VETgirl Q4 2022 Beat e-Magazine





04 Feline Stress and Urinary Disease: A Multimodal Approach to Stress Mitigation Addresses Both Cause(s) and Effect(s)

08 Treatment of Canine Parvovirus

14 Summary of the Powerful Minds

Women’s Leadership and Wellness Retreat

16 Why Veterinary Technician Utilization is Important & How We Can Advocate for it

Being this hot has never been so cool Join us August 10-13, 2023 for 20+ CE hours, 2 tracks, 20 top-notch presenters, & 50+ exhibitors Explore. Dream. Discover. VETgirl U 2023 | Scottsdale, AZ

18 Finding Work-Life Balance in Veterinary Medicine

21 27 TECH TIP 28 UPCOMING WEBINARS WHAT’S NEW 29 PROVIDER SPOTLIGHT 20 Approach to the Small Animal Respiratory Emergency





In Lucy’s case, the physical examination, radiographs and urinalysis are normal by the time she is evaluated, leading to a diagnosis, by exclusion, of FIC. While hematuria is generally present in cats with FIC during the time clinical signs are occurring, this manifestation can be intermittent and may be resolved by the time of the examination. Knowing that FIC is a stress-related disease, the next challenge is for the owner and veterinarian to determine the

and use of climbing trees, scratching posts and perches next to windows with views to capture her interest. For Gus, finding ways allow him to “escape” from the new puppy whenever possible is also indicated. LITTER BOX MANAGEMENT is another important factor. Cats will preferentially eliminate in litter boxes free of obstacles, so frequent cleaning is important

Please note the opinions of this article are the expressed opinion of the author and not directly endorsed by VETgirl.


Feline Stress and Urinary Disease: A Multimodal Approach to Stress Mitigation Addresses Both Cause(s) and Effect(s)

potential source of Lucy’s stress. In her case, the presumed cause is boredom. Lucy was accustomed to her owner’s constant presence, and it is likely she is finding her new-found solitude and its accompanying lack of environmental stimulus to be stressful. In Gus’s case, the bladder was very small on physical examination and he urinated a small volume of red tinged

to promote elimination in the litter box. 2 Keeping the litter box in a quiet, low- traffic area will also help keep cats from experiencing anxiety while urinating. Behaviorists advise having a litter box on each floor of the house and maintaining one more litter box than the number of cats in the house. A household with one cat should have at least two litter boxes, a household with two cats should have three litter boxes, and so on.

MICHAEL LAPPIN , DVM, PhD, DACVIM (SAIM) Kenneth W. Smith Professor in Small Animal Clinical Veterinary Medicine Director, Center for Companion Animal Studies College of Veterinary Medicine and Biomedical Sciences, Colorado State University

In this VETgirl feature article sponsored* by Purina, Dr. Michael Lappin reviews “Feline Stress and Urinary Disease.”

urine when palpated. The urinalysis performed on this urine reveals hematuria without pyuria, struvite crystalluria, and a pH of 8 ; radiodense uroliths are not noted on radiographs. Gus is diagnosed with stress associated FIC without current urinary obstruction. Since this patient is male, he has a long, narrow urethra that is vulnerable to blockage. Because he is also overweight and consumes relatively high levels of magnesium and phosphate in his diet, Gus might be predisposed to urinary obstructive disease even before experiencing the recent stress of living with a rambunctious new puppy. However, this ramp- up in stress level likely triggered his normally acidic urine pH to become more alkaline, causing crystallization of the magnesium phosphate molecules which may be associated with urethral inflammation and partial obstruction. Complete urethral obstruction can occur, which is life-threatening. If chronic, non- obstructive disease occurs, struvite urolithiasis may develop. Thus, it is appropriate for veterinarians to check for urinary stones when a cat is brought to the clinic with periuria that might relate to stress in the home environment. STRESS THERAPY: MAKE IT MULTIMODAL A successful stress management program addresses both the source(s) of stress and its physical effects. While medications can certainly play a role in treating stress-related diseases, some of the most effective therapies do not involve drugs. Paying attention to the environment is especially important with urinary disease, and multimodal environmental modification (MEMO) is a vital strategy for reducing feline stress. 1 The key is to implement enrichment and stress-reduction strategies that will make Lucy feel more comfortable in her environment. Lucy’s owner also needs to understand that when she goes to work each day, Lucy needs her own “jobs” to fill the absence. These jobs can revolve around toys that make her work to get food; toys that allow expression of her play and predatory behaviors;

There also is evidence that diffusers that emit synthetic versions of F3 feline facial pheromones may be effective in relieving stress and promoting a sense of well-being. 3 In multi-cat households, pheromones that promote a calming effect can also help reduce inter-cat aggression. Dietary intervention 4 and probiotic supplementation are other cornerstones of managing cats with stress- related conditions. A diverse and healthy gut microbiome is paramount to health, but stress can adversely affect it. Something as simple as a change in housing can adversely alter gut microbiome composition and contribute to stress- related illness in cats. My research group performed the following studies on the effects of probiotics on feline health and the mitigation of stress-related conditions. • Enterococcus faecium SF68, the probiotic in FortiFlora and FortiFlora SA supplements, has immunostimulatory effects and has been shown to reduce those changes in the gut microbiome that occur due to stress. 5 In a placebo-controlled pilot study of 12 cats with chronic feline herpesvirus (reactivation of FHV-1 is a known marker for stress in cats), cats in the probiotic- supplemented group had more stable fecal microbial diversity than did control animals. Although results varied among individual cats, overall results suggest that SF68 lessened morbidity associated with chronic FHV-1 infection in some cats. 5 • Another study demonstrated the efficacy of Bifidobacterium longum BL999, the probiotic in the Calming Care supplement, in reducing signs of stress in cats by presumably affecting the gut-brain Continued on page 6

