Should the EPA warn the public? vvvita / 

A report released today by the Midwest Center for Investigative Reporting and 

 has revealed that Seresto flea and tick collars have harmed many of the dogs and cats that wear them as well as the owners who love them. The US Environmental Protection Agency (EPA), which regulates pesticide-containing products, has received 

 of dogs, cats, and people being harmed by the collars, including 1698 pet deaths and just under 1000 incidents involving people.

The active ingredients in Seresto—developed by Bayer Animal Health and now owned by Elanco—are the pesticides imidacloprid (10%) and flumethrin (4.5%). Imidacloprid is commonly used in US farming, whereas Seresto is the only product that contains flumethrin. The product is labeled to provide up to 8 months of protection for cats against fleas, flea larvae, and ticks and for dogs against fleas, flea larvae, ticks, sarcoptic mange, and chewing lice. It is unclear whether flumethrin or imidacloprid—or a combination of the 2 products—is responsible for these incidents.

Except for erythema and hair loss below the collar—potential adverse effects acknowledged by Elanco—the signs of harm related to Seresto in dogs and cats are unclear. The reported pet deaths appear to have been sudden.

, clinical signs in human related to Seresto vary widely, with most incidents involving skin rashes or lesions; numbness, tingling, or pain; and nasal, ocular, or throat irritation after placing the collar on the pet, after nuzzling with the pet, or after sleeping in bed with the pet. More serious events were also reported. In many cases, clinical signs improved after the collar was removed.

Elanco “takes the safety of our products very seriously and thoroughly investigates potential concerns related to their use,” company spokesperson Keri McGrath says in an email. “Keep in mind that the existence of an adverse event report does not necessarily mean the product caused the problem,” she says. “Causality between the observed signs and the use of the product is evaluated on a case-by-case basis.”

The reported incident numbers are actually “just the tip of the iceberg,” according to Nathan Donley, PhD, a senior scientist at the Center for Biological Diversity and an expert on U.S. pesticide regulation who feels strongly that the EPA should warn the public about this issue. Not only must a connection be made between the pet’s or person’s illness and the collar, but affected individuals must know whom to contact about it. “Most of the time, people are not going to make the connection or they’re not going to take an hour or so out of the day and figure out how to call and spend time on hold,” he says.

The EPA memo notes that flumethrin incidents were first reviewed in 2016, at which time the agency said it would continue to monitor incident data. It also states that the number of flumethrin incidents have been increasing steadily over time.

The EPA did not comment about the safety of Seresto compared with other flea and tick collars, but an agency spokesperson did note that flumethrin and imidacloprid both remain eligible for continued registration, and that it is important to follow label directions when applying the product. “Some pets, however, like some humans, are more sensitive than others,” the spokesperson said.

Karen McCormack, a retired EPA employee, told 

 that more incidents have been reported with Seresto than with any other pesticide pet product. “I think this is a significant problem that needs to be addressed sooner rather than later,” she says.

Seresto products generated revenue in excess of $300 million for Bayer in 2019, according to an annual company report. At this time, the EPA is in the final stages of re-approving both pesticides, according to McGrath. There is no timeline on the final decision.

Articles

The EPA has received 75,000 incident reports involving Seresto since the flea and tick collar was introduced nearly a decade ago.



Seresto collar linked to nearly 1700 pet deaths, EPA monitoring situation

Caring for critically ill patients has its own set of unique challenges, according to Courtney Waxman, MS, CVT, RVT, VTS (ECC), an instructional technologist at Purdue University’s Veterinary Nursing Program. During a lecture at the 

 virtual conference last week, Waxman discussed patient care strategies and provided suggestions for managing professional and personal stressors technicians may encounter in small animal intensive care units and critical care services.

An important area of focus is on strategies to provide consistent, high-quality patient care in a setting that is often very busy, with critical patients whose care crosses over many shift changes. Waxman stressed the value of checklists and care bundles, which can prevent lapses in recall of important but perhaps less prominent details and provide a less labor-intensive way to capture all facets of a particular standard of care. Checklists and care bundles also create a culture of accountability, provide consistency, establish patient care standards, improve patient care quality, and reduce morbidity and mortality.

One example of a widely used checklist is Kirby’s Rule of 20, which is a suggested list of 20 parameters for daily assessment of critically ill patients. Similarly, care bundles can provide a standardized approach to patient care related to a particular disease or procedure to prevent common oversights. Examples include all treatments (major or minor) associated with urinary catheter care or ventilator care.

