CV M A VO ICE
Today’s Voice, Tomorrow’s Vision
The Cannabis Issue Also featuring . . . • CVMA Position Statement on No-Kill • Legislative Session Comes to a Close • Join Us for Convention 2019
2019, ISSUE #2
CV M A VO ICE
TABLE OF CONTENTS Inside
CVMA Position Statement on No-Kill Movement in Animal Welfare
President’s Post . . . . . . . . . . . Briefings . . . . . . . . . . . . . . . . . Of Note . . . . . . . . . . . . . . . . . .
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CVMA No-Kill Position Statement . . . . . . . . . . . . . . . 6 The Ever-Changing Landscape of Cannabis . . . . . . . 8 Stanley, Me, and CBD . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Updates from the CSU College of Veterinary Medicine and Biomedical Sciences . . . . . . . . . . . . . 12
Government Affairs . . . . . . . . 16 Let’s Be Blunt: Impacts of Marijuana on Veterinary Practice . . . . . . . . . . . . . . . . . . . . . . . . . . 16
The Ever-Changing Landscape of Cannabis
2019 Colorado Legislative Session Comes to a Close . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Science Update . . . . . . . . . . 20 Similarities in Marijuana Exposures Among Pets and Children in Colorado: 2000–2017 . . . . . . 20
In Practice . . . . . . . . . . . . . . . . 24 Flip the Script: Success, Stress, and Burnout in Veterinary Medicine . . . . . . . . . . . . . . . . . . . . . . . . . 24 Practice Management: Leadership vs. Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Let’s Be Blunt: Impacts of Marijuana on Veterinary Practice
Three Ways to Help Your Clients Say Yes! . . . . . . . . 26 Celebrating New Skills, Knowledge, and Character at Convention 2019 . . . . . . . . . . . . . . . . . . 28 Five Steps to Improving Employee Retention Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
CVMA Events and Deadlines July 18
How to Succeed With Demanding Clients* Webinar colovma.org/webinars
Convention Early Bird Registration Deadline—Save $200! colovma.org/convention
How to Engage Callers* Webinar colovma.org/webinars
Convention Registration Deadline— Save $100! colovma.org/convention
Convention 2019 Keystone colovma.org/convention
Capture Compliance in the Exam Room* Webinar colovma.org/webinars
CE Southwest Durango colovma.org/ce-southwest
BIG Ideas Forum | Harnessing the Power of CVTs Breckenridge colovma.org/big-ideas-forum *Discounted webinar offered to CVMA members by Communications Solutions for Veterinarians.
I Have a Degree and Enormous Student Debt—Now What? A Guide to Ownership . . . . . . . . 32
CVMA News . . . . . . . . . . . . . 34 Chapter Connections . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Invest in Your Employees, Save Your Practice From Costly Turnover . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Similarities in Marijuana Exposures Among Pets and Children
PetCheck 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Join CVMA and Your Colleagues in Colorado on Facebook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Find Jobs and Candidates in the CVMA Career Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Our Mission To enhance animal and human health and welfare, and advance the knowledge and wellbeing of Colorado veterinarians.
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Colorado Veterinary Medical Association 191 Yuma Street Denver, Colorado 80223 303.318.0447 Fax 303.318.0450 firstname.lastname@example.org colovma.org MANAGING EDITOR Katherine Wessels PUBLISHER Diane Matt The CVMA VOICE is published quarterly to members (Core and Premium members will receive a mailed print copy and Basic members will have online access only) and once a year to nonmembers free of charge. Information and advice presented in this publication do not necessarily represent the views of CVMA.
Deadlines for Submission All articles, contributions, and display ads must be received in the CVMA office by the dates below. For more information or to obtain a rate schedule, contact the CVMA office at email@example.com. Issue Issue Issue Issue
#1 — January 15 #2 — April 15 #3 — July 15 #4 — October 15
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PRESIDENT’S POST Will French, DVM CVMA President My heart sank as I looked out our kitchen window. “This can’t be happening,” I thought as I threw on my muck boots and ran out the door. It took two seconds of evaluation to confirm my fears. Yes, my wife’s mare was down in the pen, and yes, she appeared to be in labor. Welcoming a foal into the world is normally a joyous occasion right? The equine gestational cycle certainly lends itself to delayed gratification. Eleven months of anticipation, planning, and waiting. This one of course was even more meaningful than usual. As an undergraduate student at Virginia Tech, my wife Becca participated in the foaling class. Phoenix was the product of that class, and Becca has known her from the moment she was born. This spring, the plan was for Phoenix to bring a foal of her own into the world. Our “birth plan” for Phoenix included taking her to our clinic and having her foal there. Surely two veterinarians could foal a mare at home, but we both felt like having her in a more controlled environment with more eyes on her given our busy schedules increased our chances for a successful outcome. Take Plan A and light on fire.
As I yelled for Becca to come quickly and grabbed a halter, we decided to try to have her birth in the green grass. Clean is good right? Time to check positioning. Becca has foaled out hundreds of mares, and the look as she took a feel did not inspire optimism. Short, terse, words like “huge, weird, not good” meant only one thing; time to load up and go to the clinic. Apply lighter fluid and match to Plan B. The transformation from veterinarian to client happens to most of us at some point in our career. The dystocia protocol at our clinic was in full effect as we hurried in the door. IV catheter in? Check. General anesthesia induction? Check, 10 minutes after walking in the door. Start the clock for timing attempted controlled vaginal delivery? Twenty minutes max. All the things we learned in veterinary school, and preached to our clients, rolled along like a well-oiled machine, and unfortunately steadily toward cesarean section. Everyone’s role was well defined, and each step clearly mapped out President’s Post continued on page 9
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CV M A VO ICE
BRIEFINGS Diane Matt CEO The Backstory on CVMA’s New Position Statement: The How and Why Many of you may have seen recently in eVOICE that the CVMA Board of Directors approved a new position statement entitled “CVMA Position Statement on the Socially Conscious Animal Community and No-K ill Movements in Animal Welfare.” This position statement was adopted by your CVMA Board of Directors April 7, 2019. I applaud these visionary veterinary leaders for taking a strong stand for animal welfare in Colorado. Why did CVMA take this step? Why were CVMA leaders moved to action? Three reasons: 1) Dedication to the oath veterinarians take; 2) A drive to represent the voice and opinions of members; 3) Commitment to the mission of advancing animal welfare in our home state. Across Colorado, our state has accomplished what many thought impossible. Here in Colorado in 2019, we have: • Achieved a 90%+ live release rate within communities • Fostered collaboration among shelters and the veterinary profession to achieve high standards of care • Reached out to minimize the number of animals relinquished by people in need • Supported other regions by sharing expertise and providing new forever homes Quoting Dr. Rebecca Ruch-Gallie, CVMA member and 2018–2019 AVMA Delegate, “This success was not instantaneous. It has taken decades of work, of developing relationships, and of respectful listening.” Advocacy, or public support for or recommendation of a particular cause or policy, is a key pillar of CVMA’s mission. Members often say that CVMA’s work to advance and protect what matters
CVMA Board of Directors Dr. Will French President
on behalf of the profession is a primary benefit of membership that fully justifies their dues investment. Last spring, CVMA advocated for the profession by publishing a trio of articles in the VOICE on the role of the veterinary profession in animal welfare, particularly as it relates to the no-k ill movement. My favorite of the three is a reprint from the March 25, 2018 Grand Junction Sentinel written by Anna Stout, executive director of the Roice-Hurst Humane Society in Grand Junction. She points to the value and importance of the collaborative relationship between the community’s limited admission humane society and Grand Junction’s open admission shelter, and criticizes skewed calculations that do not take into consideration animals that are so sick, injured, or aggressive that they cannot be saved During CVMA’s chapter visits with members across the state in summer 2018, there were lively conversations about these articles and the no-kill movement in our state. The view of members was clear. They were committed to the principles in the veterinary oath, especially “ . . . the protection of animal health and welfare, the prevention and relief of animal suffering, the conservation of animal resources, the promotion of public health . . .” Veterinarians recognize the importance of euthanasia to prevent and alleviate animal suffering. Members attending CVMA’s Leadership Commission meeting in November 2018 took the next step and recommended that the Board of Directors prepare a position statement on the concepts of socially conscious animal communities and no-kill in animal welfare. The statement was adopted by the Board of Directors on April 7 and publicly released. Many of you emailed CVMA to express appreciation for taking the position, and we appreciate your comments—thank you for taking the time to reach out. I am grateful for the socially conscious animal community concept that CVMA has supported. It calls for a focus on
Dr. Stacee Santi President-elect Dr. Jackie Christakos Secretary/Treasurer Dr. Ashley Ackley Secretary/Treasurer-elect Dr. Sam Romano Immediate Past President Dr. Rebecca Ruch-Gallie AVMA Delegate Dr. Curtis Crawford AVMA Alternate Delegate Ms. Diane Matt CEO*
Chapter Representatives 1 – Dr. Courtney Diehl 2 – Dr. Teva Stone and Dr. Brooke James 3 – Dr. Hannah Klein 4 – Dr. Adam Tempel 5 – Dr. Colleen Carnes and Dr. Allison Kean 6 – Dr. Michelle Larsen 7 – Dr. Steve Graff 8 – Dr. Dale Davis 9 – Dr. Kayla Henderson 10 – Dr. Marguerite Flett 12 – Dr. Randal Hays 13 – Dr. Renee Rumrill 14 – Dr. Matt Braunschmidt 15 – Dr. Mark Ryan 16 – Dr. Alison McNeilly 17 – Dr. Leon Anderson
Student Chapter Representatives Class of 2019 – Amy Zug Class of 2020 – Laurel Krause Class of 2021 – Sierra Drizin Class of 2022 – Stephanie Cruz Castro * Ex-officio, non-voting
Briefings continued on page 19 CVMA VOI C E 201 9 :2 | PAG E 5
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CVMA Position Statement on the Socially Conscious Animal Community and No-Kill Movements in Animal Welfare Adopted by the CVMA Board of Directors April 7, 2019
The Colorado Veterinary Medical Association (CVMA) strongly supports the socially conscious animal sheltering movement and opposes the no-kill movement in animal welfare. The socially conscious animal community movement strives to create the best outcomes for all animals by treating them respectfully and alleviating suffering. Fundamental goals of socially conscious animal communities are achieved through shelter and community commitments to:
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• Ensure every unwanted or homeless pet has a safe place to go for shelter and care • Place every healthy and safe animal • Assess the medical and behavioral needs of homeless animals and ensure these needs are thoughtfully addressed • Align shelter policy with the needs of the community • Alleviate suffering and make appropriate euthanasia decisions • Consider the health and wellness of animals for each community when transferring animals • Enhance the human-animal bond through thoughtful placements and post-adoption support • Foster a culture of transparency, ethical decision-making, mutual respect, continual learning, and collaboration
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Protecting animal health and welfare, preventing and relieving animal suffering, and promoting public health are causes every veterinarian supports. Policies and legislation that remove professional judgement and knowledge in animal welfare and public health are counter to those causes; we cannot and will not support them. In Colorado, we have worked hard to build a thriving collaboration among animal shelters, animal welfare professionals, and veterinary professionals. Our established Colorado animal shelters have a reputation for doing amazing things in the name of animal welfare: • Collaborating with the veterinary medical profession to achieve high standards of care. • Collaborating between shelters to maximize resource use. • Reaching out to community partners to minimize the number of animals relinquished by people in need. • Reaching out to other regions to share expertise and provide new forever homes. • Finding placements for all adoptable animals. The no-kill movement increases animal suffering and threatens public health with unintended consequences:
• Animals languish in cages until they die to avoid euthanasia. • Dangerous dogs are placed in the community or remain indefinitely in shelters because of release requirements • Shelters can no longer accept lost or homeless animals from the community because cages are full of behaviorally or medically-challenged animals who cannot be placed in homes. • Animal welfare is at risk because shelters are beyond capacity-of-care. CVMA believes a socially conscious sheltering approach provides greater benefits for animals and for the community; as such, we strongly support socially conscious sheltering and oppose the no-kill movement. References Animal Welfare and the Veterinarian: http://colovma.org /wp-content/uploads/sites/8/2018/11/No-Kill-Articles -from-2018_Voice-2.pdf Crisis in Animal Welfare: https://issuu.com/cvmamedia /docs/2018_voice-2_final No Kill Movement Seeks to Kill Collaborative Animal Welfare Efforts: https://www.gjsentinel.com/opinion /columns/no-kill-movement-seeks-to-kill-collaborative -animal-welfare-efforts/article_6a129886-2fc8-11e8 -95c3-10604b9f7e7c.html
• Animals in need are turned away from shelters because shelters are not able to meet required live release rates if they are admitted.