While the causes of stress in companion animals can vary significantly from species to species, as well as from individual to individual, there is no question that stress can have negative physical effects. Many owners who have boarded their anxious dogs are familiar with the tendency for them to develop acute diarrhea. While cats can also suffer gastrointestinal effects from stress, respiratory complications from the reactivation of feline herpesvirus type-1 (FHV-1) or feline caliciviruses also occur. Feline lower urinary tract disease (FLUTD) is the umbrella term for diseases affecting the lower urinary tract and the most common cause, feline idiopathic cystitis (FIC, also known as feline interstitial cystitis), is believed by most veterinarians to be a stress associated syndrome. FIC may also be associated with development if urolithiasis. One of the unfortunate manifestations of FLUTD is the tendency for affected cats to urinate in places other than their litter boxes (periuria) which can lead to relinquishment by owners--the consequences of stress in cats can clearly be dire. Let’s consider a couple of hypothetical feline patients and how stress affects them: • “Lucy” is a 2-year-old spayed female whose owner adopted her as a kitten when she was working from home, but recently returned to an 8-to-5 office job. Once indulged and played with throughout the day, Lucy is now alone for 9 hours per day. She recently began urinating outside her litter box in the laundry room. • “Gus” is a neutered, overweight, male middle-aged cat living in a household that acquired a new puppy several months ago. Like Lucy, Gus recently began urinating outside his litter box and is also urinating more frequently than in the past and appears to be straining and

uncomfortable when he does so. While these patients have different circumstances and may have different conditions, both are likely to be suffering from stress. In addition, both likely have unhappy owners who are mystified by their cats’ sudden “bad” behaviors. Luckily, Gus’ and Lucy’s owners will have made appointments with you, their veterinarian, before taking any drastic action. THE WORKUP AND THE RESULTS Inappropriate elimination is often—and wrongly—perceived to be a purely a behavioral problem by cat owners. The reasons are typically complex, with emotional and physical factors intertwined. Lucy’s and Gus’ workups should include urinalysis and radiographs to screen for urinary infection and radiodense urinary stones —the former of which is relatively rare, but possible, in cats. Depending on the patient’s age and clinical signs, practitioners may also elect to conduct an ultrasound examination to rule out neoplasia. If screenings are negative for these conditions, a diagnosis of FIC can be presumed.




axis. 6 We used a number of behavioral markers and signs of FHV-1 to evaluate the effects of BL999 in a 12-week study in which cats moved back and forth from group housing to individual cages to induce mild stress. During periods of individual housing, probiotic-supplemented cats demonstrated increased social interactions (reaching out through kennel bars) with their caretakers and were less likely to pace in their cages.6 In addition, probiotic- supplemented cats were significantly less likely to have elevated levels of serum cortisol concentrations and were significantly less likely to be observed sneezing. Dietary changes can also benefit cats with urinary stones. Because the goal in this case is to promote greater urine volume, feeding a cat a canned diet can be helpful. A therapeutic urinary diet can also be a tool for dissolving struvite stones and preventing the recurrence of both struvite and calcium oxalate stones. 7 THE FUTURE OF STRESS MANAGEMENT IN CATS I am confident that in the future we will have more studies to support the use of nutritional therapeutic tools alone or in combination to help veterinarians manage cats suffering from stress-related disease. We’ve only scratched the surface of what we might be able to do with probiotics to affect both the gut and brain. Meanwhile, we continue to learn more about how nutrients such as medium-chain triglycerides and tryptophan can affect behavior in companion animal patients. I’m excited about what the future holds.

References 1.

Westropp JL, Delgado M, Buffington CAT. Chronic Lower Urinary Tract Signs in Cats: Current Understanding of Pathophysiology and Management. Vet Clin North Am Small Anim Pract. 2019 Mar;49(2):187-209. doi: 10.1016/j. cvsm.2018.11.001. PMID: 30736893. 2. Ellis JJ, McGowan RTS, Martin F. Does previous use affect litter box appeal in multi-cat households? Behavioural Processes, 141, 284-290. doi: 10.1016/j. beproc.2017.02.008. 3. Contreras ET, Hodgkins E, Tynes V, Beck A, Olea-Popelka F, Lappin MR. Effect of a Pheromone on Stress-Associated Reactivation of Feline Herpesvirus-1 in Experimentally Inoculated Kittens. J Vet Intern Med. 2018 Jan;32(1):406-417. doi: 10.1111/jvim.14894. Epub 2017 Dec 8. 4. Lappin, M., et al. (2019). “Effect of 2 Urinary Diets on Hematuria in Shelter Cats with Suspected Interstitial Cystitis (Abstract NM14).” J Vet Intern Med 33(5): 2518. 5. Lappin MR, Veir JK, Satyaraj E, et al. Pilot study to evaluate the effect of oral supplementation of Enterococcus faecium SF68 on cats with latent feline herpesvirus 1. J Feline Med Surg 2009;11(8)650-654. 6. Davis H, Franco P, Gagné J, et al. Effect of Bifidobacterium longum 999 supplementation on stress associated findings in cats with feline herpesvirus 1 infection (Abstract). ACVIM Forum 2021 Proceedings. 7. Torres-Henderson C, Bunkers J, Contreras ET, Cross E, Lappin MR. Use of Purina Pro Plan Veterinary Diet UR Urinary St/Ox to Dissolve Struvite Cystoliths. Top Companion Anim Med. 2017 Jun;32(2):49-54. doi: 10.1053/j. tcam.2017.07.007. Epub 2017 Jul 31. PMID: 28992903.


