Many practice managers and team leads have experienced the frustration of a hospital owner not supporting their initiatives and vision. It can be aggravating and belittling to say the least.

My personal experience involved a hospital owner who would completely disregard my guidance to direct reports, even contradicting company policy. This type of behavior can create an environment of confused employees and disgruntled managers. For me personally, it damaged trust between me and my direct reports.

In an organization with multiple owners and one overly controlling one, the lack of consistency across the organization can also create equity issues. For example, if you allow employees in one part of the hospital to leave early and not abide by their shift schedule, but not others, this creates a lack of fairness among groups. Some employees may feel they can't continue in their positions due to scheduling and personal demands, but others are allowed that flexibility and can keep their positions. Legal issues can arise out of this inconsistent favoritism.

So what do you when you're stuck between an immovable rock of an owner and a hard place of employee frustration? First off, if all else is going well with your position, consider talking directly with the owner. They may be surprised to hear of the negative effects of their behaviors, including how you feel belittled.

When I started this conversation, I began by explaining that I was entrusted with this position and responsibility because of my experience and personal capability to do so. That trust should extend into my day-to-day work to allow me to be as effective as possible and to allow the owners to focus on their responsibilities and the bigger picture of the organization's success.

Through these conversations, I found out the owner was uncomfortable stepping away from these daily operational concerns-he 

wanted to be in control. Does this mean you give up control in your position to accommodate this? No. Quite simply, I involved him in any conversations that had to do with his direct team. I did so to create transparency in the discussions for our veterinary support staff and managers as well as to make him feel that he had a voice. If I felt strongly about a certain decision, I would usually take the approach of trying to explain what was in it for him. If you can find an angle to benefit this kind of owner, they'll likely jump onto the bandwagon.

Over time, I made sure his constant rebuttals to my decisions didn't hurt my own self-worth and the view of myself as a leader. It's easy to get caught up in the negativity and frustration of someone going against your well-thought-out advice, but it usually doesn't impact all aspects of your job. I  put less of my sense of personal success on the items that he tended to fight me on-scheduling in particular-and more on other elements of my job, such as learning and development projects and employee relations. I reminded myself that I had positive, strong relationships with pretty much every other employee and leader in the organization, so I didn't need to fret over every interaction with this one person.

Part of surviving an undermining owner or boss is focusing on ways to fulfill yourself in your own career. Try to look at the bigger picture. You're likely not going to stay at this one hospital your entire career. Think about where you want to be in the next five to 10 years. What steps do you need to get yourself there? Often, when you step away and remind yourself that dealing with these petty behaviors is not the most important thing on your professional plate, it will be easier to keep these issues from overwhelming your job, your workday and your state of mind.

Oriana Scislowicz, LVT, PHR, was a veterinary practice manager for many years before becoming senior HR specialist at Pharmaceutical Product Development.

Articles

If the hospital owner constantly discredits the guidance you provide to your veterinary team, having that uncomfortable conversation with him or her about how their behavior makes you feel could help set things straight. 

When the hospital owner undermines your leadership

	Cannabidiol (CBD) use in pets is a hot topic that is gaining serious traction, and veterinary professionals must to be prepared to talk about it with clients. But if you're not up on all the lingo, don't fret. Stephen Cital, RVT, RLAT, SRA, VCCS, VTS-LAM, can help get you up to speed.

Atlantic Coast Veterinary Conference (ACVC)

, he shared with dvm360 some of the key phrases you'll hear when talking about the cannabis culture and its relationship to medicine.

	So, if you're confused about exactly what terms like endocannabinoid system, cannabidiol, cannabinoids and hemp mean, take a listen as Stephen explains what they mean-and why being knowledgeable about CBD terminology is key to understanding current laws.

Veterinary technician Stephen Cital shares some essential cannabidiol terminology that your veterinary team should know.

Clearing up cannabis confusion for veterinary professionals

Throughout my career as a veterinary technician, I've lived in a constant state of burnout-with a dash of compassion fatigue sprinkled in. Years ago, I was unaware of what was happening to me but figured it was just a normal part of the career path I chose.

