But I did not arrive at this finding lightly…

Since beginning the role as the Professional Services Veterinarian at a plant-based pet food startup, I have gained several certifications in animal nutrition, with plans to pursue my Masters in Animal Nutrition. I have worked tirelessly to compile the evidence for plant-based feeding in dogs, have spoken to leading experts in the field, and have come to see the benefits of a plant-based diet for longevity and symptom relief. 

Through my work, my passion for education has extended past pet parents to include veterinarians as well. As a profession, we are all taught to be open-minded (as science is ever-evolving) and to think critically about the evidence presented. Yet, many of us will shut down when we hear the words “plant-based.” I was once in your shoes, and I first had to unlearn the myths that surround a plant-based diet for dogs—and there are a lot of myths out there! 

As veterinarians, we need to think critically and adjust our mentality based on the overwhelming weight of evidence on the side of nutritionally sound plant-based diets. It is interesting to think that we will recommend a dog food whose protein source is feathers for food-allergic dogs, yet hesitate to recommend a nutritionally complete and balanced plant-based diet devoid of the most common food allergens for that same dog. 

It is my goal to provide evidence-based data to those who seek it, and to be a reliable source of information to help dogs live longer, healthier and happier lives…and what I have found in my unlearning was that some dogs live longer, healthier and happier lives on a plant-based diet.

So, let’s bust the four most common myths about vegan diets for dogs:

1. Dogs need meat for protein.

Not exactly…Dogs don’t need to eat meat, but they do need high-quality protein. And you know what’s loaded with protein? Plants and fungi—which dogs can eat because they are scavenging omnivores that evolved alongside humans over tens of thousands of years. During all those years of evolution, dogs have been a man’s (or woman’s) best friend, eating table scraps like bread and potatoes, so it’s no wonder that they have developed gut enzymes that allow them to digest a wide variety of foods; not just meat. That brings me to the next myth…

2. Dogs are carnivores.

From a biological perspective, dogs actually lack most of the metabolic adaptations to a strict diet of animal flesh that is seen in true carnivores, such as cats. Compared to true carnivores, dogs produce more of the enzymes necessary for starch digestion and can easily utilize vitamin A and D from plant sources, just as people do.

The truth is, the digestive system of a dog doesn’t care where the protein comes from—what matters is that the protein is complete, high-quality, bioavailable and highly digestible. In fact, one recent study conducted by Professor Andrew Knight¹ found that “the pooled evidence to date indicates that the healthiest and least hazardous dietary choices for dogs are nutritionally sound vegan diets” when compared to conventional and raw meat diets. 

3. A dog’s health will decline on a vegan diet.

Nope. More and more studies continue to come out proving that vegan food can be healthier for some dogs than conventional diets, and promote longevity for our best friends. Another study which surveyed dog owners² found that dogs who were fed plant-based diets “reported fewer health disorders, specifically with respect to ocular or gastrointestinal and hepatic disorders. Dog longevity was reported to be greater for dogs fed plant-based diets.”

As I mentioned earlier, the most common culprits involved in cutaneous adverse food reactions in dogs are beef, chicken and dairy. I’ve found firsthand that when dogs who are experiencing food allergy symptoms like skin irritation and itching switch over to alternative protein sources, like dried yeast, they experience symptom relief.

Additionally, the study results by Prof. Knight¹ indicate that when looking at specific health issues, the vegan diet-fed dogs were shown to be significantly less likely to fall prey to common disorders, with 36% of vegan-fed dogs suffering from health issues, compared to 49% of processed meat-fed dogs.

4. A plant-based diet is not nutritionally sound.

On its face, this is a myth. Vegan diets for dogs can be nutritionally complete and balanced, they just need to be carefully formulated. Veterinarians have rightfully been very skeptical of alternative diets, including plant-based diets for dogs, because many past studies found that, historically, these were nutritionally deficient. The reason for this was that most people were formulating their own vegan diets and these, of course, were not nutritionally complete and balanced. 

In the last several years, however, there has been an explosion in evidence-based research that supports plant-based food in dogs, and now we have many commercial companies manufacturing these foods on an industrial level, most of which are taking good steps to ensure that products meet a high standard and are nutritionally complete and balanced. 

Plants and fungi are wonderful sources of the essential nutrients dogs need. For example, microalgae is a great source of DHA, an essential fatty acid that dogs need for cognitive health. Flaxseed, soybean oil and sunflower oil provide even higher amounts of omega-3 and omega-6 fatty acids than animal sources such as chicken fat and fish oil. Amino acids, taurine, choline and L-carnitine are also commonly added to most commercial dog foods, whether plant-based or animal-based, to ensure a well-rounded diet. 

A vegan diet for dogs can be balanced and nutritious, help dogs live healthier and longer lives, and be a diet that dogs love. However, this is not to say that all plant-based diets are created equal, and careful evaluation of the diet must always be completed. As with all commercial diets, it’s important to look carefully at the guaranteed analysis, ingredient list and AAFCO nutritional adequacy statement to begin. 

As a veterinarian, I know that nutrition is the cornerstone of health. But as a veterinarian who backs plant-based diets for dogs, I also know that the work I’m doing improves the lives and health of dogs—and in a sustainable and cruelty-free way. +

References:

1. Knight A, Huang E, Rai N, Brown H. (2022) Vegan versus meat-based dog food: Guardian-reported indicators of health. PLoS ONE 17(4): e0265662. https://doi.org/10.1371/journal.pone.0265662
2. Dodd S, Khosa D, et al. (2022) Owner perception of health of North American dogs fed meat- or plant-based diets. Science Direct. https://www.sciencedirect.com/science/article/pii/S0034528822001345?via%3Dihub#ac0005

The post 4 Plant-Based Dog Food Myths Debunked appeared first on PetVet Magazine.

Although the majority of our appointments are for euthanasia, we also offer veterinary hospice care to our concerned pet parents. For years, veterinary hospice was very misunderstood, even within our profession. I would often be asked by veterinarians and technicians, “What is veterinary hospice?” or “Isn’t hospice prolonging the inevitable and making the animal suffer?” But it is quite the opposite.  

What Is Veterinary Hospice?

Hospice is simply a medically supervised service dedicated to providing comfort and quality of life for the pet (and the owners) until euthanasia is elected or natural death occurs.  We manage their symptoms with palliative care, support the family with caregiving and ensure the pet is not suffering.  I am happy to say this type of care is on the rise! 

We are finding an increase in families who wish to keep their pet alive for as long as possible while also maintaining a good quality of life. As a veterinary hospice practitioner, I am able and willing to help extend life as long as pain and anxiety are controlled, but this is always preceded by a lengthy discussion on the progression of the disease process present and a clear “stop point” which we agree is the ending of a good quality of life.  Communication, preparation and more communication is the hallmark of a successful hospice case.  

Many of our clients are referred to us from veterinary specialists—mostly oncologists, cardiologists and internists.  While much of veterinary hospice is ideally done in the home, where the pet is most comfortable, many discussions and treatments should be started at the clinic with the veterinarian that the client has had a long relationship with. We are seeing more families ask their primary care veterinarian for this type of service, and while some veterinarians are hesitant, many are now embracing this type of care. By using the word “hospice” with clients, it redirects their thoughts from curing their pet to caring for them and preparing for death, grieving and healing. 

