This new resource offers veterinary professionals and students an opportunity to earn RACE-approved CE credit via a series of informative online webinars.

dvm360 launches online CE center amid pandemic

Registration is now open for the first virtual Fetch dvm360 conference, which combines three of our exclusive annual live events: Fetch Baltimore, Hospital Design 360 and Fetch Kansas City.

Registration for Fetch dvm360 virtual conference is open

This exciting event is ideal both for recent graduates and veterinary professionals looking for new opportunities.

dvm360 hosts second virtual recruitment event

Married for 22 years, communication experts Carolyn Shadle, PhD, and her husband John Meyer, PhD, have cultivated an immense passion for the human-animal bond and helping to improve the veterinarian-client-patient relationship.

In this episode of The Vet Blast Podcast, the couple talks with Adam Christman, DVM, MBA, about why empathy is so important in veterinary medicine and share some of their lecture highlights for the 

The couple tells Dr. Christman that their lectures will focus on the science behind the human-animal bond, the economic impact of the ever-evolving human-animal bond on pet owners, plus how to express empathy to your clients both verbally and nonverbally .

“Pet owners come to veterinarians quite often stressed. One of the champions of communication is showing empathy. It’s not easy.… It takes time and a different way of listening to hear the feeling behind the words,” says Dr. Shadle.

Check out this podcast to learn more about this couple’s passion for the human-animal bond, plus enjoy a fun surprise at the end! 

If you’d like to be featured on our podcast, 

Podcasts

In this episode of The Vet Blast Podcast, married communication experts Drs. Carolyn Shadle and John Meyer share why empathy is so important in veterinary medicine and offer a sneak peek at some of their upcoming Fetch talks.

 Episode 6: One couple’s shared passion for the human-animal bond

The goals of osteoarthritis (OA) management in companion animals are aimed at improving quality of life by controlling pain and restoring mobility to the extent possible. Traditional modalities for accomplishing these goals include dietary manipulation, physical therapy, surgery, and pharmaceutical agents (nonsteroidal anti-inflammatory drugs, corticosteroids, disease-modifying osteoarthritic drugs, nutraceuticals).

But veterinary clients are inquiring with increasing frequency about alternative modalities for managing OA in their pets. As veterinarians, we hold the keys to safe and effective treatments for patients suffering from this debilitating disease. Here’s a brief overview of some alternative modalities that can be used for primary or adjunctive OA management.

The connection between OA and overweight/obesity is undeniable. According to Banfield’s 

, 52% of dogs and 41% of cats with OA cared for in 2018 at Banfield practices were obese.

 Overweight and obesity increase the load on joints, in turn increasing the development of OA, the speed of disease progression, and patient discomfort. Results of a lifelong study of 48 Labrador retrievers showed that restricted feeding (vs. feeding ad libitum) delayed or prevented the development of radiographic signs of hip OA.

 With this in mind, evaluating a patient’s diet is an important first step in managing OA.

 are available to aid in weight control and OA management. These diets are often lower in calories than typical diets and contain high levels of omega-3 fatty acids, which help support joint health and mobility by reducing inflammation, as well as glucosamine and chondroitin, which help slow cartilage deterioration.

 for treating OA has become more common in general practice in recent years, as it is often requested by clients as an alternative to pharmaceuticals. Acupuncture is a form of traditional Chinese medicine that is performed by introducing thin, specialized needles into acupoints.

Multiple techniques, including dry needling, aquapuncture, moxibustion, electroacupuncture, and laser acupuncture, may be used either alone or in combination to stimulate acupoints. Aquapuncture is the introduction of sterile fluid into an acupoint as an alternative to setting dry needles. Moxibustion incorporates the burning of moxa (small cones of dried herbs) to apply heat safely to acupoints. Electroacupuncture, which combines mechanical and electrical effects, is commonly used to relieve pain associated with OA.

 Laser acupuncture involves the use of a low-intensity laser to stimulate acupoints. Laser acupuncture and aquapuncture are ideal for patients that cannot tolerate dry needling or electroacupuncture.

A number of Chinese herbal formulations containing boswellia and turmeric have been proven safe and effective for reducing OA pain and inflammation in dogs.

In my experience, Chinese herbal formulations are best used in combination with acupuncture to increase the effectiveness of treatment.

Commercially available autologous adipose-derived mesenchymal 

 have been used by veterinarians since 2003 to treat joint disease as well as tendon and ligament injuries in horses.

 This modality is becoming more common in small animal medicine as well, particularly for improving mobility and quality of life in dogs with OA. In a 2007 study, dogs with hip OA treated with stem cells showed a significant improvement in mobility and pain scores.