The value of care bundles is illustrated by 2 nationally recognized care bundles: the RECOVER Initiative, which is an evidence-based care bundle providing guidelines for veterinary cardiopulmonary resuscitation (CPR),

and the Surviving Sepsis Campaign, which is a human adult and pediatric care bundle to provide reduced morbidity and mortality for patients with sepsis.

Given the critical and often fragile nature of these patients, biosecurity practices are also of great importance as patients may be infectious or immunocompromised. Waxman directed the audience to the American Animal Hospital Association’s 2018 biosecurity consensus statement, which details protocols for those sites that need guidance.

 Necessary routine practices include wearing gloves for all patient care, changing gloves between patients, and frequent hand washing. Where appropriate, personal protective equipment may be required of the nursing staff or any visiting owners, and in some cases, owner visits may need to be minimized.

An additional area of importance is the transition between nursing shifts. Waxman presented some startling data from human medicine. In a study of nurses, information retention from verbal rounds was only 26%. This rate improved to approximately 31% to 58% when written notes were taken in addition to verbal rounds. However, where a preformatted rounding form was used, the retention rate jumped to 96% to 100%.

 It is worth noting that for patients undergoing long hospital stays, the loss of information during verbal rounds can be compounded over multiple shifts and multiple days, potentially translating to patient care mistakes or omissions. Waxman likened this to a real-life game of “telephone,” which may be amusing as a children’s game but is far from ideal in a critical care setting.

Another strategy to standardize rounds and improve information transfer is to overlap shifts to allow for a dedicated rounds time during each shift change. The amount of time needed should be estimated as 1 to 3 minutes per patient for rounds associated with each shift change, and 5 to 10 minutes per patient for more detailed daily rounds that involve the entire interdisciplinary care team. Rounds are most effective when conducted cage-side to better visualize the status of each patient while discussing the case details.

In addition to rounds, each technician should do a walkthrough at the start of their shift to familiarize themselves with cases and review patient orders and treatment sheets. Talk to the clinician on the case about the patient care plan for that day. When performing patient care, attend to the most critical patients first. Additional tasks that are not specific to an individual patient are to check fluid pump programming for each patient, verify alarm parameters for each monitoring device, check all intravenous catheters, and ensure at the beginning of each shift that the CPR area and resuscitation supplies are stocked and ready for emergency use.

In addition to medical strategies, Waxman addressed the important professional and personal stressors that exist in the critical care setting. These stressors are not necessarily unique to veterinary medicine or critical care, but are very common in the veterinary critical care setting. Burnout, compassion fatigue, decision fatigue, and imposter syndrome are the 4 types of emotional tolls that affect veterinary professionals working in these environments.

Although there are similarities across these 4 conditions, they are not alike. Burnout is a physical or mental collapse that results from overwork or stress in one’s work or personal environment. This is slightly different than compassion fatigue, which is a traumatic stress disorder that occurs in caregiving environments as a result of emotional challenges. Although symptoms may overlap, there are some differences, and the causes of burnout and compassion fatigue are different.

Decision fatigue is another condition that occurs in the critical care environment. After making decision after decision, eventually the quality of decisions can deteriorate over time as if the decision-maker’s ability is getting “worn out.” One strategy to offset this fatigue is to minimize decisions in situations that you are able to control, and to reduce the stress of decision-making.

Finally, imposter syndrome is characterized by feelings of inadequacy despite evidence of competence and success. Imposter syndrome is common in the veterinary community, affecting both veterinarians and technicians. Strategies to combat imposter syndrome include focusing on successes, focusing on the value provided by your work, and avoiding the tendency to compare yourself with others. Ultimately, although there are differences between the signs associated with these 4 emotional conditions, the underlying theme is to focus on physical, mental, and emotional elements self-care.

Rebecca A. Packer, DVM, MS, DACVIM (Neurology/Neurosurgery), is an associate professor at Colorado State University College of Veterinary Medicine and Biomedical Sciences in Fort Collins. She is active in clinical and didactic training of veterinary students and residents and has developed a comparative neuro-oncology research program at Colorado State University.

Fletcher DJ, Boller M, Brainard BM, et al. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 7: Clinical guidelines. 

 2012;22(S1):S102–S131 doi:10.1111/j.1476-4431.2012.00757.x

Levy, M.M., Evans, L.E. & Rhodes, A. The Surviving Sepsis Campaign Bundle: 2018 update. 

