Learn how IDEXX is enhancing the lives of animals, people, and the planet.

IDEXX: Contributing to something bigger

It's National Veterinary Technician Week! This week is dedicated to recognizing these professionals’ contributions to veterinary medicine. According to the American Veterinary Medical Association (AVMA), they are critical to the function of veterinary practices and play an important role in the welfare and health of animals in their care.

 Additionally, AVMA says, veterinary technicians drive practice efficiency and well-being, allowing veterinarians to focus on work requiring a more advanced veterinary education.

First observed in 1993, National Veterinary Technician Week is held annually during the third week in October, according to AVMA.

® asked veterinary technicians about their roles and what motivates them most. The responses came by email and through the Veterinary Support Staff Career Group on Facebook. They include the following:

Q: What inspired you to become a veterinarian technician?

Stephanie Adams, LVMT; Family Pet Health, Murfreesboro, Tennessee: 

I have always loved medicine, science, and helping [individuals]. I grew up with various pets and combined my interests in animals and medicine to be an LVMT [licensed veterinary medical technician].

 I was inspired to be a veterinary technician because I love how animals touch our lives. There is just something about the human/animal bond that has always moved me. [Although] the pandemic continues to be a challenge for us in the profession, one aspect that has touched me deeply is how important pets have been to so many who needed connection and love this past year and a half.

Alexia Minschwaner, CVT; Dresher, Pennsylvania: 

My love for animals and natural curiosity inspired me to become a veterinary nurse. Animals can be so different from us regarding diet, health, and mannerisms. Becoming a vet nurse has enabled me to learn so much about our pets.

Bash Halow, BA, CVPM, LVT; Halow Consulting, New York, New York: 

My first position in an animal hospital was a kind of veterinary attendant. I was supposed to do whatever anyone else on the staff told me to do. Sounds terrible, but I loved it. Then after enough [individuals] quit, I got to work the front desk. I got [chewed out] by clients, doctors, techs, you name it. I loved that job too. It didn’t matter that I got [chewed out]. I just loved it. I loved the multitasking; I loved learning about the medicine; I loved gabbing with my coworkers and the clients.

Still, the real siren song was “the back.” If you were a technician who worked in “the back,” you got to answer the hard questions, you got to do the cool jobs, and you were directly associated with patient outcomes. I wanted to be a technician. And after enough callouts, enough staff shortages, and enough pleading, I learned some technician skills.

Many years later, New Jersey offered technicians a chance to be “grandfathered in” if you could pass a licensing exam and could get letters from vets vouching for your skills. I studied for weeks to pass that test and pass it I did.

That’s how I got to be a licensed tech, but now that I think about it the license is almost an afterthought. The thing that has always turned me on about my position is the learning, the care, and the client education. The knowledge and experience I have had as a tech has made an impact on my own animals’ lives and the lives of countless other pets and pet owners I have enjoyed meeting over the years.

Tasha McNerney, BS, CVT, VTS (anesthesia and analgesia): 

. I wanted to be the veterinarian in that movie. When I realized there was a career [like] being a veterinarian but with more hands-on nursing skills, I went for it.

Alyssa Mages, BS, CVT; Empowering Veterinary Teams LLC: 

To be a voice for the voiceless and to lend my skills and compassion to those who truly need it.

Kelly Piedrahita, LVT; Bond Vet, New York: 

I would say my passion for animals inspired me to become a vet tech. Since a little girl, I was obsessed with animals. When I discovered there was a profession to help and save them, I was sold.

Q: What is your favorite part of being a vet tech?

I love nursing sick pets back to health and reuniting them with their pet parents.

My favorite part about being a vet tech is being able to provide quality pet care and seeing our patients thrive. Seeing patients with illnesses come in for treatment and being able to help make them feel better really makes my day.

My favorite part of being a technician is the constant opportunity to grow and improve. There is always a new skill or some new knowledge or information that comes up that improves our level of patient care. I strive to be a lifelong learner and I love that there will always be something to learn in the veterinary profession.

I love learning. I love helping clients understand the value of veterinary care and oversight by a veterinary medical team.

The constant learning, from new techniques to new anesthetic drugs...I love being able to learn new things to make anesthetic events safer for my patients.

Being part of an incredible community that is constantly growing and evolving, all while helping animals and utilizing cutting-edge medicine and technology.