The Five Ingredients of My Hospice Appointments

First, it is most important to help the family understand the disease process their pet is facing.  Although we cannot predict exactly what will happen in the future, we can use our medical training and experience to give each family facing an end-of-life experience with their pet a possible and probable progression of their pet’s disease process.  As doctors, this is the most important piece of information we have to give them and the most valuable tool families have in the decision-making process.  This step also includes prescribing palliative care medications. I want to ensure the pet is as comfortable and anxiety free as possible. 

Second is helping the family set up their environment so the pet is safe, comfortable and clean. A clinic can ask the family to bring videos of the living space, where the pet eats, sleeps, etc. and then make recommendations to ensure proper care. Some owners are not familiar with products like support harnesses or sticky mats for the ground. You would be surprised how appreciative they are with the simplest recommendation. 

Third is discussing caregiver burden. Managing a terminally ill or aged pet is challenging. It will pull on the emotional and physical budgets of a family, and we all must recognize that.  I often send families to petcaregiverburden.com for more information. 

Fourth is my favorite part, and that is discussing quality of life and where to draw a line in the sand. This is about a 30-minute conversation and one that is so beneficial to the family. This part can often be done via telemedicine. 

Fifth is to discuss natural passing and euthanasia. We must, to the best of our ability, explain the most likely “natural” method of death, if left unattended, and then also discuss the process of euthanasia. This educated approach to the physicality of death is essential to veterinary hospice care. By providing the family with knowledge and expectations, we give them the ability to make an informed decision based on their personal wishes for their pet with the gentle guidance of their veterinarian. 

The Benefits of Veterinary Hospice

Sadly, 50% of pets that are euthanized in a clinic have not seen their veterinarian a year before that appointment.  Hospice can help bridge that gap and provide great comfort to the pet and family. Typically, hospice is done in one appointment lasting about an hour, and a clinic can charge appropriately. There may be a few follow-up appointments which, in many cases, can be done via tele advice (and often by a technician). The families who bring their pet to their veterinarian at least once in the last year of the pet’s life have a 10% higher chance of returning to the clinic after the euthanasia. 

 While offering veterinary hospice may not provide the largest avenue of revenue, the benefits are immeasurable. Clients tend to experience a high level of satisfaction and gratitude for the knowledge and insight offered during these visits. In addition, this experience will lead to positive word-of-mouth referrals, repeat business with other pets from that client and, most importantly, it is what is best for the pet.  

Veterinary hospice is here to stay. When families have a better end-of-life experience with their pets, they heal more quickly from the debilitating emotional loss. They are also able to cope better with their decisions, feel confident in their ability to care for their pets, and more quickly open their homes and hearts to pet ownership again. +

The post There Till the End: The Rising Trend of Veterinary Hospice appeared first on PetVet Magazine.

For one, the trend toward larger corporate veterinary hospitals will continue to put further pressure on smaller independent practices. Increasingly, younger pet owners seek the same conveniences in their veterinary choices as they experience in other aspects of their lives.

Meanwhile, we’re still seeing an arms race for talent. Veterinary practices aren’t just trying to attract and retain clients, they’re trying to attract and retain veterinarians and technicians, too. Those practice owners with business acumen are seeing this and are making changes accordingly; others are running out of time to move their practice into the future.

Here are five major trends that are impacting veterinary facilities and their overall real estate:

1. Ease of access reshapes property needs.

Like many other medical facilities, the veterinary office changed a lot to meet virus-related protocols. There were increases in curbside drop-offs, mobile offices and telehealth appointments, and many pet owners appreciated the ease of access these services provided. 

These trends aren’t going anywhere now that virus mitigation efforts are dwindling. Many pet owners are going to expect the same conveniences, and it will have a real impact on how many veterinary practices think about their parking lots and, in turn, their real estate. 

Will you need to add more parking spaces? Should your parking lot be designed in a way that lends itself to curbside pick-ups and drop-offs? These are real considerations many office owners are thinking about today, and it will have an impact on the industry into the future.

2. Office design gains a greater purpose.

The homey, converted house that has long been a staple in veterinary medicine and other medical practices has seen a significant drop. Once viewed as the standard, these cottage-style facilities no longer meet the needs of today’s veterinarians or their clients. Instead, veterinary real estate owners are looking for spaces that are thoughtfully designed to optimize flow and enable growth.

It’s no secret that the veterinary industry is facing a labor shortage.¹ Vets are quickly burning out while trying to keep up with the increasing number of pets and appointments, which spiked during the pandemic.² To help make their jobs easier, working in an office that is well-laid-out, has the necessary space and allows to efficiently care for clients is crucial. 

This change in design also makes attracting and retaining talent easier since veterinarians and technicians don’t love being forced to work in tight quarters. Giving them larger, cleaner and more modern facilities keeps morale elevated in a profession that is already stressful, and is only becoming more so due to workloads.

This focus on purposeful design is also forward-looking. Working in larger, more open spaces allows your practice to prepare for growth. More pets in homes and more American pet owners working from home will also mean an increase in visits to the veterinarian. 

3. Practices are building from scratch around new trends.

The last few years have seen an increased focus from corporate veterinary owners launching new practices. This has resulted in retrofitting of existing buildings and ground-up construction to house newly created veterinary practices and hospitals.

Well-established corporate veterinary groups are designing new veterinary offices with more purpose, thereby changing the way we think about the veterinary facility. These facilities, with modern amenities and well-intentioned buildouts, are becoming trendsetters in their specific markets. They impact the way other veterinary practices in the region think about hospital design. In fact, many corporate groups were already focused on purposeful renovations and new office buildouts, but the increasing focus on growth through new practice creation has amplified the concentration on design.

4. Relocations and renovations continue (with a twist).

Twenty or 30 years ago, a veterinary practice may have started in a strip mall and stayed at the same location for years. Nowadays, smaller practices are recognizing that these strip-mall storefronts may not fit their business needs, and many are ditching those facilities to expand and better situate themselves for growth.

We’re seeing an increase in these relocations—from shopping centers to freestanding facilities—in order for practices to take advantage of some of the aforementioned benefits. We’re also seeing an increase in renovations to existing veterinary practices.

Given the labor market, these relocations and renovations are also an effort to keep staff. It used to be that practitioners were nervous about losing clients if they moved locations; now, they’re more worried about losing talent to other facilities. 

5. Interest rates are climbing.

You can’t write a real estate story right now without mentioning a jump in interest rates. Rapidly rising inflation is being combatted, in part, with The Federal Reserve elevating interest rates.³ 

The question now is, when will rising rates affect cap rates and the overall value of real estate? Typically, when rates go up, value eventually comes down. We’re already starting to see an increase in the desire to sell as a result. 

So, what does the future look like?

The veterinary real estate space has undergone a lot of change over the last few years, and we will continue to see the impacts into the future.

Here are a few things to watch out for:

We’re going to continue to see larger groups of general practices in those more purposefully built buildings that are seeing an increase in clients (with satellite locations, too).

Expect to see growth in specialty emergency hospital facilities. There is a real sense that many major metro areas in the U.S. lack sufficient specialty emergency veterinary hospitals.

Practices in those old, converted homes are not likely to be able to recruit and retain veterinarians and technicians as well as the more modern facilities.

Similarly, while strip-mall practices may work in certain metro areas, they are not likely to be as successful as other freestanding locations.

