There are many myths and misconceptions when it comes to veterinary anesthesia. Darci Palmer, BS, LVT, VTS, explains a few of the most common myths and what clinicians should do instead.

View the video below for the entire discussion. The following is a partial transcript.

: I have like a long list of myths to talk about, you know. We did an hour at Fetch [Charlotte] with Stephen Cital, Tasha McNerney, and myself. And we could have honestly talked for 4 or 5 hours, just going through the long list of myths associated with anesthesia. But if I had to choose, I would say that the most common myth centered around anesthesia has to do with the drugs and there's there's so many, but I'm just gonna throw one out there, and that is that butorphanol is an appropriate analgesic agent for surgical pain. This is so not true, and we have a lot of evidence now to support that.

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Darci Palmer, BS, LVT, VTS, explains common myths and misconceptions surround veterinary anesthesia and analgesia. 

Veterinary anesthesia myths and misconceptions

Image provided by Kristy Oliver VN, DipAVN (surgical), RVT, VTS (Physical Rehabilitation), CCRP, CVPP, CCMT

The use of water as a therapeutic modality in veterinary practice is becoming commonplace, but the therapeutic properties of water have been used in the human and animal worlds for hundreds of years. The Greeks were using public baths in 500 BC and the Romans had heated bathhouses in 350 AD. Arctic monkeys realized that during the winter, the hot springs kept them warm.

Hydrotherapy, a term used when water is a therapeutic modality,

 covers the use of exercises, such as swimming, and walking on an underwater treadmill.

 By using the properties of water, for conditions identified as pre- and postsurgical, neurologic, and orthopedic, as well as conditioning, patients can benefit from muscle relaxation, improved joint range of motion, muscle tone, strength, and endurance.

It is important to understand the properties of water and what water does to a body placed in it. The temperature, hydrostatic pressure, viscosity, and buoyancy will all influence the patient

 and must be taken into consideration when planning therapeutic exercises in water. Forces exerted on a solid body in water include gravity, drag, thrust, buoyancy, and movement (

The temperature of the water is important, as are the thermal properties of water. The thermal conductivity of water is 0.6 m.K, which is the exchange of thermal energy when a body comes into contact with water.

Certain temperatures of the water can aid in soft tissue relaxation, decrease pain, and aid in circulation and tissue perfusion,

 while also increasing tissue extensibility. The temperature of water typically used in veterinary hydrotherapy ranges from 83 to 88 °F. Care must be taken to monitor patients participating in hydrotherapy for signs of exhaustion and/or overheating, such as increased respiratory rate, lagging at the back of the underwater treadmill, and visual signs of an increase in stress.

Pascal’s law states that fluid pressure is exerted equally on all surfaces of an immersed body at rest and at a given depth. This also means that pressure increases with the density of fluid and depth of submersion and is expressed in pounds per square inch (PSI), which may be calculated as 1 PSI = pound of force (lbf) divided by square inch of the container. Some of these effects can be translated into benefits, such as decreased swelling to an area and decreased pain.

 As there is a measured amount of pressure related to the water level, care must be taken in patients with cardiac, circulatory, and respiratory disease.

Frictional resistance is created by the cohesiveness or 

Water is 15 times stickier than air, therefore, water resists the motion within it. There is a decrease in resistance to flow and resistance is dependent on speed, the velocity of the fluid, and the shape of the body within the fluid. Aquatic exercises can be fatiguing

 so it is important to monitor patients for signs of fatigue, pain, lameness, and distress.

Buoyancy is the force exerted on an immersed object that is opposite gravity.

 Archimedes’ principle states that when a body is partially or wholly immersed in fluid, it experiences upward thrust equal to the weight of displaced fluid. Therefore, as the water depth increases, weight bearing decreases. (Figure 2

) When working with buoyancy, it is also important to understand specific gravity (SG), which is the ratio of the density of a substance to the density of a standard, usually water for a liquid or solid. The SG of water is 1.0. How well a pet “floats” depends on SG. Pets with lean body structure and lower amounts of body fat have an average SG of 1.10, whereas pets with a higher amount of body fat have an average SG of 0.93. Therefore, patients with a lower SG can float a little better than others.

Fluid dynamics is a description and study of liquids and gases and in part involves the study of the motion of a given fluid. Laminar flow is the smooth flow or straight flow of water particles moving in 1 direction and speed where all molecules are parallel. Turbulent flow has a more chaotic, non-linear motion where the water particles flow in all directions, creating more dynamic pressure differentials, so the resistance increases with velocity.