I love that there is practically no limit to what I can do to help my patients. We as technicians wear so many hats! From basic things like administering vaccines to doing blood transfusions, monitoring anesthesia, performing dental prophylaxis, taking radiographs, caring for wounds, and so much more. I am able to take care of whatever they need to keep them healthy and thriving.

Q: What is something clients would be surprised to know that you do as a vet tech?

I research for hours before performing anesthesia on animals that have underlying health issues. I want to be sure I know what to do in any situation.

Many of us are passionate about training and behavior. I think clients would be surprised to know that we really do take our time and work with our patients and make sure they are not stressed. We want the vet office to be a happy place for every animal and client.

I think clients would be surprised to know that as licensed technicians, we do a little of everything. We draw blood and run analyzers, screen blood work and lab results before the doctor sees them, fill prescriptions, answer phones, monitor anesthesia, educate clients, clean up stinky messes, and in the best moments, we get to play with puppies and kittens.

I honest to goodness treat their pet like a thinking, feeling being. I don’t work with animals all day; I work with individuals.

I think clients would be surprised to know the vet tech is usually the one monitoring your pet under anesthesia and is sometimes specialized in anesthesia.

Everything. All joking aside, there is a lack of understanding among the general public of all the things that veterinary technicians and nurses do—anesthesia, phlebotomy, radiology, etc—and we’re only limited by how much we push ourselves to learn to accomplish.

 I find it humorous that most people don’t compare both human medicine and veterinary medicine when they're actually very similar. Clients are usually surprised knowing that I've performed anesthesia on their pets, pulled blood work, helped doctors come up with a differential diagnosis, and [performed radiographs].

Q: What should veterinarians know about the veterinarian technician role?

LVMTs are the most valuable resource veterinarians have available. Use us to our fullest extent and show gratitude. You want us to be around and to stay around.

 I wish all veterinarians and practice owners understood the value of their staff. Treating LVTs and assistants as valuable assets with knowledge, as well as being kind and supportive of them and their mental and physical health, goes a long way to retaining a staff that is loyal and wants your practice to grow and succeed.

Tell me what you need to get done, train me. I’m ready and eager to learn. You and I can make a great team.

Hire more VTS [veterinary technician specialist] techs in private practice; they will help make your practice more efficient and elevate the standard of care

We’re here, we’re skilled, and we’re ready to be utilized. Let us do what we are capable of doing so that we can support you to do the amazing work you do.

With all the roles and tasks that [veterinary] nurses have, it is imperative that our voices are heard and respected.

Q: What advice would you give aspiring veterinary professionals?

Surround yourself with kindness and positivity. Be the vet or LVMT that you want your pets to have.

Although this field can be challenging mentally and physically, quality pet care starts with you. Always take care of yourself.

 I would advise them to know their worth. Without a support staff, even the best doctor cannot succeed. Take what you know and use it. This is a hard job but it’s incredibly rewarding when you find a practice that values you. Don’t dwell on mistakes; own them and learn from them, but then move on.

Show up. Learn. Be ready to help. The profession is exploding with opportunities. As the world modernizes, there are fewer gatekeepers between you and your goals—but skip the entitlement thing. Be worth it and you will be treated as worthy.

Go into it with eyes wide open. It’s very rewarding, but the field has some drawbacks such as lower pay compared with our human nursing counterparts.

Remember: No one is “just” anything. Own your awesome and advocate for it.

The advice I would give to aspiring veterinary professionals is to never forget why you wanted to enter the profession and how you have grown within your role. We work in a profession where you will never stop learning. There will be instrumental people who will help advance your skills regardless of their position title. It is important to always remain open to learning from others and remember to help empower the next generation to thrive as others did for you.

National Veterinary Technician Week. American Veterinary Medicine Association. Accessed September 22, 2021. www.avma.org/national-veterinary-technician-week

Editors note: All veterinary technician content for this month is supported by Banfield Pet Hospital.

Articles

National Veterinary Technician Week focuses on the professionals who play a vital role in caring for animals in a veterinary practice.

Veterinary technicians embrace their roles

Canine hypothyroidism is a slowly progressive disorder resulting from failure of the thyroid gland to secrete amounts of thyroid hormones adequate for maintaining normal organ functions. Although hypothyroidism is relatively common and thyroid hormone testing is readily available, there is a diagnostic challenge because the clinical signs can be subtle and highly variable. Furthermore, there are numerous causes of low thyroid hormone levels in euthyroid dogs. Because of these factors, making a correct diagnosis of hypothyroidism can be difficult.