 44(6):925–928 (2018). doi:10.1007/s00134-018-5085-0

Stull JW, Bjorvik E, Bub J, Dvorak G, Petersen C, Troyer HL. 2018 AAHA Infection Control, Prevention, and Biosecurity Guidelines. 

. 2018;54(6):297-326. doi: 0.5326/JAAHA-MS-6903

Starmer AJ, Spector ND, Srivastava R. Changes in medical errors after implementation of a handoff program.

 2014;371:1803-1812. doi: 10.1056/NEJMsa1405556

Discover the strategies you need to develop standard protocols and best practices in critical care units, as well as important tools to maintain mental health while working in such a stressful and demanding environment.

ICU bootcamp

The American Association of Feline Practitioners has announced the publication of a digital 

 to help veterinary professionals diagnose and treat systemic arterial hypertension in cats. Sponsored by Boehringer Ingelheim, the toolkit emphasizes the importance of checking blood pressure routinely to aid in tracking trends and detecting hypertension in cats early.

“Assessing blood pressure in the feline species is an important part of feline preventive care, yet it is uncommon for practices to routinely perform this test,” says Kelly St. Denis, MSc, DVM, DABVP (Feline), chair of the task force that created the guidelines, in an association press release. “This toolkit provides a quick, go-to reference that will help veterinary professionals overcome the difficulties and obstacles associated with assessing blood pressure in cats.”

When cats have high blood pressure, a lack of accompanying clinical signs often makes diagnosis difficult. While the toolkit encourages using the information provided on all feline patients, cats aged 10 years and older are at higher risk for hypertension and should be monitored more frequently than younger cats.

The toolkit provides tips for successful blood pressure management, including cuff selection and placement, recommendations for taking blood pressure measurements, and the equipment and environment. Each page also has an associated printable PDF that you can use in your practice. A new Blood Pressure Assessment Form is available to download for recording results and other necessary information. Tabbed sections on clinical signs of hypertension, treatment, classifications, frequently asked questions, client resources, and more make the toolkit easy to navigate.

“With its user-friendly format, veterinary professionals can quickly learn how to perform a Cat-Friendly blood pressure assessment, how to interpret the numbers, and how to treat hypertensive cats,” says St. Denis.

This new digital resource will help veterinary professionals access and gather vital information quickly. 

AAFP releases feline hypertension toolkit 

It had been 28 days since I had pondered wearing jeans—scrubs are so comfortable and don’t judge my waistline. After finally getting into my jeans, I was out of breath and feeling extremely uncomfortable. Then it hit me: I wasn’t myself. I was beyond stressed not just from weight gain, but also from my high workload, late hours, and exhaustion.

I always thought I was good at managing stress, but my poor quality of life told a different story. So what did I do about it? Like many veterinary professionals, I attended a well-being lecture. Afterward, I was inspired and ready to tackle the world—or so I thought.

That Monday morning, I strolled into the clinic, prepared to take my life back. I was going to stay focused and positive and leave on time. But 4 hours into my shift, after several frustrated clients and emergencies, I felt like all the strategies I learned during the lecture went right out the door. My old habits began to take over, and I wondered why my new well-being plan didn’t work.

If this scenario sounds familiar, it’s time to adjust your approach to well-being. Here are my top 3 reasons why well-being plans fail, plus some strategies to help you succeed.

It’s easy to visualize the end result of a well-being plan, but the choices, sacrifices, and willpower it takes to follow through don’t get nearly enough attention. At the beginning of my well-being journey, I was told I would have to make changes. My first impression was that it wouldn’t be too hard or take too long, but boy I was mistaken.

I quickly realized that I was in a toxic friendship and needed to reevaluate my inner circle. After feeling inspired by the well-being lecture, I was finally ready to let this friend go. I tried weaning myself off the relationship by telling myself why it didn’t work. Then I asked myself what it would mean if I let her go. If she wasn’t around, I reasoned, I would be bored and lonely. Once I confronted these underlying assumptions, I was able to release my grip. I trusted that I could connect to more positive individuals in the future. This process took more than 6 months, but with practice, the time frame for making change happen will get shorter.

To help identify—and overcome)—subconscious assumptions about your well-being plan, ask yourself these questions and write down your responses:

What expectations do I have about this well-being plan?

What will I need to give up or add to my life to make this plan work for me?

What areas of my life will I have to reevaluate to improve my well-being?

Talking about or writing down your assumptions can help put your journey into perspective. We might think we make perfect sense, but when we share your thoughts with someone else or write them down, we might notice that some of our well-being goals are unreasonable.

