We know you know: Technicians are vital to any veterinary practice. And yet, so many are left feeling underappreciated, underutilized and just plain dissatisfied after a hard day's work. Veterinary technician extraordinaire Kenichiro Yagi, MS, RVT, VTS (ECC, SAIM), understands this on a deeply personal level, and while 

 to help combat this, he has a few ideas for ways veterinary teams can show their appreciation for techs in the meantime, particularly as we approach National Veterinary Technician Week (NVTW; Oct. 13-19).

At his technician critical care sessions at 

 in San Diego, Yagi suggested many creative ways for veterinary practices to show how much they appreciate their hard-working techs.

“It was an awesome day facilitating for Ken Yagi in the technician critical care lectures,” Elizabeth Johnson, DVM, assistant dean of student success and assistant professor of veterinary medicine at Lincoln Memorial University College of Veterinary Medicine, wrote on the 

. “In our last session, we discussed ideas for [NVTW] (or vet tech appreciation anytime!).”

Suffice to say, their brainstorming session, with attendees chiming in with their own creative ideas, was a success. Here are a few of the ideas they came up with.

One thoughtful way to show your technicians how appreciated they are is to offer them all the bells and whistles, completely personalized just for them. That includes new scrubs, personalized tools and instruments (think bandage scissors, thermometers and stethoscopes) and technician patches that can be ironed onto clothing. Yagi suggested gifting your technician team with one item for each day of NVTW-but feel free to present them in any way you see fit.

Next on the list were special gifts meant solely for pampering. That includes spa and nail salon gift cards, Uber Eats credit, a day (or more) off and personalized wine glasses for your techs to sip out of after a long day at work. First thing's first, though-

 and give that to them, rather than guessing. Might we also suggest 

Whether it's a day at a theme park, a lunch out somewhere or another fun trip you think your techs would enjoy, you can treat your team to a day out on the town. (

Another idea the group came up with: Vet Tech Olympics, with one “event” per day where techs can win prizes. You can spin this however you'd like, such as creating small challenges (like making that client with an ever-present rain cloud hanging over them 

No matter how you show appreciation for your techs, putting some thought and just a little bit of elbow grease into it will make your techs feel more valued no matter what time of year it is. Go out and make a tech's day!

Articles

Whether its National Veterinary Technician Week or any other week of the year, your technicians are amazing. Here are three ways you can show how them much you care.

Three ways to celebrate your veterinary technicians

On the lecture circuit, I hear many veterinary clinic owners and managers complain about how the internet and big-box stores are taking over their prescription business and cutting into their profits. But there's a little irony here, as a lot of the same practice owners and managers who cry about the prescription marketplace are buying their eye glasses at national discount outlets, their groceries at Sam's Club and Costco, and playing veterinary distributors against each other for the best deals for products and supplies to stock their clinics. So I have to ask: Why is it OK for 

? Don't get me wrong, I'm on your side, but some of what we're seeing is human nature.

“It's not personal,” goes the old cliché, “it's business.” And business is about innovation and change, and the prescription and retail business is continuing to change. What clients want and expect is changing. Take it as a compliment that the veterinary industry is on the radar of many businesspeople who want to compete for those veterinary dollars. What worked for us in the 1990s and early 2000s isn't going to cut it in today's market. The good news is, there's still plenty we can do to adapt and stay successful in our pharmacies.

Improving your sales and getting more patients the right products you recommend isn't about dumping your online pharmacy, say some practice owners. It's about knowing which items folks should buy online from you (with online pharmacies set up through companies like 

) and which items you should carry in store. 

Read more about a well-rounded pharmacy approach here

I am a firm believer in the truth that veterinarians know what's best for their patients. That goes for diagnoses, treatments, services and, yes, products and pharmaceuticals. And after a doctor makes the recommendation and educates, explains, sets expectations and convinces a client about the need for a product, the client will be disappointed if that product isn't in stock.

The days of ‘Come back next week and we'll have the product for you' are over.