—and the endocannabinoid system as a whole—is flourishing. One of the primary areas under study is the use of cannabinoids to treat pain and inflammation in OA patients. In a study published in April, cannabidiol (CBD) was shown to induce broad anti-inflammatory effects in vivo and to greatly reduce proinflammatory tumor necrosis factor-alpha in vitro.

 Legislation regarding cannabinoids varies widely, with restrictions in most states on discussing and prescribing cannabinoids for veterinary patients, but with further research cannabinoids could become a viable treatment option for animals.

The prevalence of OA, combined with a shift in client perceptions and the desire to treat with alternative modalities, pose a unique challenge to veterinarians. The good news is that safely and effectively improving quality of life in these patients is now possible when surgery and pharmaceuticals are not options. As always, the modalities selected should be tailored to the patient's specific needs and the owner's ability to remain consistent in their role as caregiver.

Osteoarthritis: When age is not to blame. Banfield Pet Hospital. Published January 2020. Accessed August 6, 2020. 

https://www.banfield.com/Banfield/media/PDF/Downloads/soph/2019-SOPH-Report.pdf

Smith GK, Paster ER, Powers MY, et al. Lifelong diet restriction and radiographic evidence of osteoarthritis of the hip joint in dogs. 

. 2006;229(5):690-693. doi: 10.2460/javma.229.5.690

Davies M. Practical management of canine osteoarthritis. Vet Times. Published January 19, 2015. Accessed August 1, 2020. 

https://www.vettimes.co.uk/app/uploads/wp-post-to-pdf-enhanced-cache/1/practical-management-of-canine-osteoarthritis.pdf

Zhang R, Lao L, Ren K, Berman BM. Mechanisms of acupuncture-electroacupuncture on persistent pain. 

. 2014;120(2):482-503. doi:10.1097/ALN.0000000000000101

Dejonckheere V. Turmeric for osteoarthritis in veterinary medicine: a review. (2016). Herbal Vets. Published 2016. Accessed August 1, 2020. 

http://www.herbalvets.org.uk/wp-content/uploads/2016/10/turmeric-dejonckheere.pdf

Miscioscia E, Shmalberg J,Scott KC. Measurement of 3-acetyl-11-keto-beta-boswellic acid and 11-keto-beta-boswellic acid in 

 2019;15;270. https://doi.org/10.1186/s12917-019-2021-7

Black LL, Gaynor J, Gahring D, et al. Effect of adipose-derived mesenchymal stem and regenerative cells on lameness in dogs with chronic osteoarthritis of the coxofemoral joints: a randomized, double-blinded, multicenter, controlled trial. 

Shah K, Drury T, Roic I, et al. Outcome of allogeneic adult stem cell therapy in dogs suffering from osteoarthritis and other joint defects. 

Verrico CD, Wesson S, Konduri V, et al. A randomized, double-blind, placebo-controlled study of daily cannabidiol for the treatment of canine osteoarthritis pain [published online ahead of print, 2020 Apr 24]. 

. 2020;10.1097/j.pain.0000000000001896. doi:10.1097/j.pain.0000000000001896

Articles

Osteoarthritis is a painful, debilitating condition that affects countless animals. Here’s a look at alternative treatments being used in veterinary practices across the country.

Alternative therapies for managing osteoarthritis

When presented with an unfortunate and unexpected turn of events, we tend to become angry, confused and downright impatient. However, being in quarantine taught me that while there are many obvious cons to this situation, there’s also some silver linings.

Coronavirus: a ‘novel’ situation for veterinary students

,” you’ll quickly learn that third-year students have started clinical rotations in a very unorthodox way. I also shared some of the fears and anxieties that we faced during this pandemic.

In this article however, I’ll discuss some of the positives about this 

With the inability to treat actual patients, rotations primarily consist of rounds and case-based discussions, allowing us to closely interact with the clinicians. Usually students aren’t able to establish these close relationships, mainly because clinicians typically discuss treatment options with interns, residents or house officers. But due to the current state of affairs, we have the opportunity to not only gain a better understanding of why the clinicians’ select certain treatments, but we also can form a stronger bond with them.

Because of the pandemic, clinics are now a cross between the traditional clinic setting and a classroom. This new learning environment allows us to ease into things instead of just being thrown into the “lion’s den.”

A key trait in veterinary medicine is adaptation. We are constantly adjusting to many new situations — whether it’s a different animal species, varying client financial situations and sometimes limited resources at some hospitals. During this pandemic, we are continually learning to adapt in an unprecedented manner, which I believe will be beneficial in the future.