I once worked for one of the largest shelters in a big city and felt a strong sense of purpose helping animals that didn't have a home. The workload consistently kept me late, and I ran off of a steady diet of self-inflicted guilt when I finally left: 

What will happen to this dog if he doesn't get his medication tonight? I don't want anyone to think I don't care. If I stay a little later, maybe I'll feel better about leaving for the day.

I know many veterinary professionals who burn out on their jobs because they continue to make decisions based on guilt. No veterinary professional entered the field because they wanted to make tons of money-they did it because they loved animals. But that dedication to animals can create a work-till-you-drop mentality and guarantee trauma on the job. Let's talk definitions first:

 In May 2019, the World Health Organization recognized burnout as a syndrome resulting from 

“chronic workplace stress that has not been successfully managed”

: The current definition of this “occupational phenomenon” contains three elements: (1) feelings of energy depletion or exhaustion, (2) increased mental distance from one's job or feelings of negativity or cynicism related to one's job, and (3) reduced professional efficacy. Burnout is a direct result of continued stress at work. When you stay late or skip your breaks because you feel guilty, you're diminishing your ability to continue doing and enjoying your job.

Burnout and compassion fatigue are sometimes used interchangeably, but the American Institute of Stress defines compassion fatigue as 

or secondary traumatization. It's the emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events. It can coexist with burnout. 

(Editor's note: You can go even deeper with definitions here.)

 Many of us veterinary professionals can recall traumatic events happening to animals in great detail.

An example from my own life is the time I came home with my first foster pet, a 6-month-old German shepherd puppy. She had a broken front leg that was casted instead of surgically repaired, and she was not potty trained. I came home one day to find her, the kennel and half my kitchen floor covered in poop. As I was cleaning her up, she yelped and tweaked her leg. I rushed her to the shelter for radiographs, which revealed an additional fracture. I was waiting to hear that her surgery went well, but instead was told that she'd stopped breathing and CPR had been unsuccessful. Having worked in shelters, I was not sensitive to death itself, but this was the first dog I'd taken home since losing my own dog only a few months prior. For some, this wouldn't be a traumatic event, but for me it was. My trauma isn't your trauma-but the results are still the same. If we don't develop some resilience, traumatic situations can add up.

3 ways to manage burnout and compassion fatigue

Even with all the lectures, webinars and advice out there for managing burnout and compassion fatigue, many of us still haven't learned the tools or put them into action yet. In case this helps you finally take a step toward self-care, here are some ways I manage:

When I was suffering from both burnout and compassion fatigue, there were times I annoyed even myself with how often I complained. I could be at a party having a great time, then someone would ask me about work. I'd feel myself slide into a terrible mood instantly but had no idea how to stop it.

If you're used to holding onto stress, it's time to start learning to let go. You can choose gratitude instead. But beware: When I started trying to focus on gratitude over my negative self-talk, I expected to snap my fingers and never be sucked into complaining ever again. That didn't happen.

Realistically, you have to start small. Try to notice when you're talking in a negative way. Once you notice you want to say something negative to someone, be mindful enough to move onto gratitude. When you're stating gratitude:

 Research by bestselling author Brené Brown, PhD, found a common thread with participants who practiced gratitude: They wrote down their gratitude in a journal or stated out loud what they were grateful for every day. My favorite gratitude exercise is using a gratitude journal and setting a goal of writing or stating what I'm grateful for every day.		 

 On a really bad day it can be extremely hard to find something you're grateful for. I usually try to think of three things, and when I say, “I'm grateful today wasn't the worst it could be,” it can be difficult to come up with my three things. Getting specific about what I'm grateful for helps me define what interactions add value to my life and helps me scan my day for the good instead of the bad.		 

The more you practice gratitude, the easier it gets and the better you feel, but 

 to develop. Still, you should feel effects of habit change much earlier.

is coming up with a different, more truthful (and possibly positive) interpretation of an event or experience. When I'm stressed or frustrated, I have a hard time seeing other perspectives. Restructuring (or reframing) is important, because this tool of cognitive behavioral therapy (CBT) can break a cycle of negative thoughts and force you to logically evaluate the situation. This tool is still challenging for me, but I also see the best results when I'm able to execute it. The next time you feel negative about an event, try asking yourself some questions (drawn from 

Would I be thinking about this differently if I were in a better mood?

