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IDEXX: Contributing to something bigger

This doesn’t feel like a hospital!” That often heard exclamation pleases Lukas Keindl, cofounder and chief product officer of Bond Vet in New York, New York. But the comment also baffles him. “We’d like to think that this is what a hospital should feel like,” he says. “You are supposed to feel comfortable and calm because this is such an important place for you and your pet, whether you’re here for a wellness visit or if your pet is sick.”

Bond Vet is a veterinary-led company with 7 locations in New York and several more in the works. The idea behind all the locations, including the first hospital in the Cobble Hill neighborhood of Brooklyn, is to build better places for team members, clients, and pets to give and receive care and to deliver urgent care to pets in need. “When you look at our clinics, starting with Cobble Hill, you can see the focus on those things throughout the design,” says Keindl.

The small animal practice focuses on general care as well as urgent and emergency services. The facility’s attention to detail, clean floor plan, and inviting environment earned Bond Vet (Cobble Hill) a Merit Award in the 2021 dvm360

The Bond Vet website says, “Bond Vet is an animal hospital designed around you and your pet. Because that’s how we think pet care should work.” Starting with a clean web design, bright colors, easy-to-navigate pages, and virtual appointments (daily hours are 10 am to 8 pm, even on holidays), clients can see how that clarity and care follows into the physical facility.

The practice owners chose Cobble Hill to allow them to become part of a residential community full of pet owners. “For any neighborhood we move into, it is important to us to be part of the community we are serving, and we like that our spaces become hubs for gathering for monthly events,” Keindl says.

A minimalist desk provides a simple place for clients to check in. All phone calls happen at a different location, allowing receptionists to focus solely on in-person client interactions.

They leased the Cobble Hill space for the long term and renovated it to match their brand and fit while standing out. Key design elements are a modern feel, from the seating to the artwork and the large murals in the lobby. A consistent color scheme of blue, white, taupe, and natural wood throughout, highlighted by the Bond Vet logo in blue and red, ties the facilities together. Comfortable seating that is custom produced, with a material that gives pets grip but is hard to scratch, punctuates the waiting spaces.

“Our patients love being allowed on all of our furniture, and the pet parents appreciate the design and warmth of our spaces,” says Keindl. “They can relax and get comfortable and feel at home with their pet.” The flooring was designed with a good friction coefficient to feel better on pet feet. Another way the hospital feels like home is the hospitality station in the lobby, stocked with beverages, hot tea, and snacks for the humans—and a “snout-level” treat bar for the canine clients, allowing them to pick out a treat while waiting or after an appointment.

Patients and clients alike are welcome to help themselves to refreshments while waiting. This “snout level” treat bar features a variety of pet treats.

“When designing the clinic, it was important for us to build a space that works better for everyone who will experience it, pet and human alike,” says Keindl. “We spent a lot of time with our doctors, nurses, and care team to learn what they would love to see. We partnered with an interior designer who specializes in hospitality design, having designed spas, hotels, and restaurants across the country. This was a natural choice for us, because we wanted to end up with something that feels comforting, calm, and enjoyable but that’s atypical for a veterinary clinic.”

The art directors at Islyn Studio, the creative genius behind Bond Vet’s physical spaces, say they “reenvisioned the animal health care space through the lens of compassionate hospitality, crafting an environment that anticipated pets’—and their humans’—every need.… We designed an empathetic, multisensory interior that utilizes pastel colors, tender touchpoints and calming scents to mitigate the stress and trauma often associated with vets’ offices.

The doctors’ lounge offers a quiet place to get paperwork done, all in a stylish space flooded with natural light.

For the Bond Vet team, tender touchpoints mean eschewing everything from the traditional cold metal tables to communal waiting rooms in favor of soft seating, plush pillows, warm lighting, fun artwork, and other elements that draw clients in rather than push them away. “We considered the functional priorities of the space, ensuring every material was durable and easy to clean but never sterile. Bond Vet feels like you’re visiting a friend’s comfortable city home,” the designers say.