Clients value “easy.” The days of “Come back next week and we'll have the product for you” are over. Drug stores are promising to fill prescriptions in 30 minutes and text and email you when they're ready for pickup. Don't bother getting out of your car-they've got a drive-thru. Get it? Easy! We live in a world of “Right now!” and instant gratification. UPS and Fed Ex took over with overnight shipping.

Carry the product and close the open loop

I see doctors every day working tirelessly to evaluate medical plans and communicate those plans for optimal patient health. This care often includes products to achieve or maintain peak health that clients want for their beloved pets. The veterinarians have done the research, been educated on the products and expected results, and understand the safety information and precautions. They've worked harder and harder in recent years to improve their ability to communicate these recommendations to clients.

But what happens when veterinarians convince a client, but then they have to be shy about product availability?

I know veterinarians don't like to think of themselves as salespeople, but in a sense, we're all salespeople. It's true that bad sales folks are pushy, mean and even cutthroat. But what's so wrong with assuring a client their pet needs something and making sure you've got that on hand to sell right now?

Making the recommendation, convincing a client of the need for a product, and then selling it in the hospital is anything but dirty. It's closing the gap between recommendation and compliance. It's doing what is in the best interest for the pet. When you recommend something but don't sell it, you decrease the likelihood that the client will find the exact product on the internet or in the pet store or big-box store and follow the exact directions you intended. Selling the product is closing the loop; sending clients off into the wild, wild world of pet care outside your doors is leaving it open. When the client walks out your door without the pharmaceuticals, the supplements, the behavior aid or the nutritional product you recommend, you're playing the odds. And the odds favor a negative outcome when the client runs into less-informed salespeople out there on the internet and in stores, giving well-meaning misinformation. Ultimately, the pet loses.

‘But I can't compete with the internet!'

Before you give up on your pharmacy, have you, your manager or your best product-minded team member explored all the options to improve your ability to carry and sell products your patients need?

As long as my clinic experiences positive cash flow on these purchases, I'm happy.

> Dump across-the-board mark-ups and hard-and-fast percentages

-especially for flea, tick and heartworm preventives, NSAIDs and other long-term medication you prescribe. As long as my clinic experiences positive cash flow on these purchases, I'm happy. It's not just about the profit on a bottle of something. The relationship your team is building with clients, face to face, is priceless, and the more times you can get clients to walk through the doors, the greater likelihood they'll be back for future services and products. Client loyalty and stability is worth a few percentage points off any product sale.

 Product and drug manufacturers offer significant deals to you and your clients. I see many clinic leaders refuse to participate in programs like these-too much like “sales programs,” right? Do your business a favor and investigate today all the ways you can offer clients deals on products you recommend. You'll find you 

 compete with the internet and not take a huge hit to your bottom line. Embrace these programs and educate your staff to spend time educating clients on the advantages of purchasing products with you as opposed to calling around to other sources to find them a better deal and losing the sale in the process.

I firmly believe it is a huge mistake to dismiss product and prescription sales. By no means is it easy, but if it were, everyone would be doing it. When I led an initiative in my clinics to improve product sales, we saw double-digit growth in flea and tick preventives in 2017 and the start of 2018. The product was one you can find on multiple websites, in many supermarkets and plenty of big-box stores. Yet we still found success with our recommendation and the ability to leverage manufacturer rebates and consumer programs. 

It's time to rally your troops and take back what you've lost. Get yourself and your staff excited and focused. Find unique ways to stay competitive and celebrate with the clients as they walk out your doors with the most advanced and efficacious products available for their beloved pets from the most knowledgeable pet person in the community: You.

 speaker Brian Conrad, CVPM, has been practice manager for Meadow Hills Veterinary Center in Kennewick, Wash., since 1999. He is a past president of the Veterinary Hospital Management Association.

After your hospitals veterinarian has explained the need for a product or pharmaceutical, dont hand off your clients to websites, pet store employees and big-box aisles and aisles of competing products. If this is the right product for this pet, carry it. The sales will follow.

Why is your veterinary clinic giving up pharma sales?

You're probably familiar with the increasing trend of veterinary clients coming in who are afraid that vaccines will hurt their pets.

