Hemangiosarcoma is often the first thing that comes to mind when a splenic mass is found in a dog. Although hemangiosarcoma is the most common malignant splenic tumor, it is not the only differential. Unfortunately, obtaining a definitive diagnosis and prognosis requires histopathology that must be obtained surgically. The decision to proceed with surgery in the face of a potentially poor prognosis can be a difficult one for clients, especially in an emergency, where the tumor has ruptured and is actively hemorrhaging.

During a session at the 2020 American Veterinary Medical Association Virtual Convention, Sue Ettinger, DVM, DACVIM (oncology), an oncologist at VCA Veterinary Referral and Emergency Center in Norwalk, Connecticut, discussed what practitioners need to know about hemangiosarcoma to help their clients make the best decision for their pet and family.

According to Ettinger—known by many as Dr. Sue Cancer Vet—clinical signs of hemangiosarcoma vary greatly depending on tumor location and how advanced the disease is at diagnosis. Tumor location can vary from the skin to subcutaneous tissue to visceral organs. The most common primary visceral sites are the spleen, heart, and liver. As a cancer of blood vessels, hemangiosarcoma metastasizes quickly, with the liver and lungs being the most common targets.

Some patients with splenic hemangiosarcoma present with nonspecific signs such as decreased appetite, lethargy, or gastrointestinal distress; others present in hypovolemic shock after an acute collapse. Still, other patients have no clinical signs, and the mass is found incidentally.

Ettinger reminded clinicians that while large-breed dogs are generally thought to be at increased risk, any dog can present with hemangiosarcoma. German shepherds and golden and Labrador retrievers are believed to be at the highest risk, and a genetic predisposition is suspected.

Ettinger said that only about 45% of splenic masses are hemangiosarcoma based on the “double two-thirds rule.” According to this rule, two-thirds of patients presenting with a splenic mass have a malignant tumor. Of these malignancies, two-thirds are hemangiosarcoma. This rule is supported by the literature, which shows 45% to 65% of splenic masses in dogs to be hemangiosarcoma.

Differentials for the one-third of dogs with benign masses include nonneoplastic masses
such as hematomas, abscesses, nodular hyperplasia, or a benign hemangioma. Differentials for the remaining malignancies can include lymphoma, histiocytic sarcoma, and osteosarcoma, among others.

Despite the double two-thirds rule, Ettinger said that in her experience, emergency clinicians have a higher suspicion of hemangiosarcoma when a splenic mass is identified. This is likely because patients presenting with a splenic mass in the emergency setting often have ruptured tumors and hemoabdomen, both of which increase the index of suspicion for malignancy. In 1 study that evaluated dogs presenting with nontraumatic hemoabdomen, 80% of the splenic masses were neoplastic and, of those, 88% were found to be hemangiosarcoma.

Another exception to the two-thirds rule is that nonruptured splenic masses found incidentally, commonly called “incidentalomas,” are less likely to be malignant. In a 2016 study, only 30% of these masses were malignant.

Although the definitive diagnosis of any splenic mass is made via histopathology, clinicians should perform several diagnostics before surgery to assess patient risk and stability. Bloodwork is an essential part of the preoperative workup, including a complete blood count (CBC) and chemistry panel at a minimum. CBC results may raise the suspicion of malignancy if anemia, nucleated red blood cells, abnormal red blood cell morphology, or thrombocytopenia is present. CBC results can also help to assess perioperative mortality risk. Patients with marked preoperative thrombocytopenia or anemia (hematocrit < 30%) are at increased risk for death.

Assess coagulation status with a prothrombin time or partial thromboplastin time, conducted in house if possible. If this test is not available in house, evaluate buccal mucosal bleeding time or clip the toenail to assess clotting. Half of the patients with hemangiosarcoma will present with a coagulopathy.

Perform chest radiographs prior to surgery to assess for gross meta- static disease, which is present in 50% of dogs at the time of diagnosis. Obtaining 3 views of the chest is essential to maximize the chances of detecting a lung nodule if present.