Drag is anything that increases resistance. In the case of hydrotherapy in veterinary practice, the drag relates specifically to hair coat, type, and length, as all of these create drag and increase resistance.

A general rule is that the taller and longer the dog, the higher the speed of the treadmill belt is required to reach a normal walking gait. Increased turbulence, resistance, and friction can cause increased exertion. Movement, hair coat, weight, and speed all influence overall exercise exertion.

Swimming allows for non-weight–bearing exercise, is relatively low impact, is an excellent upper body workout with active range of motion (AROM) of all joints,

 especially the front limbs, which are affected more with increased workload,

 and improves core and trunk strength. Davis et al indicated that hip range of motion was not affected significantly by swimming compared with walking.

Patients beginning swimming should not be left unsupervised and a flotation device should be utilized to aid in buoyancy. Care should be taken to ensure the patient acclimates gently to decrease stress and anxiety, as not all patients inherently know how to swim. Excessive forelimb motion due to stress or anxiety will increase turbulent flow and make moving through the water more difficult, which will likely increase the stress level further.

Walking on an underwater treadmill can be a relatively more controlled form of aquatic exercise. Less stress is placed on the joints and spine,

 making it a more appropriate form of hydrotherapy for early rehabilitation of patients. It can provide variable and adjustable weight-bearing exercise, improved AROM, proprioceptive gait training, and improved balance when walking, can build lean muscle mass, and is a starter for swimming. Patients also have the benefit of proprioception—the ability to identify the place and position of one’s own body part, which involves balance.

 It also allows for engagement of the triceps brachii and quadriceps femoris, which are essential for weight bearing and ambulation.

Hydrotherapy is growing in the veterinary field and is an important tool for the rehabilitation professional. Hydrotherapy proves to be an integral part of a multimodal approach to canine and feline physical rehabilitation. It can be used to introduce early weight-bearing exercise in postoperative patients, improve proprioception and balance in the neurologic patient, and aid in the improvement of joint range of motion in the osteoarthritic patient, while aiding in the development of muscle mass, strength, and endurance.

Understanding the properties of water and the effects on the patient while undergoing hydrotherapy will assist the rehabilitation team in providing the right type of hydrotherapy based on these factors.

Kirsty Oliver, VN, DipAVN (surgical), RVT, VTS (Physical Rehabilitation), CCRP, CVPP, CCMT, is a rehabilitation practitioner with Veterinary Surgical Centers in Virginia. She earned her veterinary nursing degree from the Royal College of Veterinary Surgeons in the United Kingdom, and has earned additional certifications in the United States.

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Nganvongpanit K, Boonchai T, Taothong O, Sathanwongs A. Physiological effects of water temperatures in swimming toy breed dogs. 

Nganvongpanit K, Kongsawasdi S, Chuatrakoon B, Yano T. Heart rate change during aquatic exercise in small, medium and large healthy dogs. 

Tomlinson, R. Use of canine hydrotherapy as part of a rehabilitation programme. 

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Levine D, Millis DL. Percentage of normal weight-bearing during partial immersion at various depths in dogs. Presented at: Second International Symposium on Rehabilitation and Physical Therapy in Veterinary Medicine; 2002; Knoxville, TN.

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Articles

By using the properties of water, patients with certain conditions can benefit from muscle relaxation, improved joint range of motion, muscle tone, strength, and endurance

A closer look at hydrotherapy for rehabilitation

After crossing the border into Romania, a young girl showed her hamster in a cage. She called the pet her "best friend" and had traveled with it from neighboring Ukraine.

A mother and her 2 young daughters—refugees from war-torn Ukraine—arrived at a shelter in Romania, each with a pet: a muzzled dog, a cat carried in a backpack, and a hamster in a small cage. Marty Becker, DVM, a volunteer with the nonprofit, international veterinary aid organization World Vets, watched as the trio reunited with the girls’ father, from whom they had been separated for about a month. Along with the humans’ excitement, the dog greeted the man by jumping up on its hind legs and furiously licking him.

“He was happy to see the dog. The dog was happy to see him,” said Becker.

One of the girls had told Becker the hamster was her “best friend.” Upon seeing her father, she held the cage up to proudly show her pet as the man knelt to look.

“That human animal bond, to her, I think, was a lifeline,” Becker said in an interview with 

Many people are leaving Ukraine as refugees, seeking safety from the violence that has come with Russia’s ongoing invasion. The humanitarian crisis has also displaced countless pets, according to World Vets. Many of these animals need food, shelter, and veterinary care for their survival.