What am I meant to learn from this situation?

How could I explain this situation if I were not taking it personally?

 the answers to these questions. The goal is to think about where your emotions may be overriding reality and what you 

Because you're in a caretaking career, it may feel unnatural to put yourself first. It's easy to go on your one vacation all year just to jump right back into work within hours of getting home. Maybe you finally went to that yoga class after work but gave up after only one session. Many people will “splurge” on self-care in these ways and wonder why they still feel exhausted. Self-care can be like a fad diet-one day or weekend of self-care won't be enough to create a lasting benefit.

It was a hard for me to start prioritizing self-care. I felt guilty putting myself first. I wasn't ready to choose myself until I had no other options. It helped me to say out loud what I was choosing to do that might hurt me when I was worn out: 

I'm choosing to take an extra shift and not go to the gym. I'm choosing to stay late. I'm choosing not to take my lunch break.

When my choices were out in the open, it got a lot harder to ignore what I knew, deep down, I needed.

 Owning your choices is a powerful tool that will help you focus your thoughts

. When you're focused on changing your circumstances, you're better able to see the possibilities that lay before you.

As you work to create new habits that can help you better manage job burnout and veterinary compassion fatigue, it's important to remember that you will experience failure. Stress happens. Feelings of burnout happen. Trauma happens. The difference will be whether you can learn from these experiences and continue forward-or if you give up and need to leave the profession.

Kristina Guldbrand worked as a certified veterinary technician for 12 years before becoming an account manager for Veterinary System Services, a company that provides staffing, consulting and hiring help to practices in the Denver, Colorado, area. She has received training through the International Coaching Federation and provides workshops, leadership and wellbeing coaching as well as team-building for practices.

Some things in life you dont control. One thing in your control that might help is your own thinking. Check out these proven ways we veterinary professionals can help manage job burnout and compassion fatigue.

3 ways veterinary professionals can reframe negative thinking

Jessica Molina is one of 10 finalists for 2019 dvm360/VHMA Practice Manager of the Year. Learn more about the contest and read more stories from other entrants, finalists and winners 

There is something the Avengers, the X-Men, the Justice League and the Teenage Mutant Ninja Turtles all have in common-they believe in the power of a team. Each team member has unique strengths and weaknesses, and their success is best accomplished by leveraging their individual skill sets. These superheroes are all highly desirable.

However, there's another type of superhero out there. This one tends to operate alone and with ego. This superhero I refer to as the “Luckily I” superhero.

“Luckily I” superheroes also aspire to do their best, and they execute activities with excellence. But these superheroes tend to work alone, because they set high and often unreasonable expectations on others-finding fault and highlighting others' weaknesses. They are often quick to point out, “Luckily, I fixed the problem,” or “Luckily, I was there to intervene.” Due to their lack of leadership skills, they set up peers for failure. Doctors often unintentionally cultivate this type of superhero by delegating tasks solely to those individuals they “know will get the job done and done right,” which unfortunately communicates a lack of confidence in other team members.

I saw this in my own team, so I knew I needed to make critical changes. My clinic culture and patient care ultimately depended on it.

My big changes involved communication and collaborative thinking in a big exercise I called Superhero Academy. I brought the team together to openly share feelings about the culture and then went around the room asking each person to describe their ideal workplace culture. We made note of these descriptions, as they played an instrumental role in developing our clinic's cultural vision.

I then shared with them the two types of identifiable superheroes (team superheroes and “Luckily I” superheroes), including their motives and actions. What an eye-opening, reflective session this was.

I asked the team to think about a situation: Your teammate is high on a ledge. What are some possible outcomes? A few of the responses included: They could fall off the ledge, be talked or guided away from the ledge, recognize their unsafe position, or you could catch them if they fell.

Then they were asked to think not only about what the two types of superheroes would do, but what might they say. They replied that a team superhero would either guide the person away from the ledge or catch them if they fell, communicating that they cared. They thought the “Luckily I” superhero would let a teammate fall, perhaps remarking to everyone else, “At least you still have me!”