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OF NOTE The Ever-Changing Landscape of Cannabis Katherine Wessels CVMA Director of Membership and Communications During BIG Ideas | Spring 2019, presenter Dr. Jeffrey Powers asked a roomful of Colorado veterinarians how many of them had discussed or had a client ask them about cannabis for their pet. Every hand in the room went up. With both medical and recreational marijuana now legal in Colorado, veterinary professionals are increasingly facing questions from clients about using it for their pets. To help CVMA members better understand cannabis and its intersection with veterinary care in Colorado, CVMA selected the Ever-Changing Landscape of Cannabis as its topic for BIG Ideas | Spring 2019, held March 8-9 at the Inverness Hotel in Englewood. The forum featured three key presenters who offered insights into cannabis and its impact on the veterinary practitioner and pet health in Colorado. Presenters included Dr. Jeffrey Powers (Owner, Veterinary Clinics North) Dr. Stephanie McGrath (Assistant Professor of Neurology/ Neurosurgery, Colorado State University College of Veterinary Medicine and Biomedical Sciences) and Dr. Gail Golab (Chief Veterinary Officer, AVMA). Powers kicked off the discussion by offering a practical overview of cannabinoids in veterinary practice. According to Powers, hemp varieties of the cannabis plant offer high concentrations of the potentially beneficial CBD and do not have the toxic and psychotropic effects of THC due to containing less than 0.3% THC. Marijuana varieties of the cannabis plant can also be processed to be high in CBD, which is common in states where medical marijuana is legal. Powers indicated that caution must be exercised under these circumstances as the extracts can contain dangerous amounts of THC which could lead to toxic reactions in pets and humans, especially in children. Powers cited a 2017 study published in the Journal of the American Medical Association1 that showed rampant mislabeling in CBD and THC products. The study found that out of 84 products purchased from 31 online CBD retailers, only 31% were accurately labeled. The study revealed 43% contained more CBD than stated on the packing and 26% contained less than claimed on packaging. However, a lack of cannabis research has limited the educated use of cannabis. “Research in veterinary and human medicine has been limited primarily due to the difficulties associated with the long prohibition placed on marijuana products stemming back to the 1930s and before,” Powers said. That’s where McGrath comes in. 1 https://jamanetwork.com/journals/jama/fullarticle/2661569 2 https://avmajournals.avma.org/doi/abs/10.2460/javma.254.11.1301 PAG E 8 | CV M A VOICE 2019 : 2
McGrath began her cannabis research journey after becoming frustrated at seeing epileptic canine patients euthanized due to medication side effects. “It’s really not acceptable for dogs to have seizure after seizure, but it’s also not acceptable for them to have a low quality of life because of seizure medication side effects,” McGrath said. “We need something better.” McGrath referenced her epilepsy pilot study, published in the June 1 issue of the Journal of the American Veterinary Medical Association2, which aimed to assess the short-term effect of CBD on seizure frequency in dogs. The doubleblinded study showed a significant reduction in seizure frequency for the treatment group with no significant changes in behavior. The study also revealed a statistically significant reduction in seizures when there was a higher concentration of CBD in the plasma. Dogs that were enrolled in the clinical trial received CBD oil for 12 weeks and were randomly assigned to the treatment or placebo group. All of the dogs were required to stay on standard anticonvulsant drugs including phenobarbital and potassium bromide. The CBD product used in the study was derived from a hemp plant, which has 0.3% or less of the psychoactive component of cannabis; this was not considered marijuana and could be used for research purposes based on the 2014 United States Department of Agriculture Farm Bill. McGrath also conducted an osteoarthritis study to assess the short-term effect of CBD on pain associated with arthritis. This double-blinded study resulted in improvement in client outcome assessment, along with limited adverse events of liver enzyme elevation and some vomiting. Presently, McGrath is carrying her research forward with a clinical trial involving 60 client-owned dogs with intractable epilepsy (see page 12 for more details). McGrath’s hope is that this double-blinded, placebo-controlled, crossover study will reveal data that can better inform practitioners looking to have educated conversations with clients about the potential risks and benefits of CBD for their pets. Continued on next page
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“We have to be educated about it so that we can help guide them,” McGrath said. Golab concluded the forum with a presentation on the legal and regulatory implications of the current cannabis climate. At the state level, laws for recreational and medical use of cannabis currently apply to people, not animals. At the federal level, cannabis manufacturers are regulated under the Food, Drug, and Cosmetic Act. The act classifies CBD and THC as drugs, rather than as food. As of June 2019, there were no natural or synthetic cannabisrelated drugs approved for animals; additionally, there are no cannabis-related ingredients for animal feed. Cannabis is also regulated at the federal level under the Dietary Supplement and Health Education Act of 1994 (DSHEA), which regulates dietary supplements for people but does not apply to animals. The FDA has indicated that cannabinoids are not eligible because they have been previously authorized for investigations as new drugs for which substantial clinical investigations have been instituted and that have been made public. There are currently no approved animal drugs derived from cannabis. “Unapproved animal drugs are considered to be ‘unsafe’ under the FDCA because they have not been shown to be safe and effective for their intended use,” Golab said. “Unapproved drugs may create level risk for veterinarians who administer, prescribe, dispense, or recommend them.” In 2015, 2016, and 2017, the FDA issued warning letters to firms marketing unapproved cannabis-derived drugs. “Under current federal and Colorado state law, veterinarians who administer, dispense, prescribe, or recommend ‘hemp’ products that are not approved for use in animals, or for animals or people in accordance with FDA extralabel drug use regulations, face increased potential legal risk if there is an adverse event,” Golab said. Adverse events can include unintended effects (side effects) of a drug or it could be that the drug doesn’t deliver the intended therapeutic effect. Legal risk to the veterinarian can be heightened if there are approved drugs available to treat the condition and those are not selected as part of a treatment plan or in the absence of a related standard of care. Although CBD products for animals are currently unapproved drugs and technically illegal for use in animals, the FDA’s approach to enforcement will be key. Even if FDA enforcement is minimal, Golab said, CBD products for animal still remain unapproved animal drugs and the risk exposure for veterinarians is greater due to variations in manufacturing processes and a lack of standardization. Golab noted there is a difference between discussing cannabis with patients and actively recommending it. “Laws and regulations come down to enforcement,” Golab said. “It’s up to you to decide if you want to take that risk.” n
CVMA’s BIG Ideas Forums are held twice annually and offer continuing education on real-time issues facing veterinarians in Colorado. BIG Ideas | Fall 2019 will focus on Harnessing the Power of CVTs. Reminder! Premium members receive complimentary registration to two BIG Ideas Forum per year; core members receive one complimentary registration per year.
