1 toothbrush can be used on the afected claw fold. Additionally, samples of claw fold fur can Toothbrush technique Hair plucks be obtained with a sterile hemostat, and the can potentially miss infected hairs and may not proximal afected nail can be sampled by using a sample infected epithelium adequately, so it is scalpel blade to shave of small pieces of keratin. ideal to also obtain samples using the Mackenzie (Precleaning the nail with alcohol is recommend brush technique. For this technique, use a new to help reduce accumulated saprophytic or envi- toothbrush to rub gently over the suspect area, ronmental fungal organisms.) If an avulsed claw including the skin and haired margins of alopecic is considered for fungal culture, discard the distal or scaly lesions (Figure 1).1 Brush the unafected part of the nail, and obtain samples by scraping area frst, and then brush the lesions to avoid the proximal concave surface of the claw.1 spreading spores to unafected areas and to You can obtain toothbrushess in bulk from avoid losing spores from afected areas. Ten online distributors. Tey can be used once and gently embed the toothbrush bristles into the discarded or gas sterilized for repeated use.

2 | June 2013 | dvm360.com/toolkit

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medium to red at the same time the dermatophyte colony appears. Most other fungi initially use carbohydrates and produce acidic metabolites; these saprophytic fungi can eventually consume protein and cause media color change, but it occurs several days after fungal growth appears.1,3 Daily observation and logging of fungal growth correlated with media color change is, thus, important in correctly interpreting dermatophyte test medium culture results. Culture plates are recommended over vials, as the vial openings are usually too narrow to pass toothbrush heads for inoculation or to easily sample fungal colonies for microscopic analysis.4 To facilitate fungal sporulation and identifcation, it may be helpful to use a dermatophyte test medium plate that has a separate area of plain Sabouraud’s agar or rapid sporulation medium, which does not contain inhibiting agents. For example, the Dermatoplate-Duo (Vetlab Supply) culture plate has dermatophyte test medium on one side and enhanced sporulation agar on the other side. According to recommendations from a fungal culture media manufacturer, culture media should be stored at 36 to 77 F (2 to 25 C) and protected from light before inoculation.5 Te

Figure 1. The Mackenzie brush technique is used to collect samples plates should be warmed to room temperature for dermatophyte culture. (77 to 86 [25 to 30 C]) before inoculation. Before Figure 2. The toothbrush bristles have been gently pressed onto the and during the inoculation procedure, the plates fungal culture media. should be handled in a manner that minimizes exposure of the media to the environment. Do SELECTING AND INCUBATING not use expired plates or any plates that exhibit CULTURE MEDIA drying, cracking, discoloration, microbial con- Dermatophyte test medium contains Sabouraud’s tamination, or other such signs of deterioration. dextrose agar with cycloheximide, gentamicin, Excessive condensation may appear in plates that and chlortetracycline as antifungal and antibacte- have been damaged by exposure to temperature rial agents that will retard the growth of contami- extremes.5 nant organisms. Te pH indicator phenol red is Fungal cultures should be incubated at room also added. temperature (77 to 86 F [25 to 30 C]) with 30% Dermatophytes preferentially metabolize humidity.1,5 If room temperature is not main- protein in the culture medium, releasing alkaline tained, use an incubator, or send the samples to a metabolites that turn the yellow fungal culture reference laboratory for culture.4

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Most organisms will ap- macroscopic colonies gives you pear within seven to 10 days; information about the severity however, plates should be kept of infection and, in animals un- for 21 days, especially when no dergoing antifungal treatment, growth is seen initially or when information about the response the sample has been obtained to therapy.4 from a pet receiving antifungal Microscopic evaluation of therapy. According to a fungal suspect fungal growth is also

Figure 3. The dermatophyte culture plate exhibits Mi- culture media manufacturer, important since some envi- crosporum canis growth (the white-to-pale-yellow fungal dermatophyte culture plates ronmental fungi can mimic colonies at the top of the culture plate) that is at risk of being overgrown by the gray saprophytic fungal colonies may be incubated in full light, dermatophytes in gross colony on the bottom of the plate. Daily fungal culture observation with or without sampling suspect dermatophyte although some authors recom- morphology and in their abil- colonies and inoculating them on a new culture plate is mend incubation in the dark ity to turn the media red1 important to ensure that saprophytes do not overgrow the dermatophytes and potentially cause a false negative to avoid UV light-induced and because some strains of culture result. inhibition of fungal growth.1,5 In Microsporum canis may not dry climates, it is suggested that produce media color change.6 plates be placed in plastic bags Microscopic examination can or containers to prevent dehy- be done in the clinic, or the dration of the media, which can entire culture plate can be sent inhibit organism growth.5 After to a reference laboratory for 48 to 72 hours, begin examin- fungal identifcation (usually at ing the plates daily for charac- a reduced cost compared with teristic media color changes fungal culture). and fungal growth. Microscopic IDENTIFYING identiﬁcation process Figure 4. Trichophyton mentagrophytes culture often produces a white-to- cream-colored powdery surface. DERMATOPHYTES Because the organisms are This culture plate has been incubated with inadequate Understanding macroscopic zoonotic, wear gloves to avoid humidity, causing cracking and separation of the culture media on the right side. fungal colony morphology is an transmitting dermatophyte important frst step in deter- spores to your hands. Gently mining whether a dermato- touch a small piece of clear phyte is present. Microsporum acetate tape to the surface of and Trichophyton species—the the fungal colony, and then ap- most common dermatophytes ply the tape to a glass slide over in dogs and cats—are white, a drop of blue stain (methylene light yellow, tan, or buf-colored blue, lactophenol cotton blue, cottony-to-powdery-appearing or the blue Dif-Quik solution colonies (Figures 3 & 4). Der- [basophilic thiazine dye]) (Fig- matophyte colonies are never ure 5). Examine the slide under black, green, or gray. 100X to 400X magnifcation Figure 5. To obtain a sample for microscopic fungal iden- Additionally, with positive to identify the characteristic tiﬁcation, touch the tape to the top of the fungal colony and then carefully apply the tape to a slide on top of a dermatophyte culture results, dermatophyte macroconidia. drop of blue stain. determining the number of In the early stages of growth,

4 | June 2013 | dvm360.com/toolkit

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only fungal hyphae with no macroconidia may be seen, es- 6 7 pecially in cases of Trichophy- ton species infections. Incubate these cultures longer to allow spore development for more reliable identifcation.

Microscopic dermatophyte characteristics Microsporum canis spores are large, spindle-shaped, and 8 9 thick-walled with six or more internal cells (Figure 6) and often have a terminal knob. If M. canis is identifed, then other animals in the household should be screened via dermatophyte culture using the toothbrush technique to determine whether they are Saprophytic fungi will form matophyte culture incubation Figure 6. Microsporum canis macroconidia and asymptomatic carriers. All pets hyphae and often small spores, conditions, daily observation fungal hyphae (Diff-Quik, with positive culture results but do not form macroconidia. of fungal colony growth and 400X). should be treated with topi- In cases in which the fungal media color change, and sub- Figure 7. Microsporum gypseum has numerous cal antifungal therapy, with or species cannot be easily identi- sequent microscopic identifca- macroconidia with no terminal knob and thin- without systemic treatment. fed in the clinic, submit the tion of suspect fungal organ- ner walls and fewer inter- Culture-positive animals should dermatophyte culture to a isms are not feasible in your nal cells than M. canis has (Diff-Quik, 400X). be isolated from culture-nega- veterinary reference laboratory clinic, then submitting samples tive animals if possible. for fungal identifcation. of surface skin debris and hair Figure 8. Trichophyton mentagrophytes is Microsporum gypseum (placed in a sterile red top tube) characterized by cigar- shaped macroconidia, produces large spindle-shaped CONCLUSION from suspect cases to a veteri- which may be few in spores with thin walls, no Diagnosing dermatophytosis in nary reference laboratory for number, and numerous globose microconidia terminal knob, and six or fewer companion animals can be dif- fungal culture is recommended (Diff-Quik, 400X).

internal cells (Figure 7). fcult. However, with appropri- to avoid misdiagnosis. Even Figure 9. Spiral hyphae Trichophyton mentagrophytes ate quality control and practice, some veterinary dermatologists are often characteristic of T. mentagrophytes produces long cigar-shaped your in-house dermatophyte elect this option to minimize (Diff-Quik, 400X). macroconidia with thin walls cultures will be more success- the chance of false negative or (Figure 8). Spiral-shaped hy- ful—and you may even reduce false positive dermatophyte phae and numerous grapelike the need to send samples to a culture results. clusters of microconidia are reference laboratory. also characteristic of Trichophy- Nevertheless, if optimal For references and more, visit ton species (Figure 9).1 culture media storage and der- dvm360.com/dermatophyte.

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Video Dermatology and your clients Dr. Laird Goodman offers suggestions on how to control—not cure—dermatologic conditions in pets, plus, how to set realistic expectations for clients.

To play this video on your mobile device, scan the QR code, above.

atch Laird Goodman, DVM, CVA, agnoses don’t have a quick f x. Still, by acknowl- owner and hospital director of edging the client’s feelings and showing that WMurrayhill Veterinary Hospital in you empathize with their frustrations, you’ll Beaverton, OR, of er his take on the best way to gain their both their trust and their compliance tackle dermatology issues with clients. with your treatment protocol. Since dermatologic conditions are often Share this video with your team so you’ll all chronic, Dr. Goodman stresses how important be up to date with the latest in dermatology and it is to stay positive in your approach with cli- client communication. And as always, check ents. Spend an ample amount of time preparing out this video and much more when you visit clients for the reality—often, dermatologic di- dvm360.com/dermatologytoolkit.

Scan the QR code, right, to watch a video with Dr. Gene Nesbitt giving tips for a great dermatology visit that could result in business beneﬁ ts for your practice.

6 | June 2013 | dvm360.com/toolkit

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Image QuIz: A bulldog with erythematous plaques

his 8-year-old bulldog has a history of slowly Tprogressive, minimally pruritic erythematous crusted plaques on its trunk and ven- trum. An aspirate was obtained for cytologic examination, and the results are shown below.

