Our team at dvm360.com and Firstline magazine asked practice manager Emily Shiver to answer your questions about life in practice for managers, technicians, assistants, client service receptionists and more. Got a question for her? Email us at firstline@mmhgroup.com.

 I manage a small, very busy veterinary practice. I’d like to set up at least one all-hands staff educational meeting per month, but some doctors and team members are pushing back. Do I need this meeting?

Staff meetings are your chance to reach your team, nurture culture and teamwork, provide invaluable training and include everyone in the plans and success of the practice.

Some people will say they don’t have the time, some staff won’t be on board, and maybe you don’t have a solid plan to lead them right now. But your team will feed off your excitement about this chance to listen, inform and inspire. Involve them!

Here are some dos and don’ts for launching monthly staff meetings in a veterinary hospital.

Map out meeting topics for the entire year. Not too hard—you only have to come up with 12 topics! Let the staff weigh in on what they’d like to learn.

Ask hospital leaders or other team members who may be passionate about a particular topic to present. You don’t have to be the educator at every single one! Make sure you’re there to support and give guidance.

Assign seats for the meetings so the team can learn to start sharing with the entire team, not just their friends.

Incorporate interactive table activities to encourage teamwork.

Set staff meetings for two hours. This length has worked well worked for me.

Waste time with staff meetings about new products you don’t plan to carry.

Dismiss team members' ideas to improve meetings without first discussing and considering them.

Make the topic of every meeting super heavy—try to balance them. Provide interactive fun activities when appropriate.

Embrace educational staff meetings in your veterinary practice, and make them events that everyone starts looking forward to. Once implemented by inspired colleagues, you could see big effects in just a couple months. Every month you don’t have a staff meeting is a growth opportunity missed.

Emily Shiver, CVPM, CCFP, is practice manager at Cleveland Heights Animal Hospital in Lakeland, Florida

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My veterinary team is smart and we’re really busy, but ongoing education is vital to practicing good medicine. So, are monthly staff education meetings are a necessity?

Ask Emily: Do I need a monthly staff meeting?

For several years I worked at a veterinary specialist facility. Internists, oncologists, dermatologists, neurologists and more would see cases when a patient's regular veterinarian couldn't perform further diagnostics or surgeries. During my time there, I witnessed a range of emotions displayed by clients-sadness, grief, anger and, in some cases, happiness. But being that this hospital was a last resort for pets with problems, I saw more sadness than anything else. On a daily basis, I saw clients crying in the lobby, spoke with upset clients on the phone and gave out a lot of hugs and tissue boxes. Unfortunately, death was a common occurrence and I dealt with it every day.

I was always taught to be strong for clients in these situations. They look to you for kind words and sincere actions, even as slight as a hand on a shoulder. Most pet owners were faced with making the difficult decision to euthanize when their doctor ran out of options and their pet lost his or her fight. A small portion of clients never got the chance to say goodbye as their pet passed away during a procedure. No matter what the cause of death, it was heartbreaking every time. Every day, I watched pets and their owners go through both dilemmas and frequently found myself watching the pet owners' reactions. Tears would run down their faces, tissues would be strewn all over the floor and the worst part was seeing the men cry. Nothing is worse than seeing a man cry over the loss of his best friend.

Over my time there I noticed something about myself and thought, "What is wrong with me?" I never cried. I never had tears in my eyes or a lump in my throat or even felt like I needed to cry. I repeatedly told myself that I had to be strong for the owners because if they saw me crying, it could make them more upset. I remember talking to my mother one day after work and telling her how I thought this job was making me coldhearted because I never cried. It was like I was missing the compassion switch in my head. Little did I know, I had the switch, it just hadn't been turned on.

Shortly after leaving that specialty hospital, I started working at the clinic where I lost my lovely dog Lylah, and my switch was flipped. Every euthanasia appointment that I experienced after that made me break down in tears. Any emergency where the pet couldn't be resuscitated made me feel like I could have done more to help. Losing Lylah had opened my eyes to a whole new world of pet ownership-and it wasn't a world I wanted to know. After losing her and experiencing such an emotional roller coaster, I took a few months off from being a veterinary technician. I needed time to regain composure and focus.

My first job back in a vet clinic was nine months after Lylah's death. I had finally decided to get back in to the groove because my grandfather motivated me while he was losing his own battle. Hesitant and scared to go back to work, I took a leap of faith and knew this is what I was meant to do. During my first euthanasia appointment back, I cried. I couldn't hold it in, as much as I tried. However, it felt different. The pet owner and I had something we both could relate to. We chatted, while crying with each other, about our dogs and our unforgettable experiences we had them. I had found a way of connecting with clients on a personal level and losing Lylah had helped me get there. I had never known what it felt like to lose a pet, so I never had the emotions related to it, until I lost my own. I now understood how all the clients that I had interacted with in the past had felt during such a painful moment. After a while of crying so much about it, I learned to be strong again. This time, it wasn't just for the pet owner, but for me as well.