Canine hypothyroidism usually results from failure of the thyroid gland. This can be due to lymphocytic thyroiditis (destruction of the thyroid gland by inflammation) or idiopathic thyroid atrophy (degeneration of the thyroid gland in the absence of apparent inflammation). Failure of the thyroid gland is termed primary hypothyroidism and accounts for most cases of canine hypothyroidism. Less commonly, there is secondary hypothyroidism, in which the thyroid gland is healthy but the pituitary gland fails to secrete thyrotropin (TSH), resulting in a secondary failure of the thyroid gland to secrete the hormones thyroxine (T4) and triiodothyronine (T3).

Primary hypothyroidism affects different breeds; mixed breed dogs, golden retrievers, Doberman pinschers, and Labrador retrievers are among those most affected. The age at which clinical signs manifest varies but diagnosis at middle-age to senior years is typical. Because it is the most common, the diagnostic approach to primary hypothyroidism will be the focus of this article.

Because thyroid hormones affect virtually every organ, the clinical manifestations of disease can be different for each patient. Dogs affected with hypothyroidism often have a decreased metabolic rate resulting in lethargy, dullness, and weight gain without polyphagia. Dermatologic effects are the most common clinical sign of hypothyroidism, including alopecia, a dull and brittle hair coat, skin hyperpigmentation, and pyoderma. Neurologic (peripheral neuropathies, vestibular disease, myopathy) and cardiovascular effects (bradyarrhythmia) are less common but do occur. Rarely, dogs with severe, untreated hypothyroidism can develop myxedema coma, characterized by life-threatening hypothermia, bradyarrhythmia, and deterioration in mental state. Myxedema coma is typically the result of untreated hypothyroidism in the face of additional serious illness.

Clinicopathologic changes in hypothyroid dogs are relatively few but characteristic. Hypercholesterolemia is seen in approximately 75% of hypothyroid dogs; some will also have hypertriglyceridemia. Hyperlipidemia can result in the deposition of ocular lipid, which may be recognized on physical examination. A mild, normocytic, normochromic, nonregenerative anemia is seen in approximately one-third of hypothyroid dogs.

Causes of diagnostic confusion: factors that decrease T4 in euthyroid dogs

It is critically important to remember the factors that can influence thyroid hormone testing, and the following should be carefully considered before making a diagnosis of hypothyroidism.

Various drugs can influence multiple thyroid hormone tests, especially the total T4 (TT4) test. Prednisone, nonsteroidal antiinflammatory drugs, phenobarbital, and tricyclic antidepressants are some of the more common offenders. If possible, patients should be removed from treatment with these drugs before evaluation for hypothyroidism.

Euthyroid sighthounds are known to have TT4 levels below the reference interval. Fortunately, these dogs are rarely affected by hypothyroidism.

The TT4 level decreases with age and can dip below the reference interval in very elderly dogs.

Occasionally, euthyroid dogs with no other complicating factors can have a TT4 level that transiently drops below the reference interval. This should not be accompanied by clinical signs and repeat evaluation will likely show a TT4 level in the normal range.

Systemic illness, malnutrition, trauma, and surgery can all cause decreased thyroid hormone levels. This is often called euthyroid sick syndrome. Although the mechanism is unclear, the condition is thought to be a physiologic adaptation to stress or illness. Most commonly, the TT4 level is decreased, but the free T4 (fT4) level can also be affected.

Diagnostic approach: specific thyroid tests

The TT4 test includes both bound and unbound (free) T4. T4 is the most abundant hormone secreted by the thyroid gland. This test is used to rule out hypothyroidism. Very few truly hypothyroid dogs will have a normal TT4 level. As mentioned, many factors can cause a low TT4 level in euthyroid dogs. Because of this, a low TT4 level alone should never be used to diagnose hypothyroidism. Additional thyroid diagnostics should be pursued to support the diagnosis before initiating treatment.

The fT4 is the small fraction of the total T4 that is biologically active. Because the fT4 level is less affected by nonthyroidal illness (NTI) than TT4 levels are, this test is frequently used as a follow-up to a low TT4 result if there is clinical suspicion of hypothyroidism but NTI is present.

The lack of negative feedback to the pituitary gland in primary hypothyroidism will result in increased TSH. Hypothyroid dogs will have a TSH level above the reference interval in about two-thirds of cases. The TSH test is used in combination with low TT4 and/or fT4 test results to support a diagnosis of hypothyroidism.