President’s Post continued from page 4
ahead of time. No need to ignite Plan C. C-Section full steam ahead. Those few hours underscored the importance of a plan. Our team has a very detailed action plan for when the call for a dystocia comes in. Calling trees, equipment laid out, timing allowed for each attempt, all seemingly small details, that when part of a larger plan fit together like a well-orchestrated puzzle. Organizations need plans and direction, and CVMA is no different. CVMA has had a strategic framework in place since 2015 that has directed and focused our efforts in key areas. This strategic plan has produced some very tangible results. The shift from districts to chapters, tiered membership pricing, and increased leadership development opportunities are just some of things that came forward from that work. It is time however, for a refresh. What CVMA looks like over the next 3–5 years will certainly be different than the previous 3–5 years. Besides an overall strategic framework, CVMA staff is hard at work developing communication and membership engagement strategies. Thanks to thoughtful, exciting work on the part of staff, both of these strategies will have immediate impact for you as a member. Communications more closely tailored to your personal preferences, and examining exactly which member benefits are most important to you are just some of the benefits of having these intentional strategies in place. This strategy and planning does not happen in a vacuum. We cannot complete this important work without your feedback. Hopefully you had a chance to fill out the member survey recently, and as always please feel free to reach out to CVMA staff or any member of the Board of Directors at any time. We would love to hear from you about how CVMA can better deliver value, and meaningfully advance this profession. Luckily Plan C came through as a success. Our mare and foal are doing well now, thanks to long and stressful hours put in by a whole team of our colleagues. A well-defined, well executed plan can be a beautiful thing. n CVMA VOI C E 201 9 :2 | PAG E 9
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OF NOTE Stanley, Me, and CBD Curtis Crawford, DVM CVMA AVMA Alternate Delegate The sound of the explosion was as deafening as a .30-06 fired off in that small room. And the lights went out. I awoke to find myself Iying with my back up against the shelves of the utility closet. Blood was pouring down my face and my broken glasses were sitting on the other side of my head. I could feel the thuds of running footsteps coming down the hall. A muffled “What the heck was that?” cry from the front desk managed to make it through the ringing in my ears. I wasn’t exactly sure, but as my vision cleared, I suspected it had something to do with the channel-lock pliers in my right hand and the smoking thermos bottle between my legs. I thoroughly enjoy DIY projects. There is something deeply satisfying in building something from scratch with your own two hands. Remodeling a home. Changing the shocks on the car. That is also one of the attractions of surgery. There is immediate gratification in seeing a femoral fracture come together with pins and cerclage wires or a horse going home with what had been a gaping wound now neatly closed with sutures. I enjoy building Thomas splints for calves from aluminum splint rods. Even getting a plugged tom cat to pee brings a smile to my face. Elucidating the complexities of internal medicine with its challenging mysteries is cool, but the “laying on of the hands” in healing has a special appeal to me. Even some of my DIY gear from the home tool box has made it into the practice. An angle grinder with a round sandpaper disc and reciprocating saw saves a lot of time and effort over trimming those long cattle hooves with hoof nippers. A cordless DeWalt drill is a standard part of the orthopedic surgery set. Vise grips and lineman pliers are indispensable in applying cerclage wires or getting fishhooks out of lips and paws. An oscillating saw is slick for cutting casts and dehorning. The Leatherman Multitool on my belt fixes microscopes, gets stubborn needles off automatic syringes, cuts plastic spoon splints as well as drives prolapse needles through thick cow hide. I now see most tools as dual purpose when I go down the aisle at Big R. But some tools apparently just don’t belong in a veterinary clinic. Many years ago, cryosurgery was just coming into its own in veterinary medicine. A horse came into the clinic with a skin tumor that was too close to an eye to be properly removed by standard surgery without severely affecting the eyelids. The thinking of the experts was that freezing the tumor with liquid nitrogen was the best course PAG E 10 | CV M A VOICE 2019 : 2
of action. But of course, the owner didn’t want to haul the horse to a referral institution for “that kind of money” and we didn’t think we could invest in a new-fangled cryosurgical unit and make it pay out in our little town. Interestingly, one of the veterinary journals about that time contained DIY plans for making your own liquid nitrogen gun. The basic parts included a thermos bottle, some metal tubing, a cork, a bit of rubber tubing from a Simplex IV set, and the bulb from a blood pressure cuff to pressurize the system. Scrounging around the clinic, we found the tubing and bulb. I stole a rubber sink stopper from the utility room, and one of the techs had some metal diesel injector pump tubing from an old tractor. All we were out was a $15 Stanley thermos bottle and a pint of liquid nitrogen. An hour later, we had entered the 20th century of medicine. The horse was brought back, sedated and a Styrofoam coffee cup was cut up and slathered with Vaseline to protect the surrounding tissue while we froze the tumor. There was some nitrogen left over, so of course we couldn’t resist seeing whatever else we could freeze. Cottonwood leaves, flies, and someone’s lunch leftovers all got cryogenic experimentation until the gun wouldn’t shoot anymore. I placed the screw cap back on the thermos bottle, threw it up on the utility closet shelf, and shut the door until a couple of months later when another case looking like it could use a little modern medicine came in (has there been enough foreshadowing in this story so far?). When I went to get the thermos bottle, I couldn’t get the plastic screw cap out of the neck of the thermos. I figured the thermos must have been so cold when I put the screw cap in that it cross threaded. I jammed the thermos up under my arm pit and tried twisting until I thought I would peel the hide off my hand. I even used both hands. No luck. Maybe it had a reverse thread for some goofy reason. No movement either way. In a flash of inspiration, I got a pair of channel lock pliers out of the tool box, sat down on the mop bucket, crossed my legs as I locked the thermos between my thighs, grabbed the cap with the pliers, hunkered down over the obstinate contraption and squeezed with all my might as I started to untwist the cap. Right about here is where you all came in at the start of this story. Turns out the cap wasn’t cross threaded after all. It was being crushed into the threads of the neck. Remember that metal injection pump tubing that we used to get the liquid nitrogen out of the thermos to freeze the tumor? Well, apparently, it didn’t reach quite all the way to the bottom of the thermos so there was some nitrogen left in there when we got through freezing that bologna sandwich and I put the cap back in. The left-over liquid nitrogen did what liquid nitrogen does and evaporated into gas. If you remember your chemistry, the gas form of a substance takes up a whole lot more space than the liquid form but that thermos didn’t get any bigger to accommodate it (Stanley, you might want to work on that). The pressure built up in that thermos to k iloton levels. So, when I squeezed that cap with Continued on next page
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the channel locks, they deformed it just enough to come shooting out of there like a cannon ball (I don’t know why that vacuum bottle inside that thermos hadn’t broken; Lord knows that I have busted my fair share of them just dropping them on the floor). Since I was bent over the end of that thermos, my face took the cap right amidships. The cap came up and took my nose from nostrils to glasses. If my head had been a little more forward, I would have had the nasal equivalent to a cyclops. As it was, it broke my nose, shattered the glass lens in my glasses, then lodged in the ceiling tile of the closet. My bell was good and thoroughly rung. Worker’s comp didn’t quite know how to classify that one, but the stupidity code was probably keyed in there at least once. If you get close enough to look at my nose, I still carry the scar that stood out for several months like the lightening bolt on Harry Potter’s forehead. There are some grand ideas out there. Then there are fads. Hang around long enough and you will see the pendulum swing wildly between fantasy and fact when it comes to medicine. Especially in areas where there are no satisfactory treatment protocols. Snake oil cures pour into the public arena with no scientific proof of effect. There may be tons of testimonials extoling the virtues of XYZ Syrup from
John or Jane Doe, but the FDA doesn’t exactly consider that adequate enough to approve the drug. Sorta puts you and me in a dilemma. If the feed store or dispensary advertises CBD for the treatment of every disorder known to veterinary medicine, where do we sit? Welcome to the same issue that we faced with DMSO a couple of decades ago. Clinics reeked of a strong garlic odor as DMSO was used for everything that we couldn’t cure with steroids. Does each have a place? Yes. But what is that place in veterinary medicine and how far do you want to hang your hind-end out there, especially considering the feds frown pretty hard on cannabis? The CVMA and AVMA are working hard to try to help you navigate the landscape of medical cannabis in a responsible manner. Competing federal and state laws. FDA regulations. Manufacturer claims. Scientific evidence of effect. Liability issues. It is a complicated road fraught with some pretty deep pot-holes (oh come on, that’s a good one!). Take a read of this VOICE edition to see what we have discovered in our last BIG Ideas Forum and where we are heading in Colorado. The AVMA website also has some great additional guidance policies (http://jav.ma/cannabispets). After all, we’re all here trying to keep this from blowing up in our faces. CVMA, welcome to the herd. n
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OF NOTE Updates from the CSU College of Veterinary Medicine and Biomedical Sciences CBD Clinical Trial Seeks Dogs with Epilepsy Breonna Thomas, MS Veterinary Teaching Hospital Neurology Clinical Trials Coordinator With the ever-growing popularity of CBD (cannabidiol, a component of the Cannabis sativa plant) across the country, there are claims that it cures just about everything and that it is safer than most conventional medications. With all of these glowing tales it’s no surprise that we’re seeing a rising interest from owners to use CBD in their canine companions. However, since no research backs these claims, veterinary professionals have been left with our hands tied. CVMA member Dr. Stephanie McGrath and her neurology team are investigating the safety and efficacy of CBD’s use in uncontrolled epileptic patients.
Owners will need to bring their dog into CSU every four weeks throughout the study and during the seven-month trial they will be unable to make any changes to their dog’s routine AED therapy. All testing and bloodwork will be covered by the cost of the study, and owners will receive periodic monetary credits to their VTH account to be used at their discretion. While this trial is not guaranteed treatment, it’s incredibly important in helping advance our understanding of CBD’s efficacy for this horrible disease process that afflicts so many dogs. If you know a dog who may be a good candidate please have their owner reach out to our clinical trials coordinator, Breonna Thomas at 970.305.0455 or CSUNeuroTrials@colostate.edu. Get more details on the study at csu-cvmbs.colostate .edu/vth/veterinarians/clinical-trials.
Feline Cancer Core Seeks Answers Lauren Mingus Flint Animal Cancer Center Outreach Coordinator
Our goal is to enroll at least 60 dogs in this doubleblinded crossover clinical trial so we can come closer to answering questions such as: • Is it effective? • Is it safe? • Does it have any interactions with other medications? In order to qualify, dogs must be having two or more s eizures per month for four consecutive months while on therapeutic levels of routine anti-epileptic medications. After an initial screening over email to determine that dogs meet the basic qualification criteria, they will come to CSU for an MRI and CSF tap in order to rule out any other underlying causes of the epilepsy. Assuming there are no other obvious causes for their epilepsy, they will begin the seven-month crossover study. All dogs start with either CBD or placebo for three months, undergo a four-week washout period, and then crossover to the opposite oil for the remaining three months. PAG E 12 | CV M A VOI CE 2019 : 2
The Feline Cancer Core, a multidisciplinary CSU team, has joined forces to find answers to a question that has vexed animal owners and clinicians alike: Is it cancer or is it IBD? It’s an issue that has puzzled veterinarians for years. A cat comes in with chronic diarrhea and vomiting, symptoms that occur in gastrointestinal lymphoma and Inflammatory Bowel Disease (IBD). While IBD is the most common reason for these symptoms, veterinarians do not have an effective method to confirm IBD or rule out gastrointestinal (GI) lymphoma. A lack of research into the root cause of these conditions (diet, environmental toxins, viruses or bacteria, genetics) leaves open questions about the best way to treat patients. “We’re hoping to find answers to some big questions, including what causes this cancer in cats and is there a relationship between IBD and GI lymphoma,” said Dr. Craig Webb, CVMA member and professor of small animal medicine at CSU’s James L. Voss Veterinary Teaching Hospital. Continued on next page
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The Feline Cancer Core is seeking answers to: • What is the best way to confidently distinguish between feline IBD and feline GI lymphoma? • What genetic and environmental factors contribute to the development of IBD and lymphoma? • Does chronic feline IBD progress or transform into feline GI lymphoma over time? • What therapies can be developed to treat IBD and GI lymphoma? Those big questions require big thinking and a great team. Feline Cancer Core investigators bring a wealth of experience and expertise. In addition to work using stem cells to treat cats with IBD, co-investigator Dr. Tracy Webb has an extensive background in GI immunology. Dr. Anne Avery, CVMA member and veterinary pathologist, has spent much of her career studying lymphoma, while CVMA member Dr. Sue VandeWoude is a feline infectious disease specialist. “One exciting aspect of this project for me is that we are addressing a complex challenge in veterinary medicine with a collaborative, ‘Team Science’ approach to enhance our chance of success,” said Tracy Webb. Cats helping people? Yes! Prior to leading this project, Craig and Tracy Webb have been exploring the use of stem cells to treat cats with IBD. Their work was based on treatment protocols for people suffering from forms of IBD, including ulcerative colitis and Crohn’s disease. “When you simply remove the word feline from our study questions, you have translated this project into one that has direct and significant impact on the human condition,” said Craig Webb. In particular, the project’s focus on environmental triggers may prove very relevant to people. “Cats live in the same environment as their owners, breathe the same air, drink the same water” said Craig Webb. “Through our study, we may find triggers that place both cats and people at higher risk for developing disease.” The goal is to recruit 100 owner-enrolled cats diagnosed with either IBD or GI lymphoma over the next two years. “Our infrastructure is ready to go,” said Craig Webb. “All we need now are the cats.” For information about enrolling in the study, email Dr. Craig Webb at firstname.lastname@example.org
Easley Wins 2018 Zoetis Veterinary Research Excellence Award Mary Guiden, CSU Division of External Relations CVMA member Dr. Jeremiah Easley’s career path has come full circle. As a young boy, he lived with his family in Fort Collins while his father, Jack—an accomplished equine
veterinarian—completed a sabbatical under Dr. Simon Turner at Colorado State University. Now, he serves as co-director of the Preclinical Surgical Research Laboratory at CSU, which was launched by Turner more than 20 years ago to test new medical devices for use, eventually, in human patients. At the college’s annual Research Day, Easley won the 2018 Zoetis Veterinary Research Excellence Award, which recognizes researchers whose innovative studies have advanced the scientific standing of veterinary medicine. Growing up as a veterinarian’s son, Easley said, he always had an interest in the field, but he wasn’t sure if it was for him. He explored other areas as an undergraduate, majoring first in art and then marine biology. But he was ultimately drawn to veterinary medicine, and received his DVM from Virginia-Maryland College of Veterinary Medicine in 2007. He completed a residency at the University of Florida in large animal surgery before returning to Fort Collins in 2011. “He’s unbelievably good at nurturing relationships with corporate sponsors and companies,” said lab co-director and CVMA member Dr. Howard Seim III. “He is driven to make a community of people in a team that can function together to absolutely be successful, and everybody can share in the success.” To date, the laboratory has worked with companies— including startups—on more than 30 devices that have been approved by the U.S. Food and Drug Administration following testing at CSU. Easley said it’s imperative for students to see themselves as integral parts of the lab. He and Seim include the students, staff and veterinary technicians in dinners with corporate clients, send them to national conferences, and hold team-building experiences, including renting out an arcade for a few hours of down time. “I hope that when students leave our lab, they recognize what it’s like to be part of a good working experience, where teams work together and get a lot of work accomplished,” said Easley. Contacts: Felix.Duerr@colostate.edu, 970.297.4140; Nic.Lambrechts@colostate.edu, 970.297.4304
CSU continued on page 14 CVMA VOI C E 201 9 :2 | PAG E 1 3
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OF NOTE CSU continued from page 13
VandeWoude Elected to National Academy of Sciences CVMA member Dr. Susan VandeWoude, professor of Microbiology, Immunology and Pathology and associate dean for research for the College of Veterinary Medicine and Biomedical Sciences, was elected April 30 to the National Academy of Sciences, a top honor in recognition of her distinguished and continuing achievements in original research. She is the twelfth CSU faculty member elected to the elite society. New Service: Orthopedic Medicine and Mobility To accommodate the growing need for nonsurgical orthopedic treatment options, the Veterinary Teaching Hospital is introducing the Orthopedic Medicine and Mobility service, led by CVMA members Drs. Felix Duerr and Nic Lambrechts. Surgical cases will continue to be seen through the Orthopedic Surgery service, led by CVMA member Dr. Ross Palmer and Dr. Clara Goh. “We’ll be able to focus on diagnosis and providing nonsurgical treatments,” said Duerr. “Some owners know they don’t want to pursue surgery for their pet, so we can offer a more specific referral option that’s tailored to the client.”