I just had my first emotional breakdown in three years because of a pet's death at the clinic-a 14-year-old Chihuahua with a liver mass the size of my fist underwent surgery at our clinic in hopes that the cancer hadn't spread. But the doctor opened her up and removed the liver with the mass, only to find that the cancer had not only spread, it was also not possible to remove all of it and have the pet survive. A call was made to the pet owner and the decision was made to euthanize on the surgery table. As the doctor was administering the euthanasia solution, memories of Lylah flashed in front of my eyes as I watched the Chihuahua's tongue color go from pale pink to blue. Her life had ended, and I had witnessed the entire event. I just stood there, watching her pass into oblivion, like I had with Lylah.

The first thought that ran through my mind was, “Am I even in the right career?” I texted my mom and told her that I love what I do, but it's cases like this that make me think of Lylah and wonder if I'm in the wrong profession. My mom bluntly but so perfectly replied, “Nope ... you just have compassion. This is what Lylah would want you to do.” Of course, that just made me cry harder but after I calmed myself down, I took to heart what my mom told me.

I won't be able to save every animal, it's inevitable, but I can damn sure try my best.

My work in a specialty practice where loss was commonplace didnt resonate with me until much later. After losing my own pet, I understand clients pain more acutely.

How losing a pet helped me connect with veterinary clients

As a longtime veterinarian, I've had to deal with grief. Grief when a pet receives a bad diagnosis and grief when that pet's life comes to an end. Recently, I wrote about how 

 and how we should embrace grief as being a part of love. I believe that, but it got me to thinking about how we navigate that grief.

I was reminded of the work of Elisabeth Kübler-Ross, MD, in 

which talk about the stages of grief. Kessler writes, “The stages … are responses to loss that many people have, but there is not a typical response to loss as there is no typical loss.” Grief is as unique as the person who is experiencing it. 

I find that to be true in my experience with my clients and their pets.

The five stages of grief are: denial, anger, bargaining, depression and acceptance. Kessler writes that not everyone goes through all of the stages, and not everyone experiences them in the same order.

 is usually the first stage of grief, involving confusion and shock. It's our brain's way of guarding us from the emotions that will follow, and it causes us to avoid the reality of the situation until we have the capacity to really feel. When I lost my first dog as a young adult, I couldn't face the fact that I was going to have to make a decision to let her go.

 is what gives our grief structure and makes us feel stronger. When we feel anger towards another person, the situation or even God, it makes us feel more in control than the denial that feels so chaotic. Anger is the manifestation of underlying pain, and lashing out makes us feel more powerful in a situation where we might be powerless. While I've experienced personal anger when losing a pet, I've been on the receiving end of anger as a veterinarian when delivering bad news. I don't take it personally, because I know that it's a necessary part of the natural grieving process.

, which is often mixed in with denial or anger, is the thinking that if only we'd done something different, this wouldn't be happening. We wish we'd brought the pet in earlier, paid closer attention or been there when they died. Veterinarians do some bargaining of their own when a severely ill pet is presented to us, and we think we may have been able to do more if we'd seen a pet sooner. Bargaining allows us to remain in the past and avoid reality, and it seems to crop up over and over again as we navigate grief. It's what makes us question our decision to euthanize and wonder if we chose the correct time or waited too long.

Once we've let go of the bargaining, we feel the true weight of the situation as 

. This isn't just feeling sad but really feeling lost. The realization that your pet is gone and is not coming back causes profound sadness, but that's necessary to get to the other side and move on to acceptance. There's no proper way to deal with this stage, but talking through our grief with a family member, friend, support group or therapist can help us navigate it. Remembering that pets are a significant part of our lives and not being ashamed to talk about it to others will help us progress beyond the depression and move into acceptance.

. It's not being OK with the loss or feeling good about it and moving on. It's about accepting the reality of your pet being gone but not forgotten. Accepting that life has changed and will be forever different going forward. I see acceptance in one way, as a veterinarian, when people adopt a new pet after a loss. They are not replacing the love that they had for the deceased pet, but they've chosen to love again. I personally spent a year without a dog after I lost both of my previous dogs within four months of each other. When I got to the point of acceptance and my house felt empty, I adopted my Sheltie, Trent. I will never forget my other two dogs, but I chose to open my heart to another.

I write about this subject not to make you feel sad but to help us all to feel supported and understood. There are people that pass judgment about grief surrounding pets and lack empathy when it comes to the choices surrounding pet care, illness and euthanasia.