What is your diagnosis? Turn the a) mast cell tumor page to b) Lymphoma ﬁnd the c) Plasmacytoma answer. d) Histiocytoma

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Answer C: Lymphoma is correct! Cytology of cutaneous lymphoma shows neoplastic lym- phocytes ranging in size from small to large, with round, indented, or convoluted nuclei. Basophilic cytoplasm is scant to moderate. Uniformity of the lymphoid population without signifcant infammation or plasma cell infltration is suggestive of cutaneous lymphoma, but biopsy is required for defnitive diagnosis. Biopsy will help diferentiate between epitheliotropic and nonepitheliotropic lymphoma, which can afect the chemotherapy choices and prognosis.

Visit dvm360.com/dermatologytoolkit for more interactive online image quizzes and brush up on your diagnostic skills. 2

IMAGE quIz: IMAGE quIz: IMAGE quIz: A pitbull with Te case of the Te case of the bullous lesions crusty cat blind Akita

This young pit bull has ery- This 8-year-old neutered male a 4-year-old neutered akita thematous bullous skin lesions domestic shorthaired cat has was presented for evaluation that occasionally drain and a two-month history of pruritic of acute onset of blindness are mildly pruritic. antibiotics generalized crusting dermatitis and skin lesions character- and corticosteroids have been that has been poorly responsive ized by inﬂammation, depig- prescribed with only partial to antibiotics and bathing. Head mentation, and crusting of improvement. Can you solve to dvm360.com/dermatology- the eyelids and nasal planum. the case? toolkit for more on this case. What’s your diagnosis?

8 | June 2013 | dvm360.com/toolkit

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Help clients tackle dermatology dilemmas Social media can be more than skin deep. We’ve scraped together these tweets and posts so you can raise awareness about dermatology. Did you know that allergies are caused Have you noticed any by the immune system overreacting, discharge from your #pets’ not a weakened immune system. Got ears? This is not normal— eeling frustrated with Facebook? another question? Come in and ask us! let the veterinarian take a Not sure how Twitter can be of look. #petcare #pethealth Fact: Both canine and feline sarcoptic service to you? Not to worry— F mites can cause lesions in people. This If your #pet’s dermatology we’re here to help your practice get the is one reason why regular veterinary issues (scratching until right message out to clients on key pet visits are so important. Help us help bleeding, losing hair, etc.) healthcare topics like dermatology. you keep mites off of your pets! have you stumped, we’ll By serving up a mix of statistics and play detective! #pethealth Have you noticed an odor coming reminders, you’re encouraging your from Bella’s ears? This could mean DYK? Some breeds are clients to join in the conversation— something is not right. Let us take a more likely to develop and learn something, too! look and we’ll tell you what’s going on. medical problems because Visit dvm360.com/dermposts to of their ear structure. Let’s DYK? There’s no accurate blood/skin get your hands on the Facebook posts look at your #pet’s ears! test that can diagnose whether a pet #pethealth and tweets (at right) for your practice’s has a food allergy. The best way we Facebook and Twitter pages. For more can make a diagnosis is to change your If your #pet is up all night ways to customize your message, visit pet’s food to an appropriate elimination scratching, call us! We can dvm360.com/socialmediatoolkit. food-trial diet. Come in and we’ll tell treat the problem and help you all about it! her—and you—get some shuteye. #pethealth Q: “How do I decontaminate my environment while treating my pet Is your #pet always messing for ringworm?” You should vacuum, with her ears? Let’s take Use your mobile device to scan the disinfect, and steam clean the affected a look and make sure QR code at left and environment and discard infected everything is OK in there! send your ﬁ rst tweet bedding. What other questions are on #petcare #pethealth right now. your mind?

dvm360.com/toolkit | June 2013 | 9

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Educate clients WITH YOUR IPAD Use this exam-room module to help clients understand your dermatologic diagnoses.

ermatology diagnoses that clients’ pets receive the will f nd both interesting and can be tricky—of- best possible care. educational. So next time you Dten times there is no One suref re way to educate want to give your communica- simple solution or quick f x clients is to use the ready-made tion a bit of a boost, download for chronic conditions. But by client modules on the dvm360 the free app and hand the iPad opening up the lines of com- iPad app. T e dermatology over to your clients—you might munication between you, your client module of ers interactive be surprised at how readily team and your clients, you’ll quizzes, videos, and easy-to- they embrace your tech-savvy increase compliance and ensure process information that clients approach.

INTERESTED? Update your app via iTunes to your iPad to download, or search “dvm360” in the check out our client education tools right now. Apple App Store. As always, the dvm360 app and Don’t have it yet? Visit dvm360.com/ipadapp on client modules are free to download.

10 | June 2013 | dvm360.com/toolkit

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Quickly and effectively treating skin infections can be challenging “CONVENIA reaches peak plasma concentrations within six hours for you and frustrating for your clients. Depending on pet owners and stays above the minimum inhibitory concentration (MIC) for to appropriately administer medication can mean you lose valuable up to 14 days in the tissue,” Bird said. time resolving the infection and providing the best treatment for the patient. Two-year-old American Staffordshire terrier with an acute moist pyoderma on ventral neck area, treated Timothy Smaha, DVM, of Banfield Pet Hospitals in Columbia, S.C., only with CONVENIA 8 mg/kg.* suggests an alternative approach to treating skin infections. “When Baseline 24 hrs. post-injection 72 hrs. post-injection presented with a skin infection in a dog or cat, my first treatment choice is an injectable antibiotic,” Smaha said. “I use Convenia® (cefovecin sodium), because with one injection I can be assured of accurate delivery of the medication and fast resolution of the infection. “With a course of oral antibiotics, there are too many mitigating factors,” he continued. “Even well-intentioned pet owners often don’t give medication at the recommended intervals—or miss doses altogether. With time-dependent antibiotics, dosing according to Photos: Timothy Smaha, DVM schedule is important. When I give the injection in clinic, I am offering the best medicine and maintaining control over the treatment.” “I want a medication to have three attributes for treatment of skin infections: fast-acting, long- David Bird, DVM, of Morehead Animal Hospital in Morehead City, lasting, with accurate dosing. We do not have an N.C., agrees. “Even when oral medications are appropriately alternative to CONVENIA that hits all three.” dosed by pet owners, it is not unusual for them to discontinue Timothy Smaha, DVM, Banfield Pet Hospitals, Columbia, S.C. use when they see an improvement,” he said. “This leaves the possibility that the infection will not resolve and could be a factor Along with the ability to quickly resolve the infection, both Bird in a therapeutic failure.” and Smaha choose an injectable product over an oral antibiotic because of the accuracy of dosing. “When giving oral antibiotics, the accurate dose for a dog may fall between tablet sizes. As CONVENIA: Guaranteed compliance assures veterinarians, we tend to round down to the lower tablet size, which best chance for optimal drug concentrations may result in the dog not getting the right therapeutic levels of the drug in its system,” Bird explained. “With an injectable, very precise dosing is achieved, regardless of the patient’s weight. That accuracy combined with the assurance that the pet has received

day 1 day 2 day 3 day 4 day 5day 6 day 7 day 8 day 9day 10 day 11day 12day 13 day 14 the complete dose of medication are important reasons why I choose an injectable antibiotic.” Smaha added, “I want a medication to have three attributes for treatment of skin infections: fast-acting, long-lasting, with accurate Oral antibiotics: Non-compliance may lead dosing. We do not have an alternative to CONVENIA that hits all three.” to sub-therapeutic drug concentrations Both doctors concur that there is one additional beneﬁt to treating skin conditions with an injectable antibiotic, and that is the peace of mind it brings to clients. As Smaha pointed out, “I like the fact day 1day 2day 3day 4day 5day 6day 7day 8day 9day 10day 11day 12day 13day 14 that in most cases, results are seen quickly—that makes clients happy. Happy clients and healthy pets is what practicing best medicine is all about.”

IMPORTANT SAFETY INFORMATION CONVENIA is not for use in dogs or cats with a history of allergic reactions to penicillins or cephalosporins. Similar to other cephalosporins, side effects for both dogs and cats include vomiting, diarrhea, decreased appetite/anorexia and lethargy. The safety of CONVENIA has not been determined in lactating or breeding animals. For more information, please see Brief Summary of Full Prescribing Information on page 12.XX.

*Case included an initial skin cleansing with a dilute topical antiseptic.

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No.1 VPI searched its database of more Canine health condition: than 485,000 insured pets. Atopic or allergic They tallied dermatitis 68,000+ canine claims for atopic or allergic dermatitis. Policyholders spent more than $58 million in 2012 treating the ten most common medical conditions The average claim fee to treat this condition was affecting their $96 per ofﬁ ce visit. pets.

Source: Veterinary Pet Insurance (VPI)