If available, abdominal ultrasonography can be a helpful tool because it is less affected by effusion than radiographs. Ultrasonography allows the clinician to confirm the presence of splenic tumor(s), assess the degree of effusion, and assess for gross metastasis to other abdominal organs. Additionally, it can help evaluate the architecture of the mass, which guides the decision to perform a fine-needle aspiration (FNA). FNAs are not recommended on cavitated splenic masses. Generally, cytology is low yield and inaccurate for hemangiosarcoma, and obtaining the sample carries a high risk for hemorrhage due to the friable nature of the mass. If a solid splenic mass is visualized, an aspirate may aid in the diagnosis.

While some textbooks recommend echocardiography before surgery to screen for right atrial masses, Ettinger does not feel it is necessary in most cases. A better use of the client’s money is electrocardiographic monitoring during and after surgery, as arrhythmias are common in patients with both benign and malignant masses. The presence of intraoperative ventricular arrhythmias doubles the risk of perioperative mortality.

Hemangiosarcoma is a treatable cancer and treated dogs do live longer. However, the 1-year survival is less than 10% regardless of how aggressive treatment is.

 Nonruptured and low-grade splenic tumors offer the best prognosis. Surgery is the firstline treatment for splenic masses. During surgery, fully explore the abdomen. The gross appearance and size of the primary mass at the time of surgery do not correlate with malignancy. Suspected meta- static lesions on other abdominal organs, such as the liver, may be hematomas, extramedullary hematopoiesis, or another benign process. Thus, biopsy and submit all suspicious lesions for histopathology along with the entire spleen. Surgeons must remember that hemangiosarcoma can only be diagnosed definitively by histopathology and should not make intraoperative assumptions about malignancy.

Ettinger cautioned that the iatrogenic spread of neoplastic cells is possible due to the tissue’s highly friable nature. To minimize seeding of neoplastic cells during surgery, lavage the abdomen thoroughly prior to closure and use fresh gloves and instruments for closure.

Surgery alone is considered a palliative treatment that controls local disease and reduces acute hemorrhage risk in the future. Average survival time following palliative surgery is 1 to 3 months.

Average survival time can be extended to 6 to 9 months when surgery is followed by systemic chemotherapy. Doxorubicin-based protocols are the most common, but the accumulated cardiotoxicity limits the number of treatments a patient can receive. Other protocols, including the use of metronomic chemotherapy, are being investigated to maximize survival times and quality of life following surgery.

There is also ongoing research into new therapeutic options for hemangiosarcoma, but limited data are available at this time. A new drug called eBAT is being studied at the University of Minnesota as both a treatment and preventive option. Losartan, an angiotensin II blocker in dogs, is being investigated as a possible palliative option due to its antitumor effects. Ettinger said she is excited about the potential of new therapies, but more research is needed.

Ettinger also discussed the use of supplements as a part of both palliative and curative-intent treatment protocols. Polysaccharopeptide mushrooms are an Asian blend of mushrooms that have antitumor properties. Several blends are available, but many are proprietary, which makes comparing brands difficult. Ettinger recommends I’m-Yunity, which was used in a small study of 15 dogs and showed a slight increase in survival times beyond surgery alone.

 However, this product can be expensive, so she offers an alternative, K9 Immunity Plus (K9 Medicinals), noting that this blend has not been studied.

Yunnan Baiyao, a Chinese herbal mixture commonly used in veterinary patients with hemorrhage, may also help patients with hemangiosarcoma. Ettinger suggests this product as a palliative measure for patients with metastatic nodules that could rupture and bleed or in cases of splenic tumor that has ruptured, but the client declines surgery.

When talking to clients about hemangiosarcoma, Ettinger suggests describing it as an “aggressive and malignant cancer of blood vessels” that can occur in many locations in the body. She stresses to clients that noninvasive tests will not tell us if a splenic mass is hemangiosarcoma. Wait for biopsy results before giving an accurate diagnosis and prognosis. Treatment for hemangiosarcoma is fought on 2 fronts: locally (where the cancer is growing), and distantly (where the goal is to control metastatic disease). According to Ettinger, despite the poor long-term prognosis, many of the clients she treats are very happy with surgery alone because the quality of life they get is good.

Kate Boatright, VMD, a 2013 graduate of the University of Pennsylvania, is an associate veterinarian and free- lance speaker and author in western Pennsylvania. She is actively involved in organized veterinary medicine at the local, state, and national levels and is a former national officer of the Veterinary Business Management Association.