, judgment and regret have no place in this discussion.

There is no correct way to lose a pet and no correct way to grieve.

Julie Cappel, DVM, works as a small animal and exotic pet veterinarian, leadership and life coach. She has been a practice owner for more than 20 years, running a four-doctor veterinary practice in Warren, Michigan.

Losing a pet is hard on owners and veterinarians alike, but knowing how grief works may help navigate the loss. 

Grief comes in many forms

Not all wounds should be closed right away-instead consider keeping some of them open while you evaluate. Bronwyn Fullagar, BVSc, MS, DACVS, says that the temptation can be to close wounds first, but you should allow yourself a little time. Think of it, she says, as a “long-term project rather than a short-term fix.”

What you want to achieve in your open wound is a healthy bed of granulation tissue. Once you've achieved that granulation bed, you have options for closing the wound over it.

In general, if the wound isn't an acute onset and clean, don't stitch it up on day one. Wait even just a few days. “Let the tissue kind of declare itself,” says Dr. Fullagar. This allows you the chance to determine what's healthy and what's not before closing it up.

Get more of her thoughts on open wound management in the video, shot at 

You have an open wound come into your practice. Your first temptation is to close it right up. But you might want to wait a few days first, suggests Dr. Bronwyn Fullagar.

A primer on veterinary open wound management

Reports exist of toxicity from a pet eating just one grape, Dr. Wismer attendess at Fetch dvm360 conference in San Diego. 

Time is of the essence when diagnosing and treating patients with toxicosis. At 

 conference in San Diego, Tina Wismer, DVM, MS, DABVT, DABT, reviewed five common renal toxins: cholecalciferol, ethylene glycol, nonsteroidal anti-inflammatory drugs (NSAIDs), lilies and grapes/raisins. Identifying these cases quickly in the clinical setting will enable veterinarians to implement treatment or mitigation procedures more rapidly.	

Vitamin D toxicity can occur at doses as low as 0.1 mg/kg, Dr. Wismer said. The incidence of cholecalciferol toxicity in pets is increasing due to its use as an ingredient in psoriasis creams as well as increased use as an ingredient in rodenticides. Initial clinical signs typically include vomiting, depression, polyuria and polydipsia 12 to 18 hours after ingestion. Increased phosphorus concentrations can be identified within 12 hours, and increased calcium concentrations within 24 hours. Renal failure can occur within 24 to 48 hours.

Treatment includes emesis, if ingestion occurred within the previous 30 to 60 minutes (creams) or four hours (rodenticides). Administration of a single dose of activated charcoal is also recommended, followed by cholestyramine. When monitoring calcium, phosphorus, blood urea nitrogen (BUN) and creatinine, the addition of 0.9% NaCl is indicated for patients with increasing calcium concentrations to provide competition to calcium reabsorption in the renal tubule. For rapid calcium increases, calcitonin, pamidronate or zoledronate may be administered, as well as phosphate binders. Furosemide and corticosteroids may be used as adjunctive therapies.

Despite its commonality, toxic doses of ethylene glycol have not been well established. Clinical signs vary depending on the stage of toxicosis and metabolism of the parent compound. Central nervous system (CNS) signs appear first, followed by metabolic acidosis and renal tubular necrosis. Neurologic signs, polyuria/polydipsia and hypothermia generally appear within 30 minutes of ingestion and may be brief or last up to 12 hours. Cardiopulmonary signs generally occur 12 to 24 hours after ingestion. Renal effects may be seen as early as 12 hours after ingestion but more commonly are seen within 24 to 72 hours.

Laboratory findings include hyposthenuria, glucosuria and (inconsistently) the presence of calcium oxalate crystalluria on urinalysis. In later stages (after 12 hours), azotemia may be present, but a diagnosis is typically necessary prior to this stage. An ethylene glycol test kit is a valuable tool for rapid diagnosis, and kits are available for both dogs and cats. Note that activated charcoal and some medications (e.g. diazepam) contain propylene glycol and can interfere with test results, so test kits should be used prior to their administration.

Treatment for asymptomatic animals or recent exposures (within 45 minutes of presentation) includes induction of vomiting or gastric lavage. Activated charcoal is not generally effective. High rates of intravenous crystalloids promote renal perfusion. The key to successful treatment is early administration of ethanol and fomepizole, which delay the breakdown of ethylene glycol to its toxic metabolites. Be aware that ethanol will worsen metabolic acidosis and CNS depression. Prognosis is dependent on the amount of ethylene glycol ingested, the time between ingestion and initiation of treatment and the aggressiveness of treatment. The presence of oliguria/anuria is a grave prognostic indicator.

