The Wagging Tail

The Banfield Applied Research and Knowledge (BARK) team has compiled a heap of data about national, regional, state and age-based prevalence of fleas and ticks, as well as factors associated with flea and tick infestation in dogs and cats. These findings have been shared with other members of the veterinary community, industry and hospital teams, but we’d also like to share them with you!

From noon to 1 p.m. on Tuesday, June 8th, the BARK team will present the first in the “BARK & Bite” series in Hannah’s Place at our World Headquarters, with exclusive research scoops (pun intended) and specific information on prevalence in Oregon and Washington, as well as prevention.  Plus, all attendees will receive one FREE tube of FirstShield for your Pet! 

If you have any questions about the BARK & Bite, or about any of the BARK team’s other research, please e-mail BARK@banfield.net.

Date: Tuesday, June 8th

Time: noon – 1:00 (bring your lunch)

Where: Hannah’s Place at the Banfield World Headquarters at 8000 NE Tillamook St., Portland, Ore. 97213

Banfield’s internal research team just completed their latest research effort, which revolved around parasites. We focused primarily on fleas and ticks, but also pulled data on the prevalence and distribution of other parasites as well. Most information confirmed what we already know, for example, that heartworm and fleas are more widespread in the southeastern states or that endoparasites are most common in the spring. Some of the findings were unexpected, namely the difference in prevalence of fleas and tapeworms in cats.

We found that the prevalence of tapeworms in cats is greater than the prevalence of fleas. This seems counterintuitive since tapeworms are transmitted when cats ingest fleas. This probably means two things – first, that cats probably remove most of their visible flea burden when they’re grooming (which makes it more difficult to diagnose flea infestation) and second, that flea control in cats is probably lower on most people’s list of priorities than ideal.

This is potentially important, as tapeworms are zoonotic. It’s no cause for alarm, as the prevalence of all the internal parasites (tapeworms, hookworms, whipworms and roundworms) is low, but it reinforces the point that year round flea, tick and worm prevention is extremely important.  It also should remind us of our responsibility as health professionals to discuss zoonotic diseases and how prevention can eliminate disease transmission with our clients.

Have you found the same thing out in practice and how do you approach the subject of regular parasite control? We’d love to get your feedback.

If you’d like to subscribe to the Banfield Applied Research and Knowledge (BARK) quarterly white paper, email us at bark@banfield.net and include SUBSCRIBE in the subject line.

I had the good fortune to attend this year’s Student AVMA meeting in Madison, Wisconsin. I’m always impressed with the enthusiasm, intelligence and motivation of veterinary students. Perhaps I’m biased, but I know of no other group that is as passionate about their chosen profession as veterinarians. The future of our profession is in very good hands.

Today’s veterinary graduates face a growing student debt load, not commensurate with increases in starting salaries. Last year’s veterinary graduates averaged $130,000 in debt. Ouch. Average starting salaries for those entering private practice is about $65,000.  This results in a debt to starting salary ratio of 2:1, far higher than other health professionals. This issue has been referred to as the Elephant in the Room.  What can be done to help tame this beast?

Limiting the growing cost of higher education in today’s economic climate is difficult. However, we can help today’s veterinary students incur less debt, and graduate better prepared to earn a higher income through participating in paid or unpaid hands-on clinical programs while in school.   Does your hospital employ students in the summer?  If not, you might consider this golden resource for your busiest time of the year. 

Banfield hospitals will employ over 550 veterinary students in the student jobs program this year, and host at least 300 externs. An additional 600 veterinary students will be hosted through our partnerships at Western and UNAM Universities, the student ambassador program, and employed part-time veterinary students. These veterinary students will not only earn over $3 million dollars in compensation, but will gain essential skills in client communication, team work, and hands-on technical skills.

Banfield has been able to prove that new graduate veterinarians who have participated in our student programs are significantly more productive in their first year of practice, when compared to new graduates that have not participated in our student programs. This increased productivity translates directly into better patient care for our clients’ Pets and increased compensation for graduates.  Because of these proven benefits, we have developed a rewards program wherein students who participate in our student programs while in school can earn up to an additional $10,000 in first year compensation.