Brief Summary of Prescribing Information and ketoconazole. Concurrent use of these or other drugs that have a Table 3: Number of Cats* with Adverse Reactions Reported high degree of protein-binding (e.g. NSAIDs, propofol, cardiac, During the Field Study with CONVENIA. anticonvulsant, and behavioral medications) may compete with Active cefovecin-binding and cause adverse reactions. Adverse Reaction CONVENIA Control (n=157) Positive direct Coombs’ test results and false positive reactions for glucose (n=163) (cefovecin sodium) in the urine have been reported during treatment with some cephalosporin Vomiting 10 14 Antimicrobial for Subcutaneous Injection in Dogs and Cats Only antimicrobials. Cephalosporin antimicrobials may also cause falsely elevated urine protein determinations. Some antimicrobials, including Diarrhea 7 26 CAUTION: Federal (USA) law restricts this drug to use by or on the order cephalosporins, can cause lowered albumin values due to interference Anorexia/Decreased Appetite 6 6 of a licensed veterinarian. with certain testing methods. Lethargy 6 6 INDICATIONS: Occasionally, cephalosporins and NSAIDs have been associated with Hyper/Acting Strange 1 1 Dogs myelotoxicity, thereby creating a toxic neutropenia4. Other hematological Inappropriate Urination 1 0 CONVENIA is indicated for the treatment of skin infections (secondary reactions seen with cephalosporins include neutropenia, anemia, *Some cats may have experienced more than one adverse reaction or superficial pyoderma, abscesses, and wounds) in dogs caused by hypoprothrombinemia, thrombocytopenia, prolonged prothrombin time more than one occurrence of the same adverse reaction during the study. susceptible strains of Staphylococcus intermedius and Streptococcus (PT) and partial thromboplastin time (PTT), platelet dysfunction and transient canis (Group G). increases in serum aminotransferases. Four CONVENIA cases had mildly elevated post-study ALT (1 case was elevated pre-study). No clinical abnormalities were noted with these findings. Cats ADVERSE REACTIONS: Twenty-four CONVENIA cases had normal pre-study BUN values and CONVENIA is indicated for the treatment of skin infections (wounds and Dogs abscesses) in cats caused by susceptible strains of Pasteurella multocida. elevated post-study BUN values (37– 39 mg/dL post-study). There were 6 A total of 320 dogs, ranging in age from 8 weeks to 19 years, were included CONVENIA cases with normal pre- and mildly to moderately elevated post- CONTRAINDICATIONS: CONVENIA is contraindicated in dogs and cats with in a field study safety analysis. Adverse reactions reported in dogs treated study creatinine values. Two of these cases also had an elevated post-study known allergy to cefovecin or to β-lactam (penicillins and cephalosporins) with CONVENIA and the active control are summarized in Table 2. BUN. No clinical abnormalities were noted with these findings. group antimicrobials. Anaphylaxis has been reported with the use of this Table 2: Number of Dogs* with Adverse Reactions Reported During the One CONVENIA-treated cat in a separate field study experienced product in foreign market experience. If an allergic reaction or anaphylaxis Field Study with CONVENIA. diarrhea post-treatment lasting 42 days. The diarrhea resolved. occurs, CONVENIA should not be administered again and appropriate therapy should be instituted. Anaphylaxis may require treatment with FOREIGN MARKET EXPERIENCE: The following adverse events were re- Active ported voluntarily during post-approval use of the product in dogs and epinephrine and other emergency measures, including oxygen, intravenous Adverse Reaction CONVENIA Control fluids, intravenous antihistamine, corticosteroids, and airway management, cats in foreign markets: death, tremors/ataxia, seizures, anaphylaxis, (n=157) (n=163) as clinically indicated. Adverse reactions may require prolonged treatment acute pulmonary edema, facial edema, injection site reactions (alopecia, due to the prolonged systemic drug clearance (65 days). Lethargy 2 7 scabs, necrosis, and erythema), hemolytic anemia, salivation, pruritus, lethargy, vomiting, diarrhea, and inappetance. WARNINGS: Not for use in humans. Keep this and all drugs out of reach Anorexia/Decreased Appetite 5 8 of children. Consult a physician in case of accidental human exposure. Vomiting 6 12 For a copy of the Material Safety Data Sheet, (MSDS) or to report a suspected adverse reaction call Zoetis Inc. at 1-888-963-8471. For subcutaneous use in dogs and cats only. Antimicrobial drugs, including Diarrhea 6 7 penicillins and cephalosporins, can cause allergic reactions in sensitized STORAGE INFORMATION: Blood in Feces 1 2 individuals. To minimize the possibility of allergic reactions, those handling Store the powder and the reconstituted product in the original carton, refrig- Dehydration 0 1 such antimicrobials, including cefovecin, are advised to avoid direct erated at 2° to 8° C (36° to 46° F). Use the entire contents of the vial within contact of the product with the skin and mucous membranes. Flatulence 1 0 56 days of reconstitution. PROTECT FROM LIGHT. After each use it is PRECAUTIONS: Prescribing antibacterial drugs in the absence of a Increased Borborygmi 1 0 important to return the unused portion back to the refrigerator in the original proven or strongly suspected bacterial infection is unlikely to provide *Some dogs may have experienced more than one adverse reaction or carton. As with other cephalosporins, the color of the solution may vary from benefit to treated animals and may increase the risk of the development more than one occurrence of the same adverse reaction during the study. clear to amber at reconstitution and may darken over time. If stored as of drug-resistant animal pathogens. recommended, solution color does not adversely affect potency. Mild to moderate elevations in serum γ-glutamyl trans-ferase or serum alanine The safe use of CONVENIA in dogs or cats less than 4 months of age and aminotransferase were noted post-treatment in several of the CONVENIA- HOW SUPPLIED: in breeding or lactating animals has not been determined. Safety has not treated dogs. No clinical abnormalities were noted with these findings. CONVENIA is available as a 10 mL multi-use vial containing 800 milligrams been established for IM or IV administration. The long-term effects on of cefovecin as a lyophilized cake. injection sites have not been determined. CONVENIA is slowly eliminated One CONVENIA-treated dog in a separate field study experienced NADA# 141-285, Approved by FDA from the body, approximately 65 days is needed to eliminate 97% of the diarrhea post-treatment lasting 4 weeks. The diarrhea resolved. administered dose from the body. Animals experiencing an adverse Cats reaction may need to be monitored for this duration. January 2013 A total of 291 cats, ranging in age from 2.4 months (1 cat) to 21 years, were Distributed by CONVENIA has been shown in an experimental in vitro system to result included in the field study safety analysis. Adverse reactions reported in cats Zoetis Inc. PAA035845A&P in an increase in free concentrations of carprofen, furosemide, doxycycline, treated with CONVENIA and the active control are summarized in Table 3. Kalamazoo, MI 49007 12 | June 2013 | dvm360.com

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dermatology TOP questions clients ask 3 technicians Use this information to successfully answer clients’ questions about their pets’ dermatology issues.

Client Why does my pet need Client Why can’t my pet’s allergies be cured? such a high dose of antibiotics for such a long time Technician: to treat his skin infection? Allergies, whether they are due to fl eas, food or environmental agents, are caused by the immune Technician: system overreacting, NOT a weakened immune Most pets, especially dogs, system, a common client misconception. Stud- with skin infections have ies have shown that animals with fl ea allergic what is called bacterial fol- dermatitis cannot be desensitized for fl eas, so the liculitis, meaning the bacte- only treatment is avoidance. T e same is true of ria have colonized the hair animals with food allergies. follicles. T is is in contrast Animals with environmental allergies, or atop- to the classic “hotspot” a ic dermatitis, can be desensitized to what they fl ea-allergic dog may create are allergic to through the use of allergen-specifi c after an hour of scratching immunotherapy. Immunotherapy “retrains” the its rump, where the infection body’s immune system, but, even when it works, is usually very superfi cial. animals usually require it for the rest of their lives One of the most important to control the disease. In extremely rare cases reasons topical therapy alone and usually after years of therapy, immunothera- is not adequate for pets with py can switch the body’s immune response, and bacterial folliculitis is because the animal no longer needs to be treated. their infections aren’t entirely on the skin surface. For a pet with a standard Client Is my pet’s condition contagious? bacterial folliculitis, at least three weeks of antibiotics are Technician: Both canine and feline sarcoptic mites—canine needed, and the general rule Sarcoptes scabiei and feline Notoedres cati—can is to treat until the pet’s clini- cause lesions in people. T e canine Demodex cal signs have been resolved mites are not contagious to people, but Cheyleti- for one week. ella mites can be. Some dermatophyte infections are transmissible to people, with the most common being Microsporum canis.

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magentablackcyanyellow ES252371_dvmtoolkit0613_013.pgs 05.21.2013 00:55 ADV To download these handouts for your team and clients, head over to DERMATOLOGY dvm360.com/dermatologytoolkit.

The facts about pemphigus foliaceus Don’t let a diagnosis of this common immune-mediated skin disease overwhelm clients—just give ‘em the facts.

hile diagnosis- ing and treating Information for owners Wdermatologic diseases might be an every- day occurence for you and Answers to your questions about your veterinary team, your pemphigus foliaceus in dogs and cats clients may be confused and Pemphigus foliaceus is a disease of the immune system and the skin. In fact, it is the most common immunemediated overwhelmed when their pet is skin disease in dogs and cats. Although pemphigus foliaceus can also occur in people, it is not contagious.

discovered to have an immune- Pemphigus foliaceus occurs when the immune system begins attacking the skin. Dogs and cats with pemphigus foliaceus develop skin lesions that ﬁrst start as small, red spots that then rapidly form a pustule (pimple) and burst. In mediated disease like pemphi- most cases, you may only notice the thick crusts, or scabs, that form after the pimple bursts. Some pets with pemphigus foliaceus are itchy, but most are not. A pet with pemphigus foliaceus may develop skin infections as a result of the gus foliaceus. damage to the skin or rubbing.

Use this handout to help an- WHY DOES IT DEVELOP? Te cause of pemphigus foliaceus is unknown. In dogs, pemphigus foliaceus is seen more commonly in certain swer their questions and address breeds such as Akitas and Chow Chows. Rarely, certain drugs may be related to the development of pemphigus common concerns they may foliaceus. Exposure to sunlight (ultraviolet light) can worsen the skin condition. HOW IS IT DIAGNOSED? have about managing and treat- Several tests may need to be performed if your veterinarian suspects your pet has pemphigus foliaceus, including ing this condition. • Skin cytology (microscopic examination of supermcial cell samples obtained from the skin) and bacterial or fungal culture to identify skin infections that may require treatment • Blood tests and urine tests to diagnose other health conditions and help your pet’s doctor determine which medications to use for pemphigus foliaceus • Skin biopsy to conmrm the diagnosis of pemphigus foliaceus by allowing a microscopic examination of all the layers of the skin

Many other skin conditions can look like pemphigus foliaceus. Multiple skin biopsy samples may need to be taken to obtain a sample that will conﬁrm the diagnosis of pemphigus foliaceus.

HOW IS IT TREATED? Medications that suppress the immune system are used to treat pemphigus foliaceus. Side effects can develop in response to these medications. Recheck examinations and tests will be required to monitor your pet’s response to treatment and to monitor for side effects. Once your pet responds to the treatment, the medications will be decreased over time to find the lowest possible dose that can be used to manage your pet’s pemphigus foliaceus.

WILL THE SKIN PROBLEMS RESOLVE? Pemphigus foliaceus is a skin condition that typically waxes and wanes over time. For some pets, pemphigus foliaceus becomes a chronic condition that requires life-long monitoring and treatment. Very rarely, some pets will fully recover from the pemphigus foliaceus with treatment and never again develop signs of the skin condition.

ͳe information in this handout was provided by Kathy C. Tater, DVM, DACVD, Angell Animal Medical Center, 350 S. Huntington Ave., Boston, MA 02130, and Tierry Olivry, DrVet, PhD, DECVD, DACVD, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.