That sensibility did not stop the day they called the design done and opened the practice doors. It now continues with the warmth of the doctors and a continual investment in daily cleaning, ongoing maintenance, a recent expansion of the surgery suite, and more to make sure it stays as beautiful and functional as on the first day, Keindl says.

When designing the ideal space, Keindl says, “We often say that the most important room we design in each hospital is the break room.” That sums up the company’s philosophy on how to treat care team members— giving them a comfortable, relaxing environment to work in with plenty of space to move.

The color scheme and clean design elements extend into the exam rooms. White brick walls, open shelving, and deep blue cabinets give these rooms functional style.

Team members also appreciate the modern equipment built into all Bond Vet hospitals. “Our teams love that the spaces are built with modern equipment so we can practice the best medicine, and that we have spacious exam rooms that are large enough even for the occasional Great Dane,” Keindl says.

“We’ve spent a lot of time thinking about our team’s flow through the space, and a pet’s flow through a visit to the clinic, and we designed the clinics and equipment placement to make sense. The team seems to really appreciate that we’ve put as much thought into the team-only spaces like the treatment area, doctors’ office, and break room as we have into the clientfacing areas.”

The doctors are especially excited to show off the built-in oxygen system, ultrasound equipment, and efficient treatment area layout to their new team members or veterinary professionals who visit. Keindl says veterinarians who visit get excited about several things: “Our large treatment areas with top-of-the-line equipment, our beautifully designed doctors’ offices with quiet phone booths, and the warm, soft lighting,” he says. “But above all, the thing that probably stands out the most to veterinarians is how calm the clinic is.” This is in part because Bond Vet uses a fully remote communication center that takes calls and does callbacks for all of their clinics, meaning the phone never rings in the clinic.

The treatment area enjoys large windows to the outside world.

“This allows our doctors and nurses to focus on providing the best care to the patient in the treatment room with no distractions,” he says. And, no doubt, the sense of calm that starts with the doctors and staff also emanates from the warm, relaxed design they have honed.

Sarah A. Moser is a freelance writer in Lenexa, Kansas

Articles

Clean lines and comfortable spaces help clients, pets, and staff members relax at this upscale New York hospital. 

Minimalist design, maximum effect

Many pet owners remain unaware of the benefits efficient dental care can provide their beloved pets. According to 

, some key benefits of brushing a pet’s teeth include preventing the build-up of plaque, tartar, and calculus, examining the mouth for signs of trauma (ie, broken or fractured teeth), and beyond. Encouraging owners to establish a regular dental health routine is a crucial step, and it starts by providing them with oral care suggestions.

 recommends sharing with clients to help prevent and protect their pets from several oral diseases. 

#1. BC Pets Smart Dental Pet Toothbrush Kit

This kit features 2 silicone finger toothbrushes, a dual-ended toothbrush, and an original 2-ended toothbrush ideal for front and side teeth. Each brush has soft yet durable bristles and comes with a cap so they don’t get dirty while they are stored. Pair the desired brush with toothpaste before cleaning to ensure a complete dental care session. The brushes are intended for both canine and feline use.

These finger brushes are gentle on the teeth and gums but effective at removing plaque and tartar while freshening a pet’s breath. They have a flexible design that forms to your finger comfortably and targets hard-to-reach areas in the mouth. Use the brushes with pet-friendly toothpaste for a thorough cleaning. This value pack includes 10 finger brushes safe for dogs and cats of all sizes.

#3. Arm & Hammer Tartar Control Dental Kit for Dogs

This kit comes with a dual-sided toothbrush and flexible finger brush designed to reach all areas of a pet’s mouth. The soft, durable bristles reduce tartar buildup while eliminating bad breath and brightening dogs’ teeth. Plus, the tartar control toothpaste derived from natural ingredients features a baking soda enhanced formula and beef flavor and fresh mint scent. This kit is designed for dogs.

Here are a few dental health solutions to consider when guiding owners through the process of at-home oral care routines in-between visits. 

Keep your patients' mouths clean with these 3 pet toothbrushes

I recently wrote an article discussing causes of the predominant whiteness in veterinary medicine. In case you missed it, approximately 89% of veterinarians in the US are White, whereas less than 2% are Black—of this number, 63% are women and 37% are men.