Eberle N, von Babo V, Nolte I, Baumgärtner W, Betz D. Splenic masses in dogs. Part 1: epidemi- ologic, clinical characteristics as well as histopathologic diagnosis in 249 cases (2000-2011). Tierarztl Prax Ausg K Kleintiere Heimtiere. 2012;40(4):250-260.

Johnson KA, Powers BE, Withrow SJ, Sheetz MJ, Curtis CR, Wrigley RH. Splenomegaly in dogs. Predictors of neoplasia and survival after splenec- tomy. J Vet Intern Med. 1989;3(3):160-166. doi:10.1111/j.1939-1676.1989.tb03092.x

Pintar J, Breitschwerdt EB, Hardie EM, Spaulding KA. Acute nontrau- matic hemoabdomen in the dog: a retrospective analysis of 39 cases (1987-2001). J Am Anim Hosp Assoc. 2003;39(6):518-522. doi:10.5326/0390518

Cleveland MJ, Casale S. Incidence
of malignancy and outcomes for dogs undergoing splenectomy for incidentally detected nonruptured splenic nodules of masses: 105 cases (2009-2013). J Am Vet Med Assoc. 2016;248(11):1267-1273. doi:10.2460/ javma.248.11.1267

Wendelburg KM, O’Toole TE, McCobb E, Price LL, Lyons JA, Berg J. Risk factors for perioper- ative death in dogs undergoing splenectomy for splenic masses: 539 cases (2001-2012). J Am Vet Med Assoc. 2014;245(12):1382-1390. doi:10.2460/javma.245.12.1382

Helfand LC. Canine hemangio- sarcoma: a tumor of contem- porary interest. Cancer Ther. 2008;6(2):457-462.

Mullin C, Clifford CA. Hemangiosarcoma. In: Small Animal Clinical Oncology. 6th ed. Elsevier Saunders; 2020:773-778.

Cimino Brown D, Reetz J. Single agent polysaccharopeptide delays metastases and improves survival in naturally occurring hemangio- sarcoma. Evid Based Complement Alternat Med. 2012;2012:384301. doi:10.1155/2012/384301

Articles

A renowned veterinary oncologist outlines the current knowledge about this cancer of the blood vessel walls, from presentation to prognosis.

Essential information for veterinarians about hemangiosarcoma

Providing relief for animal suffering is an important component of the Veterinarian’s Oath and a common aspect of practicing veterinary medicine. At the inaugural Fetch dvm360® virtual conference, veterinary pain management expert Robin Downing, DVM, MS, DAAPM, DACVSMR, CVPP, CCRP, presented a multimodal approach to both acute and chronic pain management in dogs and cats.

According to the International Association for the Study of Pain (IASP), pain is defined as an unpleasant and emotional experience associated with actual or potential tissue damage.

 The IASP further explains that the inability to communicate in no way negates the possibility that an individual is experiencing pain and is in need of appropriate pain-relieving treatment. This is particularly applicable for veterinary patients, which lack the ability to communicate in a traditional way yet still experience pain. Downing reminded attendees of the old Buddhist proverb “Pain is inevitable. Suffering is optional.” It is our duty to prevent suffering in our patients.

Downing described pain as a complex and 3-dimensional experience. The first dimension is the sensory component, which is the traditional informational component of pain. The second is the emotional dimension that occurs with suffering. The third is the cognitive component, in which past experiences of pain can influence both future perceptions of pain and assessment of perceived threats.

Pain is categorized as either adaptive or maladaptive. According to Downing, adaptive pain is the pain that protects us, and the same holds true with our pets. The types of pain that fall into this category are transient nociceptive pain in response to a noxious stimulus (such as what occurs as a warning sign to avoid further injury) and inflammatory pain. By contrast, maladaptive pain has no such beneficial effect, and pain in this category is considered pathological. Neuropathic pain, functional pain, and windup pain are all types of maladaptive pain. In the case of windup pain, the area of perceived pain expands beyond the original site of pathology due to sensitization of nociceptors in the peripheral and central pain pathways, in response to a barrage of afferent nociceptive impulses. Any of these types of maladaptive pain may become chronic.

Studies have shown the beneficial results of administering intraoperative local analgesia to prevent chronic pain. Intraoperative local analgesia can lessen the occurrence of chronic pain postoperatively, lower the doses of postoperative analgesics needed to control pain, and improve patient outcomes.