NSAIDs provide analgesia and reduce inflammation by inhibiting prostaglandin synthesis; however, toxicity results in increased production of gastric acid and pepsin, decreased secretion of the protective mucus layer in the stomach and small intestine, and vasoconstriction in the gastric mucosa (which can lead to mucosal hypoxia and thrombosis). Renal effects include vasoconstriction and inhibition of renal blood flow, reduced glomerular filtration rate and hypoxic renal damage, among other biochemical effects, leading to accumulation of toxic substances in the medulla and renal papillae and resulting in papillary necrosis. Gastrointestinal upset may occur within two to six hours of ingestion, with gastric hemorrhage and ulceration occurring 12 hours to four days post ingestion. Dogs, cats, rats, mice and pigs are thought to be most sensitive to NSAID toxicosis. Treatment is comprised predominantly of intravenous fluids and gastroprotectants.

When ingested, lilies may cause acute renal failure in cats. The mechanism of this toxicosis is unknown. Emesis, often the first clinical sign, can occur within a few hours of ingestion. Oliguric/anuric renal failure develops within 24 to 72 hours, with increases in BUN and creatinine apparent within 12 hours. Within 24 hours, urinalysis may show isosthenuria, abundant casts, proteinuria and glucosuria. Additional clinical signs often include vomiting, depression, anorexia and dehydration.

Toxicity may be fatal, especially if treatment is delayed beyond 18 hours. Intravenous fluids should be administered at twice maintenance rates for 48 hours in an attempt to prevent tubular necrosis and renal failure. For cases resulting in renal failure, dialysis may be used to manage renal failure until tubular regeneration occurs.

Grapes and raisins may cause renal failure from proximal tubular necrosis in some dogs, but there is variability in susceptibility and toxic dose. When it occurs, renal failure is usually apparent within 72 hours of ingestion. Toxicity has been documented from doses as low as 0.7 oz/kg (grapes) and 0.11 oz/kg (raisins), although Dr. Wismer noted that reports exist of toxicity from just one grape. When it occurs, vomiting may begin within six hours of ingestion, and BUN and creatinine may become increased within 12 to 18 hours.

Treatment of grape/raisin toxicity consists of intravenous fluid diuresis and symptomatic care. Oliguria/anuria is a poor prognostic indicator. Dialysis may be attempted with oliguric/anuric patients, with mixed results.

Dr. Packer is an associate professor of neurology/neurosurgery at Colorado State University College of Veterinary Medicine and Biomedical Sciences in Fort Collins, and is board certified in neurology by the American College of Veterinary Internal Medicine. 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. 

The key to managing any toxicity in pets is early identification and timely treatment. Keep these common renal toxins in mind when obtaining veterinary patient histories and examining dogs and cats.

A practical review of common veterinary renal toxins

You've probably heard it said that human kids don't come with instruction manuals. But according to 

 educator Amanda Dykstra, DVM, MPH, DABVP (Shelter Medicine Practice)-a former professor of shelter medicine at the University of Tennessee College of Veterinary Medicine now working as medical director for a nonprofit and a shelter consultant-this adage doesn't need to apply to foster kittens.

, you already know that Dr. Dykstra recommends providing kitten foster parents with a manual. “A foster manual with detailed care instructions will help families give foster kittens the best start in life while saving the veterinary staff precious time and resources,” she explains.

Dr. Dykstra's foster manual includes sections on housing, feeding, elimination and socialization. It also provides information about weight gain and milestones as well as answers to common medical concerns and what to do in case of emergency, she says.

Dr. Dykstra notes that because shelter veterinarians often spend less time with clients and more time talking with other veterinarians, they need to be especially cognizant of the vocabulary they use when those interactions do occur. “A lot of your foster parents won't have any medical care knowledge, so you need to make sure you're speaking to them in a way they can understand,” she says. This holds true for both written and verbal communication.

According to Dr. Dykstra, providing warmth is the most important housing concern for neonates and infants, because hypothermia has a negative impact on immunity, feeding and digestion.

She sends foster kittens home with a safe source of heat, such as a heat lamp or a Snuggle Safe pad.

“Kittens don't regulate their own body temperature well in the first four weeks of life and can only maintain a body temperature that's about 12 degrees higher than their environment,” she explains. “This is due to their large body surface area with noncornified skin and their lack of insulating fat as well as the fact that they can't vasoconstrict their peripheral vessels. Neonates are especially susceptible because they're unable to shiver at birth.”

Dr. Dykstra also advises foster parents to house kittens in an area that can be disinfected easily and where visits from children and other animals are restricted. “I say limited, because it's not like we don't want children to be around them at all. We want kittens to be socialized, but the interactions need to be supervised by an adult for the protection of the kitten and the child,” she says.