Many articles and opinion pieces have discussed the need for diversity and inclusion across myriad disciplines.

Although the current climate seems more accepting of this dialogue, I often ask myself what value there is in highlighting a problem without also coming up with workable solutions. In the absence of writing a followup, as a change agent, I would be committing social malpractice. Having said this, I acknowledge there is certainly no shortage of thought pieces on this topic. We must create more conversations, action, and solutions—not less.

The good news is the solutions are doable and right in front of our faces. The bad news is the solutions are doable and right in front of our faces, yet meaningful change has not occurred. This article’s focus is on veterinary medicine but some, if not all, premises can be applied across multiple disciplines where diversity is needed or lacking.

For any endeavor aiming to diversify the workplace to have a chance of succeeding, we need to first point out the overwhelming evidence supporting the benefits of diversity. Further, the people making decisions need to accept these data and embrace the positive effects of diversity including, but not limited to, improved workplace morale, increased innovation and creativity, client retention, improved production, and enhanced standing among business cohorts.

Once we value these facts, we then must take a forensic look at our individual workforces and begin exploring policies that will inch us closer to our diversity goals. You might be thinking, “What should the goals be?” Well, we should strive for our workplace demographics to closely mirror the melting pot society we live in, to the greatest extent possible.

Let us address the always-present elephant in the room whenever we talk about policies geared toward increasing diversity: affirmative action (AA). What inevitably follows the invoking of AA is the notion of “reverse racism.” Those who oppose the idea of policies geared toward increasing diversity usually subscribe to a “color-blind” ideology, in which privileged individuals deny or minimize the degree of racial inequality or explain contemporary racial inequality as the result of factors unrelated to racial dynamics.

The negative connotation that comes with AA stems from the belief that you are sacrificing talent for diversity. Despite the obvious conflation, the two things are not mutually exclusive, and when framed this way a false choice is created. Research supports the opposite conclusion: When you have a highly homogenous workplace—that is, when diverse candidates are overlooked—you end up reaching further down into the talent pool of members of the majority group.

 Once you evaluate your organization for needs, you then need to come up with requirements and thresholds for individuals to meet to be eligible for employment. Once you have a robust group of qualified candidates, you must then make selections based on who will get you closer to your stated diversity goals.

The above approach is categorized as goal-oriented, as opposed to the more process-oriented approach that we see with traditional AA programs. Hiring unqualified candidates in any circumstance would be detrimental to your organization and set the candidate up for failure.

Next, we must incentivize or motivate people from the majority group to become personally invested in mentoring or sponsoring people from vulnerable populations. (When I say motivate, I am adopting GEN Dwight D. Eisenhower’s take on the word. He famously said, “Motivation is the art of getting people to do what you want them to do because they want to do it.”) The natural aversion people experience when they are made to feel they are being forced to do something is well documented. Therefore, having willing participants is likely to yield more favorable results.

Now that you have a deeper understanding surrounding the benefits of diversity and have acknowledged the effects of not having it, you can put a mechanism in place and criteria for potential candidates to meet. With that mechanism in place, you can make your choice from qualified candidates while keeping your diversity voids in mind. How does one seek out and find these diverse applicants and, as important, how can one retain them? The former can only occur if we go beyond slogans, catchphrases, and pamphlets—which are passive— to active measures.

Active measures require going to where diverse populations are and educating them about the benefits of joining your hospital or organization. A good place to start would be historically Black colleges and universities and early preparatory schools located in underserved communities. Once candidates are attracted, retention and nourishing must occur, and this is best done by the invested and incentivized individuals you have in and around your organization. In this way sponsors and mentors, often members of the dominant group, can give access to networks and resources that might otherwise be inaccessible.

Promoting Black veterinarians to meaningful leadership roles within the organization signals that there is a future in your company for minority employees beyond associate and middle management. This added investment and representation helps attract diverse candidates and is more likely to make minority employees feel they have an advocate in upper leadership and a person to voice their concerns to. Some organizations have opted instead to create positions to be filled by minority employees, positions usually dealing with the recruitment of minority candidates.