Innovation (telemedicine, mobile house calls, etc.) will continue to put pressure on smaller practices. +

References:

1. The Looming Vet Tech Shortage: Yes, It Could Get Worse. (2022, March, 11). AAHA. https://www.aaha.org/publications/newstat/articles/2022-03/the-looming-tech-shortage-yes-it-could-get-worse/

2. New ASPCA Survey Shows Overwhelming Majority of Dogs and Cats Acquired During the Pandemic Are Still in Their Homes. (2021, May, 26). ASPCA. https://www.aspca.org/about-us/press-releases/new-aspca-survey-shows-overwhelming-majority-dogs-and-cats-acquired-during

3. Nations Move To Tackle Inflation, Increasing Risk To Global Economy. (2022, May, 13). Washington Post. https://www.washingtonpost.com/business/2022/05/13/federal-reserve-global-economy/

The post Top 5 Trends That Are Shaping Veterinary Real Estate appeared first on PetVet Magazine.

However, veterinary technicians who have spent years in practice may feel that there are not many options for growth. And in a field with notoriously-short career longevity, technicians who are feeling unsatisfied frequently explore a new occupation entirely. 

Fortunately, technicians who feel professionally stunted but wish to remain in veterinary medicine have the option to specialize. Specialization can create opportunities in an existing job as well as support expansion outside of clinical work. 

I spoke with two Veterinary Technician Specialists (VTS) about their experience with specialization:

Kristen Cooley, BA, CVT, VTS Anesthesia and Analgesia

Kristen Cooley has worked at the University of Wisconsin-Madison Veterinary School as an Instructional Specialist and Senior Anesthesia Technician, and is currently the CEO and sole proprietor of Veterinary Anesthesia Support and Training, an educational consulting business. Kristen co-edited the textbook Veterinary Anesthetic and Monitoring Equipment and has written a chapter for the same textbook, titled “Pain Management for Veterinary Technicians.” In addition, she is published in the Journal of the National Association of Veterinary Technicians in America and Journal of the American Veterinary Medical Association. 

Why did you choose to pursue your Veterinary Technician Specialty? 

Kristen: I originally wanted to become a veterinarian because I love science, medicine, and animals. I didn’t think that being a tech would be enough for me. I didn’t like the feeling of having a ceiling above my head that kept me from growing. Once I found out about Veterinary Technician Specialists, I made it my goal to become one. 

How have you used your VTS to create new opportunities and shape your career path?

Kristen:  I use my VTS to teach and hopefully improve the practice of anesthesia and pain management in veterinary medicine. Because I have my VTS, clinicians and other techs are more willing to listen to what I have to say and to use me as a resource. 

What do you find most fulfilling about your current career?

Kristen: I love making a difference in the lives of the animals I work with and the people who care for them. Making a veterinarian or a technician just a little bit more comfortable and confident is what it’s all about. I also enjoy running my own consulting business. Not having to answer to anyone other than myself is liberating! 

Jordan Porter, CVT, VTS Internal Medicine (Small Animal Internal Medicine)

Jordan developed an interest in internal medicine shortly after becoming a Registered Veterinary Technician, and that interest quickly became a passion. In 2019 she obtained her VTS in Internal Medicine. That same year she co-founded Internal Medicine for Vet Techs, a continuing education membership site that includes her popular weekly podcast (accessible without a membership). Jordan has been published in the Journal of the National Association of Veterinary Technicians in America, Pet Health Journal’s “Internal Medicine for Pet Parents” series, and is currently working on a contribution to a textbook. She was also a presenter at the Midwest Veterinary Conference in 2022 and the 2022 American College of Veterinary Internal Medicine Forum. 

Why did you choose to pursue your VTS? 

Jordan: I wanted to prove to myself that I had mastered my skills and that I was at the top of my career. I wanted to test my knowledge while continuing to learn. 

How have you used your VTS to create new opportunities and shape your career path?

Jordan: With my VTS, I think it opened doors for me to help educate other technicians. I started a podcast and a membership site where I offer continuing education to other technicians. I have been able to create these platforms to share my knowledge and help others reach their full potential. 

What do you find most fulfilling about your current career?

Jordan: I may not be physically helping as many animals since making a bit of a career change, but I am still helping to educate pet parents about their pets and I am helping technicians up their game. That means I can help more animals in the long run.

Specialization Opportunities

Veterinary Technician Specialties are governed by the National Association of Veterinary Technicians in America (NAVTA).¹ Their stated goal is “to help veterinary technicians attain a higher level of recognition for advanced knowledge and skills in a specific discipline.” Veterinary technicians who wish to pursue a specialty must commit to a multi-year process in which they complete a certain number of hours in their chosen specialty field, document detailed case studies, attend specialty-specific continuing education and ultimately pass an examination. 

Most technicians who choose to specialize do so based on an interest in a certain aspect of veterinary medicine. This may be something they already have experience with, or it may be a subject they would like to explore further. NAVTA currently offers VTS certification in the following areas:

Specialties with full recognition:

• The Academy of Veterinary Emergency and Critical Care Technicians
• The Academy of Veterinary Dental Technicians
• The Academy of Internal Medicine Veterinary Technicians
  • Cardiology
  • Equine Internal Medicine
  • Neurology
  • Oncology
  • Production Animal Internal Medicine
  • Small Animal Internal Medicine
• The Academy of Veterinary Technicians in Anesthesia and Analgesia
• The Academy of Veterinary Zoological Medicine Technicians
• The Academy of Veterinary Technicians in Clinical Practice
  • Canine/Feline
  • Avian/Exotic
  • Production Animal

Specialties with provisional recognition:

• The Academy of Laboratory Animal Veterinary Technicians and Nurses
• The Academy of Veterinary Behavior Technicians
• The Academy of Veterinary Clinical Pathology Technicians
• The Academy of Dermatology Veterinary Technicians
• The Academy of Equine Veterinary Nursing Technicians
• The Academy of Physical Rehabilitation Veterinary Technicians
• The Academy of Veterinary Nutrition Technicians
• The Academy of Veterinary Ophthalmic Technicians
• The Academy of Veterinary Surgical Technicians
• The Academy of Veterinary Technicians in Diagnostic Imaging

Becoming a Veterinary Technician Specialist has the potential to take your career to new heights and in new directions. General practice clinics may employ individuals with a VTS in leadership roles. Technicians with a VTS can bring their expertise to referral clinics and teaching hospitals. Opportunities outside of clinical work include publishing, lecturing, education and consulting. 

A Veterinary Technician Specialty can give a technician a new outlook on their career and increased agency to pursue growth within the field of veterinary medicine. +

Resources:

1. NAVTA Veterinary Technician Specialties. https://www.navta.net/veterinary-technician-specialties/

The post Taking Technician to the Next Level with Veterinary Technician Specialties appeared first on PetVet Magazine.

Veterinary Podcasts

My Veterinary Life is an interview-based podcast produced by the American Veterinary Medical Association. Hosts and veterinarians Dr. Anna Reddish and Dr. Marci Kirk speak with veterinary professionals from a wide range of backgrounds in their specific areas of interest or expertise. Each episode begins with the guest sharing their personal journey in veterinary medicine, allowing the listener to feel personally connected to the speaker. Guests share their unique perspectives, experiences and knowledge, all of which broaden the listener’s understanding of what is possible in the field of veterinary medicine. You may even find yourself discovering a career path you never thought of! 