Nutrition can be one of the greatest challenges for foster families, says Dr. Dyskstra. “Bottle feeding is done wrong all the time. It's amazing how often people try to bottle feed kittens like they do human babies,” she says.

Keep track of weight (and maintain your sanity)

One of the most important things you can do to set up your foster kittens for success is to send them home with a gram scale. “Weight loss is one of the most prominent indicators of illness in kittens,” says Dr. Dykstra, “so it's really, really important that your fosters are monitoring weight.”

She shares a trick for keeping track of weight without investing a lot of time: To avoid a bunch of phone calls and back-and-forth with foster parents, set up 

 where they can go in and record their foster kitten's weight and how much it's eating every three to seven days. You can also ask if everything is OK and whether the foster parent needs a call from you. The document can be quickly and regularly reviewed by your shelter's foster coordinator.

Give foster parents the guidance they need by including specific instructions in the foster manual on preparing and warming the formula, feeding frequency, feeding positioning (it should be a 45-degree angle), weight monitoring and weaning. Dr. Dykstra also spells out signs of feeding problems as well as the risks of overfeeding, using cow's milk or mixing in too much water. “It's not uncommon for well-meaning foster parents to cause unintentional harm in an attempt to save the shelter money,” she says. “Make sure they understand how this can affect the animals in their care.”

Dr. Dykstra notes that, when available, lactating foster queens are the best option for feeding orphaned kittens as they can provide both nutrition and maternal care. “Most lactating queens will accept the additional kittens, but it's important to place foster kittens with similarly sized animals to avoid size discrepancy,”

On the topic of weaning, Dr. Dykstra says that kittens generally start drinking formula from a dish at around 3 or 4 weeks of age and that solid food can be introduced by mixing canned food with milk replacer in a flat dish. “Slowly decrease the amount of milk replacer until the kitten is primarily eating solid food,” she explains. “By the time the kitten is 5 to 6 weeks old-and possibly sooner if the teeth are coming in well-it can chew dry food and should be eating about one-third of its daily calories in the form of solid food.”3 Kittens should be completely weaned by the time they are 6 to 9 weeks old.

 Elimination can be a major struggle for foster parents, so be sure to give them the educational (as well as material) tools they need to be successful. In kittens younger than 3 weeks old, urination and defecation must be stimulated, says Dr. Dykstra. “Normally, this is done by the queen when she licks the kitten's perineum,” she explains. “To mimic this in young orphans, foster parents need to rub the kitten's lower abdomen, genitals and rectum with a cotton ball dipped in warm water before and after each feeding.”

Explain to foster parents that kittens tend to urinate with every stimulation and defecate at least once a day, and include a poop chart in your manual so foster parents can easily keep track. “When the kitten starts eliminating on its own, it should be given a litter box with shredded paper or nonclumping litter (as kittens tend to have a taste for the clumping kind),” Dr. Dykstra says. “Stool should be placed in the litter box until the kitten learns to eliminate there.”

 The importance of the sensory phase, which begins at around 3 weeks of age and lasts until the kitten is approximately 2 months old, cannot be overstated, says Dr. Dykstra. “Opportunities to gain desirable conditioning during this time will improve the kitten's ability to be a well-socialized companion animal in the future,” she explains. “Make sure foster parents understand that their job isn't limited to keeping the kitten alive with food and water. Kittens really need frequent, careful handling.”

 If you'd rather not receive a desperate call at 2 a.m. about a foster kitten with a slight limp, you'll want to detail in your foster manual what constitutes an emergency (and, perhaps just as importantly, what doesn't).

Dr. Dykstra recommends having the shelter veterinarian clearly outline the clinical signs that fall into the following three categories:

Needs to be examined at foster parent's convenience

The signs that go into each category aren't universal. “The specifics will depend on your shelter's human and material resources,” she says. 

figuring out what basic resources a kitten foster program needs

The above represents a small smattering of what you'll need to include in your kitten foster care manual, but don't get overwhelmed by the prospect of creating your own in full. Dr. Dykstra insists there's no need to start from scratch. She's found this 

 from the University of Wisconsin-Madison School of Veterinary Medicine to be a tremendous asset in creating her own resources. (You can also learn more about medical protocols for foster kittens here.)

Lastly, a manual is only useful if it's read, so don't just hand it to foster parents and cross your fingers that they'll crack it open when they get home. Take the time to walk through it with them so they know all of the answers it holds-whether one-on-one or during a foster orientation session.

	1. Davidson AP. Neonatal resuscitation: improving the outcome. 

	2. Thomovsky E. What to expect in a neonatal kitten or puppy, in 

	3. Little S. Playing mum: successful management of orphaned kittens. 

Sarah Mouton Dowdy, a former associate content specialist for dvm360.com, is a freelance writer and editor in Kansas City, Missouri

Shelter medicine expert Dr. Amanda Dykstra makes a case for equipping foster parents with detailed instructions on the care and keeping of kittens.