Although this is better than nothing and a step in the right direction, it creates 2 problems. First, there is the false sense that if the minority employee in charge and tasked with boosting minority candidate recruitment into the organization is unable to do so, then there must not be a problem, or nothing can truly be done. Secondly, it sends the message that the company does not value a person of color’s input outside of the inherent factor of race. If so, why not promote them to an already established, more impactful role within the organization?

A better approach to tackle diversity needs within organizations would be to form a task force consisting of many different voices from different backgrounds. Anything less suggests that diversity and inclusion is a problem for minority individuals alone to address. Remember, if we do nothing, the system is designed to yield results favorable to the dominant group (the status quo).

If change is to be realized, a thoughtful and vigorous approach is needed to counter the ubiquitous, pervasive nature of racism. The best way to do this is by programming ourselves to be active in our pursuits of a more diverse and inclusive profession.

Charles D. McMillan, DVM, is a veterinarian with IndeVets and is based in Atlanta, Georgia. He is a 2012 graduate of Tuskegee University School of Veterinary Medicine and has a keen interest in developing the public’s understanding of veterinary medicine, finding ways to foster a healthy veterinary workplace ecosystem, and exploring workable solutions to make veterinary medicine more diverse and equitable. You can find him on Instagram at @yourfavoritepetdoc or visit his website www.doctorthinker.com.

US Census Bureau. Microdata. Accessed July 14, 2021. 

https://datausa.io/profile/soc/veterinarians#demographics

Racism Without Racists: Color-Blind Racism and the Persistence of Racial Inequality in America. 

John F. Dovidio and Samuel L. Gaertner, “Aversive Racism,” 

Advances in Experimental Social Psychology 

One veterinarian addresses the need for diversity, equity, and inclusion by offering invaluable guidance on how to promote, hire, and retain a more diverse workforce. 

Practical solutions to combat racial disparities within veterinary medicine

The early management of myxomatous mitral valve disease (MMVD) in dogs has historically been problematic. Diagnosis and staging without echocardiography were something very few of us had at our disposal several decades ago. Thus, it was difficult to justify early treatment with medications with little (or no) data. Today our understanding of MMVD and how to diagnose and treat has progressed.

Don’t wait…investigate the heart murmur at the earliest stages 

Based on recent data, the American College of Veterinary Internal Medicine (ACVIM) consensus committee published updated guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs in 2019.

 Among other revisions, the treatment recommendations for congestive heart failure (CHF) were updated. The 

approach to CHF with a loop diuretic, pimobendan*, an angiotensin-converting enzyme inhibitor (ACEI), and the mineralocorticoid receptor antagonist (MRA), spironolactone, is now recommended for the latter stages of the disease complex.

Beyond the murmur intensity (grade I-VI/VI), these dogs should be staged based on objective, diagnostic parameters. A visual summary of the ACVIM guidelines staging is noted in Figure 1.

Stage A dogs are at risk (including all small dogs) but do not currently have a mitral valve abnormality. An example of a stage A patient would be the classic MMVD poster-child, the cavalier King Charles spaniel. There are however many other at-risk breeds that should be identified. Stage B dogs do have a mitral valve abnormality. They usually have a systolic heart murmur and may have some degree of cardiac enlargement. 

Stage B dogs have a murmur but no significant evidence of left atrial enlargement or cardiomegaly. B2 denotes dogs with a left atrium to aorta ratio (LA:Ao) of >1.6 and a left ventricular end- diastolic diameter normalized for body weight (LVIDDn) >1.7. Because many veterinarians do not have access to echocardiography, the ACVIM does acknowledge that the vertebral heart score (VHS) > 11.5 with a systolic heart murmur > 3/6 (or 1 of the newly recognized mensuration systems that have been published) can substitute for quantitative echocardiography to identify stage B2. Such measurement techniques provide similar, if not specific, evidence of changing cardiac (left atrial) enlargement patterns. While there are multiple techniques demonstrated to show close proximity to echocardiographic derived measurements, where possible the echocardiogram remains the standard of choice for identifying these morphologic changes in the heart affected by MMVD.