We closed the conversation outlining the characteristics of a team superhero: looking out for those around you, preserving safety and integrity, preventing or cushioning falls and believing in the power of a team. We all pledged to be superheroes who work together for the greater good-providing support to others so they can reach their potential, capitalizing on their own strengths and preserving the integrity of the team.

You could see an immediate difference in the staff members after the meeting. They started to work together more. Over time, my “Luckily I” superheroes transformed. Instead of using the mistakes and failures of others as stairways to their own success, they began to find opportunities to demonstrate their leadership skills, guiding teammates away from the ledges of failure. Now thoese are some real superhero powers!

“Luckily I” superheroes can be tremendous assets to a team. Their exceptional skill sets make them ideal candidates for leadership-if they can learn and practice emotional intelligence and self-awareness. Because of open communication and team commitment, I've certainly been rewarded with a team of individuals no longer afraid to be vulnerable in front of their peers who proactively help others overcome their obstacles. What I now have is more than just a better culture-I have a true superhero family.

Jessica Molina, PHR, CVPM, CCFP, is hospital administrator at Lee Veterinary in Atmore, Alabama, and a finalist for 2019 dvm360/VHMA Practice Manager of the Year.

Even the loner Batman joined the Justice League for the good of all. Heres how this 2019 dvm360/VHMA Practice Manager of the Year finalist inspired her veterinary practice team to be all for one and one for all.

Pledge to be a veterinary superhero

No, skin diseases in small animals aren't typically fatal.

However, the lesions associated with some skin diseases in dogs and cats 

 severe enough to make a pet look so bad (not to mention, feel) that its owner no longer wants to deal with the disease and decides to relinquish-or even euthanize-the pet.

Stephen D. White, DVM, DACVD, professor of medicine and epidemiology at the University of California-Davis, recently spoke about the skin conditions that threaten the well-being of the affected animal. Here are his insights on neoplastic, metabolic, immune-mediated and neutrophilic small animal skin diseases.

 acute in onset, rapidly progressive and symmetrical, affecting the ventrum and limbs. Affected cats groom excessively and have characteristic glistening (but not fragile) abdominal skin. Footpads can also be affected with crusts, fissures and sloughing.1,2 A secondary 

 infection may be present. Histopathology reveals severe hair follicle atrophy and miniaturization.1,2 Diagnosis can be made with thoracic radiographs but is most commonly made with abdominal ultrasound.

This disease is associated with exocrine pancreatic adenocarcinoma. Unfortunately, once the alopecia is noticed, the cancer has likely already metastasized. Removing the primary tumor provides only temporary relief. In addition, removing the pancreas can lead to diabetes.

In short, feline paraneoplastic alopecia does not have a good prognosis.

 occur in cats and affect the distal extremities, particularly the front feet. The skin lesions are associated with the metastasis of a primary lung tumor (bronchogenic or squamous cell carcinoma); however, the lesions may be mistaken for inflammatory pododermatitis.3 Also, the skin lesions may be noticeable before tumor detection. Other than palliative treatment with corticosteroids to relieve discomfort, little can be done for cats with this disease.

 primarily affects older dogs and goes by several other names, including hepatocutaneous syndrome (HS) and diabetic dermatosis. It is thought to be caused by extremely low plasma amino acid levels; many dogs with these amino acid deficiencies also have liver dysfunction, Dr. White explains. Dogs with SND can have glucagonomas-resembling the glucagonoma syndrome in humans-but this is quite rare. Interestingly, about 20% of dogs with SND will become diabetic. Although any breed can be affected, Shelties and Australian Shepherds seem to be most susceptible.

Skin lesions include crusting (which can be dramatic), erythema, perioral and periocular alopecia, and footpad hyperkeratosis and ulceration. Secondary pyodermas are common. A definitive diagnosis is made with skin biopsy and abdominal ultrasound. Skin biopsy findings reveal characteristic “red, white, and blue” epidermal lesions: parakeratosis on the top layer, inter- and intracellular edema in the middle layer, and proliferation on the bottom layer.4 Abdominal ultrasound will demonstrate a liver with a “Swiss cheese” appearance.