Because many anti-vaxxer clients are driven by fear (and can't we all relate to some irrational fears?), it can be difficult or even impossible to convince them to vaccinate. However, some clients may change their minds about vaccines if you approach them in a consistent, empathetic way. If you run up against this, here are eight tips that have helped me.

2. Don't assume that clients understand how vaccines work

 explains why there is no link between vaccines and autism.)

 where applicable-for example, the recent whooping cough and measles outbreaks due to the rise in people not vaccinating their children. Educate, don't scare.

 by asking about their concerns, using phrases like, “Tell me more about … ” or “Help me understand so I can best advise you.”

-do you come off as overbearing or rigid?

Going hardcore? Drawing a line in the sand? 

. Even though it feels like a personal rejection of your role as wise counselor when clients refuse to follow your vaccine recommendations, it's really not about you.

8. Above all, remember that the client wants to be heard

, wishes to be respected, seeks credible information, desires informed consent and wants to be involved in decisions about their pet's healthcare.

If you come to a client from a place of understanding and are willing to hear their concerns, you might be surprised at who will come around once they've had the chance to say their piece. And, if not … you can decide how to move forward.

Dr. Sarah Wooten graduated from UC Davis School of Veterinary Medicine in 2002. A member of the American Society of Veterinary Journalists, Dr. Wooten divides her professional time between small animal practice in Greeley, Colorado, public speaking on associate issues, leadership, and client communication, and writing. She enjoys camping with her family, skiing, SCUBA, and participating in triathlons.

Your anti-vaxxer veterinary client might never change their minds, but you can try a few different approaches.

Having a vaccine talk? Keep these 8 tips in mind

 on the long hours that veterinary students put in during school, Facebook users chimed in to say, “Yup, been there, done that.”

“It's a big issue, I think. I was exhausted, and looking back I think I came out of vet school burnt out. There was never enough time to study. But then the reality is, when you get out of vet school and get a job, you're often expected to work 24 hours or more in a row. One weekend I worked 68 out of 72 hours.” 

“I was super sleepy-and still am 12 years later. In vet school I used to stay at school until sometimes 8 or 9 at night, study until 1 a.m. then set my alarm for 4, study for a bit then go back to school. I can't believe I did it. Then 10 years of ‘on call.' Needless to say, my sleep is now permanently screwed.”

“The pinnacle for me was my surgery rotation. There were supposed to be eight students, but there was an outbreak of MRSA on the surgery ward, so four dropped it last minute. So we had the case load for eight with [only] four students. I was there every day until 11 p.m. and had to be back the next morning for 5 a.m. to have all my patients written up before rounds. Let's just say that is not the ideal way to learn. Definitely nearly passed out holding a leg for the surgeon. I lost 10 pounds in two weeks.” 

"I survived clinics despite the lack of sleep."

“Just because it's the way it's always been doesn't mean it has to be that way forever. I'm sure someone will reply with something along the lines of ‘Spoiled millennials' and ‘We had to put in our time, so should you.' But if that's true, and you suffered, why not let that motivate you to affect change? IDK. I survived clinics despite the lack of sleep. I know there's sleepless nights ahead. But if students after me can have it easier? Great. I want that for them.” 

“I spend at least 12 to 14 hours on campus each day, including weekends. I definitely feel like addressing the wellness problem in the health profession in general means taking a closer look at where it all begins. You're trained to push yourself harder than you ever have before until it's this vicious cycle, where you get out into the world and accept it as life. It helps no one when the person standing between you and the grave hasn't slept in 24 hours.”

Have something to say about whether long hours in veterinary school are a learning tool for the future or whether exhaustion is a barrier to learning? Email us your thoughts at 

Veterinarians and veterinary students on Facebook told us long hours were a given to get into the profession. But are they good for practitioners, patients and the learning process?

Post-veterinary school, my sleep is permanently screwed

As veterinary professionals, you're a little used to danger-after all, your patients come with naturally built-in weapons. But what happens when it's not a pet getting violent in your clinic? What if it's the pet's owner?