Your kitten foster care program needs a manual

While the current focus on the human-animal bond (HAB) feels new(ish) to many, the roots for exploring the connection between healing and wellbeing in humans through relationships with pets, therapy animals and more go back in time as well as into our future.

The term “human-animal bond” was coined in the 1960s when Austrian zoologist and ethologist Konrad Lorenz, MD, PhD, became known for his principle of attachment, or imprinting, by which a bond is formed between a newborn animal and its caregiver. In 1969, Boris Levinson, PhD, professor of psychology at Yeshiva University, published the book 

 based on his discovery in his psychotherapy practice that when his dog Jingles was in the room, a child would speak more freely. He later coined the term “pet therapy.”

In the mid-1970s other visionaries founded the Delta Foundation (which became the Delta Society) as a clearinghouse for research involving animal-assisted interventions and the HAB. In 1981, William McCulloch, DVM—brother of one of the Delta Foundation founders—helped start the AVMA's Human-Animal Bond Task Force.

Putting this research to work resulted in the development of the Pet Partners program, the first comprehensive, standardized training in animal-assisted activities and therapy for volunteers and health care professionals. In 2012, the Delta Society formally changed its name to Pet Partners, and the organization 

During the 1980s and 1990s, hunches and observations moved to research and documentation. Alan Beck, ScD, and Aaron Katcher, MD—a psychiatrist at the Center for the Human-Animal Bond at Purdue's School of Veterinary Medicine—co-wrote 

Between Pets and People: The Importance of Animal Companionship

, in which they cited a 1992 study of 5,000 people that revealed that pet owners had lower blood pressure and blood fat levels than non-pet owners.

Another of the recent contributors to the field is Philip Tedeschi, who serves as executive director of the Institute for Human-Animal Connection at the University of Denver within the Graduate School of Social Work. He launched the school's Animal-Assisted Social Work Certificate program for master's of social work students as well as the Animals and Human Health online professional development certificate program. Inspiration for the program began when Tedeschi was a student of veterinary medicine at the University of Wisconsin. As a student, he moonlighted teaching horseback riding to adults with schizophrenia. As he recognized positive changes in the riders, he became fascinated with human-animal interactions.

“Increasingly, it is becoming clear that humans' optimum health and resiliency occurs in the presence of other healthy living systems,” he writes on 

, “whether it is a pet in our home … or recognition that our global biodiversity health and ecological systems provide us a needed life support system.”

The burgeoning field of psychoneuroendocrinology has brought into focus understanding of the presence of important hormones like serotonin, oxytocin, dopamine and endorphins. Of particular interest to those researching the human-animal bond is the presence of oxytocin. This has long been advertised as a “love hormone,” made in the hypothalamus, stored and released by the posterior pituitary gland in the brain.

In 1992, documentary producer Meg Daley Olmert joined a team studying the neurobiology of social bonding headed by Carol Sue Carter, PhD, of the University of Maryland. This inspired Daley Olmert to write the 2009 book 

Made for Each Other: The Biology of the Human-Animal Bond

, in which she chronicles the study of oxytocin.

Daley Olmert points out that oxytocin was first identified in 1902 as the hormone that acts on the muscles of the uterus to produce labor contractions. Some 50 years later it was discovered that this hormone produces the spasms that release breast milk. In the 1980s, scientists realized there was even more to the oxytocin story. When released, the hormone produces a feeling of love and satisfaction and is the primary hormone released during an orgasm. Not only does it cause new mothers to form a loving bond with their babies after their birth, but it's related to sexual arousal, trust and more general bonding.

This plays out in the benefits of the human-animal bond that Pet Partners 

A therapy dog has a positive effect on patients' pain level and satisfaction with their hospital stay following total joint arthroplasty.

Fibromyalgia patients spending time with a therapy dog instead of in an outpatient waiting area at a pain management facility showed significant improvements in pain, mood and other measures of distress.

A walking program that matched sedentary adults with therapy animals resulted in an increase in walking over a 52-week graduated intervention, with participants saying they stuck with the program because “the dogs need us to walk them.”

The presence of an animal can significantly increase positive social behaviors among children with autism spectrum disorder.

Children made fewer errors in match-to-sample categorization tasks in the presence of a dog compared with a stuffed dog or human. Similar studies may indicate that presence of a dog serves as both a source of motivation and a highly salient stimulus for children, allowing them to better restrict their attention to the demands of the task.

Therapy animals in pediatric cancer studies improved motivation to participate in treatment protocol, to maintain motivation over time and to want to “get better” or stay optimistic.