Stage C dogs have current or past clinical signs of congestive heart failure secondary to MMVD and evaluated.

Stage D dogs are end-stage congestive heart failure patients. These dogs have either acute or past clinical signs of congestive heart failure and are refractory to the standard treatment. Usually, Stage D dogs require more than 8 mg/kg/day of furosemide or the equivalent dosage of torsemide (also known as torasemide or DEMADEX®, a registered trademark of Meda AB).

The ACVIM endorsement of a quadruple therapy approach for CHF was a significant update to the consensus statement that was previously published in 2009. The use of spironolactone in CHF is an important part of that update. Its addition to traditional CHF therapy may not be for the reasons you were taught in school. Spironolactone is actually a powerful mineralocorticoid receptor antagnoist or blocker (MRA or MRB). The consensus panel agreed that a robust, broad-spectrum approach to suppression of the renin-angiotensin-aldosterone system (RAAS), including aldosterone inhibition, should be standard of care for CHF patients.

Why is control of the renin-angiotensin aldosterone system important?

One consequence of MMVD is activation of the RAAS. The RAAS is a primal, lifesaving mechanism meant to detect and adjust for changes in body homeostasis. For example, in situations where blood loss or dehydration occur, the kidneys detect decreased perfusion and release the hormone renin. This begins the cascade causing vasoconstriction and retention of sodium and water. These functions work to expand blood volume and maintain organ perfusion. When the bleeding is stopped or dehydration is corrected, the cascade is deactivated. Short-term activation is a good thing—a great thing, particularly if the animal is experiencing blood loss or dehydration. This is not the case for the dog with MMVD. Long-term, chronic, unchecked activation of the RAAS occurs with MMVD because of decreased cardiac output. Negative consequences occur due to excess production of angiotensin II and aldosterone. When this system is activated chronically, retention of sodium and water, chronic vasoconstriction, and cardiac remodeling or fibrosis result (see Figure 2).

Why aren't ACEIs enough to suppress RAAS?

It was long-believed that inhibition of angiotensin II production (with the use of ACEIs such as benazepril or enalapril) would benefit the patient by reducing overall angiotensin II concentration and by preventing the downstream production of aldosterone. While this is true in some cases, aldosterone breakthrough (ABT) occurs in approximately 30 to 40% of dogs on ACEIs.

 Because there are non-ACE-dependent pathways of aldosterone production and possibly some negative feedback mechanisms at play, we now know that ACEIs alone are not enough. In fact, broadspectrum inhibition of this deleterious system with a combination of spironolactone and benazepril (CARDALIS™) resulted in better outcomes for patients in a recently completed clinical trial.

 As with so many diseases that we treat in veterinary medicine, a broad-spectrum approach is often the path to success.

If we know that quadruple therapy is best for the patient, then what’s the problem? If you are a seasoned veterinary practitioner, you’re aware of the inevitable challenges associated with polypharmacy. With more drugs comes poor compliance which leads to less effective clinical outcomes and lowered client satisfaction.

In early 2021, Ceva Animal Health, LLC came to market with a solution to the issue of polypharmacy and compliance in the cardiac patient. CARDALIS™ is a combination of spironolactone and benazepril hydrochloride developed to provide for a more complete RAAS blockade. Available in a convenient, once-per-day, flavored, chewable tablet, CARDALIS™ was found to be safe and effective by the FDA and is approved for mild, moderate, and severe congestive heart failure (CHF) due to mitral valve disease in dogs.

CARDALIS™ provides half of the ACVIM quad therapy recommendation for CHF due to MMVD in dogs (see Figure 3). 

I would expect a convenient, chewable option to provide the pet owner and mitral valve disease patient with a more pleasant, effective, and superior medication experience. Improved compliance results in a longer life, better quality of life, and increased client satisfaction. Having an alternative to human generics in the form of an FDA-approved, once-daily medication with proven safety and efficacy data provides the practitioner with peace of mind when prescribing for one of their most vulnerable (and difficult to medicate) patient populations.