Not All DiAgNoses Are this eAsy to spot
Referring veterinarians will still be able to send patients to the hospital for orthopedic surgery, as well as for non surgical treatment options and preventive exams. Zersen joins Emergency and Critical Care After more than three years as an intern and a resident, Dr. Kristin Zersen has joined the Emergency and Critical Care faculty as a clinical instructor. She came to the hospital as an ECC specialty intern after completing her rotating internship at VCA West LA. Her collegiality, clinical aptitude, and leadership abilities led to converting her internship to a residency in January 2016. Over the past three years, she has tirelessly dedicated herself to her patients, clients, and colleagues, has excelled in her research, and has been a strong advocate for clinical teaching. She works alongside Small Animal Urgent Care section leader and CVMA member Dr. Amanda Cavanagh. Also in Urgent Care, Drs. Kevin Castle and Nicole Chamney have recently transitioned into part-time positions. Castle has several years of small-animal emergency experience that complement his keen interest and advanced training in caring for our avian and exotic patients. Chamney completed specialty critical care training at CSU last year, honing her skills as a caring clinician in fast-paced ER setting. n
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GOVERNMENT AFFAIRS Let’s Be Blunt: Impacts of Marijuana on Veterinary Practice Katherine Garcia Peer Assistance Services In November 2000, voters in the state of Colorado passed Amendment 20, which legalized possession and use of limited amounts of medical marijuana for those patients holding a medical marijuana card or their primary care givers.1 Fast forward 12 years, and the state of Colorado became the first state in the United States to legalize the possession and consumption of recreational marijuana for individuals age 21 and older with the passage of Amendment 64.2 Colorado’s unique marijuana laws have created significant confusion and brought about numerous questions such as: Does this mean I can use marijuana with no implications? Do I have different responsibilities as a veterinary professional in regard to my marijuana use? Since marijuana is used for medical purposes, does that mean I’m not impaired if I use it? Though Colorado law permits individuals to use marijuana both medically and recreationally without the fear of prosecution from county and state authorities, the use of marijuana remains illegal federally and remains a Schedule I Controlled Substance based on the United States Controlled Substances Act.3 While state officials may no longer prosecute the use and possession of marijuana by adults, the U.S. Constitution’s “Supremacy Clause” continues to grant ultimate control over policies related to marijuana to the federal government. When considering the employment implications, a direct quote from Amendment 64 sums the situation up nicely: “Nothing in this Section is intended to require an employer to permit or to accommodate the use of marijuana in the workplace or to affect the ability of employers to have policies restricting the use of marijuana by employees.”2 Employers continue to have the ability to create and enforce drug free workplace policies to ensure their organization is
Peer Assistance Services provides the statewide Veterinarian Peer Health Assistance program through a contract with the Colorado State Board of Veterinary Medicine. CVMA partners with Peer Assistance Services to provide confidential services to those in the veterinary profession who may be experiencing physical, emotional, psychological, or substance use problems. The program accepts self-referrals and calls from persons who may be concerned about themselves or others. The referral may come from a friend, family member, colleague, supervisor, self, or the Colorado State Board of Veterinary Medicine. The calls are confidential and you do not need to give your name or the name of the individual. Staff are available during business hours as well as after hours and weekends by calling the 24-hour information line (720.291.3209).
providing quality and safe healthcare for the public. These include the same zero-tolerance policies as they existed prior to marijuana legalization. Court cases, such as Coats vs. Dish Networks (heard by the Colorado Supreme Court), still maintain employers’ rights to enforce policies prohibiting the use of marijuana by employees; even if employees have medical marijuana cards. While the medical marijuana system permits physicians’ ability to recommend marijuana as a treatment for certain health conditions, such as chronic pain or nausea, research continues to identify that marijuana use is related to certain cognitive impairments. Research conducted by the National Institute on Drug Abuse shows marijuana use impairs judgment and motor coordination, delays reaction time, and inhibits memory consolidation.4 Transfer these effects of marijuana use to the practice of veterinary medicine and consider how one’s ability to care for a patient in the operating room, conduct a sound clinical assessment of a patient, or ability to remember patient history may be impacted. Though the idea of marijuana use and impairment continues to be debated, the Colorado Physician Health Program (CPHP) has taken a stance and considers a physician who uses marijuana in any form, medically Continued on next page
1. Amendment 20 Medical Use of Marijuana: ARTICLE XVIII Section 14. (2000). Colorado. 2. Amendment 64 Use and Regulation of Marijuana: Article XVIII Section 16. (2012). Colorado. 3. Title 21 United States Controlled Substances Act. (1978). Retrieved from US Department of Justice: Drug Enforcement Administration: http://www.deadiversion.usdoj.gov/21cfr/21usc/812.htm 4. How does marijuana use affect your brain and body? (2012). Retrieved from National Institute on Drug Abuse: http://www.drugabuse .gov/publications/research-reports/marijuana/how-does-marijuana-use-affect-your-brain-body PAG E 16 | CV M A VOICE 2019 : 2
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or recreationally, unsafe to practice medicine. Dr. Doris Gundersen, medical director of CPHP, acknowledges that the state’s position on physicians using marijuana is a conservative one, but clarifies that physicians are in safety- sensitive positions much like pilots and other healthcare professionals, making public protection a top priority. According to Dr. Gundersen, public safety supersedes individual rights and this policy not only protects the public from risks associated with impaired practice, it also averts even minor medical errors.5 Similarly, the Colorado Veterinarian Peer Health Assistance Program takes the same position on marijuana use and considers a veterinarian who uses marijuana in any form unsafe to practice, due to the safety sensitive nature of veterinary medicine and the priority of public protection. While the use of marijuana as a legal substance remains controversial, it’s important to remember that other
legal-yet-potentially-impairing substances have been addressed by workplace and professional licensure policies before, including alcohol and prescription medication. Those working in a veterinary setting should be aware that the use of marijuana could place an individual’s cognition, employment, and license in jeopardy. For more information contact: Katherine Garcia, MA, LAC, MAC, Clinical Services Manager. email@example.com Office locations: 2170 South Parker Road 200 Grand Avenue Suite 229 Suite 270 Denver, CO 80231 Grand Junction, CO 81501 303.369.0039 970.291.3209 24 hour information line: 720.291.3209 n
5. Johnson, K. (2012, October 29). Physicians who use marijuana are ‘unsafe to practice’. Retrieved from Medscape: http://www.medscape .com/viewarticle/773544
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GOVERNMENT AFFAIRS 2019 Colorado Legislative Session Comes to a Close Katherine Wessels CVMA Director of Membership and Communications Every time CVMA asks members what they value most about CVMA membership, the answer is the same: Advocacy. A key part of CVMA’s mission is to advocate for members and veterinary medicine in the state of Colorado. Among party politics and special interest groups and scores of lobbyists, it would be impossible for one person, alone, to be heard. But CVMA—representing 2,000+ members—can cut through the noise and make sure your best interests are represented and our opinions and comments are heard by those who can help us shape legislation that benefits both veterinary practice and animal welfare in Colorado. The 2019 Colorado legislative session adjourned on May 3, 2019. CVMA was hard at work January-May advocating on behalf of veterinary medicine and animal welfare in Colorado. Here is a snapshot of the highlights from the 2019 legislative session: SB 19-228: Substance Use Disorders Prevention Measures Passed right at the end of the session on May 2, this bill stipulated that the licensing boards for seven prescribing professions (including veterinarians) must establish rules for up to four hours of CE by October 1, 2019 to ensure competency regarding: • Best practices to prescribe and dispense opioids • Recognition of human substance abuse disorders • Referral of patients/clients with substance abuse disorders for treatment • Use of the Prescription Drug Monitoring Program The bill was broadly supported and had little opposition among legislators. Because veterinarians only accounted for 1% of total opioid prescriptions in 2017 and because the bill would add additional burden to veterinarians, CVMA testified against the bill on April 11, and distributed an issue brief to legislators outlining its opposition on April 19. CVMA’s next step is to monitor the State Board of Veterinary Medicine’s preparation of rules that will implement the bill. HB19-1092: Animal Ban for Cruelty to Animals Conviction The bill requires a court to enter an order prohibiting a person convicted of felony animal cruelty from owning a pet animal for a period of 3 to 5 years and a juvenile adjudicated a delinquent for an animal cruelty crime from owning a pet animal, unless the defendant or juvenile’s treatment provider makes a specific recommendation not to impose the ban and the court agrees with the recommendation. CVMA actively monitored this bill’s progress throughout the session. PAG E 18 | CV M A VOICE 2019 : 2
SB19-158: Sunset Pet Animal Care and Facilities Act This bill was sent to the governor May 13. It concerns the continuation of the “Pet Animal Care and Facilities Act”, and implements some of the recommendations contained in the 2018 sunset report by the department of regulatory agencies. CVMA actively supported this bill. These are just some of the bills CVMA tracked during the 2019 legislative session. For a full listing of bills CVMA tracked on your behalf, see the CVMA Bill Tracker, available at colovma.org/legislative. State Board Clarifies Role of VCPR in Telehealth Policy In April, the Colorado State Board of Veterinary Medicine amended its Board Guideline for the Appropriate Use of Telehealth Technologies in the Practice of Veterinary Medicine to clarify that when an existing VCPR relationship is not present, a provider must take appropriate steps to establish a VCPR that is consistent with state statute 12-64-103(15.5), C.R.S. CVMA requested clarification on the state board’s telehealth guideline to clear up confusion regarding the establishment of a VCPR for telehealth scenarios. CVMA is pleased to see this clarification, supports the full use of telehealth within the guidelines to enhance the health and welfare of Colorado’s animals, and thanks the board for approving the amendment to update the guideline. The guideline now states: Section III B: Establishment of a Veterinarian-Client-Patient Relationship (“VCPR”): Where an existing VCPR relationship is not present, a provider must take appropriate steps to establish a VCPR consistent with section 12-64-103(15.5), C.R.S. (Please refer to section II H (b) which provides the definition of VCPR.) Section II H (b): “VETERINARIAN-CLIENT-PATIENT RELATIONSHIP (“VCPR”)” means the relationship as defined in section 12-64-103(15.5), C.R.S., and reads as follows: “Veterinarian-Client-Patient Relationship” means the relationship established when: (a) The veterinarian has assumed the responsibility for making medical judgments regarding the health of an animal and the need for medical treatment, and the owner or other caretaker has agreed to follow the instruction of the veterinarian; (b) There is sufficient knowledge of an animal by the veterinarian to initiate at least a general or preliminary diagnosis of the medical condition of the animal, which means that the veterinarian has recently seen and is Continued on next page