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Online TOOL Diet trial compliance Download this form to pass out to clients at dvm360.com/ dermatologytoolkit. At-home tips for diet trials

A food allergy may be what’s causing your pet’s skin problems. To uncover which food or ingredient may be the culprit, you need to be committed to your pet’s diet trial. To stay on track, post this handout, along with any other dietary information provided by your veterinarian, in a highly visible spot, such as on your refrigerator or your pet’s food container.

Te following points are key to the success of this diagnostic protocol:

• Feed your pet only the prescribed diet. No other foods or treats are allowed.

• Make sure all family members and friends know that your pet is receiving a special diet, and not to give outside food.

• If you need to use treats for rewards or training purposes, use some of the prescribed diet.

• If you have other pets of the same species in your house, feed them the same diet and feed them separately.

• Keep your pet out of the room during meals to avoid him or her picking up dropped food.

• If pills are prescribed for your pet, don’t hide them in anything other than the prescribed diet. If giving medication is a problem, please discuss with your veterinarian.

• Flavored products, such as those found in medications, toothpaste, and certain plastic toys, must be avoided during the diet trial.

• If your pet is in the habit of eating dropped food or garbage when exercised outside, keep it on a leash.

Information provided by Hilary A. Jackson, BVM&S, DVD, DACVD, Dermatology Referral Services, 528 Paisley Road West, Glasgow G51 1RN, Scotland. Tis client information may be photocopied for distribution by veterinary professionals to their clients. Written permission is required for any other use.

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Ask goodbetter questions answers to get Your patients can’t talk, so it’s up to you to ask the right questions to get the information you need from clients.

he list of questions a veterinarian and her Tteam ask as a pet’s medical history is taken may Dermatology: vary from clinic to clinic, based on the pet’s signs and reason for visiting the practice. But no matter how dif erent each clinic’s questions are, the goal remains the 20questions same—to determine what’s wrong with the pet. T is handout, with 20 good

questions to ask clients about to ask clients their pet’s skin, ears and overall health, can be a start- The more you know about your patients, the better. Ask clients these ing point to ensure you cover questions while taking a dermatology history. all your bases and get to the 12. Do you use any ear medications? If yes, which types? root of the pet’s dermatologic 1. How did you ﬁrst realize the ears were a problem? 13. Is your pet itchy anywhere else? problem quickly. 2. Did you see head shaking or scratching at the ears? 14. Does your pet lick or groom its paws? 3. Have you noticed an odor coming from the ears? 15. Where does the pet or lick? Please describe all sites, 4. Does another pet lick the pet’s ears? even if no skin lesions are present.

5. Have you noticed any discharge from the ears? Some less frequently asked questions that will be helpful as the doctor makes a diagnosis include queries 6. Do you clean your pet’s ears? about the pet’s gastrointestinal health:

7. If yes, do you clean them on a regular basis, or only 16. How many bowel movements a day does your pet when signs occur? have?

8. What signs do you notice? 17. Is your pet gassy?

9. Why do you clean the pet’s ears? 18. Do you hear stomach sounds or gurgling?

10. Have you ever been told to clean the pet’s ears 19. Do you ever see blood or mucus in your pet’s stools? regularly? 20. Does your pet burp? 11. Do you clean the pet’s ears during grooming?

16 | June 2013 | dvm360.com/toolkit

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Environmental control

of infectious disease Online Take these precautions in your hospital if one TOOL Download of your patients is suspected of having or is this checklist by using the QR code known to have an infectious disease such as a above or by visiting dvm360.com/ methicillin-resistant or a parvovirus infection. dermatologytoolkit.

Upon In the patient’s arrival examination 1to the clinic 2room

❍ Isolate the patient from ❍ Wear protective clothing (gloves and gowns or other patients. dedicated lab coats) when handling the patient or ❍ Immediately usher the patient items it has been in contact with. into the examination room. ❍ Wash hands or apply alcohol-based hand sanitizer before and after patient contact, even if gloves were worn. ❍ Use pens and stethoscopes dedicated to the patient. ❍ Use disposable thermometer covers and discard them as they are used, or use dedicated digital thermometers.

After 3discharge

❍ Clean and disinfect equipment dedicated to the patient. ❍ Disinfect exam room tables, ﬂoors, door and sink handles, light switches, scale surfaces, cages, and medical equipment (e.g. scales, otoscopes) used with the patient.

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Dermatology Lisa Petty, BS, RVT, a technician at Animal Dermatology Clinic in Indianapolis, offers DOs and these tips to keep communication lines open when you and your team are guiding clients DON’Ts through their pet’s dermatology diagnosis.

✘ DON’T guarantee a spe- of their pets or that they don’t clients see the same team mem- cifi c timeline for a response care about their pets based on bers each time. It’s less confus- to treatment or a specifi c what their pet’s skin looks like. ing for pet owners, and clients outcome. For example, “His hair “Sometimes people will see an know they have someone to talk will grow back in six weeks and animal walking across the street to when they have problems. it will look beautiful” or “After he that doesn’t have any hair and “The worst thing that could goes on allergy medicine he’ll they assume it’s been abused,” happen is we send them home never scratch again. He’ll never Petty says. “I tell our new team with medication, the pet starts need another steroid. He’ll never members that it doesn’t mean to vomit or has diarrhea, and have another fl are.” that they haven’t been well they stop the medication and cared for. It means they really don’t call us—and we don’t see ✔ DO give clients an idea of do need to see us. So we can’t them for a month. So they don’t what you hope will happen and assume they’re being neglected give anything that whole time give them the success rates of just because their skin and hair between visits and they never different therapies. coat don’t look good.” call to let us know,” Petty says.

✘ DON’T make a client feel ✔ DO make yourself avail- ✔ DO follow up with phone bad or guilty for choosing a able to clients. Make sure updates. “Our software is set less expensive treatment pro- clients know that they can call up so we can put in reminders tocol. “Our job is to give clients at any time with a question or to call clients,” she says. “And all the available options and let problem. “We want their pets to we print that list daily and call to them choose what suits their get better as much as they do, ﬁ nd out how pets are doing. If budget and lifestyle,” says Lisa and we want to know if their pet the client prefers email, we use Petty, BS, RVT. is having a problem. If their pet email. And email actually works is vomiting because of a medi- really well, because there’s noth- ✔ DO deliver what’s best for cation or doesn’t like the new ing lost in translation with the clients and what’s best for their food that we put them on for a message, and we can copy and pets within the scope of what dietary trial, we want to know paste it right into the medical re- pet owners tell you they can do. that, because it’s crucial to their cord. The important thing is, we compliance,” Petty says. want clients to feel comfortable ✘ DON’T assume that Petty says at her practice, contacting us with any concerns people aren’t taking good care technicians follow cases so they might have.”

18 | June 2013 | dvm360.com/toolkit

magentablackcyanyellow ES252355_dvmtoolkit0613_018.pgs 05.21.2013 00:54 ADV DERMATOLOGYD

One more tip “Gross” dermatology images educate clients

“I take digital photos of cytologic exam and skin scraping ﬁ ndings (bacteria, mites) through one eyepiece of the microscope by using the camera’s macro setting,” says Dr. Brett Wildermuth, DACVD, a veterinarian in San Diego, Calif.

He then shows the photos to clients in the exam room. The pictorial representation of the high numbers of “gross” bacteria drives home the necessity for antibiotic therapy and reduces complaints about antibiotic costs.

The next step kin issues, especially those associated with patient might include a standardized medical allergies, are some of the most common history form, an extended examination time and Shealth problems you’re going to see in standard diagnostics (skin scraping, dermatology practice. So they’re a great growth opportunity— culture and skin cytology). if your team is ready to learn. More importantly, handling dermatology cases well can bond clients 3. Explain your plan. Pet owners are to your practice forever. more compliant if they know you have a plan, so be upfront with them from the get-go about their 1. Train your team. A dermatology pet’s treatment. But be realistic and outline a program requires your whole team’s support “plan B” in case the f rst approach doesn’t work. to f ourish. One good way to get your team on board with training is to invite team members to 4. Work it out. Successful management of bring their own pets into the practice for exams. dermatology cases often requires ongoing focus on client education and patient workups rather 2. Make a plan. Once team members are than just treating the symptoms. If clients refuse excited and knowledgeable, your next step is to the diagnostics or treatment you recommend, be create protocols for common dermatology issues. prepared with alternatives that will still let you For example, a protocol for a f rst-time allergy help the pet.

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magentablackcyanyellow ES252354_dvmtoolkit0613_019.pgs 05.21.2013 00:54 ADV CYTOKINES MAY BE THE KEY—GET THE FACTS ON JAK

To ﬁnd out more about the itch cycle and breakthrough science in Canine Allergic Disease, please visit www excellenceindermatology.com.

FOR ANIMALS. FOR HEALTH. FOR YOU.

magentablackcyanyellow ES252049_DVMTOOLKIT0613_020_FP.pgs 05.18.2013 03:02 ADV CLIENT relations

Tweet this Take the STING out of a Share how you support diabetic cat owners on Twitter @FirstlineMag diabetes diagnosis #felinediabetes. Be supportive of pet owners when they’re faced with their cat’s diabetes diagnosis. Use these communication techniques to ease the burn of this challenging disease. By Mandy Stevenson, RVT

iabetes. T is single Diabetes diagnosis: a more complete picture of word can bite cat the ﬁ rst bite Toonces’s health and how we Downers, especially if Mrs. Sweet calls because she’s can help him feel better.” they’re unprepared or they’ve concerned about her 11-year- witnessed the disease before old cat, Toonces. She says he’s When Mrs. Sweet and Toonces in other pets or people they been drinking and urinating arrive at the clinic, the vet- know. Although we go out of a lot, and he’s not grooming erinary team will perform a our way in the veterinary in- himself like he used to. physical exam, blood work and dustry to prevent such disease, urinalysis to check for internal it’s still a common illness that Mrs. Sweet: “My friend abnormalities. we see in feline patients. With told me he’s just getting old, proper communication and and not to worry. Should I be Mrs. Sweet: “Why does my commitment, you can help concerned?” cat need all of these tests?” cat owners manage their pet’s disease. You: “Mrs. Sweet, you did You: “Generally your cat’s As you know, all diabetic the right thing by calling us. symptoms help Dr. Cares patients are treated and man- I know Dr. Cares will want make a diagnosis, but there are aged on a case-by-case basis. to take a look at Toonces. other factors that can af ect T ey can all experience dif er- She will thoroughly examine the success of the treatment ent outcomes, depending on Toonces, including checking for diabetes. For instance if concurrent disease, lifestyle, to see if he’s lost any weight Toonces has pancreatitis or an personality and so on. Not all or is dehydrated. You might underlying kidney problem, he clients will choose the same also watch to see if you notice may not respond well to the treatment for many dif erent Toonces isn’t jumping well or if diabetic treatment and this can reasons. Your practice will his rear legs seem f atter to the complicate the situation long have its own protocols for f oor. Dr. Cares will also use term. So we need to be able to ef ective diabetic treatment blood work and a urinalysis to rule out concurrent disease so and may not follow the same check for any abnormalities. we can of er Toonces the right approach in this example. T is will help her give you care to help him feel better.” ➤