Volunteers like Becker, founder of Fear Free and a 

® advisory board member, and his World Vets peers are helping displaced dogs, cats and other pets at Ukraine borders. Becker recently traveled to Romania and Moldova—the 91st country he has visited—to help assess unmet needs and facilitate free veterinary services for animals arriving from Ukraine.

“Moldova, Romania, and Ukraine come together in this one spot, right by the Danube River,” said Becker.

According to World Vets, Becker’s mission was to coordinate efforts with the organization’s existing partners in Romania and Moldova.

 Cathy King, DVM, PhD, World Vets founder and CEO, said Becker spent time in clinic and on the border’s front lines. “His first hand accounts helped to guide our strategy for prioritizing aid in the region. He has also done a tremendous amount to bring awareness to the situation and to direct funding to local groups aiding refugees and their pets, especially in Romania,” said King, in an email to 

Becker also met with the head of Romania’s veterinary medical association to discuss what local veterinarians were seeing and where help was needed. “The 1 thing you don’t have to worry about is the animals in need finding love and attention,” said Becker. “I met people over there who walked 20 miles carrying a dog to safety.”

Sava’s Safe Haven in Galati, Romania is one partner Becker worked with during his trip. The family-run, nonprofit shelter is dedicated to caring for homeless and stray animals in the region’s poor, rural areas.

 World Vets knew it had a capable, dedicated partner through an established working relationship with Sava’s Safe Haven, and is providing free veterinary services to pets of Ukranian refugees as well as veterinary supplies at the shelter, noted King.

“We are helping to financially support their aid station that is located at the entry point where refugees are crossing the Ukraine border into Romania with their pets. It is anticipated that the need for veterinary services will continue long term in the region and, therefore, we are also making longer term plans to recruit a veterinary team in the coming months to go there to provide additional medical, surgical, and preventive health campaigns for pets of refugees as well as abandoned pets that are brought to the shelter,” said King.

Marty Becker, DVM, (left) with Alexandra Sava of Sava's Safe Haven, a nonprofit shelter near Galati, Romania, and Phyllis, a dog being adopted by Becker.

Sava’s Safe Haven is also working to find new homes for displaced pets in need, and sending food and other supplies across the border to Ukraine. According to social media statements made by the organization, these critical supplies are being shared with people who chose to remain in Ukraine, many of whom are elderly and include individuals who are feeding street animals.

In a social media post, Becker said he witnessed Sava’s Safe Haven sending 2.5 tons of dog food to a ferry crossing between Romania and Ukraine to feed pets that are owned and living in shelters— even though the organization was starting to run short on dog food. A similar run is made “at least every other day,” he wrote on Facebook.

At a partner clinic in Chișinău, Moldova, World Vets previously funded the costs of veterinary services for pet owners who were strugging during the COVID-19 pandemic, according to King. “We are now offering free veterinary services for any pets from Ukraine at that same clinic,” she said.

Becker, a World Vets advisory board member, said one the biggest takeaways from his experience near Ukraine are the strength of the human-animal bond and the resilience of people and pets. “If you’re tested, you’ll really see what you can do,” he said.

He recalled a Ukrainian woman who had lost her husband and her home because of the war. She arrived at the border aid station in Moldova with a young girl and a dog that had been injured. Although the dog had been limping, it began running after smelling the shelter. “It’s got a fight or flight response,” Becker said.

Grieving the death of her husband, the woman said the dog would now be her constant companion, according to Becker. “Beyond that affection connection, and the healing power of pets, I don’t know what else she would do. There’s nothing [for her] to go back to. Her house is gone,” said Becker.

Another woman, he said, crossed a border from Ukraine with 10 leashed dogs. She had walked in freezing temperatures, pulling a wagon with food and supplies to care for her pets but nothing for herself.

Becker noticed during his trip that veterinary technology in the region he visited is generally lacking compared with modern US facilities, although not as primitive as he’s seen in other countries. One clinic in Moldova had a single radiology machine, for example. Becker said the staff was using oven mitts rather than the safer, lead-lined gloves US veterinary professionals typically use to operate it.

Overall, he said, there is need for more modern veterinary technology and equipment as well as food and basic supplies to care for displaced pets. He brought with him to the Ukraine border region 3 large suitcases filled with toys for the animals he would be serving.

“There are things we can do to help,” said Becker.