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organ systems. Severe hypokalemia (< 2.5 mEq/L) results in neuromuscular weakness, ataxia, diaphragmatic and respiratory muscle fatigue, gastrointestinal stasis, and cardiac arrhythmias. For patients with severe hypokalemia or with clinical signs due to hypokalemia, potassium chloride (KCl) can be administered at a rate of 0.5 mEq/kg/hr for 1-2 hours. This is commonly referred to ‘Kmax’, the maximum rate at which potassium can be safely administered. Serum potassium should be monitored every 2-4 hours when administering high doses of potassium (KCl). Magnesium is an important cofactor in potassium homeostasis, and supplementation may help restore normal serum potassium levels. The recommended dose for magnesium supplementation is 0.75-1 mEq/kg/day as a CRI, which can be added to the base fluids. There are several published charts with recommendations for potassium supplementation based on the patient’s serum potassium. The author prefers to base potassium supplementation on potassium requirements. Normal potassium requirements are 0.05-0.1 mEq/kg/hr. This rate of supplementation can be considered in animals with a normal potassium. Most dogs with CPV will be at risk for hypokalemia, so supplementation with 0.1-0.25 mEq/kg/hr may be required. As a reminder, 0.5 mEq/kg/hr is considered the maximum rate at which potassium can be administered. KCl or any source of potassium should never be administered as a bolus. GASTROINTESTINAL SUPPORT Vomiting and nausea should be addressed immediately to improve patient comfort and limit ongoing losses. A multimodal approach should be considered to control vomiting. Commonly used anti-emetics are listed below with recommended doses: • Maropitant: 1 mg/kg IV q24hr Maropitant is an effective antiemetic in dogs for a wide range of etiologies, including CPV. In a previous study, maropitant and ondansetron appeared to be equally effective in controlling vomiting and nausea in dogs with CPV (Sullivan 2019). A multimodal approach should be considered to control vomiting/nausea in patients with CPV. Maropitant, ondansetron, and metoclopramide work via different receptors, so a combination of these three drugs may be considered. • Ondansetron: 0.5-1 mg/kg IV q8hr • Metoclopramide: 1-2 mg/kg/day CRI • Dolasetron: 0.6-1 mg/kg IV q24hr ANALGESICS Dogs with CPV may demonstrate moderate to severe visceral pain. Several classes of analgesics may be considered, and a multi-modal approach is recommended. Given the

A combination of fluids, such as an isotonic crystalloids and colloids, can be used and commonly provides benefits of both fluid choices without having to use large volumes/ doses of either. Fluid resuscitation should be stopped when hemodynamic monitoring parameters have normalized. Transition to the maintenance phase should be started at this point. Calculating a maintenance fluid rate includes the following components: 1. Correction of dehydration a. Liters to replace = % dehydration X body weight (kg) b. This volume should be replaced over a period of 12-24 hours 2. Sensible losses (maintenance calculation) a. mL to administer over 24 hours = BW 0.75 x 70 b. Accounts for normal urinary, fecal, and respiratory losses 3. Ongoing losses a. Due to vomiting, diarrhea, PU/PD, third spacing, etc. b. Estimated and replaced every 4-6 hours The sum of the three values obtained above is the final fluid rate. Balanced, isotonic crystalloids may be used as part of the maintenance fluid plan, although iatrogenic hypernatremia can develop in patients not receiving free water. Colloidal support can be considered in cases of refractory hypotension, progressive hypoalbuminemia, and/or in patients with signs of interstitial edema. Fresh frozen plasma doesn’t distribute into the interstitial space like crystalloids, so it treats hypovolemia more efficiently and maintains intravascular volume. In addition, FFP supports COP (albumin), replenishes clotting factors and other important molecules, and protects the endothelial glycocalyx. For more information on colloid and transfusion medicine, please review an appropriate emergency-critical care resource.

Please note the opinions of this article are the expressed opinion of the author and not directly endorsed by VETgirl.


Treatment of Canine Parvovirus

KRISTIN ZERSEN , DVM, DACVECC Colorado State University Veterinary Teaching Hospital

In this VETgirl feature article sponsored* by Elanco, Dr. Kristin Zersen, DACVECC reviews “Treatment of Canine Parvovirus.” Missed the webinar? Check it out HERE !

capillary refill time, weak femoral pulses, cold extremities, and altered mentation. Most CPV patients display moderate to severe abdominal pain, which is most likely due to diffuse enteritis. However, intestinal intussusception should remain a differential diagnosis and abdominal ultrasound should be considered in cases of severe pain. Mentation changes and generalized weakness may be due to a combination of hypoperfusion, hypoglycemia, and/or hypokalemia. Myocardial disease has been reported with neonatal infection and often results in peracute death. Other organs affected by CPV may include the respiratory system, liver, and kidneys. TREATMENT Fluid Therapy Treatment for hypovolemic shock should be initiated immediately with rapid IV resuscitation. The ideal fluid type is a balanced, isotonic crystalloid without additives, like LRS, Normosol-R, or Plasmalyte-A. A fraction of the dog’s blood volume (BV = 90 mL/kg) can be administered as a bolus over 10-20 minutes. Most clinicians start with ¼ of a patient’s blood volume, also called a ¼ shock bolus. The response to this bolus should be assessed using perfusion parameters, lactate, and blood pressure. Additional isotonic crystalloid boluses may be administered if the patient is fluid responsive, meaning the patient’s monitored parameter improved following the administration of the bolus. After one hour, approximately 20% of an administered crystalloid volume is retained within the intravascular space. The vast majority (80%) is either excreted through the urinary system or redistributed to the interstitial space. This movement of fluid into the interstitial space may be desired in dehydrated patients. However, a substantial amount of data indicate that it is detrimental in patients without an interstitial fluid deficit.