 The small, chewable tablets were found to be palatable and well accepted in 87.6% of patients in the pivotal efficacy trial for FDA approval for CARDALIS™.

 The yeast-based, beef flavoring contains no beef protein and would not be expected to create a beef-allergy challenge for food-allergic patients.

To support the product, Ceva is providing the practicing veterinarian with numerous virtual educational experiences at cevaconnect.com as well as numerous live, continuing educational events throughout 2021. Additional tools, including client communication aids and the free CARDALIS™ resting respiratory rate app, offer the practitioner a variety of helpful resources (see Figure 4).

Keene, BW, Atkins, CE, Bonagura, JD, et al. ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs. 

. 2019; 33: 1127–1140. https://doi.org/10.1111/jvim.15488 

Ames MK, Atkins CE, Eriksson A, Hess AM. Aldosterone breakthrough in dogs with naturally occurring myxomatous mitral valve disease. 

 2017 Jun;19(3):218-227. doi: 10.1016/j. jvc.2017.03.001. Epub 2017 May 31. PMID: 28576479. 

Coffman, M, Guillot, E, Blondel, T, et al. Clinical efficacy of a benazepril and spironolactone combination in dogs with congestive heart failure due to myxomatous mitral valve disease: The BEnazepril Spironolactone STudy (BESST). 

. 2021; 1– 15. https://doi.org/10.1111/jvim.16155

In 2019, the ACVIM published new guidelines recommending a quadruple therapy approach for the treatment of CHF in dogs. The safety and efficacy of CARDALIS™ has not been investigated with pimobendan.

CARDALIS™, which contains a unique combination of benazepril and spironolactone, utilizes mineralocorticoid blocking activity to help treat signs of canine mitral valvular heart disease. 

Compliance for canine mitral valve disease therapy just got easier

The International Veterinary Students’ Association (IVSA)—a veterinary student-run volunteer nonprofit organization—and Vetstream announced they will be teaming up to help provide veterinary schools and students with discounted or free access to Vetlexicon and all Vetlexicon Learn modules. 

These modules contain content relating to the care of dogs, cats, horses, cattle, and exotics such as ferrets, guinea, reptiles, and pigs.

Coordinated by IVSA’s Standing Committee of Veterinary Education, veterinary schools and their students that fall into tiers 1 and 2 in the World Small Animal Veterinary Association (WSAVA) rankings will have access to Vetlexicon Canis, Felis, Lapis, Exotis, Equis, and also all the Vetlexicon Learn modules free of charge.

, both veterinary schools and their students in tiers 3 and 4 will benefit from a 50% and 20% price reduction when subscribing to these services. Additionally, students in tiers 3 and 4 will also receive a 95% discount from the list price when subscribing to one or more of the 6 Vetlexicon services.

“Both IVSA’s and Vetstream’s missions align when it comes to making education more accessible to veterinary students all over the world, especially to those who need it most,” said Merel Knoops, president of IVSA, in the release.

“I am truly excited to see our members benefit from the Vetstream resources, and to support them on their way to a future full of even more capable and knowledgeable veterinarians,” added Knoops.

For more information about this partnership, go 

This collaboration will grant IVSA members and their universities with discounted or free access to peer-reviewed clinical content. 

IVSA and Vetstream announce a collaborative partnership 

To jumpstart your first full week of August, we're bringing you a robust mix of the latest veterinary hot topics and industry news. 

Here is what to expect this week on dvm360:

Mixlab raised $20 million with goals to improve the pet care experience with its modern pet pharmacy platform.

Synchrony is expanding in the equine market with new CareCredit financial solutions and digital innovations. 

An article detailing the ins and outs of canine spinal cord disease and treating these common conditions. 

The International Veterinary Students' Association (IVSA) and Vetstream

 have partnered to help offer veterinary students and schools discounted or free access to various Vetlexicon modules.

Stay tuned on dvm360.com and our social media channels for our latest coverage of the veterinary industry.

Here's a sneak peek of this week's headlines. 