Pet ownership, perhaps by providing social support, lowers the blood pressure response to mental stress.

Pet owners have higher one-year survival rates following heart attacks than do non–pet owners.

Recognizing and nurturing the connection between animals and humans has potential implications for individual stability and health, improved economic outputs and healthcare cost savings.

Pet ownership, particularly dog ownership, may lower the risk of cardiovascular disease.

Pet ownership was associated with a reduced risk for non-Hodgkin lymphoma and diffuse large B-cell lymphoma.

Human health savings of $3.86 billion over 10 years have been linked to pet ownership as related to a decrease in doctor visits in studies in Austria and Germany.

Pet owners intuitively know that living with a pet comes with many benefits, like constant companionship, love and affection. Not only are people happier in the presence of animals, they're also healthier. 

 conducted by the Human-Animal Bond Research Institute (HABRI), 74% of pet owners reported mental health improvements from pet ownership, and 75% reported that a friend's or family member's mental health had improved from pet ownership.

It is widely accepted by pet owners that veterinarians are a trusted resource for the health of their pets. Now these clients are also coming to their veterinarian for information on the human health benefits of caring for a pet. 

To support the launch of a veterinary professional certification program

, HABRI surveyed 2,000 pet owners after educating them on the health benefits of pet ownership. They found that:

92% said they were more likely to maintain a pet's health, including keeping up with vaccines and preventive medicine. 

89% said they were more likely to schedule regular checkups with a veterinarian.

88% said they were more likely to provide a pet with higher-quality nutrition.

62% said they were less likely to skip visits to the veterinarian.

51% said they were more likely to purchase pet health insurance.

And about that certification program: NAVC (North American Veterinary Community) launched 

the Human Animal Bond Certification program

 with HABRI and contributions from the AVMA as a founding educational partner and premier sponsors Zoetis, Petco and PetSmart Charities.

If learning about the human-animal bond inspires you in veterinary practice, the resources are out there right now to share with your own clients to inspire and inform them about the human health benefits of a close relationship with pets. The time has come for veterinary practices to embrace the human-animal bond.

Dr. Shadle earned her PhD in interpersonal and organizational communication from the State University of New York at Buffalo. Dr. Meyer earned his PhD in communication studies and speech arts from the University of Minnesota. They write and have trained veterinary professionals at numerous national and international conferences through Interpersonal Communication Services.

Study of the human-animal bond (HAB) began with psychiatry and psychology and bloomed into the world we live in today. Learn more about HAB, its history and its future in your practice.

How the human-animal bond is reshaping veterinary care

Hosting events is a great way for potential new veterinary clients to find your practice. One good one way to start is throwing an open house.

 A local holiday or an anniversary of some sort gives meaning to the party. One-year anniversary at your new location? Twenty-five years in business? Dr. Smith's five-year anniversary with the practice? Those are all good reasons to throw an open house.

 Create a one-way traffic pattern with stations throughout the clinic. Make some or all of the stations kid-friendly. Need ideas? I've got some-but brainstorm with your clinic's team and you'll come up with even better ones!

	• The first station could be an exam room with a stuffed animal patient with a fake lump inside it. You ask kids to palpate to see if they can find the (fake) puppy's lump.

	• Another station might be in the lab, where people can peer into a microscope. Provide a slide of parasite eggs and an identification chart so they can have fun figuring out what they can find. Of course, live ear mites would be exciting as well.

	• Radiology, of course, makes a great station, with a variety of interesting pictures. The activity could be counting how many puppies there were inside a pregnant patient.

	• The final station should be refreshments, along with a veterinary technician or veterinarian there to answer questions.

 Start preparing at least two months in advance so that you have time to advertise the open house and plan for every station. The open house is also a great excuse for a deep cleaning of the facility.

Tracy Sheffield, BS, LVT, CVPM, is practice administrator at Wimberley Veterinary Clinic in (you guessed it) Wimberley, Texas, as well as co-owner of T&L Veterinary Business Consulting. She was a 

dvm360/VHMA Practice Manager of the Year 

Use this strategy to help increase your clientele and gain a larger presence in the community.

One good marketing idea: Throw an open house at your veterinary clinic!

Many veterinarians have untold hobbies and talents that let them escape veterinary practice for a while. Just take a look at these 

 conference speakers. Gina Singleton, DVM, lets go of her everyday job frustrations in poetry. Last year, this Maine practitioner wrote a poem about dealing with veterinary clients. This month, she shares another amusing poem about something that every veterinary professional knows all too well-the petrified patient. We know you'll relate.

	just how this appointment is going to go.

	With tail held down and eyes to the side,

	Fido is desperately looking for somewhere to hide.

	His owner is coaxing him, trying to soothe.

	The tech's tossing treats, but he won't improve.