Despite the growing cost of higher education, the decision to enter the veterinary profession is a wise one. In the face of likely the worst recession of our lives, veterinarians continue to be in high demand, according to the following sources. A recent Government Accounting Office (GAO) report found that the DVM workforce shortage will continue to worsen. CareerBuilder.com just listed veterinarians as #5 on the list of 50 jobs that are adding workers. Money Magazine listed veterinarians as one of the top 25 best jobs in America. Veterinarians were given an “A” in benefitting society and scored near the top of all careers in job security, personal satisfaction and future growth. According to the April 2010 issue of Veterinary Practice News, veterinary care is among the leading growth areas in consumer spending, and spending on veterinary care rose by 8.5% from 2008 to 2009.

The Elephant in the room can be tamed, and we have the tools to do it.  The future is bright for the veterinary profession.

For the first time in the history of the veterinary profession, there are more female than male veterinarians.

Almost 80% of new veterinary school graduates are now female.  

Fewer veterinarians are going into large animal practice.  

Fewer veterinarians have practice ownership as a goal.  

Many have speculated on how these changes will affect our profession overall.  I can not speak for all veterinarians, or even all female veterinarians of course.  But I can, as a female veterinarian, give my perspective on some of the issues we as individuals and a profession have before us.

I will start with what I know best, my own present experience, and work backwards to when I first knew I would end up here, though I did not know exactly what this would look like.  Today, I am a female veterinarian in my thirties.  I graduated in 1998.  I am a wife and a mother of two daughters.  I love our profession.  I love my part time job and the family-friendly hours that I work.  I need you to understand that I am as hard-working and dedicated to veterinary medicine as you are.

I am a small animal veterinarian in the city.  I apologize for not being the buyer for the practice on which you are relying for retirement.  I apologize for not taking over the care of the large animal patients you now tend, or being there for the small town whose veterinary needs you have met for all these decades.  I need you to figure out a Plan B. 

I am home with my newborn on maternity leave.  It is my first time away from full time veterinary work since I started my career.  I need to be included in team meetings and continuing education opportunities, and to be kept up to date on cases we treated together, and told about new cases you are seeing. 

I am only a few years into practice and considering starting a family.  I need you to consider flexible schedules or job sharing or part time employment as I look forward to my new life as both a mother and a veterinarian.

I am a veterinary school graduate searching for my first job.  I do not expect you to ignore the possibility that I may decide to procreate at any time, but I do not want to be interrogated about my family plans or asked to make promises that have no bearing on whether I am the best person for the job you have available.  I need you to believe me when I say that I will give your practice my very best if you hire me. 

I am a twelve-year-old girl in your waiting room with my sick friend in my lap.  I want to be like you when I grow up.  I need you to tell me that even though you do not know exactly what that will look like, you do know that it is possible.

I am the future of veterinary medicine.  We are the future of veterinary medicine.  I need you to walk through this new chapter of our profession alongside me.  We will combine our strengths and work through the upcoming challenges, making our profession better than it has ever been.   Even though I do not know exactly what that will look like, I do know that it is possible.

As a veterinarian, you recognize your role in keeping Pets healthy. But, do you recognize the role that you play in the promoting the health of the human members of the family as well? Veterinarians possess knowledge and understanding about disease transmission that, when shared with clients, can help to build strong relationships. Clients respect and trust veterinarians as a highly credible source of information. As professionals, we have a responsibility to share knowledge that will optimize not only the health of the Pet but the health of all family members.

People and their Pets share close living (and sleeping!) spaces. The recent 2009 H1N1 flu outbreak with reports of the virus found in people, dogs and cats demonstrates this closeness. Did you know that over three quarters of the emerging infectious diseases are zoonotic? ⁽¹⁾ However, as a recent survey revealed, most veterinarians in the United States aren’t encouraging client practices that could help to reduce zoonotic disease transmission. ⁽¹⁾ The survey also revealed that veterinarians consider it important to educate clients on zoonotic disease prevention, but only a small percentage initiate the discussion. The Centers for Disease Control and Prevention (CDC) provide on their “Healthy Pets Healthy People” website talking points, called Pet-Scriptions, to help veterinarians communicate strategies for zoonotic disease prevention with clients. Understanding whether there are young children or immunocompromised individuals in the family help veterinarians integrate zoonotic disease risk into their medical decision-making and client recommendations. In your own hospital setting, you can encourage frequent hand-washing and wearing gloves to handle feces and other biologic samples.