According to World Vets, many in the organization’s community want to help the pets and people of Ukraine. To that end, World Vets is requesting financial contributions in support of its efforts to assist in the veterinary care of Ukrainian pets. Donors may visit worldvets.org to direct a monetary gift to World Vets’ international disaster response fund for helping pets from Ukraine.

World Vets. Helping pets from Ukraine. Worldvets.org. March 30, 2022. Accessed April 27, 2022. https://worldvets.org/campaigns/news/

Sava’s Safe Haven. A family-run shelter in Galati, Romania. Savasafehaven.com. 2022. Accessed April 27, 2022. https://savasafehaven.com/

As a volunteer with World Vets, Marty Becker, DVM, worked with local
organizations in Romania and Moldova to assess the unmet needs of pets
affected by war, and help facilitate free veterinary services to care for them.

Veterinarian travels to Ukraine border to help provide animal care

With veterinary hospitals across the country facing staffing shortages, emergency and critical care situations can put extra pressure on already-stressed clinicians. Jessica Nord, VMD, discusses the challenges veterinary professionals face and shares one tip to better handle an emergency. 

: In general practice setting right now, I think what we're seeing all over the country and we have for many years now, even before COVID, is the fact that many practices are understaffed. The staff that we have, while they're enthusiastic and willing to learn, may not be trained in the way that we want them to be trained. And we feel like we don't have the time to provide them with the training that they really need to handle these more advanced situations.

Jessica Nord, VMD, shared tips for taking the stress out of emergency and critical care situations when the hospital is understaffed.

How to handle emergencies while understaffed

“Where is everyone posting job ads for veterinary technicians?”

“We are not getting hits on our job ads.”

“We barely received any resumes or none.”

These are the most common statements I often hear with veterinary practice managers. We all wish to have a veterinary technician with years of experience, expectations of a reasonable wage, and exuding dependability walk in. According to the Bureau of Labor Statistics, the projected growth of veterinary technicians from 2020 to 2030 is 15%. Veterinary technician has one of the highest rates in demand than most career paths, but veterinary technicians’ schools may be scarce in some geographical regions.

There is no magic to recruiting veterinary technicians, but some excellent practices can help you become more strategic with attracting talent to your practice.

The labor market is competitive, and everyone knows that veterinary wages are becoming competitive with other businesses. It can be challenging for companies like the mom-and-pop practices to compete with corporations, but there are ways to be strategic in your business model.

One key consideration is to conduct a competitive salary analysis. Do you know what other competitors are paying their employees? What type of benefits are they offering? Conducting a competitive salary analysis can help your organization identify fair wages in the current market and how your compensation structure compares to the competitors. You can perform the analysis by doing online research such as searching job postings on Indeed, Glassdoor, or ZipRecruiter. The Veterinary Hospital Managers Association (VHMA) also has a compensation and benefits survey report that can be viewed on their website for free to VHMA members. A competitive salary analysis also increases your employee retention and engagement. When it is time for annual performance reviews, you will be able to know where the market is on compensation for your support staff and have a better understanding of the proper salary for your team members.

Finally, candidates tend to seek compensation in the heading of the job posting. They will often analyze the advertised wage by seeing if it will compensate for their needs and wants. If you don’t post or advertise your wages, most candidates don’t care to apply and move on to the next job posting.

Since the COVID-19 pandemic began, sign-on bonuses have been more commonly used to attract job seekers, as the number of open positions in the market increases. According to the Job Openings and Labor Turnover Survey (JOLTS) report, nearly 1 million jobs were added in the United States in August 2021, with a record-setting of 10.1 million jobs.

It has become increasingly challenging for the service industry to hire staff, which is why many businesses across the nation are offering sign-on or retention bonuses. According to GlobalData, the advertising for sign-on bonuses on job postings increased in all sectors by 454%, from 10,312 positions in August 2020 to 57,123 in August 2021.

Sign-on bonuses can help attract talent and get a candidate through your doors. Like wage transparency on job postings, sign-on bonuses attract candidates to your job posting and shows more about your veterinary practice. The labor market, overall, saw sign-on bonuses ranging from $150 to $100,000 in 2021, with animal care noted by GlobalData as a field with surging hiring bonuses. Banfield Pet Hospital, for example, was reportedly offering up to $60,000 to new hires in veterinary-related roles.