Identifying pain in our patients can be clinically challenging, and pain is easily overlooked. Using a systematic approach, Downing starts her assessment with a thorough physical examination. Patients exhibiting the third dimension of pain—in which their past pain experience is triggering fear, anxiety, or stress (eg, the perception of threats)—may require alterations to your diagnostic plan. This is a cyclic when anxiety exacerbates pain, and pain exacerbates anxiety. Previously complacent pets may now exhibit fear in these situations due to the presence of pain.

Give any pet that is reluctant to be handled the benefit of the doubt that they may be in pain and may require analgesic treatment before continuing with diagnostic tests. In these situations, consider which components of your plan for that visit are truly necessary at that time. Postpone any procedures or diagnostic tests that are not deemed necessary until pain control has improved, and the patient is more tolerant and less stressed.

A diagnostic plan should be determined as appropriate for the patient, in order to reach a diagnosis. As Downing noted, the reason for this is to ensure proper treatment of the appropriate underlying condition. For example, suppose you forgo diagnostic radiographs in a dog experiencing lameness. In that case, you may miss osteosarcoma and head down an inappropriate treatment path that could result in treating the patient for osteoarthritis, missing the true problem, and whittling away at a prognosis that was already limited. Once you have determined the location of the pain, the underlying cause, and whether the pain is acute or chronic, you can develop a plan to address the pain directly.

Chronic pain is best addressed using a multimodal management plan. Patients with chronic pain are typically less active and often overweight. This cycle can resemble the chicken and egg dilemma. In general, overweight patients put more stress on their joints, are more prone to injuries, and may develop chronic pain. Likewise, patients with chronic pain will be less active and thus prone to weight gain. Regardless, normalizing body condition is crucial. In dogs, also ensure the patient is not hypothyroid and treat as appropriate. (Don’t be fooled by euthyroid sick syndrome, which can occur when patients are painful).

Ultimately, with chronic pain, there is a need to break the pain cycle pharmacologically. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the cornerstone of pain management, for both chronic and acute pain. NSAIDs decrease inflammation and modulate pain at various levels of the central and peripheral nervous system. Some patients may have experienced a previous failure or sensitivity to an NSAID. This does not mean they will have a similar failure or reaction with another NSAID. In these cases, Downing feels it is worth attempting therapy with a different class of NSAID; however, if a sensitivity occurs again, eliminate NSAIDs as a viable option.

Another target for maladaptive and chronic pain is the dorsal horn of the spinal cord. Targeted therapy would include such medications as gabapentin and amantadine. According to a study Downing conducted, the appropriate gabapentin dosage for maladaptive pain is 5 to 10 mg/kg orally every 8 to 12 hours, titrated up to effect.

Beneficial effects may be noted within 24 to 48 hours but reach steady state with peak activity in 10 to 14 days. Gabapentin is safe for long-term use, but do not discontinue the drug abruptly or rebound pain may occur. Sedation is the primary side effect and is typically transient. Persistent sedation can be addressed by dose reductions. Amantadine is an N-methyl-D-aspartate antagonist and may be used in combination with NSAIDs and gabapentin. Amantadine is also well tolerated for long-term use and is typically dosed at 2 to 5 mg/kg per day orally. Downing noted that, in a study of dogs with osteoarthritis of the stifle and elbow, tramadol was shown to have no effect on pain management and is not recommended.

Polysulfated glycosaminoglycan (Adequan; American Regent Animal Health) is also useful in dogs and cats. Polysulfated glycosaminoglycans are the building blocks of cartilage. Although they do not replace lost cartilage, they can heal microfractures and have indirect anti-inflammatory effects. Downing uses an extralabel dosing scheme of 2 mg/lb subcutaneously twice weekly for 4 weeks, then once weekly for 4 weeks, then every 10 to 15 days as maintenance. She prefers to dose Adequan subcutaneously rather than intramuscularly. As an injectable option, this may be of particular value in cats that do not tolerate oral medication administration.

Evidence varies for the value of nutraceuticals in chronic pain. Among the discussion points in her talk, Downing cautioned attendees in using the triglyceride formulation of omega-3 fatty acids because the esterized formulation is not bioavailable. There is some evidence that undenatured collagen type II (UC-II) may slow deterioration of articular cartilage in rodent models by promoting anti-inflammatory cytokines.