Well-being workshops can help inspire change. They provide lots of useful information but no real-world practice. I can tell someone how to place a central line catheter and give tips for troubleshooting problems, but until someone tries it for themselves they won’t know how to overcome obstacles. 

When coaching veterinary professionals, a majority of my time is spent troubleshooting. For example, one of my clients wanted more balance in her life. Although she loved her job and colleagues

she also valued her personal time and often felt guilty about leaving work on time. We found a way for her to uphold her 

 and her work values. It took weeks to develop a successful strategy. In the end, the solution included a combination of letting go of what others thought about her, improving her time management skills, and communicating with her teammates. The bottom line? Well-being is not black and white—every situation comes with unique challenges.

“Semper Gumby” is an unofficial US Marine Corps motto that means always flexible. Practice being strong and flexible during this well-being journey. You will try, fail, grow, and repeat. It's all part of the process.

When a dog has a fever but no other obvious signs of illness, we know there’s more going on than what meets the eye. Feeling uncomfortable is similar because it can help us to identify some trouble areas in our life.

For example, boundaries are especially hard for me. I still feel stressed when someone repeatedly pushes my boundaries. I once had a boss, Sally, who asked me to confront another coworker, Becky, about an opinion she expressed about me. I felt it would be death by communication if I started a conversation that sounded something like, “I was told that you thought I was mad at you 2 weeks ago.” The thought of having this conversation made me cringe.

I was aware that Becky and I did not get along, but I had a plan to help rebuild our relationship. When Sally pushed me for the third time, I was ready to blow. Instead of caving on my boundary, I sat with the problem and processed the situation. This helped me realize that I never told Sally what I planned to do about Becky.

I reassured Sally that I had already started a process of trying to improve my communication with Becky. Without taking the time to sit in my frustration, I might not have upheld my boundary and could have been resentful later.

The next time you feel like your only choices are to uphold your well-being or cave in, remember there is a third option. Sit with the discomfort and ask yourself: What am I supposed to learn?

Most people are doing their best to be happy. It is hard to play the long game when you can make decisions in the moment that will give you relief.

Expectations can sneak up on you in the form of feelings such as discomfort, disappointment, or self-criticism. If your well-being is low, the journey back to happiness will have moments of triumph alongside struggles.

Viewing your path to better well-being as a journey with twists and turns will help set realistic expectations and allow you to roll with the punches. Let’s face it. Improving your well-being is hard, but it can help you live a healthier and happier life—one that you’re genuinely excited about.

Kristina Guldbrand worked as a certified veterinary technician for 12 years before becoming an account manager for Veterinary System Services, where she discovered her love of leadership and well-being. She has received training through the International Coaching Federation and provides workshops, leadership, and well-being coaching, as well as teambuilding for practices

Find out why your plan to improve personal well-being isn’t working, and learn how to tailor your strategy for success.

When intentions don’t match results: why well-being plans fail

Cutting calories is the go-to strategy for most pet owners trying to slim down their pets. But exercise is often given less weight, particularly for cats, because they tend to “exercise” at their own discretion.

Cats burn calories through natural feline behaviors, such as exploring their territory, stalking prey, navigating varying surfaces and heights, and socializing with other cats. Those kept indoors and unable to engage in these activities may be more prone to packing on pounds.

There is no match for free living. However, indoor forms of exercise—combined with calorie limitations—can keep cats fit, according to veterinary nutritionist Deborah Linder, DVM, DACVN, a research assistant professor at Tufts University Cummings School of Veterinary Medicine. “Exercise is our secret weapon,” she told attendees during a 

But owners sometimes get defensive when prodded to discuss weight loss for their pets, leading them to eschew fitness programs. “This stems from the fact that they have to acknowledge that their pet is overweight, that it’s not good for their pet, and that it’s their fault,” Linder said.

For these sensitive client conversations, she advises veterinarians to take a neutral, nonjudgmental stance that focuses on quality of life rather than obesity. She suggests kicking off these talks with something like this: “‘Let’s work as a team to have a multifaceted plan to improve quality of life, where weight management is 

Fashioning a weight management program that incorporates physical activity begins with an overall assessment of both cat’s and owner’s lifestyles. The first step is to determine the cat’s eligibility for exercise. Does the cat have health issues, such as asthma or orthopedic problems, that would restrict exercise? How about the cat’s body condition and muscle condition scores? For obese and/or muscle-wasted cats, medical workups and graduated exercise introductions may be indicated.