“The first thing I would recommend,” Caitlin DeWilde, DVM, says when asked what to do about managing an abusive pet owner, “is to protect your clinic name, your reputation, your staff.”

You can't muzzle your veterinary clients, but maybe these helpful articles can provide an even better solution:	

dvm360 Leadership challenge: Cyberbullying

Commentary: Veterinarians need better boundaries

Letter to dvm360: Should non-DVMs ‘fire' veterinary clients?

The next thing she recommends is to assess the situation and act accordingly.

“If the pet owner is being physically threatening, or threatening monetary or bodily harm, that's a totally different context than just the unhappy pet owner,” she says. “So once you've differentiated those two, I would look at it from that perspective. If they are harmful in any way, absolutely, they need to be blocked, they need to be reported and you need to consider removing them from your client list.”

However, she says, there's a difference between being abusive and being unhappy, and you need to understand that difference as well.

“If they're just unhappy, is that an opportunity that we may have to connect with them?” she wonders. “Sometimes, yes-oftentimes, no-but if you at least make those attempts, you can feel better about moving forward.”

Watch the video below to get the full story.

Videos

Your veterinary client is baring their teeth on social mediaor even in person. Heres the first thing to do in either case.

What veterinarians can do when pet owners snarl

“Herpes, the gift that keeps on giving,” is how Mary B. Glaze, DVM, MS, DACVO, an ophthalmologist at Gulf Coast Animal Eye Clinic in Houston, Texas, described feline herpesvirus (FHV-1) during her session at the 2018 Atlantic Coast Veterinary Conference, held in October in Atlantic City, New Jersey. Epidemiologists think that upwards of 95% of cats throughout the world have been exposed to the virus, Dr. Glaze said, and probably 80% of those that have been infected are now carriers.

As one of the most common causes of ophthalmic disease in cats, FHV-1 “can be a chronic source of frustration” for practitioners and owners alike, said Dr. Glaze. During her interactive, case-based lecture, she shared the recommended tests and most effective treatment options for this ubiquitous infectious disease.

FHV-1 is spread through close contact with an infected cat; respiratory, oral and ocular secretions are infective. “Cats invariably acquire the infection as neonates,” Dr. Glaze noted. The queen, who is already stressed by all of the activity around her, is likely reactivating her own herpesvirus. As the kitten's maternal antibodies begin to wane and the queen's virus is continuing to shed, she shares that with her kittens.” The kittens will either have signs of infection before their eyelids open (ophthalmia neonatorum) or they will have respiratory disease (rhinotracheitis) with bilateral conjunctivitis.

Although both kittens and adult cats can be exposed to FHV-1, they tend to show very different clinical signs. Kittens usually present with bilateral, painful conjunctivitis with first a serous, then mucopurulent, exudate. In very young kittens, Dr. Glaze said, this conjunctivitis may be accompanied by a keratitis so severe that “adjacent raw epithelial surfaces adhere to one another, producing symblepharon.”

Clinical signs in adult cats are more likely to represent viral reactivation from latency rather than primary infection. Recurrences tend to be unilateral rather than bilateral, affecting the same eye repeatedly while the other eye remains clinically normal. Recurrent conjunctivitis is the most common feature of viral recrudescence, although discomfort, conjunctival hyperemia chemosis, and ocular discharge are usually less severe than with the initial infection.

Ophthalmologists don't really like to admit it, Dr. Glaze joked, but we really only have three diagnostic tests at our disposal: tonometry (to check for secondary glaucoma or uveitis), the Schirmer tear test and fluorescein staining. All are used in potential cases of FHV-1.

Once the medical history, which is sometimes incomplete, is obtained, diagnosis continues with a physical exam. Often, examination of a particularly painful eye can be facilitated by administering a topical anesthetic such as proparacaine. This also gives the patient temporary relief. However, a Schirmer tear test should not be performed subsequently, as the topical anesthetic can alter results of the tear test. Fortunately, Dr. Glaze noted, dry eye is not very common in cats with FHV-1 conjunctivitis, so the topical anesthetic has more value than risk.