To help formalize the concepts into practice, the American Veterinary Medical Association launched the One Health initiative, which strives for an “establishment of closer professional interactions, collaborations, and educational opportunities across the health sciences professions, together with their related disciplines, to improve the health of people, animals, and our environment.” The most effective strategies for infectious disease prevention integrate the systems of medicine, veterinary medicine, and public health.

Veterinarians are essential partners in making One Health a reality. Did you know that it was a veterinary pathologist who linked a mysterious disease outbreak between humans and animals, which was later discovered to be West Nile virus ⁽²⁾! We want our clients and their pets to have long, happy lives together. When we talk about zoonotic disease, we are demonstrating our responsibility as health professionals and building trust with our clients. Sharing this information can strengthen both the client-veterinarian bond and the Pet-family bond!

What are the challenges for veterinarians in taking a bigger role in One Health? What are the opportunities? Please let us know what you think.

Further Reading:

• Childs, J.E. & Gordon, E.R. (2009). Surveillance and control of zoonotic agents prior to disease detection in humans. Mount Sinai Journal of Medicine, 76, 421-428.
• Kuehn, B.M. (2010). Human, animal, ecosystems health all key to curbing emerging infectious diseases. Journal of American Medical Association, 303(2), 117-124.

References:

1. Chomel, B.B. & Marano, N. (2009). Essential veterinary education in emerging infections, modes of introduction of exotic animals, zoonotic diseases, bioterrorism, implications for human and animal health and disease manifestation. Scientific and Technical Review, 28(2), 559-565.
2. Kahn, L.H. (2006). Confronting zoonoses, linking human and veterinary medicine. Emerging Infectious Diseases, 12(4), 556-561.

I work in a practice group that employs many different veterinarians with different backgrounds. I graduated from school in 1998, another veterinarian graduated in 2008 and a relief vet we use is working on becoming board-certified in internal medicine. With each new person we hire, I find that we all get to share a lot of information. We each learn from each other.

I’m likely to have insights on dealing with difficult clients, exam room etiquette, hospital policies, exotic medicine and some of those unusual cases that I’ve worked up over the last 10 to 12 years. Brand new graduates are likely to have insights on new technology or new medications. They have recently worked with the leaders in the field and their classroom notes are likely to be a great resource on current protocols. We have a doctor that loves orthopedic surgery. With each new addition to the team I get excited about what new things we might all learn.

I try not to think of it in terms of “How can I learn to tolerate a new associate?” or “How can I learn to get along with the younger generation?” I try to always think “How can we benefit each other? What experiences have I had that I can share and what new ideas and procedures have they seen that they can share?”

When I was a new graduate I found myself frustrated with the “old” policies of the “old” vet that I worked for, so now I actively try not to be that “old” vet. If one of my younger colleagues asks me about carrying a new medicine or trying a new therapy, I always look at that as a way to potentially improve the practice and not as questioning the current practice. By reading lots of journals and attending lots of continuing education meetings, even “old” vets are able to stay current and get as excited by new developments as do the new grads.

Oral disease affects 68% of cats and 78% of dogs over the age of three years. Because it’s a common disease with a big potential impact on the Pet-family bond, the BARK team has spent a lot of time researching periodontal disease over the last year. We’ve examined the prevalence and risk factors for diagnosis as well as learned more about how often Pets are receiving dental prophylaxis and therapy in Banfield hospitals. Risk factors for periodontal disease include increasing age and small breed (Toy Poodle, Yorkshire Terrier, Maltese, Pomeranian, Shetland Sheepdog, Cavalier King Charles Spaniel, Papillion, Standard Poodle, Dachshund, and Havanese). Additionally, we’ve learned that canine periodontal disease is associated with certain cardiovascular diseases (cardiomyopathy and endocarditis).

Despite the fact that strategies for prevention of periodontal disease are fairly straightforward, Pets still suffer from the disease. The most effective strategy is multi-faceted and includes teeth brushing at home, feeding of dental diets or treats, and dental prophylaxis performed by the veterinarian. However, client compliance with brushing is low and we’ve found that there’s a big gap between the number of Pets diagnosed with periodontal disease and those that actually receive dental prophylaxis. That gap can be as large as about 2/3 of all cats or dogs diagnosed with periodontal disease.