GETTY IMAGE/CSA_IMAGES dvm360.com | Firstline | June 2013 | 21

magentablackcyanyellow ES259348_fl0613_021.pgs 05.30.2013 19:00 ADV CLIENT relations

When the doctor diagnoses Always try to discuss this good idea to lay out an diabetes, she may suggest diagnosis before bringing the initial estimate and try hospitalizing Toonces for cat into the exam room. Clients to explain what types of home the day to perform further have usually been separated care will be necessary, includ- diagnostics, such as a blood from the pet for some time ing insulin injections, monitor- glucose curve, administer IV and get very excited. You want ing and special diet needs. T e f uids to correct dehydration them to focus on your informa- owner’s commitment becomes if needed and any other tion. Once you bring the pet crucial to help successfully testing required to treat any in, give them time to visit. Then treat the pet. concurrent disease. It’s not say you’d like them to practice Remember to discuss how uncommon for clients to feel giving the cat’s injection. This the outcome of the treatment overwhelmed at this point, usually gets them back on task. can depend on several things. and it’s vital to take the time If Toonces isn’t easy to work to discuss the details of this Help clients offer with, it can be dif cult for Mrs. disease and what they should gentle treatment Sweet to give injections at expect in the future. In this case, Mrs. Sweet is will- home. Also lifestyle can be an When a client f rst learns ing to treat her cat and seems issue if Mrs. Sweet struggles to that their companion may open to the long-term com- set a routine schedule. It’s im- have a lifelong chronic dis- mitment that’s required. It’s a portant to discuss all of these ease, it can be dif cult to deal factors with Mrs. Sweet be- with. It’s our job as fore making a game plan so veterinary profes- she can make an informed sionals to help decision on how to proceed. them understand T e discharge instructions what treatments for this cat will be extensive are available and and should be performed by support them in any an educated team member. way we can. Many Ideally, you’ll create a refer- people know some- ence sheet with the veteri- one who’s diabetic narian’s specif c instructions or they may to discuss all recommenda- be diabetic them- tions for home care. T is selves. Sometimes allows the client to have referring to ex- all of the information in amples of people one place. with this disease First discuss the insu- helps clients un- lin injections and how derstand that with often Mr. Sweet needs commitment and Offer step-by-step instructions to give them to Toonces. proper treatment, Show her the vial and Create clear, personalized home care they can often the proper syringe she instructions for pet owners of diabetic pets at manage their cat’s will use. T en f ll the sy- dvm360.com/diabetestool. condition. ringe with the amount of

22 | June 2013 | Firstline | dvm360.com

magentablackcyanyellow ES259355_fl0613_022.pgs 05.30.2013 19:01 ADV ONEthe number ONEthe number CHOICE IN CHOICE IN feline PROTECTION feline PROTECTION FROM FROm fleas1 HEARTWORMS1

REVOLUTION® (selamectin) is ﬁrst in ﬂeas. First in heartworms.1 First on your list.

You may know that REVOLUTION is the veterinarian’s #1 choice in feline heartworm disease prevention, but did you also know that it is the #1 choice in feline flea control? Your patients deserve proven protection, and you can provide it to them by recommending REVOLUTION—the leader in feline parasite protection against fleas, heartworms, roundworms,* hookworms and ear mites. Important Safety Information: Do not use on sick, weak, or underweight cats. Use only on cats 8 weeks and older. Side effects may include digestive upset and temporary hair loss at application site with possible inflammation. In people, REVOLUTION may be irritating to skin and eyes. Wash hands after use. For more information, see brief summary on following page.24.

1VetInsite™ Analytics 2012. Zoetis Data on File. *Toxocara cati. All trademarks are the property of Zoetis Inc. or its subsidiaries, affiliates and licensees. ©2013 Zoetis Inc. All rights reserved. February 2013. REV0113007

Ancylostoma tubaeforme. Questions? Contact us at 1-888-ZOETIS1 (963-8471). 10309530

magentablackcyanyellow ES262792_FL0613_023_FP.pgs 06.01.2013 04:51 ADV Topical Parasiticide for Dogs and Cats CLIENT relations BRIEF SUMMARY: See package insert for full prescribing information. CAUTION: US Federal law restricts this drug to use by or on the order of a licensed veterinarian. INDICATIONS: Revolution is recommended for use in dogs six weeks of age or older and cats eight weeks of age and older for the following parasites and indications: Dogs: Revolution kills adult fleas and prevents flea eggs from hatching for one month and is indicated for the prevention and control of flea infestations (Ctenocephalides felis), prevention of heartworm disease caused by Dirofilaria immitis, and the treatment and control of ear mite (Otodectes cynotis) infestations. Revolution also is indicated for the treatment and control of sarcoptic mange (Sarcoptes scabiei) and for the control of tick infestations due to Dermacentor variabilis. Cats: insulin Toonces will receive and show You: “Mrs. Sweet, we’re going to Revolution kills adult fleas and prevents flea eggs from hatching for one month and is indicated for the prevention and control of flea infestations (Ctenocephalides it to the client. Also teaching Mrs. send you home with a special food felis), prevention of heartworm disease caused by Dirofilaria immitis, and the treatment and control of ear mite (Otodectes cynotis) infestations. Revolution is Sweet how to remove any bubbles that will help to regulate Toonces’ also indicated for the treatment and control of roundworm (Toxocara cati) and intestinal hookworm (Ancylostoma tubaeforme) infections in cats. that may form in the syringe helps blood sugar. Let’s talk about a feed- WARNINGS: Not for human use. Keep out of the reach of children. with accuracy. Next, ask Mrs. Sweet ing schedule for Toonces.” In humans, Revolution may be irritating to skin and eyes. Reactions such as hives, itching and skin redness have been reported in humans in rare instances. Indivduals with known hypersensitivity to Revolution should use the to f ll the syringe herself so she’s com- product with caution or consult a health care professional. Revolution contains isopropyl alcohol and the preservative butylated hydroxytoluene (BHT). Wash fortable performing this step. Remind Describe in detail the diet the hands after use and wash off any product in contact with the skin immediately with soap and water. If contact with eyes occurs, then flush eyes copiously with Mrs. Smith that she should replace doctor recommends, when to feed water. In case of ingestion by a human, contact a physician immediately. The material safety data sheet (MSDS) provides more detailed occupational safety the product according to the doctor’s Toonces, how much to feed him, information. For a copy of the MSDS or to report adverse reactions attributable to exposure to this product, call 1-800-366-5288. recommendation and send home a what to do if he only eats some, Flammable—Keep away from heat, sparks, open flames or other sources of ignition. Do not use in sick, debilitated or underweight animals. (see SAFETY) box of syringes to get her started. what to do if he doesn’t eat at all and PRECAUTIONS: Always try to designate a family any other specif c instructions the Prior to administration of Revolution, dogs should be tested for existing heartworm infections. At the discretion of the veterinarian, infected dogs should be treated to remove adult heartworms. Revolution is not effective against adult D. immitis member who doesn’t mind giving the veterinarian has for this patient. and, while the number of circulating microfilariae may decrease following treatment, Revolution is not effective for microfilariae clearance. injections. If there’s only one owner, You’ll also want to take time to Hypersensitivity reactions have not been observed in dogs with patent heartworm infections administered three times the recommended dose of Revolution. Higher then he or she has made the decision review the importance of monitor- doses were not tested. to give injections because ing. Watching Toonces’ wa- ADVERSE REACTIONS: Pre-approval clinical trials: Following treatment with Revolution, transient localized alopecia with or without it’s the only way to ter intake, urine output and inflammation at or near the site of application was observed in approximately 1% of 691 treated cats. Other signs observed rarely (≤0.5% of 1743 treated cats and make the cat feel better. behavior is very important. dogs) included vomiting, loose stool or diarrhea with or without blood, anorexia, lethargy, salivation, tachypnea, and muscle tremors. Post-approval experience: In addition to the aforementioned clinical signs that were reported in pre-approval You: “Mrs. Sweet, it’s clinical trials, there have been reports of pruritus, urticaria, erythema, ataxia, Euthanasia is very much a reality feverand rare reports of death. There have also been rare reports of seizures in important to watch how dogs. (see WARNINGS) for some people. It’s important SAFETY: much water Toonces drinks, Revolution has been tested safe in over 100 different pure and mixed breeds to be prepared for this conversa- of healthy dogs and over 15 different pure and mixed breeds of healthy cats, how much and how often he including pregnant and lactating females, breeding males and females, puppies tion as a team member and be six weeks of age and older, kittens eight weeks of age and older, and avermectin- urinates and keep an eye out for sensitive collies. A kitten, estimated to be 5–6 weeks old (0.3 kg), died 8 1∕2 hours after receiving a single treatment of Revolution at the recommended dosage. able to discuss it appropriately. The kitten displayed clinical signs which included muscle spasms, salivation changes in Toonces’ behavior. If and neurological signs. The kitten was a stray with an unknown history and was We’re not here to judge or make malnourished and underweight (see WARNINGS). Toonces seems weak, exhibits an DOGS: In safety studies, Revolution was administered at 1, 3, 5, and 10 times assumptions about an owner’s the recommended dose to six-week-old puppies, and no adverse reactions were unstable gait, seems sleepier than observed. The safety of Revolution administered orally also was tested in case of willingness or ability to be able to accidental oral ingestion. Oral administration of Revolution at the recommended normal or experiences tremors, this topical dose in 5- to 8-month-old beagles did not cause any adverse reactions. manage their cat’s disease. There In a pre-clinical study selamectin was dosed orally to ivermectin-sensitive collies. might indicate his blood sugar is too Oral administration of 2.5, 10, and 15 mg/kg in this dose escalating study did are many factors in a person’s not cause any adverse reactions; however, eight hours after receiving 5 mg/kg low. If you notice any changes, call orally, one avermectin-sensitive collie became ataxic for several hours, but did decision to decline treatment or not show any other adverse reactions after receiving subsequent doses of 10 us immediately. It’s also a good idea and 15 mg/kg orally. In a topical safety study conducted with avermectin-sensitive collies at 1, 3 and 5 times the recommended dose of Revolution, salivation was try an alternative management observed in all treatment groups, including the vehicle control. Revolution also to keep some Karo syrup on hand if was administered at 3 times the recommended dose to heartworm infected technique. Depending on a client’s dogs, and no adverse effects were observed. Toonces’ blood sugar gets too low. CATS: In safety studies, Revolution was applied at 1, 3, 5, and 10 times the rec- lifestyle or limitations, they may not ommended dose to six-week-old kittens. No adverse reactions were observed. In certain cases, we may ask you to The safety of Revolution administered orally also was tested in case of accidental be prepared or able to treat their oral ingestion. Oral administration of the recommended topical dose of Revolution rub the syrup on the gums or give it to cats caused salivation and intermittent vomiting. Revolution also was applied cat. Our job is to support a client’s at 4 times the recommended dose to patent heartworm infected cats, and no a syringe in the mouth when you’re adverse reactions were observed. decision and help them in any way In well-controlled clinical studies, Revolution was used safely in animals receiving waiting to see Dr. Cares.” other frequently used veterinary products such as vaccines, anthelmintics, that we can. antiparasitics, antibiotics, steroids, collars, shampoos and dips. STORAGE CONDITIONS: Store below 30°C (86°F). Trying to discuss the signs of low HOW SUPPLIED: Available in eight separate dose strengths for dogs and cats of different weights. Revolution for puppies and kittens is available in cartons Talk about food blood sugar can be tricky. You don’t containing 3 single dose tubes. Revolution for cats and dogs is available in cartons containing 3 or 6 single dose tubes. Next, you’ll need to take a few min- want to scare clients but they need NADA 141-152, Approved by FDA. REVOLUTION is a registered trademark of Pfizer Inc. ©2012 Pfizer Inc. utes to discuss the appropriate diet to understand the importance if it All rights reserved. for this pet. occurs. If diabetic remission is pos-