*I found the “Focus on Diversity and Belonging” series particularly enlightening and personally valuable. www.avma.org/news/podcasts

The Veterinary Life Coach Podcast is hosted by Dr. Julie Cappel, a veterinarian and certified life coach. Dr. Cappel works with the Michigan Veterinary Medical Association’s Power of Ten Leadership Academy and offers life-coaching courses on her website. Her podcast provides thoughtful advice in a relatable and approachable way. She addresses a range of subjects from sensitive, highly-personal experiences such as infertility and seasonal depression to workplace skills including conflict resolution and client communication. There is likely to be at least one episode that really resonates with you.

*The “Humble and Fierce” episode helped me think about leadership in a new way. theveterinarylifecoach.libsyn.com

The Joyful DVM is a life-coaching podcast hosted by veterinarian and certified life coach Dr. Cari Wise. Dr. Wise is also an instructor for Vet Life Academy: Vet Life Reboot, which offers a 10-hour RACE approved CE course designed to help veterinary professionals manage stress, develop personal and professional goals and boundaries, and maintain a healthy work-life balance. Her podcast similarly seeks to lead individuals working in veterinary medicine toward greater fulfillment in their careers and lives. She tackles the big issues of the veterinary world head-on: toxicity, burnout, self-sabotage and anger, to name a few. Her honest approach leads to practical and accessible solutions to the problems we face inside and outside of work. 

“The Veterinary Care Cycle” episode gave me groundbreaking insight into how letting go of what I can’t control can have a positive impact on my attitude. podcast.joyfuldvm.com

The Whole Veterinarian Podcast, hosted by Dr. Stacey Cordivano, features outside-of-the-box thinkers that share new ideas on ways to increase the joy in the lives of veterinarians. From mindfulness to parenting to fitness and personal finance, The Whole Veterinarian starts a dialogue about how veterinarians can grow as people, not just as professionals. Dr. Cordivano also shares articles, books, podcast episodes and other learning resources that she believes have the potential to increase a veterinarian’s overall wellbeing. There are so many aspects of personal and financial development that can lead veterinarians to live a happier, more fulfilled life, and there are also so many people out there working to help veterinarians through creative and unique businesses and products, and Dr. Cordivano aims to highlight those working toward a better VetMed future for all of us.

In the episode “Improving Veterinary Team Culture by Focusing on Psychological Safety,” guest Dr. Olivia Oginska enlightened me on not only the definition of psychological safety, but the key role it plays in team communication and positive patient outcomes. thewholeveterinarian.com/podcast/

How to Be a Better Human is a TED podcast hosted by comedian Christ Duffy. Guests are frequently TED speakers and cover a variety of self-improvement subjects. The tone of the podcast is conversational and uplifting. The broad scope of material gives the listener an opportunity to take a well-rounded approach to personal growth. The podcast also expands outside of the self into the impact we have on the environment and our communities. Whether you want tips on how to get a better night’s sleep or guidance on using social media, this podcast has you covered. 

The episode “How to Nurture Your ‘Emotional Agility’ with Susan David Ph.D.” helped me take steps toward removing self-judgement from my emotions. www.ted.com/podcasts/how-to-be-a-better-human

Routines and Ruts is hosted by freelance writer Madeline Dore as a part of her Extraordinary Routines project. In this podcast, she interviews people about routines that can hinder us from realizing our full potential. Routines and Ruts offers fresh perspectives on behaviors that are all too easy to fall into. It can help reframe the listener’s thinking as the speakers break through culturally-normative narratives and encourage diverse perspectives. There are also mini-episodes called “Rest and Recreation,” which feature the host’s reflections on personal time and relaxation and, in her own words, “celebrate how we replenish.” This podcast’s strength is its ability to offer a new way to look at ourselves and the world around us. 

My personal favorite episodes include “Tyson Yunkaporta on How Creativity Is Inseparable from Life” and “Indecision and the Fear of Better Options.” extraordinaryroutines.com/podcast

Nothing Much Happens: Bedtime Stories to Help You Sleep Sometimes what you need is just a way to stop overthinking. One of the best podcasts for this is Nothing Much Happens. In this podcast, Kathryn Nicolai (who has a very soothing voice) reads short stories with no plot where, well, nothing much happens. She tells the story twice, lulling the listener into relaxation with beautiful imagery and repetition. This podcast reminds us that it isn’t just children who like to be told a story before bed. Allow yourself to feel comforted and cared for as you drift to sleep on the wings of these lovely little vignettes. www.nothingmuchhappens.com

The post Six Podcasts We Love appeared first on PetVet Magazine.

Taking this cultural progression into account, the AVMA created a new policy on aftercare that affects us all. We can now be held accountable for the aftercare providers we choose. The AVMA has adapted their guidelines to the evolution of the human-animal bond and it starts out by small actions that can have a ripple effect bigger than we can imagine.  

 In 2008, Dr. Bernard Rollin, a professor of biomedical sciences and philosophy of animal welfare, set out to eliminate the sow stalls that were being used as breeding factories for pigs. The first time he had ever encountered one, he was shocked. He was taken aback by the utter lack of moral treatment of animals, and right then and there he made a promise to himself that he would do whatever was in his power to eliminate that style of farming.  

 Instead of going through legislative power, his strategy was to show big businesses that their customers despised that style of practice. He marched into Smithfield, the largest pork producer at the time, and challenged them to poll their customers. “What will we find?” They asked. “You will find 75% rejection of this style of farming,” he replied.¹

They called him back six months later to inform him, “Actually, it was 78%.” Seventy eight percent of the public does not like this. 

So why keep giving it to them?  

The genius in the way Dr. Rollin strategized was that he simply asked people for their opinions and Smithfield stopped using that style of sow stalls. Actions like this have a large effect on the industry as a whole. We are progressing culturally, and the relevance of public opinion is something we will come back to when we look at the third point in the policy.

 Our perception of the human-animal bond worldwide has strongly evolved in the last decade, and the AVMA took the lead in bringing a policy to frame our practice of aftercare.

   Here are the three main points from the AVMA Companion Animal Aftercare Policy, some examples of how they work and how they can affect you:

1. “Veterinarians must understand that they may be responsible and may be held accountable for the aftercare provider they recommend.”*

 The International Association of Pet Cemeteries and Crematories (IAOPCC) told Stephen Dubner of the Freakonomics podcast that 10 years ago, only a handful of facilities specialized in pet aftercare. There is now a vast increase in the number of pet aftercare facilities to complement the ever-increasing number of pet owners. However, there is limited legislation in this industry and it varies substantially. 

 With so much emotion surrounding death and aftercare, along with the increase in number and size of aftercare providers, it makes us wonder what the margins of error are. Have you, yourself, ever visited a pet cremation facility? 

Freakonomics hosts investigated this issue.² They wanted to know, are we indeed getting the appropriate ashes back when we take our beloved pets to the crematorium?  

 To investigate this, they created a fake cat. They took fur from a rabbit, stuffed it with hamburger meat and named it Stevie. As there were no bones in Stevie, the amount of ashes returned to them should be minimal compared to normal cremains. Crematoriums should likely flag this, as the second step in cremation is to crush the bones, a process called “cremulation.” 

 They sent a version of Stevie to three crematoriums to see what they would get back. For each one, they received bone ash in the cremains. How is this possible? None of the crematoriums gave an explanation of how there could be bone fragments in the ashes. The Freakonomics team sent all of their data to the attorney general’s office and will update the viewers in the event this is pursued.  

 In line with an increasing number of pet parents and their concern, it is clear there are issues in the aftercare industry. The AVMA Policy is there to guide us and help prevent such traumatizing events.  