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personally acquainted with the keeping and care of the animal by virtue of an examination of the animal or by medically appropriate and timely visits to the premises where the animal is kept; and, (c) T he practicing veterinarian is readily available, or has arranged for emergency coverage, for follow-up evaluation in the event of adverse reactions or failure of the treatment regimen. View the telehealth guideline on the State Board of Veterinary Medicine website (scroll to pages 22–25): https://bit.ly/2JAneMi n Briefings continued from page 5
each individual animal and how that specific animal’s welfare can be thoughtfully and best addressed. It calls upon animal welfare agencies to treat animals respectfully, to make appropriate euthanasia decisions, and to alleviate suffering. We noted with sadness recently what happens as an open admission shelter shifts its focus from meeting the
needs of animals to meeting a numerical goal. A socially conscious animal welfare community places the focus on animal welfare rather than numerical targets. When a community is as successful as Colorado is in placing healthy and behaviorally sound animals in forever homes, the no- kill movement cannot make a positive contribution. Instead it poses risks to sheltered animals and confuses the public. Veterinarians can help create socially conscious animal communities by: • Offering effective medicine choices • Providing care to indigent pet owners when possible • Trusting and sharing evidence-based behavior expertise resources • Collaborating with socially conscious animal welfare organizations • Supporting thoughtful public policy • Knowing the resources available for pet owners • Volunteering time, skill, and expertise I hope you will join me in applauding the CVMA Board of Directors for taking this proactive, visionary step for animal welfare in Colorado. n
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SCIENCE UPDATE Elyse Contreras, MPH Marijuana Health Monitoring & Research Program Colorado Department of Public Health and Environment It has been nearly 20 years since marijuana was first legalized in Colorado. From a public health standpoint, marijuana products raise many concerns; one in particular is the unintentional exposure or unknowing consumption of marijuana products by vulnerable populations, such as pets and children. Monitoring adverse health effects related to marijuana consumption at the state level is limited to exposures among humans. However, parallels may be drawn in the data of marijuana exposures in pets and children. In an effort to prevent marijuana exposures in pets and children and the adverse outcomes that result, messaging responsible use and storage is key, along with continued exposure surveillance. History of Marijuana Legalization in Colorado Marijuana has had a legal presence in Colorado for nearly two decades. First legalized for medicinal use in 2000, licensed patients or caregivers could grow the plant for individual consumption. A decade later, in 2010, the first medical marijuana care centers opened for business. Further liberalization ensued in November of 2012, when 55% of Colorado voters passed a state constitutional amendment fully legalizing marijuana for recreational use.1 Recreational marijuana dispensaries opened for business January 1, 2014. Five years later, marijuana in Colorado has become a billion dollar industry.2 Products Available, Routes of Exposure Much of the success of the marijuana industry in Colorado is due to the vast array of marijuana products now available to consumers. A wide variety of smokeable products, baked goods, candies, tinctures, concentrates, and products such as nasal sprays are available. These products often contain large doses or high concentrations of THC, the psychoactive component of marijuana. THC becomes psychoactive only after it is heated, decarboxylating the THC acid (THCA) into psychoactive THC. Marijuana plant material in its raw form is non- psychoactive and will not cause impairment to humans if ingested. However, if ingested by animals, marijuana plant material is considered toxic.3,4 Marijuana edible products, which tend to be the most tempting products to children and pets, can contain up to 100 mg of pre-decarboxylated THC per product.5 The impairing effects of edibles are often delayed and longer lasting than products that are smoked.6 Marijuana that is smoked can expose children and pets to secondhand smoke containing THC and chemicals.4,6,7 PAG E 20 | CV M A VO ICE 2019 : 2
Marijuana vape pens have cartridges that contain a liquid mixture of marijuana oil and either propylene glycol or polyethylene glycol, and are similar to e-cig cartridges. These cartridges and other concentrated marijuana products, like wax and shatter, contain high concentrations of THC. A 2017 market report showed Colorado concentrates average 68.6% THC content.2 Measurements of Exposure in Conjunction with Legalization One public health measure of adverse health events involving marijuana exposure in children age 0-8 is monitoring the number of exposures reported to Rocky Mountain Poison and Drug Center. Temporal associations are evident in these data at key points in time during the progression of marijuana legalization in Colorado. Exposures reported to the poison center involving only marijuana in children ages 0–8 can be seen increasing concurrently to the opening of medical marijuana care centers in 2010. Between 2000 and 2009, unintentional marijuana exposures in children age 0–8 averaged five per year, compared to nine reported in 2010. Exposures in this age group steadily began increasing after recreational marijuana was legalized in late 2012, and increased again after recreational marijuana stores opened in early 2014 (figure 1). The upward trend of unintentional exposures in children age 0-8 continues, with 50 reported in 2017.6 Marijuana exposures reported to the poison center involving animals over the same time period shows the same temporal relationship to legalization as exposures in children 0–8 (figure 2). However, the first increase seen in animal exposures occurred in the years post medical marijuana legalization in 2000, increasing from a count of three in 2000 to 10 in 2002. Large increases in animal exposures reported are seen in both 2010 and 2014, after medical and recreational stores opened respectively. There were 10 reported animal exposures in both 2010 and 2014, compared to only four in both 2009 and 2013. This exposure trend Figure 1: Unintentional Marijuana only exposures in humans reported Unintentional marijuanaPoison only exposures humans reported (1/1/00–12/31/17) to the Rocky toFigure the 1:Rocky Mountain and inDrug Center in Mountain Poison and Drug Center (1/1/00-12/31/17) in Colorado by age: 0-8, 9-17, 18Colorado by age: 0–8, 9–17, 18–24, 25+ years 24, and 25+ years 60 50
Number of Marijuana Exposures
Similarities in Marijuana Exposures Among Pets and Children in Colorado: 2000–2017
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
25 + years old
18-24 years old
9-17 years old
0-8 years old
Produced by: Marijuana Health Monitoring Program, Colorado Department of Public Health & Environment 2018. Produced by: Marijuana Health Monitoring Program, Colorado Department Data Sources: National Poison Data System (NPDS).
Health & Environment 2018. Data Sources: National Poison Data System (NPDS).
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SCIENCE UPDATE with marijuana-related diagnosis codes in children age 0-8 were at a rate of one per 100,000 hospitalizations in 2000, five per 100,000 in 2010, 16 per 100,000 in 2014, and 31 per 100,000 in 2017.6 ED data collection began in 2011, at which time the rate of ED visits with marijuana related billing codes in children age 0-8 were at a rate of 6 per 100,000 ED visits, 11 per 100,000 in 2014, and 24 per 100,000 in 2017.6 The author was unable to obtain animal hospital and ED visit data for comparison, but animal hospitals in Colorado have reportedly experienced a similar increase in the rate of visits involving marijuana exposure.9,10
Continued from previous page Figure 2: Number of animal majijuana exposures reported to Rocky Mountain Poison and Drug Center, Colorado 2000–2017
Produced by: Marijuana Health Monitoring Program, Colorado Department of Public Health & Environment 2018. Data Sources: National Poison Data System (NPDS).
also continued to increase after 2014, with 12 animal exposures reported in 2017. Of the 153 total animal exposures reported to the poison center between 2000 and 2017, 149 (97.4%) involved dogs, three (2.0%) cats, and one (0.6%) horse. These data align closely to marijuana exposure data previously reported by the Animal Poison Control Center: 96% dogs, 3% cats, and 1% other species.8 However, it should be noted that animal marijuana exposures reported to the Rocky Mountain Poison and Drug Center are likely a gross underrepresentation of the actual number of exposures since these counts do not include reports of additional exposures reported to other animal-specific poison centers or hotlines or cases that go unreported by owners. Another public health measure used to monitor adverse health events involving marijuana are the rates of hospitalizations and emergency department (ED) visits. These data show similar temporal concurrence with marijuana legalization as the poison center data. In children age 0–8, both hospitalizations and ED visits with marijuana-related diagnosis coding have increased (figure 3). Hospitalizations Figure 3: Rates of emergency department visits and hospitalizations with marijuana-related billing codes ages 0–8 years, Colorado 2000–2017
Figure 3: Rates of emergency department visits and hospitalizations with marijuana-related billing codes ages 0-8 years, Colorado 2000-2017 35
Rates per 100,000
15 10 10
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 0-8 years Hospitalizations
0-8 years ED visits
Produced by: Marijuana Health Monitoring Program, Colorado Department of Public Health & Environment 2018. Data Sources: Colorado Hospital Association (CHA). Marijuana-related ICD-9/10-CM billing codes included at least one of the f ollowing cannabis codes in the up to 30 discharge diagnosis/billing codes: accidental poisoning by psychodysleptics (E854.1), poisoning by psychodysleptics (969.6), poisoning, adverse effects and underdosing by cannabis (T40.7), cannabis abuse (305.2 & F12.1), canabis dependence (304.3 & F12.2), and cannabis use (F12.9).