Second, obtain a detailed history that probes the cat’s current and previous activity levels, and clarifies what types and degrees of activity are possible in a particular household. For instance, does the home have spatial limitations? Are there rooms the cat is not allowed to enter?

Third, try to discern the owner’s level of commitment to controlling the cat’s weight and providing conditioning activities. Inquire about his or her goals for the cat.

Lastly, interview the owner to determine what motivates the cat, and tailor an activity program around this. For the food-motivated cat

 what are its high-value food items? If kibble, the owner can use puzzle toys, which require the cat to move about and utilize its natural agility in order to obtain crunchies. Or the owner can spread kibble throughout the house so the cat must amble about in pursuit of it. For wet food lovers, the owner can open the can and walk up and down stairs with it to entice the cat to follow in order to procure the meal.

For the hunter, pen lights and electronic toys, such as battery-operated mice, can charge up the energy. Cats that bore of these can be incentivized with hunting feeders that release kibble when batted around.

The adventuresome cat can be given outdoor exercise safely, perhaps with leash walking. While many cats eschew physical restraint, treats can be used to positively reinforce cooperation with donning harnesses.

American Animal Hospital Association weight management guidelines

World Small Animal Veterinary Association

To take the stigma out of the weight loss conversation, Linder recommends sharing relevant personal stories with their clients. She shared her own with the audience.

Linder’s 5-year-old cat, Leftie, had a body condition score of 7/9. “No, she didn’t come that way,” she admitted. “I made her that way.”

Her nutritional assessment revealed Leftie’s daily intake to be 160 kcal of adult maintenance food, capped off with bologna as a treat. When she contemplated weight loss strategies for Leftie, she said her initial thought was, “I’ll just stop the bologna.”

But Leftie loved the bologna. So, she considered ways to get her to burn more calories, and settled on puzzle balls filled with kibble. When Leftie is rolling the balls around to make them release kibble, it provides her with movement and entertainment at the same time. And when Linder gets involved in the ball game, it facilitates bonding. This, she said, is perhaps the greatest payoff.

“When you can make a weight loss plan or a quality of life improvement plan focus on the human-animal bond, I personally find that families are so much more successful and so much happier and really positive about the outcomes they see.”

While Leftie took well to the food-driven workouts, not every cat does. For naturally sedentary kitties, exercise beginners, and the obese, she advocates gradual increases in low-intensity activities, such as walking around the house. For cats with physical impairments that restrict activity, physical therapists can engage them in appropriate activities, such as treadmill walking and swimming.

Although physical activity can drive down body mass, Linder reminded the audience, it does not negate the importance of calorie control—or math. If an activity that burns 10 calories requires 100 calories of treats, she said, it defeats its purpose.

One way to bend the math in the right direction is to use low-calorie edibles when incentivizing activities. Chosen treats should not exceed 1 kcal/piece. She added that cats are texture-driven, and can often be motivated with veggies of the semisoft variety, such as zucchini, or of the moist- crunchy type, like sweet red peppers.

Linder said that once a plan that both elevates activity levels and cuts/controls calories is set into place, client follow-up is key. How does the client feel? How is the cat responding? What are the challenges? One of the most common complaints she hears now, as more people are working from home, is that these cats disrupt their owners’ work and sleep with their demands for food. This is where puzzle toys and timed food dispensers come into play.

“They shift the cat’s focus away from the owner being the source of food to the inanimate object being the source of food,” Linder said. So too, veterinarians should focus their cat owners on exercise and calorie control, which are key ingredients for physical conditioning, environmental enrichment, and feline-human bonding.

Physical activity and creative mealtime strategies can support weight loss, boost quality of life, and bond cats more tightly with their humans. 

Weight control for cats: Pushing flabby felines to flex their whiskers

Goodbye February and hello March! To kick off the new month, we will be posting a robust mix of news content this week including: 

An article that offers insight on why exercise is the secret weapon for cat weight loss.

An article that highlights strategies you need to develop standard protocols and best practices in critical care units, as well as important tools to maintain mental health while working in such a stressful and demanding environment.

An article that breaks down how and why sound affects 

animals psychologically. Fetch speaker Susan O. Wagner, DVM, MS, DACVIM, encourages attendees to utilize particular genres of music to create a more relaxed experience for their patients.

understanding the pharmacodynamics of sedative, analgesic, and induction agents

 can improve safety and stability for all anesthesia patients, regardless of age.

We will also be announcing the winner of our 2021 dvm360® Hospital Design Competition! Stay tuned on social media and dvm360.com for updates.

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