Treatment is amino acid supplementation through a central vein (60–80 mg/kg/day) for 2 to 3 days, which may need to be repeated every three to six weeks. Because these infusions require hospitalization, Dr. White cautions that overall treatment costs can be high. Alternatives to amino acid infusion are amino acid-containing oral medications like ProCel powder (1 scoop/5kg every 12 hours) and whey protein powder. Glucagonomas, if present, are benign.

 primarily affects middle-aged German Shepherds and has been associated with renal cystadenocarcinomas or cystadenomas.5 The nodules are usually found on the feet.

Diagnosis is by skin biopsy and renal ultrasound. Skin biopsy will reveal marked collagen fibrosis. If a renal cyst is present, Dr. White advises against removing the affected kidney; this will not adequately treat the problem, he says. In addition, the remaining kidney will likely develop a cyst. Treatment for this disease is monitoring; prognosis is poor.

which typically affects older dogs, is “the great impostor,” Dr. White says. It has a highly variable presentation and can mimic such disease types as allergic reactions and autoimmune diseases.

Cutaneous lymphoma has two forms: epitheliotropic and nonepitheliotropic. The epitheliotropic form, sometimes called mycosis fungoides, is usually of T lymphocyte origin and may have a mucocutaneous distribution. It progresses from a generalized, pruritic and exfoliative dermatitis or erythroderma to systemic involvement and death. The nonepitheliotropic form is of B lymphocyte origin and causes diffuse malignant lymphocyte infiltration into the dermis and subcutaneous layers. Prognosis, Dr. White says, is likely similar between these two forms.

Treatment is challenging. Standard chemotherapeutic regimens used for other lymphomas are generally disappointing. Prednisolone (1 mg/kg/day) may relieve pruritus but typically does not work well with cutaneous lymphoma. High-dose isotretinoin (Accutane, 3-4 mg/kg/day) has shown effectiveness; however, it is expensive, and tear production should be monitored during treatment.

Feline cutaneous lymphocytosis, a highly indolent disease and likely variant of cutaneous lymphoma, is rare. Chlorambucil (Leukeran), although expensive, may be effective.

 is caused by either excessive unsaturated fatty acid consumption or insufficient vitamin E intake, both of which lead to inflamed adipose tissue. Affected cats have painful subcutaneous masses and abdomens, along with inappetence, depression and fever. Histopathology demonstrates neutrophilia, leukocytosis, adipocyte necrosis and potential fat mineralization. Clinical signs are the best way to diagnose this disease, Dr. White says.

Treatment includes vitamin E supplementation (alpha-tocopherol, 50 mg/kg/day), prednisolone (1 mg/kg every 12 hours) and a fish-free diet. Treatment response may be poor, with up to 25% of cats dying or being euthanized during treatment.

 is an autoimmune disease, but is not antibody-driven. With EM, lymphocytes attack keratinocytes and trigger apoptosis. The exact etiology is unknown, with potential causes being infection, parvovirus and drugs.

EM can present in many different ways, with common signs including mucocutaneous vesicles, ulcers and urticarial plaques. Histopathology reveals apoptotic keratinocytes surrounded by lymphocytes. Treatment options are to stop the most recently taken drug, administer steroids or cyclosporine if the underlying cause cannot be identified, or administer a single dose of IV human immunoglobulin; human immunoglobulin is expensive.

 ("button tumors") originate in Langerhans cells. They are solitary lesions that frequently occur on the face of young dogs and spontaneously regress.

 is characterized by waxing and waning lesions that can spontaneously regress. Treatment options include corticosteroids, tetracycline, and, if necessary, aggressive immunosuppressive therapy.

, a progressive disease to which Bernese Mountain dogs are genetically predisposed, affects mucous membranes and various organs (e.g., liver, lungs). It has a "bottom heavy" inflammation pattern in the bottom dermal layer. Continuous immunosuppression with cyclosporine and leflunomide is often required.6-8

 is indolent and characterized by nodules and plaques. Optimal treatment is not yet known.

 is a rapidly progressive disease caused by 

 (biotype 3). Shar Peis and Great Danes may be predisposed to this disease, but there is not yet enough evidence to support this hypothesis. The skin of affected dogs appears to fall apart; other clinical signs include fever, draining tracts and severe pain on palpation. Histopathology demonstrates abundant neutrophils.