 One reason there will be more accountability on the part of the veterinarian is because the IAOPCC decided to conduct a mock trial in the event of cremation fraud to see what the peoples’ perspectives are and how they would be judged in a court setting. In the trial, jurors ruled in favor of the prosecution in all counts, with a total of $3.5 million dollars in punitive damages. The jurors charged the veterinary clinic damages for not going out to check on the crematorium. 

The public is clear that they don’t take cremation fraud lightly. So it is important we hold crematoriums to a high standard. The AVMA goes on to say, “Aftercare providers you work with or refer clients to should be seen to always handle pets with dignity and respect.”

The interesting part about the mock trial is that it shows veterinary facilities will likely be held accountable for any indiscretion on their part. To this point, the AVMA took the lead again in pointing it out in their policy that it is a very real possibility that the facilities can face damages—something to keep in mind the next time you name your crematorium. It is also notable to mention that in many cases, crematory providers are sometimes chosen on the price of their service. Many veterinarians and vet teams likely have not visited a crematorium, though we send deceased pets to them every week.

2. “Encourage prior planning so that owners are aware of their options and can easily communicate their preferences. Pre-planning can be offered by the veterinarian or delegated to the aftercare facility.”* 

The power of pre-planning for euthanasia is exceptional in that it gives the owners a chance to both prepare and begin to cope with the loss of their companion. It often empowers owners as they face the circumstance of loss. Opening a dialogue about this also gives them the time to think about what they want in terms of the appointment itself, when it should occur and aftercare options. 

 The Companion Animal Euthanasia Training Academy suggests a few points to consider for the appointment:³ 

• Where to gather (home, hospital, favorite place) 
• When it should take place (before a crisis, when loved ones will be able to attend) 
• Who should be there (family and friends, children, other pets) 
• What special touches to include (music, photos, ceremonies) 
• How the aftercare will be managed (personal preference of crematorium, cemetery or memorialization) 

Many people do not know what to expect with regard to the euthanasia appointment. A pre-euthanasia appointment is useful in helping map out the experience and inform clients of what to expect on the day of their appointment. These appointments provide time to discuss pre-planning for aftercare options. 

3. Companion animal veterinarians should […] provide adequate containment of the remains.”*

 This can be interpreted in a variety of ways, but it’s safe to say we are phasing out the use of plastic bags to store remains in. As anyone who works in a medical field knows, we have all witnessed our fair share of less-than-pleasant sights. The status-quo cannot be the definition of “adequate.” Pet parents are trusting us to protect their companions so we must keep dignity intact. The use of an appropriate body bag is not only dignified but symbolic. Think of all the extra effort we put in for our patients, but when it comes to how the body is handled after death, the same standards do not apply. 

According to a survey conducted with pet owners in July, 2019, 86% of pet owners consider proper containment important.⁴ There are more options available now to satisfy this market problem and pet parents all over are feeling the difference. 

The AVMA writes “[…] veterinarians should handle animal remains in a sensitive manner, such that it is not unnecessarily disturbing to the owner or any other person with a valid reason to see the remains.” They go on to say, “Deceased pets, whenever possible, should be maintained in a condition suitable for return to the owner or to the aftercare providers such that families may witness their pets’ aftercare.” 

Further, “the sensitive handling of pet remains is an important aspect of veterinary practice.” This adds to our code of ethics as well as professionalism as a whole. 

Like our friend Dr. Rollin, a veterinarian was curious about asking clients what their preferences were on aftercare of their pets. In a recent study by Dr. Kathy Cooney, she showed that the majority of people found it unacceptable that animals were placed in garbage bags.⁵ Much like Dr. Rollin, it begs the question: 

The majority of the public does not like this…so why are we giving it to them? 

The perception of the human-animal bond is evolving, and decisions to adhere to these higher-order guidelines help us to create a world that treats all life with respect and protects its dignity. It is something we all intuitively know, yet we must work hard to achieve. We already know what the right thing to do is and the AVMA is helping us get there. To paraphrase a concept by the philosopher Plato: we do not teach, simply, we remind. +

You can find the main policy detailed here: https://www.avma.org/sites/default/files/resources/AWF-AftercareBrochure.pdf

*Companion Animal Aftercare Policy by the AVMA is subject to the CC BY-NC-ND license. 

References:

1. PRMR, P. R. (2014), https://www.youtube.com/watch?v=HzOH_Mm7hEM
2. Dubner, (2013), https://freakonomics.com/podcast/the-troubled-cremation-of-stevie-the-cat-a-new-freakonomics-radio-podcast/ 
3. CAETA,(2019), https://caetainternational.com/making-pre-euthanasia-arrangements/
4. Euthabag, (2021), https://static1.squarespace.com/static/56473d98e4b0b493dee0ea49/t/5efbaf3e670b5d4f87aa2c1f/1593552703770/Sondage+pet+owner+EN+US+2020+WEB.pdf
5. Cooney, K. B. (2021), https://www.sciencedirect.com/science/article/pii/S193897362030101X

The post 3 Important Takeaways From the New AVMA Companion Animal Aftercare Policy appeared first on PetVet Magazine.

There are several reasons for this increase, relating both to changing human demographics in the country and changing perceptions of the animals themselves. These two factors are also leading to a demand for better quality veterinary care in reptile species. This presents revenue opportunities for veterinarians as well as opportunity to improve the lives of these unique animals. 

The Effect of Demographics

Many aspects of the demographic changes related to increased reptile ownership appear to be based in economics. Compared to decades ago, there has been an increased wealth gap. The cost of a college education has risen far more drastically than starting salaries and the minimum wage has not changed at the federal level in more than 10 years. This has led to far more young people living with parents for a longer time and living in smaller apartments rather than buying a single-family dwelling. In situations like that, ownership of an animal like a dog is more difficult. In turn, this has led to increased ownership of exotic pets overall. 

Most new jobs have been in more urban areas, leading to an urbanization of the population during this time as well. Reptiles can be some of the least demanding exotic animals in terms of space requirements, tendency to have destructive behavior and tendency to create noise. 

The wealth gap has led to many people working longer hours or working multiple jobs. This leads to less time at home and more sporadic schedules that leave less predictability. Trying to keep a feeding and care schedule for a pet becomes more difficult. Most reptiles are lower maintenance in terms of care and schedules since they will often require feeding with far less frequency and tolerate more time in the enclosure so long as the enclosure meets their need for exercise and enrichment. 

While many reptiles tolerate (and may even enjoy) human interaction, they are far less demanding of that attention than small mammals or birds. That helps increase the appeal of reptiles as companion animals as well. 

The Changing Perception of Reptiles

Even a superficial examination of reptiles in the media and popular culture shows a shift in perception during recent years. Television shows like The Crocodile Hunter depict them as animals that are important to their ecosystems and animals that are loved by their owners in captivity. There are more reptile cartoon characters in children’s shows, and no longer universally as the “bad guys.” This can be compared to less than a generation ago when the most common presentation of reptiles in film or television was as scary, evil, mindless beings. 

There has been increased research into the mental and emotional needs of reptiles that has also led to a better understanding of the complexities of their minds. There are studies that clearly show stereotypic behaviors in reptiles housed improperly and more normal behaviors in captive reptiles housed in naturalistic habitats. Other studies show the more social nature of reptiles that has been previously unknown. 

Reptiles have been increasingly trained for desired behaviors and the training has been used to decrease stress. Studies of sentience in reptiles have supported the capability of reptiles to experience anxiety, stress, excitement, fear, pain and suffering. There has also been suggestion of more positive emotions and recognition of human caretakers in a pleasant way. The information from these studies has been increasingly disseminated to people who keep them as pets. 