Produced by: Marijuana Health Monitoring Program, Colorado Department of Public Health & Environment 2018. Data Sources: Colorado Hospital Association (CHA). Marijuana-related ICD-9/ 10-CM billing codes included at least one of the following cannabis codes in the up to 30 discharge diagnosis/ billing codes: accidental poisoning by psychodysleptics (E854.1), poisoning by psychodysleptics (969.6), poisoning, adverse effects and underdosing by cannabis (T40.7), cannabis abuse (305.2 & F12.1), cannabis dependence (304.3 & F12.2), and cannabis use (F12.9).
Severity of outcomes The severity of marijuana intoxication in both children and pets depends on the dose of THC and route of exposure. In young children and pets, the route of exposure is most often via oral ingestion regardless of the type of product.11,12 Ingested marijuana plant material may not lead to THC toxicosis, but may cause concern for contaminate exposure, such as mold, microbial, pesticides, and metals if the amount ingested is considerable or repeated over time. Secondhand marijuana smoke exposure can also be hazardous to children and pets. Secondhand marijuana smoke also contains many of the same carcinogens as tobacco smoke.6 Secondhand marijuana smoke can also intoxicate exposed animals.4,13 Prognosis for these type of exposures is good, and outcomes reported have all been positive.8,11 Ingestion of vape cartridges by both children and animals have been documented with outcomes reported as severe to fatal when they contain nicotine.14,15 However, since there are no known reports of exposure involving ingestion of marijuana oil vape cartridges by a child or animal, severity of outcome for this type of exposure remains unknown. Marijuana edibles are the most common marijuana product consumed by young children.6,12 In 2018, 60.6% of all marijuana exposures in children age 0-8 reported to the poison center involved marijuana edibles, most were marijuana candy.6 Effects of intoxication in this age group can be severe, requiring hospital admission to critical care.12 However in the majority of patients, effects resolve within 24 hours and no deaths have been reported.12 Pets, especially dogs, are increasingly exposed to marijuana via edibles as well.11 An added concern for edible ingestion in dogs is the co-ingestion of chocolate in items like marijuana brownies and cookies, which may require additional treatment.16 Ingestion of marijuana edibles by dogs can lead to severe intoxication, putting them at greater risk of lifethreatening complications.9 Although rare, death has been the reported outcome of two dogs that consumed marijuana edibles.9,11 Prevention and messaging Public health efforts to monitor and prevent exposures in children may also be applied to pets. Over the past five Exposures continued on page 22 CVMA VOI C E 2019 :2 | PAGE 2 1
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years, the Colorado Department of Public Health and Environment has used data to inform marijuana exposure prevention-focused messaging. Findings from a department-administered survey of adults with young children living in the same household estimated approximately 23,008 homes in Colorado with young children had marijuana in the home and potentially stored unsafely.6 The same survey also estimated approximately 32,800 homes with young children had possible secondhand marijuana smoke or vapor exposures.6 These findings coupled with the data from poison center and hospital and ED visits informed messaging aimed at responsible adult use, such as “keep marijuana stored out of reach and locked up,” and “don’t smoke marijuana around children or pets to prevent secondhand smoke exposure”.6 Marijuana exposures in pets and children continue to rise annually. Continued surveillance in both pets and children is essential to protect these populations and support the development of prevention messaging aimed at educating adult consumers of the dangers of marijuana exposure in pets and children. Acknowledgements: Kristen Augustine, Puja Shah, and Kelsey Robinson
References: 1. Denver Post. Amendment 64 - Legalize Marijuana Election Results. 2017; Accessed May 2, 2019, http://data.denverpost.com /election/results/amendment/2012/64-legalize-marijuana/. 2. Colorado Department of Revenue. Market Size and Demand for Marijuana in Colorado 2017 Market Update. 2018. 3. ASPCA. Toxic and Non-Toxic Plants: Marijuana. 2019; A ccessed May 2, 2019, https://www.aspca.org/pet-care/animal-poison -control/toxic-and-non-toxic-plants/marijuana. 4. Gollankner R, Buzhardt, L.,. Cannabis (Marijuana) Intoxication in Cats and Dogs. 2018; Accessed May 2, 2019, https://vcahospitals .com/know-your-pet/marijuana-intoxication-in-dogs-and-cats. 5. Marijuana Enforcement Division. Code of Colorado Regulations Retail Marijuana Rules R 402 - Retail Marijuana Sales: General Limitations or Prohibited Acts. In: Colorado Department of Revenue, ed, 2019. 6. Colorado Department of Public Health and Environment. Monitoring Health Concerns Related to Marijuana. 2019; www.colorado.gov/marijuanahealthinfo, May 2, 2019. 7. Janeczek A, Zawadzki M, Szpot P, Niedzwiedz A. Marijuana intoxication in a cat. Acta Vet Scand. 2018;60(1):44. 8. Donaldson CW. Marijuana Exposure in Animals. Veterinary Medicine. 2002. 9. Meola SD, Tearney CC, Haas SA, Hackett TB, Mazzaferro EM. Evaluation of trends in marijuana toxicosis in dogs living in a state with legalized medical marijuana: 125 dogs (2005-2010). J Vet Emerg Crit Care (San Antonio). 2012;22(6):690-696. 10. Smith M. Local Veterinarians Warn Pet Owners about Growing Number of Pets Poisoned by THC. 2019; Accessed May 3, 2019, https://www.thedenverchannel.com/news/investigations/local
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-veterinarians-warn-pet-owners-about-growing-number-of-pets -poisoned-by-thc. 11. Fitzgerald KT, Bronstein AC, Newquist KL. Marijuana Poisoning. Topics in companion animal medicine. 2013;28(1):8-12. 12. Wang GS, Roosevelt G, Le Lait MC, et al. Association of unintentional pediatric exposures with decriminalization of marijuana in the United States. Ann Emerg Med. 2014;63(6):684-689. 13. Waldrop J. ACCESS Marijuana Toxicity Background Information. https://sgvh.com/wp-content/uploads/2015/06/ACCES _MarijuanaToxicity_042814.pdf: Animal Critical Care and Emergency Services Washington; 2014. 14. Porter R. E-Cigs and Toddlers: Beware. 2013; Accessed May 2, 2019, https://www.poison.org/articles/2013-sep/electronic -cigarettes. 15. Pet Poison Helpline. E-Cigarettes and Pets Do Not Mix. 2019; Accessed May 2, 2019, https://www.petpoisonhelpline.com /uncategorized/e-cigarettes-pets-mix/. 16. Guerra B. Marijuana Toxicity in Pets. Animal Critical Care and Emergency Services Washington, https://sgvh.com/wp-content /uploads/2015/06/ACCES_MarijuanaToxicity_042814.pdf2014. n
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IN PRACTICE Flip the Script: Success, Stress, and Burnout in Veterinary Medicine Josh Vaisman Flourish Veterinary Consulting There’s a formula for success many of us recognize and it goes something like this: Step 1—Work your ass off Step 2—Make some money Step 3—Rinse and repeat Boom! Success. I used to believe it. In my mind the harder I worked, the more money I’d make and, as a result, the happier I’d be. It’s a recognizable recipe and I bought into it hook, line, and sinker. Until one morning, in the middle of making scrambled eggs, I broke down in tears. Turning to my shocked wife I simply said, “I can’t handle it anymore.” I had reached burnout. I’ve since learned there’s a better way to find success and it involves flipping the script on how we typically approach things in veterinary medicine. In this article I’ll tell you a little bit about why we think about success and happiness wrong, how that applies to us in veterinary medicine, and what we can do to flip the script and approach things in a healthier way. In his famous TED talk, happiness researcher Shawn Achor told us we don’t reach happiness because of success, we succeed because of happiness. It turns out the old adage, “money doesn’t buy happiness,” is true. It’s counterintuitive for many of us (it certainly was for me) but research in a variety of social and biological sciences is showing that the human body, including the brain, is primed for optimal performance when the motivation is intrinsic. When we think things like, “if I just get XYZ, I’ll be happy,” we are creating extrinsic goals and tying our wellbeing to reaching them. When such a goal requires any level of concentration and effort beyond the mundane it makes the brain and body unhappy. Why? Because it puts us in a state of chronic stress and begins depleting our psychological resources. I like to think of this as the Donut Dilemma. I love donuts. Yes, I know…you do too. But you don’t fully understand what I’m saying here. I LOVE donuts. Of course, I limit my consumption of them but every so often I’m overcome with the thought, “man, it sure would make me happy to eat a donut.” So I break down and buy one. And, for a short time while I’m savoring the delicious pastry, I do feel pretty good. But then I swallow the last little bit and almost immediately I think, “I sure do wish that had been a bigger donut.” You know that feeling. As soon as I’ve reached the goal (eg, eating a donut) my brain is looking for the next one. Case in point, positive psychology researcher Dr. Sonja Lyubomirsky surveyed several people making roughly PAG E 24 | CV M A VOICE 2019 : 2
$30,000 a year and asked them, “How much money do you need to make to feel truly happy?” The average response was $50,000. She then asked the same question to people making $100,000 a year. Logically one might think these people might be twice as happy as those making $50,000. Alas, on average, they said they would need to make about $250,000. What about people making a cool million annually? Well, those folks felt they would need to make $3 million a year to feel “truly happy.” Our brains are incredibly adept at adapting to external stimuli and circumstances. All of us have walked into a room with a strange odor. Ever notice how after a few minutes the odor seems to disappear? That’s a form of physiological adaptation. When it comes to things like emotions and feelings our brains are also wired for what psychologists call hedonic adaptation. The raise to $50,000 feels good right now. But in short order it just feels “normal” and we begin looking for another raise. And we do this in veterinary medicine. All. The. Time. Some examples: • If I just get into vet/tech school, I’ll be happy. • If I just graduate, I’ll be happy. • If I just get a job in a vet hospital, I’ll be happy. • If I just get a raise, I’ll be happy. • If I just see one more client, I’ll be happy. • If I just learn this new skill, I’ll be happy. • If I just get a day off, I’ll be happy. • If I just improve my/the hospital’s ADT/new client numbers/gross revenue/net income. . . . I’ll be happy Any of those sound familiar? They do to me because I subscribed to almost all of them. And I actually succeeded at many of them. And still, I burnt out. The problem with these kinds of goals is they are seeking an internal result (happiness) by way of an external motivator (eg, getting a raise). We need to flip the script and begin building habits of seeking external results (impact) by way of internal motivators (meaning). I’ll explain. Our brains are hardwired for purpose. When we are behaving in ways that contribute to the betterment of others the “happiness trifecta” of neurotransmitters begin surging through our bodies. As a result, areas of the brain primed for innovation, creativity, learning, and social connection turn on. We also build psychological reserves of resilience and feel motivated and energized. Quite literally, when we feel we are living purposefully, we find meaning in the work we do and, as a result, “feel good.” Unlike with my donut addiction, our brains don’t adapt as quickly to this sense of wellbeing. And it doesn’t stop there – organizations that cultivate environments in which purpose and meaning are front and center are more profitable, see stronger growth, and enjoy significantly lower employee and client turnover. Right now you might be thinking, “is there a more purpose-driven, meaningful endeavor than the practice Continued on next page
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IN PRACTICE Practice Management: Leadership vs. Management Kat Burns, CVPM, CAWA Director of Operations and Veterinary Services Humane Society of Boulder Valley In the veterinary clinic, the practice manager should be a leader. A leader is someone who, in partnership with the practice owner, shows the way, influences others, and guides the behavior of others through ideas, strength, and actions. What kind of leader are you? Some leaders are teachers—developing skills, empowering others, or creating an environment where their followers can succeed. Some leaders are heroes—putting out the daily fires, finding causes to support, and having a vision. And finally, some leaders are rulers—wielding power, establishing a framework for others to work within, and setting expectations. The truth is most of us are some combination of each style. In our clinics, many of us are hands-on managers, filling in wherever help is needed. There is a difference between leadership and management. Managers are responsible for ensuring that tasks are carried out and that goals are met. They plan, organize, direct, and control the individuals that they manage. Their aim is to see that tasks are completed correctly, efficiently, and effectively. Leaders are not as task- oriented. Leaders also plan—by getting the right people and resources in place, and direct—by inspiring others to accomplish the highest goals. You can be a leader AND a manager.