Microlactin is a milk protein for hyperimmunized cows that has immunomodulatory effects that decrease destructive chronic inflammation. As this is a different pathway and mechanism of action than NSAIDs and corticosteroids, it can be used in conjunction with either of these. The initial effect is seen within 5 to 7 days, with peak effects within 10 to 14 days. Side effects are typically minimal and limited to sporadic gastrointestinal signs. 

 contains the essential fatty acid eicosapentaenoic acid and can be used with hyaluronic acid of the appropriate molecular weight.

Downing emphasized that it is the formulation and manufacturing process, not just the ingredient, that is important when considering nutraceuticals for pain management. All of these products must be manufactured in a way that does not denature the compounds or interfere with their efficacy. For this reason, efficacy tests should ideally be conducted for each formulation used.

Downing acknowledged that, as part of the multimodal approach to managing pain, physiotherapy also has a role and should be incorporated into pain protocols. A plethora of modalities and tools can be used to manage pain. Assistive devices such as wheelchairs, slings, supportive vests, rolling carts, and wagons also play a role in managing patients with chronic pain that require mobility assistance. Modifications to the home environment play a role as well. Pet owners should be encouraged to videotape their home environment, so that you can assess for items that should be modified (eg, raise food and water dishes, cover slick floors, secure access to stairs, use ramps, modify play with other pets in the household).

The most important aspect of pain management is breaking the pain cycle by first capturing and controlling the pain. Once pain is controlled, medications can be titrated to the lowest effective dose. This is typically only possible after employing multimodal pain management protocols.

IASP announces revised definition of pain. International Association for the Study of Pain. July 16, 2020. Accessed November 10, 2020. 

https://www.iasp-pain.org/PublicationsNews/NewsDetail.aspx?ItemNumber=10475#:~:text=The%20definition%20is%3A%20%E2%80%9CAn%20unpleasant,pain%20for%20further%20valuable%20context.&text=Pain%20and%20nociception%20are%20different%20phenomena

Andreae MH, Andreae DA. Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery. 

. 2012;10:CD007105. doi:10.1002/14651858.CD007105.pub2

Davis LV, Hellyer PW, Downing RA, Kogan LR. Retrospective study of 240 dogs receiving gabapentin for chronic pain relief. 

Budsberg SC, Torres BT, Kleine SA, Sandberg GS, Berjeski AK. Lack of effectiveness of tramadol hydrochloride for the treatment of pain and joint dysfunction in dogs with chronic osteoarthritis. 

 2018;252(4):427-432. doi:10.2460/javma.252.4.427

Bagi CM, Berryman ER, Teo S, Lane NE. Oral administration of undenatured native chicken type II collagen (UC-II) diminished deterioration of articular cartilage in a rat model of osteoarthritis (OA). 

 2017;25(12):2080-2090. doi:10.1016/j.joca.2017.08.013

Rebecca A. Packer, DVM, MS, DACVIM (Neurology/Neurosurgery), is an associate professor of 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.

Understanding the nuances of modern pain management can help you identify targeted treatments for your patients. 

The science of veterinary pain management

The coronavirus pandemic has brought many challenges to veterinary medicine. After months of stay-at-home orders, pet owners fear infection. Many veterinarians are offering curbside care, which has had some complications. We have seen an increase in telehealth in human medicine, and this may be the direction veterinary medicine is headed. Here are 6 reasons why.

1. Clients have experienced telemedicine themselves—and liked it.

In April 2020, telehealth increased 1000% from 2 weeks earlier, according to research from the medical and health sciences division at Oxford University. “There has been something like a 10-fold increase in virtual patient consultations in the last couple of weeks,” Ray Dorsey, MD, MBA, the director of the Center for Health + Technology at the University of Rochester Medical Center, told 

at the time. “It’s as big a transformation as any ever before in the history of US health care.”

 According to an Updox survey in May, 42% of 2000 individuals polled said that they had used telehealth services since the pandemic began.

When surveyed, human patients and health care providers said they preferred virtual care to traditional in-office visits because:

It strengthens the bond between patient and physician.

The software makes it fast and easy to book an appointment.

Patients do not risk exposure to illnesses.

If our clients had experience with the service and liked it—or even preferred it—is it far-fetched that they would embrace the same kind of service for their pets?