The need for enrichment of captive reptiles has been seen far more in zoos, research facilities and in homes of pet owners. Unique food items, naturalistic habitats, puzzle boxes, human interaction and novel activities have been used in all these settings to improve the quality of life for reptiles. In the pet trade, more products are being marketed for reptile owners that are directed at enrichment and improvement of the human-animal bond. Social media is also connecting reptile owners, and the posts are full of people sharing enrichment ideas, pictures of pet reptiles being cuddled in front of the TV and reptiles wearing sweaters. 

What Does This Mean for Veterinary Medicine?

Naturally, reptile owners are becoming more common with the growing popularity of these species as pets. With the increased awareness of complexities of the reptile cognition and emotion, the demand for improved veterinary care has also been increasing in this demographic. More than 75% of pet reptiles are owned by people in Gen X and Gen Y. These generations have also been found to be more likely to humanize their pets and are therefore more likely to seek veterinary care for their animals. 

For veterinarians, this means that not only are you more likely to encounter reptiles in private practice, but you are more likely to have owners who place importance on their care—and are more likely to pursue diagnostics and treatments that are recommended for the welfare of their animal. 

In current reptile practice, the use of advanced diagnostic tools is not unusual. Ultrasound, CT, digital radiography, blood testing, cytology and histopathology are all commonplace in the current environment. Hospitalization, endoscopy and surgery are also frequently pursued in order to improve the health of the pet reptile. Increasingly, wellness and routine care are being sought after by the newer generation of people who keep reptiles as pets. This trend places veterinarians in a good position to have a positive influence over the health and wellbeing of these animals. It also provides a good potential revenue stream for veterinary clinics. Treatment of these animals can not only be done out of the interest of the individual veterinarian, but can also be a good fiscal decision for a veterinary practice. 

For the veterinarian seeing reptiles in practice, there are also ever-increasing opportunities to continue acquiring the education needed to accurately diagnose and treat conditions for reptile patients and increasing numbers of referral locations for cases that require more advanced care. Numerous online educational opportunities exist and many of the larger veterinary conferences now routinely present reptile tracks as a regular part of their annual schedule. 

For more ongoing support of practice, there are great opportunities for continuing education, access to journal articles and peer support or mentoring through the Association of Reptile and Amphibian Veterinarians. This group also has an annual conference at ExoticsCon in collaboration with the Association of Exotic Mammal Veterinarians and the Association of Avian Veterinarians. 

Meeting the demands of reptile owners for good care of their animals can be an interesting, challenging and rewarding part of any practice. With the increased opportunity for learning the latest in reptile medicine and the willingness of reptile owners to seek good care for their pets, the possibilities are almost limitless. +

For more information on the Association of Reptilian and Amphibian Veterinarians, visit: arav.org

The post The Rise of Reptiles and What It Means for Veterinary Medicine appeared first on PetVet Magazine.

In addition, it has become increasingly clear that many metabolic, autoimmune and cognitive diseases start with gastrointestinal disturbances or imbalances. Therefore, these findings support that optimal health in pets (and people) cannot be achieved without a healthy gut. 

The GI tract actually has numerous important roles beyond basic digestion. It hosts trillions of bacteria, fungi and other organisms, houses 70% of the immune system, performs the majority of neurotransmitter production, influences metabolism, contributes to energy homeostasis, mitochondrial function and much more.

All veterinarians certainly recognize that chronic inflammation of the gut and IBD (Inflammatory Bowel Disease)-related disorders are a rapidly growing health issue for dogs and cats.  However, it may not be commonly recognized that chronic GI issues are often associated with a myriad of other health conditions in our veterinary patients, such as allergies, chronic skin conditions, autoimmune diseases, cancers, neurologic and cognitive diseases, and even chronic inflammatory joint disease.

Furthermore, the absence of GI symptoms does not necessarily equate to a healthy gut. Total gut health takes into account the diversity and balance of the gut microbiome and the integrity of the gut barrier amongst other factors. Dysbiosis and intestinal hyper-permeability (i.e., leaky gut) are incredibly common and may not present with obvious symptoms. 

Leaky gut occurs as a result of inflammation in the gut lining which leads to separations in the cellular tight junctions of the gut barrier. Once the gut barrier is compromised, it allows for the penetration and absorption of unwanted particles, toxins and pathogenic microorganisms to get into systemic circulation, which can lead to massive immune system disruption and inflammatory changes affecting any or all organ systems. Simply said, a leaky gut puts pets at a higher risk for food sensitivities, allergies, chronic skin disease, autoimmune conditions and metabolic disorders. 

Furthermore, it is well understood that a healthy gut barrier is critically important for optimal immune function, as this barrier also protects the GALT (Gut Associated Lymphatic Tissue) which comprises 60-70% of the immune system and creates up to 80% of antibodies.

Chronic inflammation in the gut and subsequent hyper-permeability of the gut lining is also associated with a disturbance in gut microbe populations. A healthy microbiome consists of vast communities of beneficial bacteria, fungi and viruses. Rather than just casual colonizers, these microbe populations make essential nutrients, provide immunological signaling, perform detoxifying functions and influence neurotransmitters and hormones, and even metabolism. 

Veterinarians are very familiar with the obesity rates in our canine and feline patients, and the health risks associated with this common health issue.  And while there are many casual factors involved here, there is quite a bit of interesting research demonstrating a clear association between obesity or body weight issues with the microbiome populations in both mice and people. 

It is also clear that many neurotransmitter chemicals and hormones used by the brain and nervous system such as serotonin, dopamine and GABA are produced in the gut. Serotonin impacts mood and anxiety, and has actually been termed the “happy chemical” because it contributes to happiness and wellbeing. And, conversely, low levels of serotonin have been associated with depression. It is estimated that 70% of serotonin is made in the gut. Dopamine is involved in motor function, mood, decision making and control of other hormones as well.  Reports estimate about 50% of dopamine is produced in the gastrointestinal tract by enteric neurons and intestinal cells. GABA regulates stress, anxiety and sleep patterns, and is known to be modulated by bacteria in the gut microbiome. Indeed, bacteria in the gut actually communicate with the brain and the connection between the gut and brain is called the Gut-Brain Axis.  

New research may have us looking more at gut health in addressing behavioral disorders of pets as well. A recent groundbreaking study at the University of Oregon has shown a clear link between aggressive behavior of dogs and the microbes that live in the dog’s gut. This study analyzed a population of similar-breed dogs in a shelter setting and compared evaluations of behavior with microbiome status, via testing a series of their fecal samples. While this study could not distinguish the exact relationship between cause and effect, it reveals that the gut microbiome may contribute to aggression or its severity, and that manipulation of the microbiome, via probiotics or dietary changes, may modify behavior. Furthermore, the results of this study suggest that analyzing the canine gut microbiome may have some predictive value in diagnosis of canine behavioral disorders. 

With a deeper understanding of the diverse actions of the gut and the critical role it plays in systemic health, metabolism, immune function, behavior status and overall wellbeing, it becomes clear that supporting a healthy gut environment is a powerful proactive approach in maintaining the health of our veterinary patients. +

The post The Importance of Gut Health in Pets an Integrative Veterinary Approach appeared first on PetVet Magazine.