Physical exam findings are often as expected (e.g. chemosis, hyperemia, ocular discharge), but considerable variation is possible. Dr. Glaze noted, “Cats can have some pretty profound ocular disease and not necessarily look as red as we're used to seeing in dogs.”

She discussed two diagnostic paradigms when dealing with these cases. First, when a cat presents with conjunctivitis, it should be presumed infectious until proven otherwise. “This is why we advise against using symptomatic corticosteroid therapy in feline conjunctivitis,” she said. Second, feline corneal ulceration should be considered a consequence of herpesvirus infection until proven otherwise.

Unlike other species we deal with, cats have primary conjunctival and corneal pathogens, so they don't require any other predisposing factor or precipitating event to get conjunctivitis or ulceration. FHV-1 is frequently implicated, but 

 may also be involved in feline conjunctivitis. However, chlamydia is not ulcerative. Adnexal disease, entropion, foreign bodies, and other conditions are also possible. When trying to distinguish physical exam findings, Dr. Glaze noted that “herpesvirus is a superficial corneal disease. If there is deeper corneal pathology, other factors, such as secondary bacterial infection, are at play.”

FHV-1 is typically diagnosed based on three things: clinical judgment, lack of response to routine antibacterial therapy and improvement with antiviral therapy. Dr. Glaze pointed out that there is no diagnostically reliable test for FHV-1; not even the polymerase chain reaction test can distinguish between natural infection and vaccination. Some clinicians use response to antiviral therapy to support a diagnosis of FHV-1 conjunctivitis. However, Dr. Glaze cautioned, “if you're using response to antiviral therapy as a yardstick, then you need to choose an agent that is likely to be effective, and you need an exceptionally compliant client, as topical antiviral therapy requires frequent application.” In most cases, she said, if you suspect FHV-1 in one of your feline patients, the next step is to begin treatment.

As a general rule, Dr. Glaze said to avoid corticosteroids until an infectious cause is ruled out. And cats with secondary bacterial involvement may improve with antibacterial therapy. But what about cats with unresponsive or recurrent disease? Most cats and kittens with herpes viral conjunctivitis don't end up on antiviral drugs, which may leave practitioners wondering whether antiviral therapy is a safe, effective and necessary option for the treatment of FHV-1.

Although antiviral agents cannot prevent or eradicate latent viral FHV-1 infection, Dr. Glaze advised, they should still be considered when ocular signs are severe, persistent or recurrent or when corneal ulceration is present. Dr. Glaze prefers systemic antiviral therapy to topical therapy, because orally administered famciclovir controls the disease well. However, she acknowledged that oral medication can be difficult to administer in some cats. She added, “Just remember that antiviral agents tend to be more toxic than antibacterial agents, even when applied topically. Use caution and your judgment.”

Dr. Glaze recommended a few topical and systemic antivirals that have been used to manage FHV-1 successfully in feline patients.

She said to steer clear of acyclovir and valacyclovir, which are either ineffective or potentially lethal in cats. In contrast, she has had good results with topical idoxuridine, which has to be compounded, and commented that this medication is well-tolerated by most cats and financially feasible for many clients. Topical cidofovir has the advantage of twice-daily dosing compared with five times daily for idoxuridine, but it is considerably more expensive. “Selection of an antiviral against FHV-1 is not necessarily a straightforward decision,” Dr. Glaze warned. “An agent seemingly effective in one cat may have limited benefit in another.”

Ancillary therapies include lysine (although its effectiveness has recently been brought into question, especially among shelter cats) and interferons. Dr. Glaze commented that L-lysine given in boluses twice daily helps some cats, but interferon does not seem to diminish clinical signs or viral shedding effectively. If prolonged treatment with an antiviral and/or an antibiotic fails to improve the patient's clinical signs, Dr. Glaze recommended stopping treatment for a few days and prescribing hyaluronan-based artificial tears to provide soothing for the patient during the washout period.

Treatment choices vary widely among ophthalmologists, she said, and antiviral regimens should be tailored to the individual. Topical irritation is common, she noted, especially with trifluridine, and is often misinterpreted as treatment failure when conjunctival inflammation worsens. In addition, the stage of infection, the severity of clinical signs, owner finances, and compliance should all be considered.