Some laboratories offer assays for antithyroglobulin, anti-T3, and anti-T4 autoantibodies. Approximately half of dogs with hypothyroidism will have antithyroglobulin antibodies. Anti-T3 and anti-T4 antibodies can also be detected but are less common. These tests can be added to the diagnostic workup of a dog with suspected hypothyroidism to increase confidence in the diagnosis if the combination of TT4 and/or fT4 and TSH levels is equivocal. It is important to note that the absence of these antibodies does not rule out hypothyroidism.

Diagnostic approach: putting it all together

Because of the numerous factors that complicate thyroid diagnostics, a workup for hypothyroidism should always begin with reasonable clinical suspicion based on history, examination findings, and clinicopathologic parameters. It is important to carefully consider and, when possible, exclude nonthyroidal causes of a low T4 level prior to testing.

Definitive diagnosis of hypothyroidism requires multiple supportive thyroid hormone diagnostics, with the most specific combination of tests being TT4, fT4, and TSH. Because few nonthyroidal factors affect TSH levels, a low TT4 and/or fT4 result in combination with a high TSH level is highly consistent with true hypothyroidism.

Because as many as one-third of hypothyroid dogs will have a TSH level within the reference interval, a normal TSH result cannot be used to rule out hypothyroidism. In these cases, a clinical presentation suspicious for hypothyroidism, exclusion of nonthyroidal factors, a low TT4 and fT4 result, and a TSH level in the middle to upper end of the reference interval are sufficient to diagnose hypothyroidism. In cases with equivocal laboratory findings, finding antithyroglobulin, T3, and T4 antibodies may help increase the suspicion for true hypothyroidism.

Laura R. Van Vertloo, DVM, MS, DACVIM, is an assistant professor of veterinary clinical sciences at Iowa State University, College of Veterinary Medicine in Ames, Iowa.

Understanding and diagnosing canine hypothyroidism

When you are the seller of a veterinary practice seeking to lease your real estate to a new buyer, veterinarian and lawyer Charlotte Lacroix, DVM, JD, recommends negotiating a few terms including the lease term and rent price. In a recent dvm360

 interview, Lacroix offered up a few nuggets to help practice owners successfully streamline the selling process. 

"Typically, you might have [the lease term] for 10 years with two 5 year renewals," Lacroix informed dvm360

staff. "The rent of course is clearly, very important and you want it to be fair market value so that if you end up wanting to sell your real estate later, whoever is buying your real estate has a good source of rent on that."

She then advised owners to be mindful of the escalation clause, and if the commercial lease is triple net, to determine who is responsible for expenses involving maintenance, repair, and replacement. 

“And then finally, I think 1 of the last points that can be quite important is that you should have a guarantee or guarantor sign the lease in the sense as a guarantor," suggested Lacroix. "So, that if the primary tenant defaults, you [have] somebody to go to collect your rent."

Watch the full video below for more of Lacroix's insight on legal considerations surrounding selling a veterinary clinic. 

Videos

Charlotte Lacroix, DVM, JD, shared insight on ensuring success when leasing your veterinary practice real estate to a new buyer.

Legal considerations when selling a veterinary practice

Treatment options for veterinary dermatology patients have advanced significantly in the past several years. Paul Bloom, DVM, DACVD, DABVP, summarized the latest treatments available for treating pyoderma, pruritus, and otitis. If you were not already aware, these are important additions to your treatment arsenal.

Bloom separated these new medications into the broad categories of antibiotics and antipruritics. The mainstay of antibiotics for pyoderma has previously been cephalexin, a first-generation cephalosporin. While this arguably remains the first-line treatment for bacterial folliculitis, the newer antibiotics used to treat pyoderma include cefpodoxime (an oral antibiotic) and cefovecin (trade name Convenia, a long duration injectable antibiotic), which are both broad-spectrum third-generation cephalosporins. Bloom discussed the potential concerns with using third-generation cephalosporins as a first-line treatment.