Before the pandemic, the technology may have seemed too complicated for clients to adapt to telehealth. Today grandparents are using Zoom, yoga classes are online, and church-goers are singing hymns during virtual church services. We have fallen into a wonderland of possibilities, except the looking glass is a smartphone. Your business is grounded in brick-and-mortar land, but a significant part of the population is enthusiastic about the new world online.

When veterinarians started offering curbside care, we found ourselves in a game of telephone tag. First, the doctor received a call when the client arrived. The technician called the client and then the doctor called the client to report the exam results. Finally, the receptionist called the client to process the payment and paperwork.

Telehealth cut curbside care appointment time in half. Employees working from home connect to clients using telehealth platforms and patient history. Invoicing is completed before the patient arrives in the parking lot. Once patients are on-site, their vitals are taken and exams are completed.

The workflow switch uses team members as they are available, which frees more space in the appointment book, alleviating the added time demands of curbside care.

4. We get a firsthand look at the environment.

Telemedicine consults have turned out to be more than an online exam; they are an invitation into the pet owner’s home. They let you see pets in their daily environment. We can see the stairs that the dog has trouble with, the litter pan that the cat is using, and where everything is located in the house. We can meet members of the pet owner’s family and other pets that we haven’t seen as patients. All this is possible because video chats feel more relaxed than a clinic visit.

5. There are many new care opportunities.

Now that we’ve acclimated to telehealth, we’ve discovered many other ways we can use it. This is not merely a substitution for what we were already doing. It opens up care to new possibilities. Here are some of them:

Attract new clients by advertising telemedicine services.

Include telemedicine as part of a wellness plan, allowing year-round engagement with clients and pets.

Monetize and bring more value to the free phone advice we’ve been giving clients for years.

Follow up with patients virtually to free up valuable appointment space.

Compete with big-box stores, low-cost spay-neuter clinics, and other businesses.

Increase compliance with semiannual exams and oversight on geriatric and end-of-life patients and those with chronic illness.

Viewing telemedicine as an additional service, instead of as an alternative for existing services, has changed the landscape of my practice. It is not just an online physical exam but another avenue of care, connection, and communication. There are dozens of ways we can use telehealth to increase compliance, convenience, and productivity and enhance the bond we have with our clients and patients.

6. It helps align our business model with the modern world.

Because of the pandemic, the internet has become more than a tool to source food and home supplies. Between April and June, nearly 656 million human health and fitness apps were downloaded.

For pets, the market size for wearable technology is expected to reach $4.6 billion in 2027, compared with $1.6 billion in 2019.

When we sync our software and our services to what our clients are already doing, we build ourselves inside their digital world. It seems that companies like BabelVet had it right all along.

Individuals using apps and wearables are having an ongoing conversation with service providers. Telehealth gives all health care providers a voice in that dialogue, which helps strengthen the client relationship. It is much more than a substitute for an in-person visit to the veterinarian. This technology connects us to the digital ecosystem that clients already live and work in.

Bash Halow, LVT, CVPM, runs Halow Consulting, a practice-management consulting business. In 20 years as a veterinary professional, he has been a practice manager, a regional manager, a hospital administrator, and a regular speaker at Fetch dvm360

. He is a graduate of the College of William and Mary and the Veterinary Management Institute at Purdue University.

Webster P. Virtual health care in the era of COVID-19. 

. 2020;395(10231):1180-1181. doi:10.1016/S0140-6736(20)30818-7

Updox survey reports 42 percent of Americans now using telehealth—convenience (51%) and speaking with provider of choice (49%) are top consumer demands post COVID-19. News release. Cision PRWeb; May 21, 2020. Accessed November 4, 2020. https://www.prweb.com/releases/updox_survey_reports_42_percent_of_americans_now_using_telehealth_convenience_51_and_speaking_with_provider_of_choice_49_are_top_consumer_demands_post_covid_19/prweb17139115.htm

Developer. Health and fitness app downloads jumped 47% in Q2 as COVID-19 spread. Published June 5, 2020. Accessed November 4, 2020. https://developer-tech.com/news/2020/jun/05/health-fitness-app-downloads-covid-19-spread/

Grand View Research. Pet wearable market size, share & trends analysis report by technology (RFID, GPS, sensors), by application (identification & tracking, medical diagnosis & treatment), by region, and segment forecasts, 2020-2027. Published February 2020. Accessed November 4, 2020. https://www.grandviewresearch.com/industry-analysis/pet-wearable-market

Telehealth services offer unlimited possibilities for your clinic. Here’s why you should give telemedicine a go if you haven’t already.