On the contrary, cats have traditionally been seen as “easy” pets, requiring little to no effort from owners. Why, then, do we spend so much of our time in the veterinary clinic addressing litter box issues, destructive or disruptive behaviors, and inter-pet aggression in our feline patients? The animal care world is beginning to wake up to the fact that mental health in our indoor cats is not only as important as, but directly related to, their overall wellbeing. 

As veterinary professionals, we recognize the role stress plays in the physical health of our feline patients. The most notable stress-related condition veterinarians and owners battle is feline interstitial cystitis, or FIC. While FIC is not fully understood, environmental stress is generally considered to be a major factor contributing to the disease. 

A study published in the Journal of the American Veterinary Medical Association in 2011¹ showed cats diagnosed with FIC exhibited a reduction in signs of disease with the addition of environmental enrichment, such as a consistent schedule, human interaction, classical music, catnip, treats and new toys. Conversely, “healthy” cats (not previously diagnosed with FIC) participating in the study developed sickness behaviors, including urinary changes, when enrichment was withheld. 

Cats who consistently have issues using their litter box are frequently at risk of being surrendered or euthanized. Other behaviors that can lead to cats losing their home include destroying furniture, excessive energy or vocalization, and/or conflict with other pets or human members of the family. According to Tori Peterson, a dog and cat trainer and behavior consultant from Verona, Wisconsin, these issues often have a common foundation. She explains many perceived behavioral problems in indoor cats stem from one or more of the following causes of stress: territorial stress, boredom and/or frustration.

Territorial Stress

Indoor cats may experience territorial stress from sharing space with another cat or having inadequate or inappropriate space for essential activities (eating, sleeping and eliminating). According to the International Society of Feline Medicine, most cats prefer their food and water be offered in 2-3 locations throughout the home, separate from areas housing litter boxes. Food should not be kept near plug-ins, scented cleaners or candles. Feline behavior studies suggest cats prefer to eat without other cats present, even if they cohabitate well in general. Each cat in a household should have its own food and water dishes and litter boxes to reduce resource-related territorial stress.

Behavior consultant Tori Peterson also recommends making sure cats have enough vertical space in their environment, particularly if multiple cats share a home. Vertical space can include cat trees, securely-fixed shelves or furniture that allows a cat to escape the ground level and preferably travel from one location to the next without leaving the security of a higher elevation. This is especially important in bottleneck areas such as doorways and halls. Dividing highly-trafficked spaces into different “lanes” allows cats increased freedom of movement without the threat of confrontation or conflict.

Boredom

While some cats may seem content sleeping all day and keeping to themselves, many likely desire more attention and stimulation than previously assumed. A well-known study published by Dr. Kristyn Vitale in 2017 showed that cats who were offered food, scent and human interaction most frequently chose human interaction as the preferred diversion.² Hallmarks of a bored cat include knocking things off shelves, walking on or in front of objects their owners are using, or exhibiting destructive behaviors only when in view of their owners. These cats are seeking attention, and even negative attention is preferable to being ignored. 

Positive interactions with a cat can include petting, talking and play. Cats typically prefer being petted when in a relaxed state. Attempting to pet an excited cat can lead to play-biting, scratching or overstimulation. Many cats respond to being talked to, and some behaviorists believe meowing is an attempt by domestic cats to communicate with people as vocalization is rarely seen between cats or in the wild. Playing with a cat can include human interaction by using a toy such as a wand or even playing fetch with stuffed cat toys. A surprising number of cats even enjoy positive-reinforcement training as a form of play, combining mental stimulation and time with their owners.

Cat owners can also combat boredom by enriching a cat’s environment. Tori Peterson emphasizes engaging all five of a cat’s senses as much as possible.³ Having cat grass in the house gives cats something other than their food to taste, and safely screened, open windows can provide smells and sounds from outside. Bird feeders outside windows, secure fish tanks and “cat TV” offer stimulating sights. A variety of scratching post textures such as sisal, carpet and wood should be available, and both horizontal and vertical options should be at least six inches longer than the cat is tall to allow for a complete stretch. All enrichment items should be regularly rotated so the cat has access to new and interesting experiences.

Frustration

Solving frustration in a cat is less about entertainment and more about allowing expression of natural behaviors. One of the key areas where indoor cats are likely to be unsatisfied is in their eating habits. A study published by the International Society of Feline medicine found that wild felines most closely related to domestic cats spend approximately 69% of their day hunting and foraging for food, in sharp contrast with the meager 1% spent by indoor pet cats. Additionally, a wild cat would typically eat 10-20 small meals per day rather than the 1-2 larger meals often made available to pet cats.

Owners can simulate a more natural feeding routine for their cats by using puzzle feeders. It is best to offer a variety of puzzle feeders that require different strategies (pawing, biting, kicking) to get the food inside. Cats accustomed to receiving food in a dish can become frustrated with puzzle feeders, so it is important to start with easier puzzles and slowly increase difficulty to the cat’s level.⁴ 

Tori Peterson believes mimicking the hunt-eat-groom-sleep cycle is the foundation of preventing indoor cat frustration.⁵ To effectively recreate this cycle in a home environment, an owner should first understand a cat’s need to play. The relatively low success rate of wild cats’ hunts drives an instinct to pursue prey even when not hungry, a behavior we see reflected in our own pet cats as play. Play should ideally last a minimum of 15 minutes and require a variety of movements natural to cats including stalking, jumping, pouncing and short bursts of running. Immediately following play, cats should receive a small meal, rewarding them for their “hunt” with the captured “prey.” Cats are then able to groom and sleep, having expended their energy and satisfied their hunger. Completing this cycle 2-3 times throughout the day—especially shortly before the people in the house go to bed—can reduce the incidence of cats waking their owners at night or early in the morning, and greatly increases an indoor cat’s sense of fulfillment.

When we consider the emotional health of our feline patients to be an important part of their wellness, we become more effective veterinary professionals. By educating clients about indoor cat enrichment, we can address both medical and behavioral issues, improving the lives of cats and those who love them. +

References:

1. Stella JL, Lord LK, Buffington T. Sickness behaviors in response to unusual external events in healthy cats and cats with feline interstitial cystitis. Journal of the American Veterinary Medical Association. 2011;238:67-73.
2. Vitale Shreve KR, Mehrkam LR, Udell MAR. Social interaction, food, scent or toys? A formal assessment of domestic pet and shelter cat (Felis silvestris catus) preferences. Behavioral Processes. 2017;141:322-328.
3. Peterson T. Staying busy not bored: cat enrichment ideas. Space Cat Academy. https://www.spacecatacademy.com/articles/2018/2/3/cat-enrichment. Published February 10 2018. Accessed March 15, 2020. 
4. Ryan L. Feeding cats for the future: an opportunity for creativity. Feline Focus. 2020;6:61-68.
5. Peterson T. Keeping your cat satisfied: the cycle of daily needs. Space Cat Academy . https://www.spacecatacademy.com/articles/2019/9/6/keeping-your-cat-satisfied-the-cycle-of-daily-needs. Published September 6, 2019. Accessed April 7, 2020. 

The post Rethinking Feline Wellness appeared first on PetVet Magazine.

But, no matter how quickly developed, no vaccine is effective until administered to the target population. So, how does that even happen when the country’s (and the world’s) population seems to have grown at the same warp speed? Let’s start with a bit of historical perspective.