Leadership, more so than management, requires vision. It means developing and empowering your team, setting expectations and being consistent. It means delegating, empowering, and setting the tone and “culture” for your company. As a leader, it is critical that you have the trust of your team. Without trust there is no respect, and without respect no one is following your lead. Leadership sometimes means doing what’s right, even when that is the more difficult or unpopular choice. Trust and respect enable you to make those hard choices and still keep your team cohesive. n
Are you developing yourself as a leader? CVMA’s Power of 10 Leadership Academy for Doctors and Practice Managers is an excellent way to grow your leadership skills. The program is designed to help veterinarians and practice managers develop foundational skills in leadership, communication, and business—and, participants receive a complimentary registration to CVMA Convention where they will be recognized for their achievements. Interested in applying? Mark your calendars—applications will open again in spring 2020! Check out colovma.org/power-of-ten for more information.
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of veterinary medicine?” And you have a good point. The work we do is steeped in purpose and meaning. The problem is we don’t act that way intentionally. We fail to leverage our greatest strength. When was the last time you talked to a colleague or co-worker about what gives them meaning in their work? When was the last time you actively considered the contribution you made today in other people’s lives? When was the last time you collectively considered the purpose of your hospital/organization and developed a clear vision of what it looks like when the purpose is coming to life? And if you’ve done any of these things, consider this—how many
times since have you talked about, thought about, planned around external goals like financial metrics? I’ve never met a veterinary professional who didn’t believe in the value of preventive medicine. And yet, as an industry, we tend to view our wellbeing crisis in a reactionary way. I’m grateful for the tools we have for treating mental distress and illness and the people out there meaningfully yielding those tools. That said, I believe these younger sciences such as positive psychology and neuroscience are uncovering tools that give us a real shot at well-being “preventive medicine.” We need only do the hard work of embracing them. n
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IN PRACTICE Three Ways to Help Your Clients Say Yes! Wendy Hauser, DVM Peak Veterinary Consulting Client relationships can be one of the most rewarding aspects of the veterinary profession and can cause the most discomfort too. A recent study1 identified client issues as the second most prevalent practice-related stressor for veterinarians. In this study, client issues were sub-categorized as “clients unable or unwilling to pay, unrealistic expectations for treatment, lack of compliance or responsibility for the pet, and expectations of availability.” What is the responsibility of the veterinary team to help clients to be able to “say yes” to clinical recommendations? This article will look at some of the most common ways veterinary hospitals unknowingly sabotage their efforts to gain client buy-in: Inadequate communication and the lack of clear, consistent recommendations. The importance of proactively helping clients plan for the costs of care for their pets will be discussed, and three tools to help clients “say yes” will be explored. Communication In multiple studies2,3,4 the communication skills of veterinarians have been identified as one of the primary factors in developing strong bonds between the practice and the client. The Lue study2 demonstrated that when veterinarians were good communicators, the result was a “40% increase in clients who follow directions.” What makes a veterinarian a good communicator? Studies by Coe3,4 identified a major disconnect in how veterinarians make recommendations to clients when compared to what clients need. Veterinarians discuss clinical recommendations in terms of discernible measures like the length of time needed for the veterinarian to deliver the service, the special equipment or training involved, and additional support staff needed. These explanations are offered to justify the costs of the recommendation in a highly analytical, less emotional approach. From the client’s perspective, Coe found they wanted to understand how the recommendation would have positive impacts on the health of their pets. Good communication happens when animal health care teams work to understand the client’s perspective, including their personal beliefs and goals for their pet. When care options are presented in a manner that underscores how the recommendation will benefit the pet, and by extension the client, clients become active partners in the decision-making process. This is collaborative care at its best, a joint venture between the veterinarian and the client to provide optimal care for the patient. Clients feel valued, understood, and satisfied. Clear, Consistent Recommendations Why aren’t hospitals better at defining policies and procedures? I don’t believe leaders consciously decide not to have clear guidelines; the lack of defined processes evolves due PAG E 26 | CV M A VO ICE 2019 : 2
to passivity and lack of awareness of the value of hospital standards. During his study2, Lue found that a primary reason clients didn’t adhere to veterinary advice was not due to cost, but because they were confused and misunderstood why the recommendation was made. There was a lack of perceived value that resulted in declined recommendations. Implementing clearly defined policies and procedures will: • Build teamwork and increase team member job satisfaction. • Provide a coherent framework for team and client communications. • Establish clear expectations for veterinary team members in how they do their jobs. • Serve as training tools for new employees, both doctors and animal health care team members. • Help to support a defined hospital culture. • Provide a process for reviewing what is working well and what could be even better yet. • Provide a consistent client experience. While establishing written processes might seem overwhelming, it is not difficult once the commitment is made. The following questions will help direct the development of guidelines: • How does your hospital regularly evaluate services offered? • How does the service offered fit with your culture? In other words, do you feel good about performing this service? • Does the service offered provide a clear benefit to the client and the patient? • Is the service offered in a manner that meets or exceeds best practices medicine? • Does the service offered make good financial sense? • Which recommendations are met by confusion or inconsistency, either by your clients, animal health care teams or both? Do both your clients and employees understand the “why” behind the service, and can they easily explain it? As a practice owner, I critically examined how and why I offered services on an annual basis. There were procedures that were “purposefully abandoned” when they failed to meet the criteria above. The result of this exercise allowed my hospital to focus on meeting client needs as well as allowing my team to be true to their collective values. Adoption of policies and procedures occurs more readily when the processes come from the stakeholders. In my hospital, medical protocols were designed by the doctor team. Technicians and assistants were crucial in identifying and solving communication challenges in the examination room as well as defining expectations in other hospital sections such as hospitalized patient care, anesthesia, surgery, and dentistry. I depended heavily on my manager and on the customer service representatives to design methods to optimize the client experience during appointment scheduling, check-in, and the invoicing processes. Continued on next page
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All newly created policies and procedures were reviewed by the hospital leadership team. Once the methods were fine-tuned, the new guidelines were discussed, and training occurred during staff meetings. Preparing Clients for the Costs of Pet Ownership Coe’s 20074 study evaluated the outcomes of focus groups of clients and of veterinarians regarding each group’s perceptions of the cost of veterinary care. He found clients had concerns about the lack of discussion regarding the cost of care, preferring these conversations to occur early in the course of an office visit. At the same time, clients also expressed that they expected pet care to be the primary focus, with the cost of care a secondary consideration. Veterinarians expressed frustration in trying to meet these two disparate requests, while battling their personal unease that in monetizing pet care, some clients might choose less than optimal treatment with negative consequences. In Coe’s studies, it was found that pet owners wanted a proactive discussion about anticipated health costs. Experienced pet owners understood the costs associated with preventive care but wanted to be informed about new costs. New pet owners preferred transparent conversations regarding the cost of all services. One simple solution is to educate clients early about the costs of pet ownership, beginning with the first visit. Veterinarians can explain the general course of pet owner expenses by life stage, with pets less than one and greater than six requiring more frequent visits and services, therefore requiring more financial resources. Conversely, young adult to adult pets typically use fewer financial resources, barring unforeseen injuries. By “signposting,” your clients can see what lies ahead and can plan for future expenses. Signposting can be reinforced at the end of each visit by summarizing what the pet will need in the next year of its life, and when the next examination should be scheduled. There are some resources that will help clients prepare for future expenses. As a trusted partner in the care of your patients, these three tools should be presented the same way any other clinical recommendation would be discussed, with a clear explanation of how the recommendation will benefit both the pet and the pet owner. These critical tools are: 1. Pet health insurance: Pet owners have indicated in surveys7 that they purchased pet health insurance for emotional, not financial reasons. Owners of insured pets state that the three most important factors in obtaining coverage included “a sense of security,” “it is recommended by my veterinarian,” and “it is recommended by veterinary staff.” These survey results underscore the value clients place on their relationships with veterinary teams when deciding how to strategize around the cost of care for their pets. It also highlights the trust that pet
owners place in animal health care teams to provide the best recommendations for the care of their pets, including financial solutions. 2. Preventive care plans: Whether offered in-hospital or as an endorsement to a pet insurance product, provide a pathway for your clients to understand how recommended products and services will help to keep their pet healthy. In multiple studies2,5,6 clients have expressed their preference to pay for this care in monthly installments. 3. Third party financing: Many options for third party financing exist. It is recommended that clients secure a line of credit before they need it, creating a health safety net for the patient and allowing the client to focus on the care of their pet, not the cost of care. Conclusion I have never met a client that truly did not want to do what was best for their pet. Treat your clients as “honored guests,” providing clear explanations of why and how your clinical recommendations will benefit their pet. This requires attention to how things are said and how consistent client experiences are created. Set the expectation with your team that financial discussions are a critical part of every examination. Clients deserve to receive the best clinical recommendations; how to financially provide care for their pets is one such recommendation. References: 1. Vande Griek O, Clark M, Witte T, Nett R, Moeller A, Stabler M. Development of a taxonomy of practice-related stressors experienced by veterinarians in the United States. JAVMA, volume 252, No. 2, January 15, 2018 pp. 227–233. 2. Lue TW, Pantenburg DP, Crawford PM. Impact of the owner- pet and client-veterinarian bond on the care that pets receive. JAVMA, Vol 232, No. 4, February 15, 2008. Pgs 531–540. 3. Coe JB, Adams CL, Bonnett BN. Prevalence and nature of cost discussions during clinical appointments in companion animal practice. JAVMA, Vol 234, No. 11, June 1, 2009. Pgs. 1418–1424. 4. Coe JB, Adams CL, Bonnett BN. A focus group study of veterinarians’ and pet owners’ perceptions of the monetary aspects of veterinary care. JAVMA, Vol 231, No. 10, November 15, 2007. Pgs. 1510–1518. 5. Volk JO, Thomas JG, Colleran EJ, Siren CW. Executive summary of phase 3 of the Bayer veterinary care usage study. JAVMA, Vol 244, No. 7, April 1, 2014. Pgs. 700–802. 6. Volk JO, Felsted KE, Thomas JG, et al. Executive summary of the Bayer veterinary care usage study. JAVMA, Vol 238, No. 10, May 15, 2011. Pgs. 1275–1282. 7. NAPHIA, Research Report 2016, “Driving Growth of Pet Health Insurance” About the Author: Wendy Hauser, DVM is AVP, Veterinary Relations, Crum & Forster Pet Insurance Group. In 2015, she established Peak Veterinary Consulting, after working as an industry Technical Services Veterinarian. With a DVM from OK State in 1988, she has practiced for 30 years as an associate, owner and relief veterinarian. She is highly engaged in AAHA leadership and currently serves as the AAHA Delegate to the AVMA House of Delegates. She is the co-author of “The Veterinarian’s Guide to Healthy Pet Plans.” n CVMA VOI C E 201 9 :2 | PAGE 27