Treatment, which includes antibiotic therapy, surgical debridement and pain management, must begin immediately. Clindamycin or amoxicillin-clavulanate should be administered before receiving culture results9; cephalexin, given three times a day, is another option. Fluoroquinolones should 

 be used, Dr. White warns, because they could enhance 

Surgical debridement “is a must,” Dr. White says. Patients will not improve with antibiotic therapy alone. Prognosis is guarded.

and is rapidly progressive. Affected dogs have severe malaise and leg edema. This disease can be difficult to differentiate from necrotizing fasciitis. Antibiotic therapy with cephalosporins or the osteomyelitis dose of clindamycin should begin immediately. Pugs may be susceptible.11

, also known as sterile neutrophilic dermatosis, is rapidly progressive and characterized by erythema, fever, lameness and neutrophilic joint effusion. Diagnosis is with skin biopsy and joint aspiration, both of which have a notable absence of bacteria. Interestingly, the neutrophils “don't look used up,” Dr. White says. Prognosis is guarded.

Sterile pustular erythroderma of miniature Schnauzers

 is rare, severe and often fatal. Thought to be caused by bathing, affected dogs have a fever, severe malaise and depression. Skin lesions include dramatic erythema and pustules or epidermal collarettes. High-dose corticosteroids are recommended for treatment, but the prognosis is very guarded.

 is eosinophilic and, Dr. White notes, not as dangerous as the neutrophilic skin diseases. It is occasionally associated with GI signs or drugs. Skin lesions include papules and erythema with variable pruritus. Histopathology reveals characteristics eosinophilic “flame figures” (collagen surrounded by eosinophils or their granules). Treatment options are to stop the causative drug or treat with a tapering dose of prednisolone/prednisone, starting at 1-2 mg/kg; treatment duration is usually at least 1 month.12,13

Dr. JoAnna Pendergrass received her Doctor of Veterinary Medicine degree from the Virginia-Maryland College of Veterinary Medicine. Following veterinary school, she completed a postdoctoral fellowship at Emory University's Yerkes National Primate Research Center. Dr. Pendergrass is the founder and owner of 

1. Pascal-Tenorio A, Olivry T, Gross TL, et al. Paraneoplastic alopecia associated with internal malignancies in the cat. 

2. Linderman MJ, Brodsky EM, de Lorimier LP, et al. Feline exocrine pancreatic carcinoma: a retrospective study of 34 cases. 

3. Gottfried SD, Popovitch CA, Goldschmidt MH, et al.  Metastatic digital carcinoma in the cat: a retrospective study of 36 cats (1992-1998). 

4. Gross TL, Song MD, Havel PJ, et al. Superficial necrolytic dermatitis (necrolytic migratory erythema) in dogs. 

5. Suter M, Lott-Stolz G, Wild P. Generalized nodular dermatofibrosis in six Alsatians. 

6. Moore PF. A review of histiocytic diseases of dogs and cats. 

7. Gregory CR, Stewart A, Sturges B, et al. Leflunomide effectively treats naturally occurring immune-mediated and inflammatory diseases of dogs that are unresponsive to conventional therapy. 

8. Palmeiro BS, Morris DO, Goldschmidt MH, Maudlin EA. Cutaneous reactive histiocytosis in dogs: a retrospective evaluation of 32 cases. 

9. Naidoo SL, Campbell DL, Miller LM, et al. Necrotizing fasciitis: a review. 

10. Ingrey KT, Ren J, Prescott JF. A fluoroquinolone induces a novel mitogen-encoding bacteriophage in Streptococcus canis. 

11. Gross TL, Ihrke PJ, Walder EJ, et al. Toxic shock syndrome of dogs. In: Gross TL, Ihrke PJ, Walder EJ, Affolter VK, eds. 

 2nd ed. Oxford, UK: Blackwell Publishing; 2005; 84-5.