BACKGROUND Canine parvovirus (CPV) is a small, non-enveloped DNA virus that replicates in rapidly dividing cells, including the intestinal crypt cells, bone marrow, and myocardiocytes. The two CPVs that have been described are CPV-1 and CPV-2. Dogs infected with CPV-1 are usually asymptomatic. The more virulent strain, CPV-2, has undergone many genetic alterations over the years, which has allowed CPV to be a continuing problem in at-risk populations. The three strains of CPV-2 that have been identified are CPV-2a, CPV-2b, and CPV-2c. CPV-2b and CPV-2c predominate with naturally occurring disease in the United States. Clinical research suggests that disease severity and outcome do not differ between CPV-2b and CPV-2c infection. CPV often infects unvaccinated puppies between 6 weeks and 6 months of age. Breed, genetic background, and the innate immune system are factors that play a role in the individual response to infection. Disease is rarely seen in neonatal puppies because they are protected by maternally derived antibodies for the first 10 days of life. After this, they are at risk for infection. Lack of vaccination poses the greatest threat to puppies exposed to CPV. Other factors known to predispose dogs to CPV include overcrowded and unsanitary conditions, stressful environments, and intestinal parasites. In addition, Rottweilers, Doberman Pinschers, American Pit Bull Terriers, and Labrador Retrievers have been shown to be at increased risk for infection, although the reason for this susceptibility is not known. CLINICAL SIGNS Severe vomiting and hemorrhagic diarrhea may lead to dehydration, hypovolemia, and cardiovascular collapse. Dogs often present with evidence of hypovolemic shock, including tachycardia, pale mucous membranes, prolonged

Electrolytes: Hypoglycemia and Hypokalemia Hypoglycemia can be a severe and life-threatening

complication resulting in altered mentation, weakness, ataxia, and vision loss. If the blood glucose of a symptomatic puppy with CPV is < 60 mg/dl, an IV dextrose bolus should be administered. The recommended dose of 50% dextrose is 0.5 to 1 mL/kg diluted 1:2 with an isotonic crystalloid. Additional dextrose boluses can be administered if necessary. Dextrose should also be added to the base fluids as a CRI during the maintenance fluid stage. Usually, a solution of 2.5-5.0% dextrose is sufficient. If 7.5% or higher is required, a central line should be placed.

Hypokalemia is a common electrolyte disturbance seen in dogs with CPV and can have adverse effects on multiple

Continued on page 6




Please note the opinions of this article are the expressed opinion of the author and not directly endorsed by VETgirl.


Treatment of Canine Parvovirus

B (Oral)

Give dogs the ” happy vaccine experience ” with fast, one-and-done protection

KRISTIN ZERSEN , DVM, DACVECC Colorado State University Veterinary Teaching Hospital

ampicillin-sulbactam (Unasyn™) is frequently used at a dose of 30-50 mg/kg IV q8hr. Alternatively, cefoxitin may be administered at 22 mg/kg IV q8h. NUTRITION The importance of early nutritional support cannot be underestimated in critically ill patients. Early enteral nutrition has been associated with improved clinical outcome and weight gain in dogs with CPV (Mohr 2003). One study found that dogs receiving early enteral nutrition had a more rapid normalization of attitude and appetite as well as a quicker resolution of vomiting and diarrhea. The most practical method to ensure enteral nutrition is by placement of a nasoesophageal (NE) or nasogastric (NG) tube. An added benefit of NG tubes is the ability to intermittently suction gastric contents, which may also help reduce nausea in these patients. Enteral nutrition is preferred as it is the only way to deliver nutrition directly to the enterocytes and promote healing. Enteral nutrition prevents villous atrophy and helps maintain the GI barrier functions. Parenteral nutrition can be considered in situations when enteral nutrition is not tolerated, but it is technically demanding and includes risks of metabolic, catheter, and formulation complications. OTHER TREATMENT CONSIDERATIONS GI parasitic disease is common in puppies with CPV, so a fecal examination should be performed. Alternatively, prophylactic administration of anthelminthics can be considered. N-acetylcysteine (NAC) is an antioxidant used to treat oxidative stress. A recent study looked at the use of NAC in CPV puppies. They had 2 groups – one group received supportive care and one group received supportive care plus NAC at 70mg/kg IV once daily for 5 days. In this study, the NAC treated group had lower markers of oxidative stress and improved leukocyte counts as compared to the group not treated with NAC, so they concluded that NAC could be considered in CPV puppies.