6 reasons why veterinary telemedicine is poised to go off the hook

Ushering in a new year provides a great opportunity to reflect on changes you could make to improve your personal and professional well-being. For 2021, consider ditching your standard resolutions and embrace the concept of personal innovation. Rather than vowing to lose weight, take the opportunity to gain clarity on how to achieve your goals and positively impact those around you.

“Now is the perfect time for us all to look inward,” said Mia Cary, DVM, CEO of Cary Consulting, during a lecture at the inaugural Fetch dvm360® virtual conference. “Personal innovation is to be ever-evolving with the goal of bringing our best selves to everything we do.”

Use Cary’s 5 building blocks of personal innovation to formulate strategies and habits that will fuel your positive evolution.

Nearly all businesses and associations have documented purpose/mission statements that outline the organization’s priorities. It is one of the constructs of a successful business strategy. Yet so few people invest the time to create a personal purpose statement that defines their values. “This first step is all about knowing our purpose and then being able to focus on it,” Cary said.

To begin creating a personal purpose statement, she prompted attendees to answer 4 questions:

If these questions seem too philosophical or cumbersome right now, hone in on simple keywords that resonate as core values. “If you jot down those few words they can evolve into 1 or 2 sentences,” she said, offering her succinct purpose statement as an example:“I activate others to thrive.”

As you continue to develop a personal purpose statement, keep in mind that most are action-oriented. “It also helps to remind myself that they are fluid,” Cary added. “What I may think resonates today as my statement can evolve. You are not stuck in 1 thing.”

One of the pivotal steps toward personal innovation is leveraging your attributes to create value for those around you. To explore this concept further, Cary instructed attendees to reflect on their unique assets.

“Start by writing down 3 unique attributes that resonate with you about yourself,” she said. In isolation, the words you choose may not necessarily seem unique—hardworking, upbeat, inquisitive—but what is most important is that they are personal.

Cary shared the journey of former University of Florida classmate Stephanie Jones, DVM, as an example of how to leverage uniqueness to create value. “What defines her is being extremely passionate about veterinary medicine and helping kids,” Cary explained. These are her unique assets. Jones combined those passions to launch Pets Help the Heart Heal, a nonprofit organization that aims to improve the physical, social, and emotional health of youth through the human-animal bond.

“I share this because it is such a good example of someone who has been able to tap into what makes them unique to add value to the world around them,” Cary said. “I’d love to encourage you to think about what makes you unique.”

“I like to think of this in terms of failing fast, failing forward, and failing often, and then keep going,” Cary said. “We know the most successful innovators take calculated risks. They do their homework before they jump, but when they do jump, they are all in and they do not let failures or a series of failures deter them. They use those as learnings to fuel the next round.”

Regardless of the outcome, there are a plethora of benefits to taking risks. For starters, risk urges us to learn new skills and evolve existing skills, she said. “Taking a risk also boosts creativity and creative thinking, which we know is important in terms of having an innovative mindset.”

Whether it is immediately apparent or not, needing to make quick decisions helps to define clear objectives because there is no time to second guess yourself. “The fear of failure often gets obliterated when taking risks because we are always looking for the next thing to inspire us and we know there is always more to learn,” Cary explained.

Taking calculated risks often results in a positive trickle-down effect, too. To observers, the ability to bet on yourself and adopt an entrepreneurial mindset tends to inspire confidence.“Taking risks is also about being open to new ideas, new approaches, and new ways of thinking,” she added. With this mindset, new opportunities are uncovered.

“You likely already recognize the benefits of being part of a network or community, and you know the power of collaboration,” Cary said. “But I encourage you to take a look at the people you spend the majority of your time with at home and work. Do they look, act, talk, and think like you? Do they come from similar backgrounds?” If so, it’s time to branch out.