Having more self-reflection can help you obtain a clearer view of your overarching goals. We now have more time for introspection, and thus can discover what truly peaks our interest in this field.

If you’re like me, it’s been challenging to find things to fill my time. Discovering new hobbies and passions outside of the world of veterinary medicine is a great place to start.

Although cliché, looking for the positives during trying circumstances helps to promote happiness and sanity. If we continue to focus on the few yet valid positives, we will feel more productive, less angry and will realize that the time spent in quarantine was not

Harris Fitzgerel is a current third-year veterinary student at the Cummings School of Veterinary Medicine at Tufts University. He is interested in small animal medicine with a particular emphasis on dermatology and general practice.

A third-year veterinary student shares the upside to starting clinical rotations during COVID-19.

Exploring the positives of the pandemic

dvm360 is looking for veterinary students to become a part of our new student ambassador program. Led by 2020 graduates Trusten Moore, DVM, and Danny Sack, DVM, this exciting program was created to amplify student voices within the profession and build networking opportunities.

"I wish a program like this was available when I was a student," says Dr. Moore. "With so many veterinary professionals represented on the web today, I think this is a great opportunity to foster mentorship, help students build professional relationships, and learn the importance using media and social media within the veterinary profession!"

Dr. Sack agrees, adding that he's excited "to help form a network of inspired, interactive veterinary students from around the world and share the perspectives of the new veterinary generation."

One student ambassador will be selected by Drs. Sack and Moore from each AVMA-accredited veterinary school following an application process. Student representatives will be required to: 

Follow dvm360 on social media and share relevant content with other veterinary students.

Spread awareness about dvm360 and the dvm360 conferences (Fetch and Atlantic Coast Veterinary Conference) to increase student attendance.

Participate in one video interview or write one article (600-1000 words) per year on a topic relevant to veterinary students and/or working veterinary professionals. This video or article will be posted on dvm360.com and may also appear in print.

Attend a bi-annual virtual ambassador meeting with Drs. Moore and Sack.

Still not convinced? Here are a few key benefits for our student ambassadors:

Your article or video featured on dvm360 (online and/or print)

Complementary admission to a dvm360 conference of your choice (travel and loding not provided)

"The goal of the dvm360 vet student ambassador program is to continue to create and enhance communication between veterinary students and the profession. We are honored to welcome students to celebrate their creativity. dvm360 is a home for everyone and we are here to harness and showcase their talents on our wide variety of multimedia platforms," says dvm360's Chief Veterinary Officer Adam Christman, DVM, MBA.

We welcome you to apply for our new veterinary student ambassador program. One student will be selected from each AVMA-accredited school.

Veterinary students: dvm360 is looking for you

I can vividly remember back in 1974 when Dr. Wiggins, one of my professors at Auburn University College of Veterinary Medicine, advised us students to wait until a deciduous “double” tooth falls out by itself. Fast forward many years, and I now know that postponing the extraction of persistent primary teeth often causes harm to my patients.

Waiting to perform optimum dental care is sometimes the treatment of choice and at other times is a bad idea. This article covers some of those situations where waiting is the best option. A second article will outline conditions for which waiting is just wishful thinking.

Periodontal disease arises from gingivitis caused by plaque irritating the gingiva. When left to accumulate, plaque calcifies into rough calculus (tartar), which allows more plaque to collect on the crown. In predisposed dogs and cats, plaque inflames the gingiva (gingivitis) and eventually progresses to loss of support (periodontal disease).

Periodontal disease cannot occur without gingivitis, but gingivitis can occur without progressing to periodontal disease. Regardless, once calculus contacts the gingiva and inflammation is noted, it is time for an anesthetized professional oral hygiene visit that includes dental scaling, irrigation, and polishing; tooth-by-tooth probing and full-mouth intraoral imaging; and treatment for any underlying disease discovered. Waiting will only increase patient discomfort and the extent of disease (

If calculus is clinically present but inflammation is not, the professional oral hygiene visit can wait either until inflammation becomes apparent or a year has passed from the time when the last professional oral hygiene visit, to remove the accumulated plaque and calculus.

Stage 2 external root resorption confined to the subgingiva

External root resorption can occur anywhere on a cat’s or dog’s tooth but starts in the periodontal ligament space. Many root resorptions are discovered via intraoral radiographs obtained during the anesthetized professional oral hygiene visit. Even though external root resorption is considered progressive, immediate extraction is not necessary when the resorption is shown clinically and radiographically to be located far below the gingival margin in the apical third of the tooth. Once external root resorption is exposed to the oral cavity, bacterial contamination of dentin and pulp results in painful inflammation. In those cases, extraction is the treatment of choice (

Internal root resorption is a different story in that by its nature the pulp is infected and considered painful. For internal root resorption, waiting is not an option. Root canal therapy or extraction are the treatments of choice.