The oral medication cefpodoxime is promoted by the company as a first-line antibiotic for pyoderma; however, the broad-spectrum nature enhances the development of extended spectrum beta lactamase producing gram negative bacteria. These very resistant bacteria are important causes of serious infections in humans. Whether targeted by the treatment or not, and whether pathogenic or not, resistant bacterial organisms can transfer their resistant genes to other organisms in the environment or other species (animal to humans). The advantage of administering cefpodoxime over cephalexin appears to be primarily logistical, as cefpodoxime is administered once daily, versus cephalexin which is administered twice daily. However, Bloom stated, the risks to developing resistant organisms outweigh the logistical benefits 

Similar concerns exist for cefovecin. This parenteral antibiotic has been approved in other countries for treatment of numerous organisms (including 

. Due to similar risks of selecting for resistant bacteria, Bloom cautions that cefovecin should be reserved for patients who cannot be medicated orally. Therapeutic concentrations are maintained for approximately 7-14 days post-injection, with specific therapeutic timing dependent on the specific bacteria and MIC. Although subtherapeutic, tissue levels persist for up to 65 days. There is question as to whether or not this persistent subtherapeutic tissue concentration will select for the resistant bacterial. Specific concerns exist about selecting for extended spectrum beta-lactamases (

) that are multidrug-resistant. Bloom also reminded us that, with any new therapeutic, long-term adverse effects are not yet fully known.

Available antipruritic medications include oclacitinib (Apoquel), modified cyclosporine (Atopica and Cyclavance), and lokivetmab (Cytopoint). These 3 medications have different mechanisms of action.

Oclacitinib is a janus kinase (JAK 1) pathway inhibitor. Janus kinase 1 is an intracellular pathway that is activated when cytokines bind to specific cell membrane receptors. Activation results in production of various cytokines that trigger and perpetuate pruritus. Oclacitinib inhibits activation of the JAK 1 pathway, limiting the amount of pro-inflammatory and pruritogenic cytokines produced. It may also be helpful off-label for other immune-mediated diseases, including vasculitis, ischemic dermatopathy, pemphigus foliaceus, and discoid lupus erythematous. Adverse effects appear to be rare, but may include neutropenia or leukopenia, and may reduce seizure threshold.

Bloom does remind us of one important factor to be aware of when using oclacitinib; it will mask pruritus regardless of etiology. For example, a patient with sarcoptic mange, flea allergy dermatitis, or bacterial or yeast pyoderma, possibly masking the untreated underlying disease. For this reason, identifying the underlying cause of pruritus is an important component of diagnostic and treatment planning.

Although not new, modified cyclosporines remain highly utilized in dermatology. Bloom does caution that it is essential to use the modified cyclosporines, such as Atopica or Cyclavance, to achieve consistent absorption. Bloom recommended using modified cyclosporine in uncomplicated atopic dermatitis, where oclacitinib and lokivetmab have failed. Full therapeutic effect is typically reached within 4-6 weeks of administration. Adverse effects appear to be minimal and consist of gastrointestinal signs, cutaneous papillomatosis, and gingival hyperplasia. Maropitant or ondansetron may help offset vomiting.

Another new medication used in veterinary dermatology is lokivetmab, a canine monoclonal antibody that binds to and neutralizes IL-31. Blooms noted that, although low amounts of IL-31 are beneficial, higher amounts are detrimental and contribute to the pathogenesis of atopic dermatitis. Lokivetmab is administered via subcutaneous injection, once every 30 to 60 days. As it is a specific canine monoclonal antibody, it can only be used in dogs. Bloom recommended using it in cases of pruritus from allergic skin disease, with or without concurrent demodex or bacterial pyoderma or cystitis, or patients with a history of (or current) cancer. Bloom does find that cases that failed to respond to either oclacitinib or lokivetmab, may respond to the other treatment, due to the different mechanisms of action. As such, if a therapeutic trial with one of these medications is not effective, it is worth trying the other.

Bloom’s final update in “new drugs in veterinary dermatology” relates to treatment of otitis. Administering topical ear medications can be tricky for owners, and often treatment is prescribed for 7 to 14 days. Easotic is a new product containing hydrocortisone aceponate, miconazole, and gentamicin. What is particularly unique about this treatment is the delivery system. Easotic is in a pump bottle, with a flexible tip that allows easy application of the medication deep (but safely) into the ear canal. The pump is metered to allow 1cc dispensed with each pump, and treatment duration is only 5 days. Bloom’s experience with this has been positive, due to both compliance and efficacy.

Dermatological conditions are one of the more common diagnoses requiring veterinary care, and several new treatments have become available over the past few years. Bloom’s overview of novel treatments should help all practitioners better understand the options available to care for their patients.