debilitated nature of most CPV cases, reversible opioids are preferred as titratable CRIs. For cases of mild visceral pain, the partial mu-receptor opioid agonist, buprenorphine, may be considered. Lidocaine can be administered as an IV CRI to enhance visceral analgesia. NMDA receptor antagonists, such as ketamine, help reverse wind-up pain and an exaggerated central response to painful stimuli. The use of a multimodal approach enhances overall analgesia and allows for a relatively low dose of each drug to be used, mitigating the likelihood of unwanted side effects. Due to a compromised gastrointestinal tract and concerns regarding hypovolemia, nonsteroidal anti-inflammatory drugs are contraindicated in the treatment of CPV. Likewise, 2-adrenergic agonists should be used with caution due to their adverse cardiovascular effects. Potential analgesics and doses are listed below: • Fentanyl: bolus 2-4 mcg/kg IV; CRI 2-5 mcg/kg/hr IV • Hydromorphone: 0.05-0.1 mg/kg IV q6hrs; CRI 0.005-0.04 mg/kg/hr IV • Methadone: 0.1-0.5 mg/kg IV q4-6hrs • Buprenorphine: 0.01-0.02 mg/kg IV q6-8hrs • Lidocaine (2%): bolus prior to CRI 0.25-0.5 mg/kg IV; CRI 10-30 mcg/kg/min IV • Ketamine: bolus 0.25-0.5 mg/kg IV; CRI 2-10 mcg/kg/min IV ANTIBIOTICS Intravenous antibiotics are only indicated in leukopenic puppies with CPV; if the puppy has a normal WBC count, antibiotics are not indicated. The author recommends performing a WBC count daily to determine if antibiotics should be prescribed. It is recommended to use the narrowest antimicrobial spectrum and shortest treatment duration possible. Single agent antibiotic options include extended spectrum beta lactams and second-generation cephalosporins. In the author’s hospital, single-agent



Always read, understand and follow the label and use directions.

TruCan, Elanco and the diagonal bar logo are trademarks of Elanco or its affiliates. © 2022 Elanco or its affiliates. PM-US-22-1077

Continued on page 13



Oral recuperation fluids (ORF) are generally used to promote enterocyte health, maintain hydration, and stimulate appetite. A study evaluating the use of an ORF in puppies with CPV had promising results. This study showed that the group of CPV puppies that were given the ORF had a more rapid return to voluntary food intake as compared to the group not given the ORF (1.5 vs 4.25 days). In addition, the ORF group had greater caloric intake at 24 hours as compared to the group not given ORF (100% vs 19%). The authors of the study concluded that the CPV dogs voluntarily consumed the ORF and that consumption was associated with a more rapid return of voluntary appetite and improved caloric intake. Fecal transplants allow for modification of the intestinal bacterial microbiota, and their use has shown promise as a supplemental treatment in a variety of GI diseases. In one study of dogs with CPV, fecal transplantation was associated with faster resolution of diarrhea. The process of transplantation involves collection of feces from a healthy dog and diluting the fecal sample in saline. A red rubber catheter is inserted through the anus and into the rectum, where the diluted feces are deposited. Sedation is usually not required. Immunotherapy has been advocated to lessen the severity of CPV-related disease; however, it has not been found to significantly influence clinical recovery or survival. No definitive benefit has been identified following the administration of antiviral drugs or recombinant granulocyte colony-stimulating factor. A more recent study found that administration of filgrastim, a recombinant methionyl human granulocyte colony stimulating factor, to dogs with hemorrhagic gastroenteritis and leukopenia, resulted in resolution of the leukopenia within 48 hours, and all dogs recovered. This study was not specific to dogs with CPV and there was no control group in this study. PROGNOSIS The prognosis for canine parvovirus infection is fair to good with treatment, with recent reports of 80-90% survival with both outpatient and in-hospital treatment. Resources: Acciacca R, Sullivan LA, Webb T, Johnson V, Dow SW. Clinical evaluation of hyperimmune plasma for treatment of dogs with naturally occurring parvoviral enteritis. J Vet Emerg Crit Care. 2020;30(5):525-533.

Goddard A, Leisewitz AL. Canine Parvovirus. Vet Clin Small Anim. 2010; 40(6):1041-1053.

Hayes G, Benedicenti L, Mathews K. Retrospective cohort study on the incidence of acute kidney injury and death following hydroxyethyl starch (HES 10% 250/0.5/5:1) administration in dogs (2007-2010). J Vet Emerg Crit Care. 2016;26(1): 35-40. Kalli I, Leontides LS, Mylonakis ME, et al. Factors affecting the occurrence, duration of hospitalization and final outcome in canine parvovirus infection. Res Vet Sci. 2010;89(2):174-178 McClure V, van Schnoor M, Thompson PN, et al. Evaluation of the use of serum C-reactive protein concentration to predict outcome in puppies infected with canine parvovirus. J Am Vet Med Assoc. 2013;243(3):361-366. Mohr AJ, Leisewitz AL, Jacobson LS, Steiner JM, Ruaux CG, Williams DA. Effect of early enteral nutrition on intestinal permeability, intestinal protein loss, and outcome in dogs with severe parvoviral enteritis. J Vet Intern Med. 2003;17(6):791-798.

Endless education PAW-sibilities

Pereira GQ, Gomes LA, Santos IS, et al. Fecal microbiota transplantation in puppies with canine parvovirus infection. J Vet Intern Med. 2018;32(2):707-711.

Proksch AL, Unterer S, Speck S, Truyen U, Hartmann K. Influence of clinical and laboratory variables on faecal antigen ELISA results in dogs with canine parvovirus infection. Vet J. 2015;204(3):304-8. Punia S, Kumar T, Agnihotri D, Sharma M. A study on effect of filgrastim in severe leukopenia associated with hemorrhagic gastroenteritis in dogs. J Pharm Innov. 2021;10(11): 868-870. Sullivan LA, Lenberg JP, Boscan P, Hackett TB, Twedt DC. Assessing the efficacy of maropitant versus ondansetron in the treatment of dogs with parvoviral enteritis. J Am Anim Hosp Assoc. 2018;54(6):338-343. Tenne R, Sullivan L, Contreras ET, et al. Palatability and clinical effects of an oral recuperation fluid during the recovery of dogs with suspected parvoviral enteritis. Top Companion Anim Med. 2016;31(2):68-72.