Distributed by: Pﬁzer Animal Health Division of Pﬁzer Inc. 10309503 24 | June 2013 | Firstline | dvm360.com New York, NY 10017 www.revolutionpet.com April 2012

magentablackcyanyellow ES259983_fl0613_024.pgs 05.30.2013 22:20 ADV toxin Lab It’s the tasty ingredient that makes her chocolate cake so rich.

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Be prepared. • Order your Dogs and Chocolate Risk Wheel and other free tools at www.aspcapro.org/freebies or scan the code with your Smartphone. • Add 888-426-4435 to your contacts list and speed dial. . For more information visit www.aspcapro.org. *American Board of Veterinary Toxicology www.abvt.org No animals were harmed during the production of this ad. American Board of Toxicology, Inc. www.abtox.org A consultation fee may apply. magentablackcyanyellow ES262692_FL0613_025_FP.pgs 06.01.2013 04:29 ADV CLIENT relations

sible, take a moment to discuss number for your When you call to remind the signs, because it can come clinic or the emer- clients about follow-up on quickly and monitoring is gency hospital you appointments, be sure you key to prevent major problems. recommend in case she needs discuss any need to withhold Depending on your practice helps after hours. food or the insulin injection protocols you may also discuss Finally, it’s time to bring for blood work, if indicated. the use of home blood glucose Toonces in and show Mrs. monitors to reduce the need Sweet how to give the injec- for excessive hospital testing tions. Fill the insulin syringe Prevent future stings that can cause stress to the with saline—or insulin if with follow-up care cat. You may also recommend Toonces hasn’t already had It’s critical to of er recalls for glucose detecting crystals and it—up to the correct dose line Mrs. Sweet and Toonces. T is dipsticks the client can use in and replace the cap on the allows you to check on treat- the litter box at home. syringe. You could then show ment, ask if the diet’s going T en explain you’ll schedule Mrs. Sweet how to tent the well and of er motivation as follow-up exams and blood skin and what angle to place needed. Most of the time a work until you reach regula- the syringe to hold it properly. client’s concerns will relate to tion. T is gives the doctor Sometimes clients will hold diet or injections. If the cat’s more information to discuss their thumbs on the plunger, appetite hasn’t been good or long-term recommendations. and they prematurely squirt owners struggle giving the the liquid, so show them injections, this is a good time You: “Mrs. Sweet, we’ll want where to hold their f ngers to to talk. Also regulation can to schedule follow-up ap- avoid this common mistake. be dif cult in some cats, so pointments to check on how Discuss proper injection sites it’s imperative to be sure they Toonces is responding to treat- for optimal absorption—on understand the importance ment. During these visits, we their sides if possible—and of compliance and to encour- will conduct a physical exam remind Mrs. Sweet to rotate age them to ask any questions and ophthalmic exam, conduct sites to prevent scar tissue they have. Most clients are weight check, check your pet’s from forming. Once Mrs. f ne with giving the injec- blood pressure and perform Sweet is comfortable, give her tions by this time. Set up the blood work to assess the blood the syringe without the cap next appointment and of er glucose level. We will also and have her inject Toonces. to order food and supplies discuss diet, injections and any Be sure to ask Mrs. Sweet if whenever needed. other concerns you might have.” there are other pet owners in With these steps, you can her household, and encour- help pet owners manage the Before Mrs. Sweet leaves, age her to designate someone sting of a diabetes diagnosis. you’ll of er any supportive who will give the injections Your support will ultimately materials the clinic recom- so Toonces isn’t double dosed make managing diabetes more mends, such as web links or accidently. Reassure Mrs. manageable. handouts on diabetic manage- Sweet that she will adjust to ment. Encourage Mrs. Sweet this procedure with time, and Mandy Stevenson, RVT, is a Firstline Editorial Advisory Board member to call with any questions, encourage her again to call and a technician at Rolling Meadows and give out an emergency with any questions. Animal Hospital in Adrian, Mo.

26 | June 2013 | Firstline | dvm360.com

magentablackcyanyellow ES259353_fl0613_026.pgs 05.30.2013 19:01 ADV ProFessional growth

Zoom in on a perfect annual review Whether you’re the reviewer—or the reviewee—it’s time to embrace a new outlook on employee reviews. Hint: The manager may be doing them wrong. By Bash Halow, CVPM, LVT

recently visited a practice Te longer she worked on the managers struggle with even where a manager bemoaned project, the more immobi- the idea of reviews is because I the fact she was weeks lized she became. “Will a four we’re often unclear of what behind on her reviews. She demoralize my team member? we’re trying to accomplish motioned to a stack of papers What do I put down for her and why. If you don’t believe and the current screen up personal appearance? How can me, consider the personal ap- on her computer. Before her I give her less than a fve?” She pearance question you see on bleary eyes were a series of asked for my advice. some generic review sheets. questions followed by num- “What are you trying to ac- You really waited a full year to bers one through fve. She was complish?” I responded. And bring up the fact that someone agonizing over each grade. A this is where she fell silent. had a problem with his or her fve? A four? A three? Worse? Te reason she and so many personal appearance? Worse,

Getty ImaGe/GpoIntstudIo dvm360.com | Firstline | June 2013 | 27

magentablackcyanyellow ES258383_fl0613_027.pgs 05.29.2013 23:33 ADV ProFessional growth

4 ways to be a great reviewee of you aren’t children. Tese Consider this advice to stay positive when you’re being reviewed. adults sitting across the table from you are functioning mem- Let down your guard. Even if you feel attacked during your bers of society. Tey’re probably review, a defensive position only makes things worse. 1 homeowners; they may be mar- Return to your mission. If you feel your manager is being ried and they may be parents; 2unfairly critical of your performance, circle the conversation they are probably graduates of back to your practice’s interest in client and patient care by saying high school or higher levels of something like, “I’m sorry. I was unaware that my actions had those education; and they’re prob- effects. I was trying to accomplish better client and patient care, ably over the age of 21. Pick and I now understand that you don’t approve of that approach.” some calamity: a car accident, Choose a proactive position. Don’t sit in the chair and a sick child, a food—whatever 3allow criticism—or praise for that matter—to wash over you. happens to them, they’ll fgure Use the review as a chance to explore ways to change hospital it out and move on. And here’s service and care systems for the better. the kicker. Tey don’t need your help to do it. Tey’ll work their Listen. Our reaction to criticism is often a knee-jerk apol- way through the problem and ogy or explanation. Rather than responding too fast, take a 4 move on with their lives. moment and consider the feedback. It could be right! If you’re too Now, zoom back in to the busy explaining yourself, you may miss the chance to hear a valu- review table. You’re on one able insight that could change your life—and your career. side and they’re on the other. Are you really going to give you’re going to predicate their scription. Make sure that your them instructions on how to salary on their personal ap- manager understands that your dress? Are you going to give pearance? What is the mes- actions are a response to your them hollow advice like, “Be sage you’re trying to send? understanding of those bullets. more careful?” Cleaner people make more An example of a redirect might What success rate do you money? When you add up be: “I’m aware that I some- get out of the instruction, “Be everything you and your team times appear frantic. During careful?” Tese able adults are trying to accomplish with crunch times, I start to fail and sitting across from you don’t client service, patient care and I get fustered, which becomes need their behavior reviewed workplace culture, you’re really apparent in my actions and ap- by you or anyone else. Te idea going to spend part of that one pearance. I would love help on itself is insulting, and to most hour, once a year, talking about how I can juggle all of my as- people it’s a complete turnof. grooming and deodorant? signed duties during our busiest A review is an opportunity Now, if you’re the reviewee, times so that I don’t look and for you and your team mem- you’re probably thinking you sound like I’m melting down.” bers to dig deeper into your re- have no control over the review spective responsibilities as you process—and that’s partially Clear the haze execute your practice’s mission true. But reviews should be Zoom out for a moment. Who goals. Tink about it for a a dialogue. Don’t be afraid to are you? Who are these people moment. You and 15 or more gently redirect the conversation you’re reviewing? Tis isn’t individuals gather each day un- to the line items on your job de- school and these people in front der one roof, endeavor to com-