Dr Rebecca A Packer is board certified in neurology by the American College of Veterinary Internal Medicine and is an associate veterinarian at BluePearl Specialty and Emergency Pet Hospital in Lafayette, Colorado.

She is also the founder and owner of the Pre-Veterinary Mentoring Group, LLC, through which she provides mentorship for pre-veterinary students during their path to veterinary school, and is the founder and owner of The Pocket Neurologist, LLC, a vet-to-vet teleconsulting service.

During his lecture at the Atlantic Coast Veterinary Conference (ACVC), Paul Bloom DVM, DACVD, DABVP, highlighted a few new medications to consider implementing into your treatment plan for patients with pyoderma, pruritus, and otitis. 

Dermatology advancements: An overview of the latest treatment options

It's National Veterinary Technician Week! To celebrate all the hardworking technicians out there who provide the highest quality care to their beloved patients, we are bringing a robust mix of industry news and engaging content.

Here is a quick look at this week's headlines:

A Q&A highlighting what veterinary technicians enjoy most about the profession, their inspiration for pursuing this field, and beyond. 

According to the AVMA, there has been a record number of veterinary school applications this year.

Charlotte Lacroix, DVM, JD, provides tips for success when leasing your veterinary practice real estate to a new buyer.

A veterinarian outlines the latest treatments available for pyoderma, pruritus, and otitis.

The new online toolkit from the Purina Institute offers veterinary professionals with nutritional resources to share with clients. 

Stay tuned on dvm360.com for our most recent coverage of the veterinary industry.

A sneak peek look at this week's headlines.

This week on dvm360: A Q&A spotlighting veterinary technicians, plus more veterinary news

I have highlighted 3 individuals who are leading the charge to make veterinary medicine more diverse, equitable, and inclusive. Recently, I had the honor to sit down with all 3 to ask what drives them and how others can follow in their footsteps.

Their answers were not surprising, but inspiring. All of them believe in the need to make veterinary medicine reflect the society in which we live and in their passion for a better veterinary space. Additionally, and not unexpectedly, all 3 believe in giving back to their communities. Below is a transcript of our conversation:

Juan Sebastian Orjuela, affectionally called Juancho, is a fourth-year veterinary student at 

, University of Guelph in Canada. During his time in vet school, Juancho looked around and did not see many students who looked like him. Many of us would have been discouraged but Juancho decided to do something about it. With the goal of representation in mind, Juancho cofounded the 

 (LVMA) to form a community of Latinx excellence in veterinary medicine. LVMA is open to veterinarians, veterinary professionals, students, pet parents, and allies. Additionally, Juancho is a proud member of the LGBTQ+ community.

Prior to vet school, Juancho attended the University of Wisconsin-Milwaukee. He credits his hard work ethic to having been an immigrant child. When he was just 10 years old, he and his family emigrated to Minneapolis, Minnesota, from Bogotá, Colombia, to follow other family members.

In Bogotá, Juancho’s mother was a textile designer. His father was a lawyer and ran for governor of Bogotá. Following his unsuccessful run for government, the family decided to emigrate to the United States. In Minneapolis, Juancho’s father took a job as a line cook to build a base for his family and his mother was a school cleaner. Juancho’s life is the typical immigrant story of the desire to build a better life for the next generation.

 My parents are my biggest superheroes. If it was not for them, I would not be here. Also, in third grade, I was offered a job to walk puppies. I found my mentorship through squeezing out information from other people and always questioning things and being very curious. That gave me the confidence to pursue this career. I double majored in biology and in conservation and environmental sciences in college. I also started the first preveterinary club in college.

: Coming out was really tough. I had a lot of pressure. My dad was a politician and lots of our life [consisted of putting] out a vision of our family. That caused me lots of difficulties. I thought I would be disowned. I have always been someone who was unapologetically myself; I don’t care what others have to say. I grew up really fast. I came out to my sister first. I came out last to my dad. My mom was super embracing. My mom is my number 1 fan. Following family conflict, today my dad is my second number 1 fan.

I have always had an entrepreneurial mindset. I have always been interested in law…and…I always wanted to be a servant to the people. My struggles, being told that I was not good enough to get into vet school, fueled me when I got into vet school to do something. I got into vet school and did not feel fulfilled. I felt very underrepresented. I saw zero veterinarians on social media who were Latino. I started networking with folks in the community [and] that’s when I met the other cofounder of LVMA. We joined forces. That’s when we created the mission, vision, and logo of LVMA. It was during my second year of vet school.