Vaccination, variolation or immunization are much older practices than one might think. Records indicate that crude efforts towards protection through exposure were used as early as 1000 A.D. in Asia. However, most experts seem to agree that by the mid-1500’s, efforts to inoculate against smallpox infection were wide-spread in China and India. In the late 1600’s, insufflation was the common method of inoculation. Dry scabs might be ground into a powder and then puffed up a child’s nose, or the dry scabs might be soaked in water prior to being placed in the nose. Still, another common method was to take fluid from a pustule, place it on a cotton plug and then put the plug up the nose of the child. 

By the 1700’s, trade routes had spread the practice to most of Europe and likely also allowed for the further variations in administration. The Chinese even described a method that amounted to a crude attenuated vaccine by carrying the contents of a pustule (pocky matter) at body temperature for a month, or exposing it to steam and herbs prior to placing on cotton and then into the nose. It’s likely that this handling allowed for inactivation of some viral particles and decreased the overall viral load, resulting in a very crude attempt at a modified-live vaccine. 

Fast forward to 2020, and smallpox is no longer the major focus of immunization efforts. Today’s medical sciences use a plethora of different approaches to safely stimulate immunity against a number of potentially life-threatening pathogens. Each vaccine type may use a novel platform or delivery system, target a different component of the viral molecule or seek to stimulate a specific portion of the host immune system. While each of these approaches has a unique set of advantages and disadvantages (see above table), all share a common potential point of failure. To be effective, vaccines must be administered on an individual level—no vaccine is effective if it remains in the vial! 

The portion of the population that must be immune to confer “herd” immunity varies from disease to disease and is related to how contagious the disease is from person to person. For example, an estimated 94% of the susceptible population must be immune to measles to disrupt transmission. For SARS-CoV-2, current estimates are that 70% of the population must be immune to interrupt transmission. In 2020, the estimated U.S. population is ~330 million. Thus, 231 million (or more) Americans would need immunity conferred by either natural disease recovery or vaccine to effectively interrupt the transmission of SARS-CoV-2. Current estimates are that ~5 million Americans have tested positive thus far; that’s a very long way from 231 million.

So, how do we administer roughly 200 million vaccinations to individuals all across the country? How long will it take? Some estimate that natural immunity may only last months rather than years. So does a vaccination campaign then race against the waning immunity of those recovering from natural infection? Well, we may not know the answer to how long natural immunity lasts, but we do know how to administer mass vaccination campaigns. In fact, much of the infrastructure for such efforts exists in most cities in the U.S. since President Kennedy signed the Vaccination Assistance Act into law in 1962, which provides for the mass vaccination of the population with a focus on pre-school-aged children. Additionally, the act allowed federal funds to go to state and local authorities to support vaccination of the entire population. 

The anthrax attacks of 2001 required life-saving medical counter-measures (MCM) to be distributed and administered to nearly 2,000 people in a very short time period. The survival rate for inhalation of anthrax declines precipitously if MCM are not administered within 48 hours of exposure. 

In 2004, the Centers for Disease Control and Prevention (CDC) established the Cities Readiness Initiative (CRI). The CRI program is a federally-funded program to enhance local preparedness for biological incidents. The CRI program targets a system of Metropolitan Statistical Areas (MSAs). Each state has at least one MSA and the total population of all the MSAs together is about 60% of the U.S. population. 

The CRI programs are responsible for cultivating relationships with large (and not so large) employers in their local areas. Both government and private employers are eligible to participate in efforts to provide lifesaving MCMs to their employees (and their families) by order that the employer serve as a force multiplier for distribution to meet the CRI target distribution window of 48 hours. Jurisdictions are required to maintain written plans for effective distribution schemes down to the smallest of details. Granular information such as driving routes to likely distribution points in a community is included. CRI communities are also required to exercise all components of plans routinely with analysis and corrective actions included in After Action Reports (AAR). Since the CDC funds CRI preparedness efforts, naturally, the local CRI programs are reviewed by CDC personnel regularly as well.

CRI sounds like a great idea; execution seems assured and wide-spread distribution of MCM appears well in-hand. But, anthrax-related medications such as ciprofloxacin do not require refrigeration nor injection. So, how does this change things? The good news is that vaccines requiring refrigeration are not a novel invention and such items are distributed nationwide on the daily. Federally funded CRI programs are required to provide logistics for temperature-controlled distribution plans, as well as inert products not requiring climate control. 

With climate control and distribution handled, we should turn our focus to administration of a vaccine in such a circumstance. If the hotly anticipated SARS-CoV-2 vaccine is an oral formulation, then the celebration can begin! By and large, Americans, and humans in general, are much more likely to accept a medication that is orally administered than one that is injected with that super scary object—a needle! However, it is much more likely that the vaccine will require injection instead of a simple gulp. 

Many healthcare professionals are discussing vaccines and vaccine development on webinars these days, and when the nearly inevitable question arises of who will administer all these vaccinations, given the current burden on the healthcare system, these otherwise well-informed professionals are at a loss. Many folks are wholly unaware of the legal framework in place in the U.S. for just these events. In fact, the existing framework allows for a broad swath of trained healthcare professionals to join the vaccine administration team, including, but not limited to, pharmacists, nurses, dentists and veterinarians. Additionally, all of those appropriately integrated into the public health response and under the direction of the local public health officer are typically immune from liability while conducting approved activities such as vaccine administration pursuant to a blanket prescription order. The only actions not covered by this umbrella of immunity are those committed outside of assigned tasks or those committed with willful misconduct (Federal Public Readiness and Emergency Preparedness Act (PREP Act)).  

I strongly recommend that veterinarians join their local Medical Reserve Corps (MRC) and get engaged, if not involved, in local public health efforts, even outside of a pandemic. Surely during a pandemic veterinary professionals and support staff will find the MRC an incredible outlet for community engagement and soul-satisfaction through community volunteerism. The beauty of integration with the MRC is the “cloak” of protection provided by the program’s practice of full coverage for members while actively employed in assigned tasks.

To the larger issue that will no doubt dominate media coverage and supper table discussions alike, I have no solution. That issue is public acceptance and recognition of the newly-minted vaccine as safe, efficacious and necessary. Accurate information is the only antidote to fear, and if the media coverage of this pandemic to date is any indication, accuracy is not likely to be wide-spread. So, the vaccine may sit idly in a refrigerated container at a point-of-dispensing (POD) staffed by veterinarians and medical professionals alike with no one in which to administer the potentially life-saving MCM. 

What to do to resolve this? Veterinarians can begin by making herculean efforts to remain abreast of any developments down the path to a safe and efficacious vaccine. We can also share this information with our colleagues, staff members, clients and anyone who is interested. Tell them it could be worse…at least we are not proposing to stuff a puss-soaked cotton ball up their nose and ask them to leave it there for a few days. +

Resources

1. Boylston A. The origins of inoculation. J R Soc Med. 2012;105(7):309-313. doi:10.1258/jrsm.2012.12k044
2. https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/herd-immunity-and-coronavirus/art-20486808
3. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
4. https://www.census.gov/popclock/
5. https://www.rand.org/content/dam/rand/pubs/technical_reports/2009/RAND_TR640.pdf
6. https://www.cdc.gov/cpr/readiness/mcm/cri.html
7. Centers for Disease Control and Prevention. Vaccine-Preventable Diseases, Immunizations, and MMWR — 1961–2011. MMWR 2011;60(Suppl):49-57. 
8. https://www.phe.gov/Preparedness/legal/prepact/Pages/default.aspx

The post Vaccination in the Time of COVID-19 and Before appeared first on PetVet Magazine.