Presenting written job offers is not required with offers commonly presented informally through verbal conversation in-person or via phone calls. Presenting a written offer that documents what their potential job entails adds value when contemplating offers from multiple organizations and helps candidates make faster decisions when all opportunities are laid out. Candidates will be able to see critical information in their written offers such as payment, job title, health care benefits, and additional compensation that will be offered if accepted. Importantly, written job offers make sure the candidate and the organization are on the same page with the job details and reduce confusion on what was offered or presented.

In a Glassdoor Survey, about 60% of respondents reported being strongly attracted to perks and benefits offered in a job posting.

 Presenting a competitive benefits package can increase the attractiveness of job seekers and candidates looking for long-term employment. Benefits that seem to attract recruited technicians include the following:

Flexible time, paid time off and sick pay

Veterinary technician program scholarships or sponsorships, including license and examination fees

Wellness programs such as gym memberships, healthy snacks, or discounted meal prep services.

As the labor market continues to be increasingly competitive and retaining top talent becomes difficult, it is important to evaluate your current recruiting processes and engage existing employees within your organization. Research has shown that competitive pay to competitive benefits can boost visibility to candidates seeking new employment and displays that the organization values their people by offering benefits that positively influence their personal life and professional growth.

Mary Lopez, MSOL, is a hospital and area manager at National Veterinary Associates, in Boise, Idaho.

Kelly J. A record setting over 10 million new jobs are now available. 

. August 10, 2021. Accessed May 16, 2022. 

https://www.forbes.com/sites/jackkelly/2021/08/10/a-record-setting-over-10-million-new-jobs-are-now-available/?sh=4a4643181c17

Roles offering sign-on bonus increase by a whopping 454% amid staff shortages, finds GlobalData. Globaldata.com. September 7, 2021. Accessed May 16, 2022. 

https://www.globaldata.com/roles-offering-sign-bonus-increase-whopping-454-amid-staff-shortages-finds-globaldata/

Glassdoor’s 5 job trends to watch in 2016. Glassdoor.com. January 12, 2016. Accessed May 16, 2022. 

https://www.glassdoor.com/blog/glassdoors-5-job-trends-watch-2016/

It is important to evaluate current recruiting processes and engage existing employees within an organization.

Attracting veterinary talent in a competitive market

PetMed Express, Inc. (PetMeds)—a US-based online pet pharmacy—and Vetster— a veterinary telehealth and pet care marketplace—have collaborated in the hopes to expand access to telehealth for pets and their owners. 

  the partnership will expand telemedicine access to 70,000 veterinarians and over 2 million pet parents. Additionally, through the agreement, PetMeds becomes the exclusive e-commerce provider of pet medications for Vetster, and Vetster becomes the exclusive provider of telehealth and telemedicine services to PetMeds' customers.

“PetMeds pioneered the online pet medication business over 26 years ago, and this partnership with Vetster is an important step in establishing PetMeds’ expanded strategy as the go-to expert in pet health,” expressed Matt Hulett, CEO and president of PetMed Express.

Hulett added, “Simply put, we love Vetster's business model, their team, and their technology, and we are excited for PetMeds' customers to benefit from Vetster's amazing telehealth and telemedicine services, available at their fingertips 24/7. We are looking forward to a partnership that improves the lives of pets and pet parents for years to come.”

PetsMeds’ online pet pharmacy is licensed in all 50 states to dispense prescription medications. PetMeds only dispenses US FDA/ EPA approved medications.

Meanwhile, Vetster connects pet owners to thousands of licensed veterinarians available to provide online services through video chat appointments 24/7.

“We're very excited about the partnership and investment from PetMeds, which we believe truly represents a win-win for pet parents and their beloved pets, as well as for veterinarians," said Mark Bordo, CEO and co-founder of Vetster. "Pet parents receive the affordability and convenience of telehealth, pets benefit from world-class health care without the stress of a trip to the vet, and veterinarians tap into incremental revenue streams while providing quality care anywhere and anytime.”

1. PetMeds® announces exclusive partnership with Vetster for pet telemedicine. News release. PetMed Express, Inc. April 19, 2022. Accessed May 16, 2022. https://www.globenewswire.com/news-release/2022/04/19/2424404/10002/en/PetMeds-Announces-Exclusive-Partnership-with-Vetster-for-Pet-Telemedicine.html

2. About PetMeds®. PetMed Express, Inc. Accessed May 16, 2022. https://www.1800petmeds.com/company.html

3. On-demand online vet appointments. Vetster, Inc. Accessed May 16, 2022. https://vetster.com/en-us

First-of-its-kind agreement to enable pet telemedicine on a mass scale 

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