Why, despite the prevalence and impact of periodontal disease, are preventive strategies not fully implemented for Pets? Why are the behaviors that people have adopted around their own twice yearly dental care not standard for our Pets? Do Pets (especially cats) hide the pain that they may experience from periodontal disease from us?

As veterinarians do we recommend dental therapy less often than we should? Are there factors like anesthetic risk or cost of therapy that affect your discussion of the diagnosis or treatment with clients? What factors influence your recommendations? What factors affect your clients’ compliance?

We’d love to hear what you think!

Further reading:

• BARK’s White Paper on periodontal disease

Walking into an emotionally charged, stressful situation, especially one you are not prepared for, is not something anyone would volunteer to do, even if your communication-style is up there with the likes of Dr. Phil. And yet, that is exactly what vets deal with when they close the exam room door and are face-to-face with an upset, sometimes, angry client. Being a vet means dealing with the pain of others who love their Pet; it goes with the territory. Day after day, clients enter your practice feeling distraught because their companion and friend is suffering, or dying, or both. Their worry and sadness causes pain, and unfortunately, when humans hurt, they don’t always handle their feelings in the most productive way. We tend to lash out, and it’s usually at the one who deserves it the least. In this case, you.

When someone is addressing you with an aggressive tone, it’s difficult to keep your emotions contained and not fire back in some way. In fact, after a full day of seeing patients and trying to fit it all in, it’s easy, almost understandable, to retort with a knee-jerk response that stings in return which we know is never a good idea. At best, a tête-à -tête with a valued client will leave you feeling bad and, at worst, cause you to lose business.

Veterinary schools offer helpful information on how to deal with worried, grieving clients, but once you’re out and running a practice of your own, you may find yourself focusing more and more on the physical needs of your patients and less and less on the emotional needs of your clients.

It’s natural to feel a bit angry when someone is hostile towards you, but what you do with your anger can make all the difference in the outcome of your interaction. Below are two simple, but effective strategies that can help you bridge the communication gap between you and your client.

Pause for the cause

It’s been my experience that by merely slowing down the speed of a verbal exchange, I can actually raise the odds of a more positive outcome. Just pausing momentarily before I allow myself to respond allows my brain to engage, evaluate and better diagnose the problem. Solving problems doesn’t happen when our emotions are in the driver’s seat. Allow yourself a moment to process. Create some space to regroup, rethink and redirect.

Sometimes, I find it helpful to actually remove myself, physically, from a high-stress situation. People are accustomed to medical practitioners coming in and out of examining rooms, so excuse yourself from the room, if need be, take a few deep breathes then go back in with your emotions contained and your head on straight. Creating a self-imposed “time out” is an effective tool to gaining composure. Increasing your awareness of your emotional thermostat during stressful times will allow you to adjust your internal temperature up or down accordingly and better prepare you to handle any situation.

Objects are larger then they appear

Before you walk into your next appointment, take a moment to remember that the people who come through your door (unless it’s for a routine exam) are there because they are concerned about a potential health problem with their family member. And, this may not be the only issue they are dealing with. Job loss, family problems and financial struggles might be swirling around in their head too.

When clients are agitated, try to look past what is being presented and respond back with a softer demeanor. When you take a bigger picture perspective and strive to understand your clients better, you inevitably neutralize the tone, and consequently, the outcome of the exchange.

(Print and post a copy of these concepts and use the information to discuss “How to Handle High-Stress Situations” at your next staff meeting.)

Do veterinarians practice evidence-based veterinary medicine? In the human medical profession, evidence-based medicine (EBM) has become established and clinicians have accessible EBM tools to support clinical decision-making.

What exactly does EBM mean to a practitioner? EBM is the conscientious and implicit effort to apply current best research evidence to medical decision-making. EBM should enhance clinical expertise in concert with consideration of patient needs and client circumstances.