When one of your veterinary patients develops this ubiquitous veterinary infectious disease, try these diagnostic, treatment and prevention strategies.

Herpesvirus and the feline eye

Do you work with a technician who's an ace at anesthesia, a pro at dental prophylaxis or a whiz at wound care (or perhaps a killer combination of all three)? Don't let another busy day at your practice pass without expressing your admiration!

While it's always a good day for practice owners, practice managers, practitioners and team members to recognize technicians' skills and hard work, the fact that today kicks off National Veterinary Technician Week (Oct. 14-20) makes such efforts that much more timely.

Start some complimentary conversations with these 

 that you can personalize for the technicians who knock your socks off every day.

Let the technicians in your veterinary practice know that their daily bum-busting and all-around awesomeness are not going unnoticed with these printable notes. (We like to think of them as verbal high fives.)

Print: 'You're one heck of a tech!'

As any carpenter knows, the adage "measure twice, cut once" highlights the wisdom of careful planning. Just as a rushed carpenter can cut a board too short by measuring only once, the veterinary team can make simple mistakes that can result in dire consequences for their surgical patients. Surgical complications can range from mild (such as a seroma at the incision site) to severe (such as major dehiscence, profound hemorrhage, multiple organ failure or anesthetic death).

A major study coordinated by the World Health Organization (WHO)

 and other follow-up studies have found that utilizing surgical safety checklists reduces postoperative complications and mortality in people. A recent prospective study

 performed at a university animal hospital in Sweden examined the use of surgical checklists in cats and dogs to see if a similar reduction in postoperative complications was found.

To see the surgical safety checklist used in this study, click on the link to the abstract 

To get a downloadable surgical safety checklist based on the one used in this study and adjusted by Amy Van Gels, DVM, and Jennifer Wardlaw, DVM, MS, DACVS, click 

The postoperative complications of 520 dogs and cats undergoing major soft tissue and orthopedic surgeries were evaluated. The surgical safety checklist, which was based on the one created by WHO, was read aloud at three essential time points: 

The checklists were not used for the first 300 patients but were completed for the final 220. Any complications that occurred during the four to six weeks following surgery were recorded and classified as mild, moderate or severe. The complications between the two groups were then compared.

A total of 67 postoperative complications occurred. There were significantly more complications in patients whose surgeries did not include a safety checklist (17%) as compared with the group that did (7%). The most common types of complications were:

Wound complication without infection (such as dehiscence, delayed healing or seroma formation).

There were significantly fewer surgical site infections and wound complications after the implementation of the safety checklist. A significant difference was not found between the groups regarding the severity of complications or mortality. However, the low number of deaths (one with the checklist and four without) is not sufficient to accurately compare mortality rates between the groups.

Similar to what is seen in people, the use of a surgical safety checklist reduces postoperative complications in dogs and cats. This may be due to the combination of improved surgical team communication, identification of medication errors or equipment oversights, antibiotic administration, and sterility checks, or an overall improvement in the “safety culture” of the practice.

Considering a surgical safety list's potential to reduce postoperative complications, practices should consider implementing one. The list should be modified to fit the practice's needs and then updated annually. Keeping it short and easy to use is vital for continued staff compliance. Utilizing the surgical safety checklist is a simple and quick way to plan ahead-to check thrice and cut once-to improve patient outcomes and client satisfaction.

https://onlinelibrary.wiley.com/doi/abs/10.1111/vsu.12482 

Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. 

Bergström A, Dimopoulou M, Eldh M. Reduction of surgical complications in dogs and cats by the use of a surgical safety checklist. 

Dr. Amy Van Gels practiced companion-animal medicine for seven years before becoming a freelance medical writer and editor. Drawing on her practical experience, she creates clinically relevant articles for veterinarians and their staff, training documents for sales teams, and educational materials for pet owners. Dr. Van Gels is passionate about relaying accurate medical information to everyone who impacts patient care, at every level of medical knowledge.

Can a simple safety checklist reduce veterinary surgical complications? 

Vetted October 2019