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Decaro N, Buonavoglia C. Canine parvovirus- a review of epidemiological and diagnostics aspects, with emphasis on type 2c. Vet Microbiol. 2012;155(1): 1-12.

Gaykwad C, Garkhal J, Chethan GE, et al. Amelioration of oxidative stress using N-acetylcysteine in canine parvoviral enteritis. J Vet Pharmacol Ther. 2018;41(1):68-75.




very little to do with competence; and our worth doesn’t need to be proven because we are worthy and whole, just as we are. Once we become aware of these stories – particularly those propelled by the automatic negative thoughts that rule by default -- we can counter-balance them with neutral-to- positive thoughts that restore our focus, enthusiasm and energy.

a particularly busy time in clinic, we may need to consider aftercare (leveraging social support and amplifying restoration behaviors) or even professional care. Reaching outside our professional networks to secure the support, care, and expertise of others can shift our perspective, jump start new


Summary of the Powerful Minds Women’s Leadership Retreat

self-regulation routines, and provide us with the support we need to restore a sense of balance and well-being. Maximizing alignment. Aligning everyday tasks, pop-up projects, and the wellspring of requests with our core values helps us to manage demands with integrity. Integrity is both grounding and energizing, crystallizing activities and relationships that are “mission critical” while also anchoring us in situations of moral distress. Asking a few critical

Engaging in self-regulation and recovery. Learning to implement the power of pause (taking deep breaths, and finding moments of stillness and quiet throughout the day) can help our nervous systems regulate more effectively. When we pause, we also gain clarity with how we need to use our gas pedal (focus and energy) and our brakes (soothing and calming) on

JUSTINE LEE, DVM, DACVECC, DABT Co-Founder / Medical Director, VETgirl

• Be intentional and add it to your schedule to take care of yourself • Set boundaries on emails • You don’t have to solve every problem • Slow down, fill your cup, and keep filling it with things that light your spark Pending future sponsorship, we hope to continue this women’s leadership retreat for several more years. Because it’s so important that we pass these important lessons on to our colleagues – male or female – as we lift up our field of fellow veterinary professionals. Here, Jeannine Moga’s own thoughts and summary of what she discussed at our Powerful Minds Conference on translating Wellbeing into leadership.

On November 18-20, 2022, the VETgirl team hosted its inaugural Powerful Minds Women’s Leadership and Wellness Retreat, presented by Royal Canin. This by-invitation- only event was designed to connect 50 prominent women veterinary leaders in Tucson, Arizona, thanks to the generous sponsorship of Royal Canin, AcharaVet, Banfield, Ceva, Boehringer Ingelheim, and PetDx. Speakers included Dr. Rebecca Heiss, PhD and Jeannine Moga, MA, MSW, LCSW, while I helped moderate the Q:A panels. The goal of this women’s leadership retreat? To spark new ideas and teach attendees techniques that foster leadership development while leaving attendees with a refreshed outlook on how to better balance our busy lives in veterinary medicine. Attendees had the opportunity to “pass the torch” and nominate the next generation of women leaders. Personally, just being able to attend a digital-free conference with some amazing women leaders was my favorite part of the conference. As one attendee stated, being a woman in veterinary leadership is very “lonely,” and to have the camaraderie of others was refreshing.

a day-to-day basis. When we feel extra “leaky” and aren’t sure why, that’s often a signal that a boundary of time, space, relationship or task needs strengthening. What if self-care loses its impact? When we are experiencing periods of acute stress, such as when we are pushing project work to meet a deadline or are powering through

questions, such as “What am I unwilling to give up?” and “What tenets do I live by, even when there’s no reward?” enables us to avoid (or minimize) anything that might dilute our sense of purpose. Ultimately, grounded leaders prioritize values over expectations.

By Jeannine Moga, MA, MSW, LCSW

TRANSLATING WELLBEING INTO LEADERSHIP Grounded leadership reflects the idea that how we live is how we lead: if we are feeling unwell, distracted, or overwhelmed, that is likely how we will “show up” to the people around us. Being grounded, or rooting ourselves is the relationships, activities, and values that make us feel like whole and healthy human beings, is what makes learning, growth and leadership possible. And we can grow deep roots by intentionally leveraging these wellbeing strategies: CULTIVATING AWARENESS. The stories we tell ourselves matter! Sometimes we get caught in what are often called ‘collapsed distinctions’: like the idea that I can’t be of service unless I am sacrificing myself, that competence equals confidence, or that I must always hustle to prove my worth in order to be worthy. But those collapsed distinctions rarely reflect an accurate picture of what it means to be in a service profession. On the contrary, self-sacrifice often impairs our ability to serve others from a healthy place; confidence has

WHAT ELSE DID I LEARN? • Focus on one thing • Schedule in a break • Only handle it once (OHIO) • Have a shorter to do list • Practice 1 minute meditation