28 | June 2013 | Firstline | dvm360.com

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magentablackcyanyellow ES262693_FL0613_A29_FP.pgs 06.01.2013 04:29 ADV ProFessional growth

plete any number of diverse with no colleague who acts on how you can improve. Say- and complicated activities and as a mentor or resource? A ing “I sometimes fall short on try to seamlessly dovetail your review is our chance to look showing clients I care when the eforts into an amazing client at these concepts, talk them phone is ringing and I have pa- and patient experience. Tat’s through and fgure out how we tients arriving and discharging hard. And to get it right, you shouldn’t be dressing down a How do team members fulfll their person’s character. You should be thinking about how their job descriptions if they’re placed at actions and your actions work together to accomplish goals. a desk with no other support ... with Tat’s a productive, positive experience. Tat’s teamwork. no training or a colleague who acts as a mentor or resource? Focus on speciﬁcs Use the job description as a can accomplish them together. all at once” shows you’re self- jumping-of point. Well-writ- We’re not reviewing anyone. aware and eager to improve, ten job descriptions talk about If anything, they’re reviewing and it underlines a service what you want people to do themselves. And we’re learning problem you need to address at and how to do it. It’s the “how” how to work better together. the hospital-wide level. that you want to talk about. Additionally, efective Reviews are an essential tool, Here’s an example: “Client reviews aren’t connected to but only if they’re used to refect care representatives should money. Annual raises are on better ways to work to- demonstrate that they care unsustainable anyway. Bet- gether. When you enter reviews about each client.” OK, that’s ter to use the review process demonstrating you’re genuinely straightforward enough. Or is to demonstrate your genuine interested in helping employ- it? What do client care repre- concern and support for an in- ees—or your practice—prosper, sentatives who demonstrate dividual interested in growing. the results are likely to be favor- they truly care Give them the feedback they able. Enter the review process about clients need to grow stronger not just as your one chance to “give ’em look like? Sound as employees, but as people. both barrels” and you’re on like? What do Ten ofer raises based on the track to alienate and shame. Use they say on the company’s proftability or the review time to build trust and phone, to clients increased responsibility the a stronger working relation- Managers: No in the lobby or in employee takes on based on ship. You’ll create partnerships job description? emails? How do successful growth. that help everyone look toward Check out the practice they fulfll their And reviewees, don’t take future summits you can climb manager job description job description a back seat in reviews. Dem- together. And it’s more fun. at dvm360.com/ if they’re placed onstrate you’re interested in managerjob and use it at a desk with no improving. Come armed with Bash Halow, LVT, CVPM, as a template to begin is a Firstline Editorial other support, thoughts on how you fall short building a description for Advisory Board member with no break, in the big picture of client and and co-owner of Halow your job in your practice. with no training, patient service and questions Tassava Consulting.

30 | June 2013 | Firstline | dvm360.com

magentablackcyanyellow ES258382_fl0613_030.pgs 05.29.2013 23:33 ADV Team safety

workWhen makessick you Sick over work—literally? Whether you only pick up the occasional pet mess or you’re in the back treating animals every day, you need to know how to control zoonoses. By Oriana Scislowicz, BS, LVT

oughing, snifing and sneezing just might on an understanding of routes of transmission, earn you a few dirty looks from cowork- personal protective equipment available and Cers who want to avoid falling ill with the common zoonoses seen in the hospital. It also creeping crud every time it sneaks into your of- depends on conscientious employees with a goal fce. And it’s true that during cold and fu season, of protecting themselves and others from un- viruses and bacteria spread via indirect and direct necessary exposure to pathogens. contact and aerosol exposure such as sneezing. But in veterinary hospitals, we deal with another Understand routes culprit that may occur year-round: the pathogens of transmission that can spread from our patients to us. Te frst step in protecting yourself from zoo- What’s more concerning is that we’re often notic disease is to be aware of the three main way more lax than human hospitals when it means of transmission for various hosts: aerosol, comes to protecting ourselves from the spread vector-borne and contact. Aerosol transmission of these diseases from our patients. We don’t usually occurs through coughing and sneezing wear gloves as frequently as we should, and and can be generated via procedures such as suc- we’ve likely all witnessed a dental prophylaxis tion or bronchoscopy. Vector-borne transmission being performed with a face mask and gloves can occur via vectors such as mosquitoes, feas but no protective eye wear—and maybe even and ticks. Within the hospital, it’s more common without the mask and gloves. Controlling zoo- that we come into contact with feas or ticks on notic exposure in veterinary practices depends animals that are infested. Contact may occur

Getty ImaGe/ReGGIe CasaGRande dvm360.com | Firstline | June 2013 | 31

magentablackcyanyellow ES258228_fl0613_031.pgs 05.29.2013 23:03 ADV Team safety

directly through examining, but also from other coworkers an antimicrobial soap, it’s better bathing or handling animals, or and people from outside the than holding of altogether. indirectly through contaminat- workplace. But we still prob- ed items such as cages, soiled ably don’t do it as often and as 2 Wear the right clothing. laundry or equipment.1 thoroughly as we should. You’re Gloves, sleeves, lab coats, protecting yourself in two gowns and thick-soled, Start with prevention dif erent ways by thoroughly, close-toed shoes are all First, it’s important to un- and frequently, washing your essential in any hospital. When derstand personal protective hands: f rst, by the mechanical coming into contact with feces, equipment and how to avoid action of removing any organic broken skin such as sores or exposure. Consider these tips: material and cutting down the abscesses, vomit or urine, you number of organisms left; and should wear gloves.1 T e 1 Wash your hands. Most second, by killing and hinder- biggest lapse I’ve seen in of us have heard a million ing the growth of f ora with practice is with urine. Often, times that this is the best way antimicrobial soap. Keeping team members without gloves to avoid not only transmission f ngernails short, not wearing will collect and handle urine of pathogens from our patients artif cial nails, wearing minimal samples, empty urinary bags jewelry and keeping and clean urine from patients. hands moisturized Remember that diseases such can reduce the nooks as leptospirosis, tularemia2 and bacteria can slip into lymphocytic choriomeningitis ffer Limited time o 0 and stay. T e Centers can be spread via urine. Team 499.0 NOW ONLY $ 13 VET20 Enter Promo Code for Disease Control members should also wear and Prevention rec- gloves during dental proce- ommends washing dures and necropsies as well as for 20 seconds. Try when cleaning cages or counting next time. handling lab specimens or con- T is is more than taminated laundry.1 likely much longer Sleeves and gowns are helpful than the typical to have with patients in isola- rushed hand washing tion situations, especially in you observe. Alcohol- cases such as those involving based hand rubs can MRSA infection. And it’s still A complete and work when running important to thoroughly wash comprehensive human water isn’t nearby. exposed skin underneath the resource management Apply alcohol to the gown after you carefully re- tool versatile enough to implement in your practice palms and cover all move the gown. Lab coats serve TODAY and change your surfaces of the hand as another barrier of protection, practice Get your FOREVER! by the mechanical but don’t rely on them as the step-by-step action of rubbing only method of protection in guide through until hands are dry.1 these cases. the employee While not as ideal as Shoes that are thick-soled, life cycle Go to www.veterinarypathways.com hand washing with closed-toed and nonporous and order PACE TODAY! Enter Promo Code VET2013 32 | June 2013 | Firstline | dvm360.com

magentablackcyanyellow ES258226_fl0613_032.pgs 05.29.2013 23:03 ADV Team safety

and easy to disinfect can help keep in mind that when you sies on any patient, suspected protect against bodily f uids use respirators, OSHA requires or not. T is creates another that could penetrate. Also, this annual f t testing, training in barrier between saliva and bites ensures that you expose one its use and an evaluation of the with live patients and with less part of the body to vectors health status of the user.1 necropsies. of disease, such as ticks, and > Lymphocytic choriomen- direct contact transmission Know the risks ingitis. It’s transmitted via sa- through scratches or bites. Next, let’s take a look at some liva, urine and feces of infected of the common zoonoses in mice. T is of course is more of 3 Use facial protection. veterinary practices. Consider an issue in lab animal settings Any procedure that may create these threats: and exotic veterinary hospitals. aersolization of bacteria or > Leptospirosis. It’s often T e incubation period is 15 to spraying or splashing of bodily transmitted to people via 21 days, and it presents itself as f uids should warrant the use contact with canine urine; a weaker inf uenza-like illness.2 of goggles or a facial shield.1 aerosolized urine can create Wear gloves during handling, Shields can even come attached droplets that can transmit and consider facial protection to surgical masks so you don’t disease as well. T e incubation if you’re disrupting urine and need to juggle both separately. period is about seven to 12 feces-contaminated bedding. T ese also help because they days, and symptoms often in- > Toxoplasmosis. It’s prob- ensure you’re automatically us- clude headache, muscle aches, ably one of the more misun- ing both forms of personal pro- fever and chills.2 To prevent derstood zoonoses. You’ve tection and not forgetting one. exposure, always wear gloves probably heard that the most Common procedures where when cleaning up accidents common form of transmission you might need this protection and collecting and handling in a veterinary hospital is when include lancing abscesses, f ush- urine samples, regardless of team members change litter ing wounds and obstetric and whether you suspect a patient boxes and come into contact necropsy procedures. Bodily is infected. with feline feces. However, f uids can easily come into > Rabies. It’s transmitted to toxoplasmosis is much more contact with the mucous mem- humans via infected saliva or commonly contracted by inges- branes of the eyes, nose and tissues and bites. T e incubation of tissue cysts in under- mouth and transmit pathogens tion period is about three to cooked meat.3 T ankfully, most during these procedures if you eight weeks, and symptoms hospitals change their litter don’t use proper equipment.1 may include headache, fever, boxes so regularly, the chances seizures, inability to swallow that the parasite has become 4 Use respiratory tract and salivation.2 If possible, only infectious in that time is ex- protection. Although less vaccinated personnel should tremely low—it usually takes commonly needed, respirators handle patients that aren’t up to one to f ve days after being shed that f lter smaller particles, such date on their vaccinations—and in feces.4 T e incubation pe- as the N95 respirator, may be especially for those that exhibit riod is 10 to 23 days and some needed in suspected cases of neurologic def cits. Wear full symptoms include myocarditis, disease, such as Mycobacterium protective gear including gloves encephalitis, sore throat and bovis, which can cause pulmo- when handling these patients fever.2 To protect yourself in the nary tuberculosis in people. Do and when performing necrop- workplace, always wear gloves

dvm360.com | Firstline | June 2013 | 33

blackcyanyellow ES258229_fl0613_033.pgs 05.29.2013 23:03 ADV Team safety 5 steps to cleaner hands Use this advice from the Centers for 1. Get ‘em wet. Use clean 2. Rub ‘em down. Put your Disease Conrol and Prevention to wash running water and apply hands in the tub and scrub your hands the right way every time: soap. Hot or cold will do. the front, the back, the palms, between those ﬁngers and under your nails.