For veterinarians, EBM is gaining momentum, but it is not widely employed in clinical practice. In addition to published research evidence, veterinarians still rely heavily upon textbooks, anecdotes, faculty expertise, and peer consultations. Depending on the clinical question, these may be the only resources to utilize, but they are often inadequate, outdated, and unproductive. Why has veterinary medicine been slower to adopt the practice of EBM? Is it because there is less rigorous, controlled research conducted and published in the peer-reviewed literature? These challenges create a gap between new knowledge and the practice of EBM in veterinary medicine.

How can the veterinary profession close the knowledge-to-practice gap? The gap represents a barrier to high quality care for individual patients. Where can veterinarians go to get evidence-based, synthesized information? Who teaches veterinarians how to incorporate it into clinical settings? The US Preventative Services Task Force (USPSTF) is well-known for providing physicians with recommendations and guidelines based on research evidence. According to their website, the USPSTF is “An independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services.”

Could similar guidelines for preventive care and screening be developed for veterinarians? These guidelines would support the most efficacious screening for optimal pet care. The BARK (Banfield Applied Research and Knowledge) team is using Banfield’s large database to generate new knowledge, in addition to critically appraising existing knowledge from a variety of sources, to create preventive care and screening guidelines for the common diseases of middle-aged and senior pets.

Next month, BARK’s Research Medical Advisor Associate, Patrick Shearer, BVMS, PhD, will talk about periodontal disease. Please join us, post your comments, and engage in a discussion about what we know about the disease and how as veterinarians we can promote the highest quality evidence-based dental care for the pets that we see.

• Each month thereafter, the BARK team will blog about topics such as:
• EBM and evidence dissemination initiatives in the profession
• Strategies to best apply evidence in clinical settings
• Current and future research initiatives at Banfield

Let us know if you have ideas about questions or topics that are of interest to you, especially in relationship to evidence-based medicine and getting new knowledge to our patients!

Further Reading: Click on the links below for two articles on EBM that recently appeared in the Banfield Journal. The current edition of the Banfield Journal can always be viewed online at www.banfield.net/banfield-journal.

• Banfield Journal May-June 2009
• Banfield Journal July-Aug 2009

It all comes down to this.   The knowledge from four intense years of study, summed up in one terrifying day (seven hours to be exact) of multiple choice examination.  Ready, set, go!

I have wanted to be a veterinarian since I can remember first being asked the question, “What do you want to be when you grow up?” Twenty-something years later, here I am, six months away from graduation; a lifetime of dedication to get here, over $100,000 in debt, and there is one more hurdle to cross before I can finally call myself a doctor — the North American Veterinary Licensing Exam (NAVLE).

This certainly isn’t the first standardized exam that has popped up during my education. College preparation included the ACT and SAT, and vet school admission involved the MCAT and GRE. I have obviously survived them all, so why does the NAVLE seem so intimidating?

For me, the NAVLE is a rite of passage. It is an assessment which marks the transition from student to professional. The usual test anxiety questions pop into my head: “What if I fail? What if I sleep though my alarm? What if I forget my 2 forms of identification?” These all feel normal.  The question that I’ve never dealt with before is: “What will passing this test indicate? Does it mean I am ready to be a doctor?”

It is this question which has inspired me the most to dedicate plenty of time for studying. I see NAVLE preparation not just as a bunch of questions which I would like to answer correctly. I see it more importantly as solidification of the knowledge that I have learned over the past few years, and an opportunity to make sense of and build on that knowledge before I step out into the field to put it to work.

The trick to NAVLE preparation is allowing adequate time for studying, setting realistic goals, and avoiding burnout. I began NAVLE preparation my first year by signing up for the free online Zuku Review question of the day. VetPrep is another internet site that provides practice questions and examination, and I purchased its 6 month preparation course at the beginning of my fourth year. From my past experiences with standardized examinations, I know that my success is not only dependant on how broad my knowledge base is, but also how comfortable I am with the testing format, time constraints, and taking educated guesses. Online practice tests found though Zuku Review, VetPrep and the NBVME site are valuable. Reviewing old class notes and reading board review books has also been helpful. Studying obviously takes time and energy, so I arranged my course schedule to allow for a free block during the month prior to the NAVLE.

As the NAVLE approaches, I find myself comforted by advice from graduates in years past. Study hard, avoid burnout by taking frequent breaks, get plenty of rest and absolutely do not study the night before the exam. Wish me luck!