: How can we get other Latino/Latinx veterinarians and veterinary professionals to support the LVMA mission?

: We want to put [out] a call to action and need support from others to be part of our organization. We want the purpose to be Latinx support. We want to represent more and better. Veterinarians who are Latinx need the support. We need to serve this community which is currently underserved. We want to represent veterinary professionals and veterinary students. Most of what we are doing is to help veterinarians and veterinary students.

: I am interested in emergency medicine. I’ve always been passionate about creating change in the profession. I am a believer in being the change you want to see in the world. I see a gap and I go to fill it. That’s why I costarted the LVMA, that’s what defines me. There is so much in this profession that needs to change. I want to do more things [and]…make things better. I want to create something to make life better…to elevate veterinary medicine and have an impact. I want to help more people.

Prior to finishing our interview, I attempted to recruit Juancho into a veterinary role with my organization. I have no doubt that wherever he lands, he will continue to positively affect veterinary medicine and help patients in need. Any hospital would be lucky to have him.

Mariliz Hernandez, DVM, is the proud owner of 

 in Queens, New York, a successful multidoctor 

-accredited hospital that is focused on high medical standards. Hernandez was born in Puerto Rico and attended the University of Puerto Rico in Arecibo. In 2002, she received her doctor of veterinary medicine degree from the 

College of Veterinary Medicine at Tuskegee University

 in Alabama. Her interests include primary medicine, surgery, and dermatology, as well as communicating with her Spanish-speaking clients.

: What do most people not know about you?

: I have a fraternal twin, a brother, and I have a younger sister. I lived in Puerto Rico for 23 years before I decided to join the veterinary program [in Tuskegee]…This was always a dream of mine. A lot of people thought I wasn’t going to make it, that it was just me desiring a beautiful career. I guess I proved them wrong at the end. It was always something I was very consistent [about]. You know that kids can change; I never did. I was very focused on that goal and it was very difficult at the time because usually in Puerto Rico, as you know, there’s no veterinary program.

: I went there because it was a minority school and the most important thing for me was finances but also the surgical [opportunities]. It had the surgical experience I was looking for because I’m very crafty and I love doing things with my hands. I ended up finding my husband there. [Hernandez is married to another veterinarian]. It was one of my best experiences in the middle of Alabama, in the middle of nowhere, and it was a great school.

: As a native Spanish speaker practicing in Queens, what can you tell me about your Hispanic, Latino, and Latinx clients?

: They’re my heart. They’re communicating in Spanish. When you practice and they know you know Spanish, their eyes open up, their shoulders go back, they relax, they understand.

: What is your management style toward hospital culture and staff retention?

: If they don’t fit in, they have to go. If you’re comfortable here, you stay. …I don’t even give them [doctors] a contract. If it’s meant to be for them to be here, they can be here. If they don't want to be here, I don’t want any disgruntled employees; [they] can go. [This] has been the foundation since I bought the place with my husband.

I would tell my younger self to work hard, be fair. And I would say be very frank and clear. Just don’t leave anything inside, express yourself in a very respectable way and try to…communicate to the client the truth straight in the eyes.

: We work as a team. I will never take full credit for my success. It is the people behind me that are watching my back and are my right hand. They’re the ones who are keeping me in business, and, of course, the trust of the clients. And the reason they trust me is because they’ve seen the good outcome. They know we’ve come from a good side. [They] know we want the same goals that they have to get their pets better. And if I am wrong, I have no problem saying I’m wrong because it is the way that we grow. We’re growing every day, and medicine, as you know, doesn’t stop improving. So imagine, at an emotional level, we’re constantly evolving and in order for you to continue evolving, you have to be open and receptive. I was really tough before, I wouldn’t even care. Not anymore. I let go. It’s much easier that way.

What are you doing with Tuskegee to help that next generation of veterinarians?

: I made a studio just for my [Tuskegee] interns to stay in. They don’t have money to stay anywhere. That’s free. You stay there and make it your own little bedroom and that’s it. And you stay there until you go. Because I was there and I had an amazing veterinarian student from Tuskegee that lent me her house with my cat at that time. You have to remember where you came from and how hard it was.

After such a tough, nearly 2 years, what keeps you going?