3. Think “Happy Birthday.” You want your hands nice and lathered, and that takes at least 20 seconds. To keep time 4. Rinse. Use running 5. Dry. Use a clean towel yourself, you can hum the birthday water to remove any soap or let them air dry. song at a medium pace twice. and debris.

If you don’t have access to soap, hand sanitizers are an alternative. Just make sure the sanitizer is alcohol-based with at least 60 percent alcohol. And remember, sanitizers won’t eliminate all types of germs. For a link to more free hand-washing tools, visit dvm360.com/zoonotic.

when changing litter. Avoid to seven weeks, and signs may ted via skin or mucous mem- this task altogether if you’re include fever, cough, wheez- brane contact with the bodily pregnant, and make sure your ing and blindness in cases of fuids, or tissues, of infected hospital is regularly changing ocular migration.2 Gloves are animals. With an incubation litter boxes—as you should be a must whenever dealing with period of one to 15 weeks, for the patient’s sake anyway. suspected patients and when- symptoms usually include > Visceral larval migrans ever cleaning up feces from fever, sweating and myalgia.2 (caused by roundworms). any patient, and hand washing Depending on the procedure It’s transmitted via ingestion goes a long way as a means of being performed on the animal, of eggs in contaminated feces. prevention. wearing gloves and other Te incubation period is four > Brucellosis. It’s transmit- personal protection and wash-

34 | June 2013 | Firstline | dvm360.com Getty ImaGe/dondesIGns

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magentablackcyanyellow ES263113_FL0613_035_FP.pgs 06.03.2013 18:36 ADV Team safety

ing hands thoroughly can help > Cryptosporidiosis. It’s best to treat any bodily fuid or prevent transmission. transmitted via ingestion of any scratch or bite as one from > Bartonellosis. Also known oocysts in contaminated feces. an infected animal and prepare as cat scratch disease, it’s trans- It has an incubation period before contamination occurs. mitted via bites and scratches of two to 10 days, and signs It’s easy to lapse in these prac- from cats. Te incubation often include stomach cramps, tices of personal protection on period is one to two weeks, dehydration and nausea. Tese busy days, but remember this: and signs often include fever, oocysts more readily infect Your patients and coworkers headache and swollen lymph humans when transmitted from need you in the best possible nodes.5 Using smart handling livestock. Feline and canine health so you’re ready to ofer skills when dealing with feline infections are a bigger danger for the best care for the patients at patients will help prevent trans- immunocompromised individu- your practice. mission. Remember everyone’s als.6 Wearing gloves and wash- safety, including the patient, al- ing hands aid most in preven- References 1. Compendium of Veterinary Standard ways comes before completing tion, and immunocompromised Precautions for Zoonotic Disease a task, and educate employees individuals should avoid contact Prevention in Veterinary Personnel. National Association of State Public about the behaviors that cats altogether if at all possible. Health Veterinarians. Available at: use for warnings. Wash hands nasphv.org/Documents/Veterinary- Precautions.pdf. Accessed May 28, immediately and thoroughly af- Protect your team 2013. ter a bite or scratch and contact Tese are only a handful of the 2. Zoonotic Diseases Fact Sheet. Ameri- can Biological Safety Association. a physician. zoonoses you may come into Alliance: OSHA Cooperative Program. > Salmonellosis. It’s contact with while working in a Web. Available at: www.absa.org/pdf/ transmitted via direct contact veterinary hospital. And hand ZoonoticFactSheet.pdf. Accessed April 16, 2013. with many domestic species washing and wearing gloves 3. Pregnancy and Toxoplasmosis. The including dogs, cats, reptiles, protect employees more than Humane Society of the United States. Available at www.humane society.org/ rodents, fsh and chickens as any other method of personal animals/resources/tips/toxoplasmosis. well as herd animals, and it’s protection. Facial protection html. Accessed May 23, 2013. 4. Toxoplasmosis. DPDx: Laboratory Iden- most commonly seen with and respiratory tract protection tiﬁcation of Parasites of Public Health turtles. Te incubation period are still useful, and it’s impor- Concern. Centers for Disease Control and Prevention. Available at: www.dpd is six hours to three days, and tant to be prepared in advance .cdc.gov/dpdx/html/Toxoplasmosis signs may include diarrhea, to use them during certain .htm. Accessed May 28, 2013. headache and fever.2 Washing procedures. 5. Cat Scratch Disease. CDC. Centers for Disease Control and Prevention. Avail- hands very well, Although it’s important able at: www.cdc.gov/healthypets/ especially before to familiarize yourself with diseases/catscratch.htm. Accessed May 28, 2013. eating a meal common zoonoses, it’s best to 6. Cryptosporidium. CDC. Centers for and after han- make the decision about how Disease Control and Prevention. Available at: www.cdc.gov/parasites/ dling an animal— you protect yourself by the crypto/disease.html. Accessed May Free form in particular procedure you’re performing 28, 2013. Visit dvm360.com/ turtles, chicks and how you’ll be exposed to and ducklings in bodily fuids, vectors of disease Oriana Scislowicz, BS, zoonotic for a form LVT, VDT, is a technician to identify pets most exotic hospitals— or bites and scratches instead of in Richmond, Va. Send susceptible to zoonoses. will help with the suspected pathological con- comments to frstline@ prevention. dition in a patient. It’s always advanstar.com.

36 | June 2013 | Firstline | dvm360.com

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Your go-to source for all things veterinary > Cutting-edge clinical information > Breaking news The deﬁnitive source for veterinarians > Practice-building insights and team members for veterinary news, > Team-training tools medicine, business, hospital design, events, and > Community community. And the portal site for dvm360, > The CVC in Kansas City, Washington D.C., Veterinary Medicine, Veterinary Economics, and and San Diego Firstline.

Firstline (Print ISSN: 1095-0613, Digital ISSN: 2150-6574) is published monthly by Advanstar Communications Inc., 131 W. First St., Duluth, MN 55802-2065. Subscription rates: one year $21.00, two years $36.50 in the United States & Possessions; $31.50 for one year, $57.00 for two years in Canada and Mexico; all other countries $42.00 for one year, $78.00 for two years. Single copies (prepaid only) $10.00 in the United States; $14.00 in Canada, Mexico, and $16.00 in all other countries. Periodicals Postage Paid at Duluth, MN and additional mailing offices. POSTMASTER: Please send address changes to Firstline, P.O. Box 6086, Duluth, MN 55806-6086. Canadian G.S.T. number: R-124213133RT001. PUBLICATIONS MAIL AGREEMENT NO. 40612608. Return Undeliverable Canadian Addresses to: IMEX Global Solutions, P. O. Box 25542, London, ON N6C 6B2, CANADA. Printed in the U.S.A. Copyright 2013 Advanstar Communications Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording, or information storage and retrieval without permission in writing from the publisher. Authorization to photocopy items for internal/educational or personal use, or the internal/educational or personal use of specific clients is granted by Advanstar Communications Inc. for libraries and other users registered with the Copyright Clearance Center, 222 Rosewood Dr. Danvers, MA 01923, 978-750-8400 fax 978-646-8700 or visit http://www.copyright.com online. For uses beyond those listed above, please direct your written request to Permission Dept. fax 440-756-5255 or email: [email protected]. Advanstar Communications Inc. provides certain customer contact data (such as customers’ name, addresses, phone numbers, and e-mail addresses) to third parties who wish to promote relevant products, services, and other opportunities that may be of interest to you. If you do not want Advanstar Communications Inc. to make your contact information available to third parties for marketing purposes, simply call toll-free 866-529-2922 between the hours of 7:30 a.m. and 5 p.m. CST and a customer service representative will assist you in removing your name from Advanstar’s lists. Outside the U.S., please phone 218-740-6477. Firstline does not verify any claims or other information appearing in any of the advertisements contained in the publication and cannot take responsibility for any losses or other damages incurred by readers in reliance on such content. Firstline cannot be held responsible for the safekeeping or return of unsolicited articles, manuscripts, photographs, illustrations, or other materials. Address correspondence to Firstline, 8033 Flint, Lenexa, KS 66214; (913) 871-3800; e-mail fi[email protected]. To subscribe, call toll-free 888-527-7008. Outside the U.S. call 218-740-6477.

dvm360.com | Firstline | J u ne 2013 | 39

magentablackcyanyellow ES259788_fl0613_039_CL.pgs 05.30.2013 21:00 ADV By the numbers

Kids smile more than 400times a day.

dults, on the other hand, fash their grins fewer than 20 times a day. While researchers in Swe- denA have shown smiles may be contagious, they’re not the only thing that spreads around your practice. Scan the QR code, right, with your mobile device to watch a video of Dr. Ernie Ward explaining how to stop the spread of gossip at your practice. Or check him out at dvm360.com/gossipspreads.

40 | June 2013 | Firstline | dvm360.com Getty imaGe/paul kline

magentablackcyanyellow ES257312_fl0613_040.pgs 05.29.2013 01:52 ADV for iPad Touching Medicine Revolutionize the way you treat your patients and educate their owners.

Monthy Articles | dvm360 toolkit | Client Education | Videos | Audio

Download the dvm360 app for iPad — FREE! www.dvm360.com/iPadApp

magentablackcyanyellow ES262694_FL0613_CV3_FP.pgs 06.01.2013 04:29 ADV Clear it up Anti-fungal,

Anti-inﬂammatory,

Anti-bacterial.

Anti-complicated.

TRESADERM is for topical use only in dogs and cats. On rare occasions, application of the product may result in erythema or discomfort in the treated area. Discomfort in the treated area can last from 24 hours to 48 hours.

magentablackcyanyellow ES262708_FL0613_CV4_FP.pgs 06.01.2013 04:29 ADV