Extra teeth in large-breed dogs often can be accommodated without causing harm or requiring extraction. Small-breed dogs and most cats do not have this luxury. Supernumerary teeth in small- and medium-sized breeds can cause tooth crowding, leading to gingivitis and periodontal disease resulting from the accumulation of food and oral debris between the teeth irritating the gingiva. Immediate extraction of the tooth (teeth) causing crowding is indicated in these cases (

Not all teeth erupt in normal positions. Malpositioned teeth may be secondary to birthing trauma, inherited defects, or trauma after birth. The decision to treat or wait to move or extract abnormally positioned teeth should be made after an examination that includes probing and intraoral radiographs. If the malpositioned tooth is functional and not causing discomfort, waiting to extract is the best option (

Generally, whether to extract abnormally located teeth can present a conundrum. If there is no obvious mucosal penetration causing discomfort, a wait-and-see approach is appropriate.

Chronic abrasion (i.e., tooth wear caused by contact with a nondental object, such as from self‐grooming or chewing on tennis balls) and attrition (caused by contact of a tooth with another tooth from misaligned opposing teeth) may result in excessive wear and direct or indirect trauma to the pulp. Repeated low‐grade trauma stimulates odontoblasts to produce tertiary (reparative) dentin for repair and protection. Tertiary dentin often appears as a reddish‐brown shiny spot in the center of the worn surface.

As long as the rate of wear is gradual, reparative dentin production will keep up with loss of tooth structure without causing pulpal exposure. When the rate of wear is faster than the rate of tertiary dentin production, the pulp becomes exposed, leading to bacterial invasion pulpitis and eventually pulp necrosis. Probing the worn area with an explorer and radiographic examination will help evaluate endodontic and periodontal involvement of worn teeth to see whether therapy is indicated. In cases of pulp exposure, treatment (root canal therapy or extraction) is indicated because pain and infection usually result (

When it comes to dental care, sometimes the best course of action is no action at all.

The ABCs of veterinary dentistry: W is for waiting to treat

For many people, personal and professional life goals are intertwined, and this is certainly true for current and future veterinary practice owners. Reaching your personal goals often depends on having some level of financial freedom, which is only achieved when you reach your professional goals. If your goals include early retirement complete with travel and other luxuries (boats, vacation homes, etc.), then your professional goals will likely be more audacious than if you envision a more modest lifestyle and a later retirement.

The first step in helping improve your overall financial success is to decide (or update) what you want to achieve in your life and create a list of specific goals to get you there. Only once you consider the bigger picture can you begin to refine the details. One of these “details” for many veterinarians is practice ownership.

The definition of personal financial success is different for everyone. Some people have an arbitrary number or scenario in mind that they believe they will achieve if they “grind” their way to the top. But working hard and blindly reaching for the stars may not be as successful as implementing a defined and disciplined approach to investing and saving.

Many people either have no budget or have a budget that is not strict enough for them to improve their finances substantially. The fact is that realizing financial success will likely involve time, effort, discipline, and sacrifice. If you are willing to make tough decisions and take the time to plan the framework for your personal financial growth, then all that is left to do is execute your plans and begin to see the results.

One way to determine where to make cuts in spending is to categorize your goals as needs, wants, or wishes. This allows you to see what you can do now and what will have to wait, giving you a broader understanding of what you are able to accomplish and when.

One of the best ways to create a disciplined budget is the “50/30/20” rule. This method dictates how much of your after-tax earnings you can allot for three types of spending:

50% is spent on your essential fixed costs and (e.g., rent/mortgage, groceries, utilities).

30% goes toward your wants (dining out and other discretionary spending).

20% flows right into savings/investing and paying down bad debt (credit cards, high-interest loans, etc.). 

To make a real difference in your financial habits and bottom line, this 20% number is the “magic sauce.” If your spending is allocated correctly, you should reach your desired position in due time.

The value of a practice is realized by an owner when the practice is sold. Understanding what drives practice value and how to improve it is critical. There are two primary markets in veterinary medicine today in which a practice can be sold. The first is the historical market, which is when a practice is sold from one veterinarian to another. The second is the corporate market, which is when a practice is sold from a veterinarian to a corporate entity that owns numerous practices (and may or may not be owned by other veterinarians).

The amount buyers in each market are willing to pay varies, but the practice’s profitability is almost always the most important determinant of practice value. Whether you are 2 years or 30 years away from selling your practice, this is a critical metric to understand, yet most owners don’t know what that number is for their practice. Improving profitability not only will increase your practice’s value at the time of sale, it also will increase your cash flow during ownership.