• Reconnect with people outside of the veterinary world • Don’t solve other people’s problems - that’s not your role • Start a gratitude journal • Focus on being refreshed and energized • Be intentional. Pause. Reset. • Be hopeful • It’s lonely to be a woman in leadership. Find your tribe, brag buddy and accountability partner • There is this community out there... Reach out




positive, and the second is assuming best intentions. The lack of utilization is not usually anything personal. It is truly a lack of understanding of what a technician has been trained to do and what they legally can do. The lack of understanding means the conversation needs to start with education. One of the biggest tools available to any technician having this conversation is the State Veterinary Practice Act, especially if it defines a scope of practice for veterinary technicians. Unfortunately, as mentioned before, very few of them do. That is where the American Association of Veterinary State Boards (AAVSB) stepped in to help. They have put together Model Regulations - Scope of Practice for Veterinary Technicians and Technologists . This document can be used in states that do not have a Scope of Practice of their own in place. Technicians can also use their technician program course catalog, course syllabi, and course outlines to show leadership what it is that they were trained to do. The next step is to determine the practice’s current utilization. This is normally very eye-opening for practice leadership because if asked to estimate how they are doing, most often overestimate what their true utilization is. This, again, goes back to a lack of understanding as to what a technician can do. The best way to do this is to list all the medical tasks done in the practice allowed by the state for a technician to perform. Then go through and mark who performs them. Use this to calculate a percentage. Now it is time to create a plan. This step is key, as it is important to suggest a way to tackle the problem. The plan may change as conversations move forward, but at least there is a starting place. Important keys in plan creation include: • Stay within what technicians can legally do based on State Veterinary Practice Act. • Start with baby steps – don’t try to take on the world with the first go of it. Trust takes time to build, so start with a task or two at a time. • Have the technicians write the protocols for the tasks they want to take over. This will help show leadership that they have the knowledge. • Make sure the plan includes an evaluation period, feedback, and re-training if needed. The veterinary technician shortage will not be solved with utilization alone, but this is a big part of the solution and benefits everyone. It is crucial that veterinary technicians take the reins and advocate for their utilization using all the resources available to them.

WHO BENEFITS It is a common misconception that utilizing veterinary technicians to their full potential only benefits veterinary technicians when in actuality, everyone in the practice benefits from utilization. Here are just a few of the benefits that we see for all stakeholders: • Technicians – Fully utilized technicians are more satisfied with their jobs, less likely to play into toxic behaviors, more likely to stay in their position, and more likely to stay in the field. • Veterinarians – If a technician is not fully utilized, the veterinarians aren’t likely utilized appropriately either. When both positions are appropriately utilized (per the State Veterinary Practice Act), you will have veterinarians that are able to see more patients that really need them, focus extra time on medical records and other tasks that likely keep them past the official end of their day, have a better work-life balance, and contribute to a more positive practice culture. • Practice owners – Practice owners will see two big benefits, more revenue, and a happier team. This is not anecdotal, but there is data to back it up. An AVMA Economic Study found that the typical veterinarian practice’s gross income increased by $93,311 for each additional credentialed veterinarian technician per veterinarian in the practice 7 . • This study showed positive relationships between gross practice revenue and the number of credentialed veterinary technicians, as did a study done by the Ontario Veterinary Medical Association 8 (OVMA), Canada’s largest veterinary association. • Patient – Our patients will benefit from a better quality of medicine and care. They can be seen more quickly and have a dedicated professional keeping an eye on them. • Client – Utilizing vets to see the patients that really need them and putting the technician tasks back on those that should be doing them will open the vet’s schedule up so they can see more patients. Fully utilized technicians should also be seeing “Technician Appointments” for those things that do not require a veterinarian to be directly involved. This means it will be easier for clients to get their animals in to be seen. • Practice manager – What practice manager would not benefit from fewer client complaints, a practice owner making more money, vets who have a better work-life balance, techs that are happy and staying put, and an all- around better culture? ACTION It is essential that technicians advocate for themselves when it comes to better utilization, but many don’t know where to start. This process needs to start with a conversation with practice leadership. It is imperative to think about a couple of things going into this conversation. The first is staying


Why Veterinary Technician Utilization is Important & How We Can Advocate for it

AMY JOHNSON , BS, LVT, RLATG, CVJ Manager of Content Development, VETgirl

In this VETgirl webinar “ How Veterinary Technicians Can Advocate for their Utilization ”, Amy Johnson, BS, LVT, RLATG, CVJ, VETgirl Manager of Content Development, discusses why veterinary technician utilization is important and how we can advocate for it! Missed the webinar? Check it out HERE !

Veterinary technician utilization has been a big topic in the veterinary industry over the last few years and is likely a part of the solution to the veterinary technician shortage. Utilization has become a big enough issue that the American Veterinary Medical Association (AVMA) has taken note and formed a task force to look into the problem and now has a committee to work on utilization. I believe it is essential for everyone in the industry to understand what an important issue this is for absolutely everyone in veterinary practice and beyond. THE TRUTH IN DATA We know utilization is one of the reasons technicians either leave a job or leave the industry altogether. Per Phillip Russo, the Executive director of the National Association of Veterinary Technicians in America (NAVTA), the most recent NAVTA Demographic Study (data to be released soon) found that in 2022, nearly 20% of respondents said they do not feel utilized to their fullest potential at their workplace; 41% stated they did feel utilized but not to their fullest potential while the other 40% said they do feel fully utilized. These numbers are better than what was found in the 2016 Demographic Survey but show we still have room for growth. The top 3 barriers given by the survey participants to better utilization were: • Lack of trust/confidence by the DVM in the Veterinary Technician skillset • Training uncredentialed staff to do veterinary technician tasks • Not allowing Veterinary technicians to handle tasks that they are licensed to perform, control issues on the part of the veterinarian