12. Holm KS, Morris DO, Gomez SM, et al. Eosinophilic dermatitis with edema in nine dogs, compared with eosinophilic cellulitis in humans. 

13. Mauldin EA, Palmeiro BS, Goldschmidt MH, et al. Comparison of clinical history and dermatologic findings in 29 dogs with severe eosinophilic dermatitis: a retrospective analysis. 

They're rare, unusual and prognosis is often dismal. But in the event you encounter one of these difficult dermatologic cases, you'll want to be prepared. Heres the latest on potentially fatal skin diseases in small animals.

Fatal skin diseases in dogs and cats: What veterinary professionals need to know

With bandaging being well within the scope of practice of a veterinary technician, wound management is a task commonly encountered in veterinary nursing. Here are a few tips to help you feel more confident addressing-and dressing-wounds in your patients.

Wounds are broadly defined as any damage to the skin and underlying structures, which can present as abrasions (less than full-thickness), lacerations (sharp skin edges), punctures (deep wounds through a small opening), degloving (skin and tissues torn away), burns (heat-based damage of various thickness), and decubital ulcers (compression injury). Management of each type varies depending on severity, degree of contamination, mechanism of injury, time since injury and location. Each wound requires a patient-specific approach, which makes accurate history-taking vital.

The goal: Aid healing without pain or infection

Wound healing can be optimized by maximizing factors that improve tissue perfusion while minimizing factors that delay healing. Assessing the patient's general perfusion status and paying attention to blood supply to the wound will help with delivery of vital oxygen and therapeutics such as antimicrobials. Minimizing contamination and damage to tissues will increase chances of successful healing. Proper techniques in lavaging and débriding tissues, aseptic technique and proper dressing and bandaging to provide a barrier are important. Take care in bandaging to prevent unnecessary pressure points and include strategies to prevent hematomas and seromas that could increase pressure on wound beds and provide dead space encouraging bacterial growth.

Factors such as cancer and chemotherapy, chronic corticosteroid use, Cushing's disease, diabetes, kidney disease, liver disease, pain and malnutrition are known to make wound healing difficult. Always consider controllable factors of the patient to aid healing. The use of systemic corticosteroids should be avoided, and any immunocompromising disease should be treated. Nutrition is a commonly underappreciated aspect of patient care. Adequate nutrition will ensure wound repair optimization. Stress and pain can increase sympathetic tone and increase glucocorticoid release, which impairs healing. Hypothermia can also delay healing. The combination of a well-treated wound and patient is necessary for optimal healing and prevention of infections.

Topical application of high-osmolarity substances can help draw water and lymph to the wound surface, providing nutrition for the wound. Sugar and honey are commonly used for this effect. They also have some antibacterial effect and enhance tissue growth and epithelialization. In addition, honey is acidic (pH of about 3.6) and contains hydrogen peroxide, which helps decrease bacterial growth. Unpasteurized honey seems to have better effects than pasteurized, with Manuka honey particularly being suggested as having superior effects. Other unique options, while they may require more extensive research before you use them, include 

, which uses vacuum to enhance healing of open wounds, and platelet-rich plasma and stem cell therapy, which leans on growth factors produced by these cells to accelerate healing.

Wound management is a topic that crosses several specialties. It's primarily within the domain of surgery, with the 

Academy of Veterinary Surgical Technicians

 (AVST). Techs or nurses interested in wound management are encouraged to contact the academy.

Kenichiro Yagi practices at Adobe Animal Hospital in California as an ICU and Blood Bank Manager. He is co-chair of the Veterinary Nurse Initiative and serves as a board member of the Veterinary Emergency and Critical Care Society, the Academy of Veterinary Emergency and Critical Care Technicians and the Veterinary Innovation Council.

From getting the wrap just right to managing issues that confound healing to using new tools that promote healing, jump into the realm of wound care with gusto.

Firstline March/April 2020

When the hospital owner undermines your leadership

Clearing up cannabis confusion for veterinary professionals

3 ways veterinary professionals can reframe negative thinking

Pledge to be a veterinary superhero

Fatal skin diseases in dogs and cats: What veterinary professionals need to know

That's a wrap! Wound management tips for veterinary technicians and nurses