	You try to be patient, you give them a smile,

	but you say to yourself, "Looks like we'll be here a while."

	How best to proceed from this point here?

	Simply go “old school” and ignore the dog's fear?

	Let the owner hold him, to whom he is glued

	and say to yourself, "Please, don't let me get sued."

	You decide just to do it-get the muzzle and lead.

	But now he is slipping in the puddle he's peed.

	The owner is shocked: "This is totally new!"

	with a look that really says, "He's scared of YOU."

	The poor dog is thinking he's going to die.

	The owner's embarrassed and starting to cry.

	Your tech is exhausted and covered in poo.

	And you laugh to yourself, "What IS this job that we do?"

Dr. Singleton is an associate veterinarian practicing at a small animal practice in Maine. If she had any free time, she would love to make movies, travel the world and dance. For now, she is devoted to being a mom, wife and vet.

We've all been there—trying our best to coax a terrified patient to relax so we can attempt a physical exam or blood draw or ... anything.

Rodeo: When patient fear makes a veterinary exam nearly impossible

Cats and laser pointers. Name a more iconic duo. Unfortunately for our feline friends, many cat owners are using laser pointers in potentially harmful ways.

According to John Ciribassi, DVM, DACVB, the problem with laser pointers is that they lack an endpoint. Nothing is ever physically caught. Even if the cat is “successful,” there's no reward. Such pointless play, says Dr. Ciribassi, can cause some cats to develop a compulsive disorder. Instead of engaging in normal activities like playing with their owners or even eating, these cats will spend a large portion of their day chasing things that are similar to the laser pointer light, such as shadows or reflections. “It's a quality of life issue,” he explains.

But that doesn't mean you need to instruct clients to surrender their laser pointers. Dr. Ciribassi still thinks they're great for getting cats the exercise and predatory stimulation they need. “We don't want to throw the baby out with the bathwater,” he says. “We've got a tool that works. Let's just use it in a way that's more effective.”

In Dr. Ciribassi's opinion, this can best be achieved by updating the iconic duo to a trio by adding a clicker. Here's how it works: The cat is trained to associate the sound of the clicker with pleasing its owner and with the promise of a tangible reward. Once it's clicker trained, the cat is periodically allowed to “catch” the laser light, at which point the owner delivers a click followed by a tasty treat. In this way, the cat knows that it's won and that something good is coming. “Now,” says Dr. Ciribassi, “there's a concrete, tangible result of catching the laser light.”

Editor's note: This article is based on a dvm360.com video featuring Sarah Wooten, DVM, and John Ciribassi, DVM, DACVB. 

Sarah Mouton Dowdy, a former associate content specialist for dvm360.com, is a freelance writer 

But you can educate your well-meaning veterinary clients on how to use them in the most rewarding way. 

Laser pointers can cause behavior disorders in cats

Every member of your veterinary team should be able to confidently advocate for pet dental health. Not sure where to start? Consider these suggestions for making actionable recommendations in the examination room and promoting ongoing oral care at home.

Address dental care during every well visit

During wellness visits, be diligent about making dental health discussions as routine as taking a patient’s vital signs. When technicians initiate a conversation about a pet's dental needs, it adds substantial weight when the veterinarian repeats the same points later in the visit.

Make sure clients are aware of how common dental issues are in companion animals. Although dental issues are not always apparent to pet owners, 80% to 89% of dogs

 have some level of periodontal disease by the age of three.

Help clients understand that dental disease can cause pain and infection that, left untreated, will decrease their pet’s quality of life. Send your message home by providing real-life examples, such as a photos or radiographs comparing healthy and diseased teeth. Make sure clients know that, as for people, dental disease in pets is irreversible, but treatments are available to rectify problems. The intent is not to instill fear, but rather to help clients understand the full scope of the situation.

Too often clients perceive discussions about their pet’s oral health as “friendly suggestions” instead of medical recommendations. Consider how you approach the conversation and what small, impactful changes you can make to improve compliance. For example, rather than saying simply, “You should consider scheduling a dental appointment for Fido soon,” reiterate specific concerns (e.g. gingival recession, tooth fracture) from the exam and explain that you would like to schedule a full dental exam under anesthesia so the veterinarian can make a proper diagnosis.

Put “conversations with clients about dental care” on the agenda for your next staff meeting, and take the opportunity to share real-life experiences with one another. Discuss what tactics work best with clients and how to move beyond the common pushbacks. Evaluate the feedback and, as a group, come up with brief yet compelling recommendations that staff can make to clients about dental care.

Stress the importance of home dental care

As a veterinary professional, you know how important your patients’ oral health is, but are your clients aware? Check out these tips on how to have a meaningful conversation with your clients about dental health. 

Firstline July/August 2020