Making a concerted effort to collaborate with professionals from different economic, cultural, educational, and social backgrounds provides unique perspectives to problem-solving and creative thinking. For those looking to further strengthen this area of personal innovation, Cary recommends the work of social scientist Scott E. Page and, in particular, 

Diversity Bonus: How Great Pay Off in the Knowledge Economy

. His work provides evidence that teams composed of different kinds of thinkers outperform homogenous groups on complex tasks, producing what he calls diversity bonuses.

In addition to embracing the importance of diversity and inclusion in the workplace, Cary asked attendees to consider the people in their lives who influence and guide them. “One concept I like to expose people to, is the idea of a personal advisory board,” she said. Many veterinary professionals are involved in mentoring at some level, but by creating diverse and varied connections—your advisory board—you will have a variety of people with different mindsets you can turn to with questions or potential business ideas.

Veterinary professionals are intrinsically involved in lifelong learning as a means of staying abreast of the new information and technology in the field. Whether through obtaining certifications, on-the-job training, or attending conferences, continuing education is not a foreign concept.

But here is the challenge, according to Cary: How do you fuel your intellect outside of veterinary medicine? Do you enjoy listening to podcasts, touring museums, or learning new languages? Aim to become more expansive in your learning, she said. If it has been a while since you engaged in one of your favorite activities, maybe that is 1 of the things you commit to doing next on your journey toward personal innovation, she suggested. “In doing so we may very well spark creative juices that in turn fuel new ideas that ultimately positively impact our work.”

Amanda Carrozza is a freelance writer and editor in New Jersey.

To achieve your goals and make an impact on the world around you, look inward.

The 5 building blocks of personal innovation

Wellness plans have recently become popular in veterinary medicine. We live in a membership-driven society where consumers expect to pay a smaller amount monthly for designated services or products. Think about your monthly subscription box or your membership at the gym or spa. Although implementing these plans is a great way to offer your clients comprehensive wellness services, there are some dos and don’ts you should keep in mind.

 Make sure to get buy-in from your entire hospital team before launching wellness plans. Schedule several team meetings and provide an overview of the plans you will offer. Then have smaller department meetings so you can iron out specific details about the wellness plans. Make sure your team is on the same page so clients won’t receive mixed messages.

 Try offering members a welcome gift or reward for enrolling in one of your wellness plans. Congratulate them for making the best choice for their pet’s care and wellbeing. You can also announce new enrollees on social media or your lobby’s bulletin board with bright-eye-catching colors and photos. When other clients see these pictures, they’ll want to know how to get their pet’s image on the board for all to see. Trust me, these featured images will circulate all over your clients’ social media channels. Free advertising is always a bonus!

Discuss wellness plans with owners whose pets come in for minor illnesses. A dog who goes to the clinic for an ear infection may benefit from a wellness plan today or in the future. If the pet has a potentially life-threatening issue, it doesn’t make sense to discuss wellness plans at that time.

 Don’t place wellness plans ahead of the medicine and treatment the doctor prescribes. If your team members start to recommend the wellness plan in the lobby before the pet’s appointment or discuss it over the phone when the client is making the appointment, they may feel like you are just trying to sell them the plan. Instead, try discussing wellness plans when a new puppy comes in for an appointment. Direct them to your website or email them information before their appointment. Make sure they know they can discuss these plans with the doctor.

 Don’t forget to explain the difference between your wellness plan and pet insurance. Explain what your plan includes and what it doesn’t. Make this a 

 conversation. Don’t start with a laundry list of items your plan

 cover. Instead, focus on all of the services and benefits of the wellness plan. Then reiterate to the client that this is a wellness plan for the services we know their pet will need each year. If they are concerned about unexpected illnesses or injuries, they should consider getting a pet insurance policy to complement the wellness plan.

 Don’t come across like a salesperson who’s putting wellness plans before medicine. Allow the doctor to make the recommendation for the pet’s wellness care, and then explain how your plan will support what the doctor has recommended and will help the client pay for this care over time.

Overall, implementing wellness plans into your practice will require a well-thought-out approach. Think about how you’re going to educate your clients and make sure to incorporate lots of team training, including role-playing scenarios. Then sit back and celebrate your success.

Erika Petrosino, MBA, CVPM, CVT, is practice manager at Toms River Animal Hospital in Toms River, New Jersey.

Looking to add wellness plans to your veterinary clinic’s offerings?  Here’s some advice to consider first.

Vetted December 2020

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