The other important statistic to look at is that 1 in every 5 technicians that answered the survey said nothing is being done to attempt to improve veterinary utilization. Another issue that needs highlighting here as a barrier to utilization is the lack of consistent (or any) scope of practice for veterinary technicians. According to a report by James Penrod with the American Association of Veterinary State Boards (AAVSB) at the Veterinary Hospital Managers (VHMA) 2022 Conference: • 39 states currently regulate veterinary technicians • 2 states are working on legislation that passed in 2022 that will go into effect in 2023 • 4 states are in the process of trying to pass legislation to regulate technicians But the following numbers reported by Ashli Selke, president of the NAVTA executive board, at the same conference put a light on the problem: • 31 states have nothing in their State Practice Act that defines Scope of Practice for Veterinary Technicians • 10 states have very little Scope of Practice for veterinary technicians in their State Practice Act This creates a lot of ambiguity, which can be a big barrier. Veterinarians, practice owners, and practice managers may be hesitant to let technicians practice at their full potential because they don’t know what is legal and what is not.






complicated cases for others to potentially take over when you’re not there the next day.

EXCELLENT ORGANIZATIONAL SKILLS You’ll need to rely on your organizational skills to create and maintain your own schedule and to keep track of all the clinics and hospitals that you’ll be working at. You’ll also be in charge of keeping track of billing and payments, as well as your expenses and mileage for tax purposes. Good time management skills will also be important so that you can get all your records done before the end of your shift as you may not be there the next day and so that others can follow up on any cases that need it. RELIABILITY Relief veterinary medicine really depends on your reliability to work the shifts you’ve signed up for. Oftentimes, you may be the only veterinarian at a practice that day and as you are already the back up veterinarian, if you get ill or have an emergency arise, there is often no back up for you and that would leave a clinic/hospital in the lurch. Having kids makes this a little trickier for me as I often don’t have backup care if one of the kids gets sick. Luckily, in the rare instance that has happened, I’ve had very understanding clinics. PERSONABILITY AND COMMUNICATION SKILLS Since you’ll be adapting to many different personnel and clientele, it’s important to be personable and have excellent communication skills. Being asked back to work at a clinic relies on a good reputation that you have with the staff and with the clients. You’ll also need to be able to communicate

Finding Work-Life Balance in Veterinary Medicine

Although relief veterinary medicine can be very rewarding and flexible, it may not be right for everyone. Possessing skills like adaptability, personability, good communication and organizational skills, reliability and having a good foundation of knowledge are paramount. However, it can help you achieve the work-life balance you’ve been looking for in a challenging profession.

FELICIAN LEUNG, DVM Communications Coordinator, VETgirl

and I’m my own boss. And right now, with the shortage of veterinarians, relief veterinarians are in high demand. They fill open shifts at veterinary clinics when vets need time off or temporary positions that are waiting to be filled. WHAT DOES IT TAKE TO BE A SUCCESSFUL RELIEF VETERINARIAN? ADAPTABILITY Since you’ll be going to different clinics, you’ll have to be able to adapt to different protocols and different equipment. Each clinic will have different pharmacy stock, different hospital setups and different personnel as well as clientele. If you’re a person that’s used to routine, things can vary widely since you’re not at the same clinic or hospital regularly and you’ll have to adapt readily. FLEXIBILITY With relief veterinary medicine, you need to be flexible with your schedule as there is no guarantee of your paycheck. Work may be seasonal depending on when vets will need to take time off for personal time or for vacation. You’ll have to plan in advance and I usually book my schedule 2-3 months ahead of time. With the shortage of veterinarians currently, I have fortunately not had trouble filling my schedule. A GOOD FOUNDATIONAL BASE As a relief veterinarian, you’ll want to be confident in your medicine and/or surgical skills. If you’re a new grad, you often won’t have the luxury of mentorship. Sometimes you’ll be working solo in small private practices so there won’t be other vets to consult on a difficult case and you’ll be expected to work autonomously to get through your shift. Sometimes this means bringing your own resources like reference books and apps and maybe even your own equipment if you’re used to having certain things.

Being a working mother of two children, 6 and under, and having a husband with a demanding and inflexible career made it hard for me to be an associate when I needed to be there to open and close and also be present on most weekends. Since my husband works long hours as an orthopedic surgeon and is occasionally on call on the weekends, I’m responsible for the majority of the drop offs and pickups for my kids at school. I became a relief veterinarian seven years ago when I was pregnant with my first child because we were moving for only 1 year to North Carolina. My husband needed to do a year long fellowship and I didn’t think that anyone would hire me for just one year as an associate. I started with vaccine clinics until I became established and started getting more private and corporate practices asking for my help. Now, seven years later, I’m my own boss and have an LLC for my relief business and a group of practices that I do regular relief for and I couldn’t be happier. I’ve found flexibility in determining my own schedule, not just the days I work, but the hours I work also. I can be more present in my kids’ lives and I even have time for myself each week. I’ve found a renewed interest in veterinary medicine as I was starting to experience burnout after being in the profession for almost 20 years now. I don’t get dragged down by office politics, toxic employees, or demanding long-term clients. In exchange, I pay my own taxes and all of my licenses, my liability insurance and worker’s compensation coverage, professional memberships, and expenses for my continuing education. I am fortunate that I can get coverage for a big expense, medical insurance, through my husband’s work. I needed to hire a CPA to help me pay estimated taxes quarterly and to help me find the best deductions for my work expenses. The nice thing about being a relief veterinarian though, you can charge enough to make up for all of that. I’ve been able to charge more for my services as an independent contractor and I make more than I ever did as an associate



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