Determining your practice’s profitability

Calculating the true operating profits of a practice is not a simple task. None of the standard financial or management reports a practice usually gets include this figure. Neither the taxable income from the tax return nor the net income from the profit and loss statement represents true profitability.

The operating profit is the difference between the operating revenue and the expenses a practice incurs. Operating revenue and expenses include only those items normally and necessarily seen in day-to-day practice operations, such as fees for professional services, and drug and medical supply expenses. These items should be listed at fair market value.

For ease of comparison with other practices, a hospital’s profit margin is generally stated as a percentage, which is calculated as practice profits divided by gross revenue. However, some items must be calculated differently to determine operating profit versus taxable income or net income. These include practice owner payments, facility and equipment rent (if these items are owned by the practice owner and leased to the practice), services provided by family members to the practice, depreciation, interest on debt, and perks. The resulting percentage is the true operating profit of the practice, and it is important to compare this percentage with other investments you have and with that of other practices. An operating profit of 20% or higher is considered superior, 12% to 13% is average, and less than 6% is poor.

This all may sound a little daunting, but there are resources available to help. If you work with a veterinary financial adviser, this person should be able to calculate your profitability. 

 also offers resources to help guide you through this calculation process.


Converting profitability into practice value

Once the profitability figure is determined for a veterinary hospital, that number must be converted into the practice value via an appropriate capitalization rate (or cap rate). In practical terms, the cap rate is the required rate of return an investor needs in order to be persuaded to make an investment. There is no one correct rate for all situations—the rate is determined by the market and will vary depending on both external factors (e.g., the state of the economy) and internal factors (e.g., the level and quality of the company’s earnings, the amount of competition in the area). The rate is a reflection of the risks associated with owning and managing a veterinary practice, and continuing to generate the current level of profits. The inverse of the cap rate is a multiple; for example, if the cap rate is 20%, the multiple is 5 and the formula used to derive practice value is as follows:

Annual earnings × Multiple = Practice value

To increase practice value, the management team needs to either increase profitability or decrease the risk associated with owning the practice (i.e., the risk associated with maintaining the practice’s current profitability).

A lack of profitability stems from revenues that are too low, expenses that are too high, or a combination of the two. Profitability can be improved in many ways, from increased marketing to better inventory control to improved team productivity.

A wide range of factors affects the risk related to owning a veterinary practice, including client demographics, the state of the facility, the quality of the management team, and the range of services offered, among others.

Increasing practice value involves three steps:

Understand where the practice is doing well and where it needs improvement.

Working with a financial advisor or practice consultant may help not only in gaining a greater understanding of the issues that impact profitability but also in identifying and implementing solutions.

Synergy between practice and personal financial goals

It is very possible to have a thriving business and a personal financial state that has ample room for improvement and vice versa—the two are not mutually exclusive. Having a well-organized personal financial life can impact how your practice is run, and a well-run practice sets the stage for a fruitful personal financial future. The common dominator between these two aspects of financial fitness is planning.

Dr. Felsted has spent the past 20 years working as a financial and operational consultant to veterinary practices and the animal health industry. She served as CEO of the National Commission on Veterinary Economic Issues for 3 years. Dr. Felsted is active in multiple veterinary organizations, has written extensively, and speaks regularly at national and international veterinary meetings. She owns 

PantheraT Veterinary Management Consulting

Miles Saunders owns and operates MNS Wealth Management LLC in Westport, CT. He can be reached at 

Westport Office: 55 Greens Farms Road, Suite 1 Westport, CT 06880 – Phone: 203-571-2312 www.mnswealthmanagement.com Registered representative offering securities and advisory services through Cetera Advisor Networks LLC (doing insurance business in CA as CFGAN Insurance Agency LLC), member FINRA/SIPC, a Broker-Dealer and a Registered Investment Advisor. Cetera is under separate ownership from any other named entity. For a comprehensive review of your personal situation, always consult with a tax or legal advisor. Neither Cetera Advisor Networks LLC nor any of its representatives may give legal or tax advice. All investing involves risk, including the possible loss of principal. There is no assurance that any investment strategy will be successful. Asset allocation is an investment strategy that will not guarantee a profit or protect you from loss.

For veterinary practice owners, professional and personal goals and growth go hand in hand. Success is achieved through time, effort, discipline, and sacrifice—and a little professional guidance.


Featured Content

dvm360 launches online CE center amid pandemic

Registration for Fetch dvm360 virtual conference is open

dvm360 hosts second virtual recruitment event