: I think the resilience is part of it. It’s a survival skill that comes in our DNA also. No one is going to hand it to you when you get out of your country. You want to be the best of the best to represent your country. And I think that’s in your DNA. So yes, resilience comes in our DNA and there’s no time for failure. You try and if you fail, you pick yourself back up.

: Stop doing things to impress others. Do it for yourself. You’re grown up now. You have to be happy. If that idea of being a veterinarian made you happy, go there. Find the right place, a place that can nurture your passion. I don’t want to impress anybody. I want to impress myself now. I did everything I had to do to make my parents proud. Hopefully my husband [and] my kids see what I’m doing, and I think I’m so comfortable with myself now that I hope I can inspire them too. But I’m doing this for me now.

As we continued our interview, I found myself talking with Hernandez as if she was an old friend. From the outside, it looks like she has it all. She has found a way to have a family and a successful practice and has kept her passion in place. Her humility is understated. Lastly, she reminded me again that she would not be here without the help of her doctors, staff, and hospital manager, Kyle.

 of the American Veterinary Medical Association (

) and the first Latino to hold that position. Born and raised in Puerto Rico, Arce attended Louisiana State University in Baton Rouge for his undergraduate degree and 

Louisiana State University School of Veterinary Medicine

, where he earned his doctorate in veterinary medicine. He further completed a clinical internship at Rowley Memorial Animal Hospital in small animal medicine, surgery, and emergency medicine. His medical interests include dermatology, ophthalmology, soft tissue surgery, and ultrasonography. He is also co-owner, with his wife, of 

 in San Juan, Puerto Rico, and is active in the 

Colegio Médico de Veterinarios de Puerto Rico

From a young age, Arce had a passion for animals and science and knew he wanted to be a veterinarian. He was exposed to animals on his grandfather’s farm and kept fish in aquariums while growing up. Eventually, he combined his passion and love for both and pursued the “perfect career.”

: What led you to get involved in organized veterinary medicine?

: Giving back to the profession. It’s part of why I got involved in organized veterinary medicine. My dad was involved with the American Medical Association and so it was a natural thing to me to get involved in the AVMA. I started at the Student AVMA (SAVMA).

: What is your secret to keeping employees engaged?

: I think it’s about developing that relationship with them, trusting you know them and not micromanaging everything.

: I think you have to take one day at a time and remember why you became a veterinarian. We’re all in this together to make a difference, to make the life of our clients and our patients better. And I would just encourage everyone to fight through these stressors because, at the end, I think this is the best profession on earth. I really think that most of us are here because we really think that this is a great profession. Personally, sports helped me a lot. One of my stress relievers is playing soccer. It could be walking, running, whatever. Also, separating yourself from the practice after you come home. Good nutrition is important too. If you’re going to have an unhealthy life, it’s just going to make things worse.

: How does it feel to be breaking down barriers in veterinary medicine?

 know it feels good. I feel very proud of it. At the same time, some responsibility comes with it. I’m trying to do the best job and lead by example throughout my presidency. I hope my being present in AVMA attracts other minorities. Whether [they are] Hispanic or Black or Asian American, it doesn’t matter. If I did it, anybody else can do it. When I started getting involved with SAVMA and later at the AVMA, I felt welcomed. Sometimes you hear about discrimination and I never felt that within veterinary medicine being Hispanic.

: How do we make veterinary medicine more accessible to underserved minority communities?

We have to get to these areas. We’re not there yet. The underserved communities are something we have to reach out to by getting kids from these communities interested in becoming veterinarians. That’s going to change and we’re going to have veterinarians in the middle of some of these underserved communities for the rest of our lives. We just need to get that interest, tell them that you can be a veterinarian if you’re from South LA [Los Angeles] or from the Bronx.

: I invite everybody from any background, …any type of practice, sexual orientation, or whatever it is, to get involved. Given the opportunity, get involved: whether it’s in your county VMA [veterinary medical association], your state VMA, the AVMA, AAHA [American Animal Hospital Association], or whatever association…, [you] can make a difference.

Arce knows he has a large task ahead of him and he is facing it head-on. His commitment to veterinary medicine and his need to serve is admirable and infectious. When we sat down, he was 45 days into his AVMA presidency. His 

Promoting AVMA diversity and inclusion in membership and leadership

Improving the student debt-to-income disparities in veterinary medicine

Promoting the health and well-being of veterinarians and veterinary students

This operations support manager engages in a Q&A with 3 figures in the veterinary field striving to make the industry more diverse, equitable, and inclusive. 