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IN PRACTICE Celebrating New Skills, Knowledge, and Character at Convention 2019 Rebecca Rose, CVT Denise Mikita, MS, CVT CATALYST VetPC Team For the fourth year, CATALYST VetPC is honored to design and host the CSU Veterinary Student Roundtable Discussion at CVMA Convention 2019. We create these interactive sessions with a twist! We fondly refer to these discussions as “Speed Sessions.” Students arrive and select a table. After each presenter (or “discussion facilitator”) introduces his or her topic, they each pick a table to sit at initially. They foster candid conversations from the students for 15 minutes on the topic. Then the facilitator moves to the next table to meet with a new group of students for another 15 minutes. Each presenter has an opportunity to share his/her wisdom and answer questions in rapid fire! It’s informative, builds networks and, most importantly, is FUN! Some of the past topics included: • Self-care and wellbeing tips: Put your oxygen mask on first before assisting others • Green and red flags in hiring: What to look for and what to steer clear of during the search for first employers beyond graduation • Jobs, internships, and residencies: Defining and discussing the pros and cons • Limiting beliefs about money: The “I’m not in it for the money” belief and its ability to create turmoil and internal conflict During CVMA Convention 2019 in Keystone, Colorado, the CSU Student Speed Session will focus on the topic of Celebrating New Skills, Knowledge, and Character! Speed facilitators this year include CVMA members Dr. Sam Romano, Rebecca Rose, CVT, and Ben Schaefer of Bank of America. What does this have to do you? How does a veterinarian with years of experience in the field embrace a recent graduate’s newly acquired skills, knowledge, and character? You may recall the anxiety you felt when first starting out and wanting to build relationships with your veterinary team and clients. You probably were eager to share your new skills, knowledge, and character. Embracing a recent graduate’s skills may include adjusting approaches to telehealth and telemedicine. The younger veterinary student (“millennials” and “Gen Z”) now brings both book knowledge AND technology. This is shifting the way veterinarians are delivering medicine (whether you want to shift or not). Their skills in technology began developing at a very young age. A smart phone has been in their hand since their teens or younger and they are WICKED GOOD at using it! How will you maximize their skill in technology? PAG E 28 | CV M A VO ICE 2019 : 2
The demand for veterinarians and their services continues to remain high and veterinary unemployment is below the national level. There are more jobs than there are applicants and there are more veterinarians wanting to work fewer hours for less compensation, preferring to focus on wellbeing.1 High on a new graduate priority list is finding a veterinary practice and team with a healthy culture and work environment. They are choosing well-managed practices with strong leadership and systems in place to support a healthy lifestyle and personal wellbeing. How will you leverage your healthy work environment to attract fresh new talent? Finally, you can make a difference in a student’s career. Add your name to the list of CVMA Send-a-Student sponsors. CATALYST VetPC has been supporting students in this fashion since 2015. We are grateful to be given the opportunity to fund a CSU veterinary student’s attendance to convention. We challenge you to do the same! Have you registered for convention yet? Registration is now open! Register before July 26 for early bird pricing: colovma.org/convention. We’ll see you there! References 1. Market for Veterinarians Still Strong. JAVMA. November 2018. https://www.avma.org/News/JAVMANews/Pages/181215e.aspx n
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IN PRACTICE Five Steps to Improving Employee Retention Rates Sarina Wijts, CVT Practice Coach, Veterinary Growth Partners As we run our course through the 21st century there is no doubt that technology and new ideas are whizzing by at lightning speed. No longer are we trying to keep up with the Jones’ but now we are trying to surpass the Jetsons (for those of you under 30 these were popular TV shows). We may not be flying to work just yet, but we do need to make sure that we are offering opportunities to our team members that create a very different benefits package from the past. Previously a week vacation time and a periodic raise did the trick but with employee turnover rates exceeding 40% (#separations/#employees in a time period×100) in the veterinary field (national average in 2018 around 22%), we need to listen to what the future demands. Here are five steps you can take to encourage personal and professional growth, create engaged employees, and increase retention rates in your practice. 1. Real-time coaching process When I entered the workforce, I remember the feeling of anxiety when my first annual review loomed over my head. I was afraid of what they were going to tell me. Was I failing at my position? Disappointing my team? No. I was excelling at a pace they were not familiar with, but I didn’t know where I stood since real-time coaching opportunities were being missed! Managers and team leaders, get up out of those chairs and leave your office! Get to know your team by walking the floor 2–3 times per day. Have normal conversations about their personal lives; you will become less frightening as a boss and more relatable as a co-worker. Then you will start to see opportunities for in- the-moment coaching. It is as simple as saying “great job! I love the way you just handled that patient” or stepping in and saying “Can I give you some feedback? Here is how I like to hold for this blood draw, you will see that it. . . .” Opportunities for growth and appreciation don’t have to wait until a review. 2. Quarterly team check-ins Team members appreciate honesty and clarity; the days of checking in with your employees once a year are long gone. Your annual reviews should serve as a reflection of the year, a “photo album” commemorating the items you have already discussed and illustrating the successes and opportunities for the future. Depending on the size of your team, it may be best to stagger the quarterly and annual reviews to not get bogged down one month out of the year. Instead, plan on 1 or 2 each month. Team check-ins are not only for the staff but for the leaders of the practice too! Here is an illustration of the mentor chain:
This way the practice manager can discuss team goals and leadership opportunities with the department leads, and department leads discuss personal and professional goals with their team members (if you have a staff <10, the practice manager can be responsible for all meetings). I would recommend following a format for each discussion and keeping notes; start with a review of their previous goals, discuss their successes and opportunities, then end by creating new quarterly SMART (Specific, Measurable, Achievable, Relevant, and Time-Oriented) goals. 3. CE budget and opportunities As a child, we learn that if we put a bug in a jar and close the lid the bug will not survive. It could very possibly be our first lesson in learning to let go. Inevitably, our team members will eventually move on and the question is what do they offer to the practice while here and how do I want to be remembered when they reflect on their career? Personally, I have always preferred to be the person who helped them pave the road to bigger and better opportunities than the one that placed them into the jar and closed the lid. I strongly recommend writing clear guidelines and a budget for continuing education for the entire team. You can create a tiered format where they receive a specific amount of funding based on their position and their credentials, with requirements as to how many CE credits you expect each person to receive per year. Have your team fill out an application for CE to be approved by the leadership team and then have the team bring the new education back to the practice. I would also support paying your team members when they attend CE during regularly scheduled hours; this enables the newer members of your team access to knowledge without the worry of losing money. They may find a new passion and grow with the company—SCORE! 4. Team trainings and meetings Training is not just for new employees, and sometimes in the veterinary field we often forget about that. Let us stop throwing new team members to the wolves and implement strong and fun processes to onboard and engage our new team members. Phase training offers a great check-list to monitor progress within the practice and if paired with clearly defined pay scale levels you can continue phase training throughout the career of your employees (monitored through the quarterly check-ins mentioned above). I fully believe that we should NEVER stop learning. Gallup’s Continued on next page
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IN PRACTICE Continued from previous page
latest report, How Millennials Want to Work and Live, reveals that 59% of millennials say opportunities to learn and grow are extremely important to them when applying for a job. I am going to let you into a big secret, an untapped resource, wait for it. . . . meetings! Now as soon as I say the word “meetings” about 75% of you will probably have a picture painted in your mind of team members falling asleep after a lunch and learn while you drone on about updates. This is not the meeting that I am speaking of. We need to utilize this gathering time to elevate each other. The key is to have a set time, set place, set agenda, and create attendance standards. Here is an example of how I formatted my meetings through the month in my last practice (we closed every Wednesday from 12–2 for team building): Week 1—Team member training: Every employee chose a topic that they were passionate about and were assigned a date to present this topic (content was approved by the leadership team and a quiz at the end of the session was required). I found that if a staff member is passionate about something, who better to train the rest of the team! Passion is contagious and it allows client service team members to better understand the technical aspects and visa versa, technicians learn about the challenges of handling client interactions from your client service team. Week 2—Department meetings: This time can be spent reviewing and updating processes and brainstorming on the months challenges to find solutions. It teaches the team to divide and conquer together! It is always fun to do a quick team building game like three truths and a lie during these meetings. Week 3—All staff: Spend this time celebrating your team members’ anniversaries and birthdays, updating and discussing interdepartmental processes, identifying and solving issues, mapping out goals, and releasing the details for the next awareness campaign. I always closed by reading all of the notes in the candy jar (compliments) and our ABCD nominations (Above and Beyond the Call of Duty-each team member could nominate one person per month and the winner chose a gift card and received recognition on social media for their actions). Week 4—Rotate between team building events: This can include scavenger hunts or veterinary Olympics, lunch and learns, and your doctors presenting topics on the services they offer like acupuncture, physical therapy, or TPLOs to keep the team up to date on services and products you offer. 5. Communication Skills and Emotional Intelligence Growing up in the age of technology also means that we tend to lose sight of personal interaction and
communication. To elevate the client service your team offers, I recommend implementing communication skills training and emotional intelligence training into your practice. A fter all, how will a client service team member know how to react to an emotional client if they themselves cannot identify emotions and read a person’s body language? This will not only improve the experience for your clients, but also enrich the lives of your team members. A few ways to implement these tools are to start a book club, attend a VGP Commando Conversations Workshop or EQ seminar, or dedicate five minutes of your all-staff meeting to a different topic each month (use TED talks or exercises like the Johari Window). The possibilities are endless. A practice that invests in its team will have a team that invests in the practice. Through creating engaged employees, you will see a lower turnover rate, team accountability, and an elevated client and patient bond with the practice. Always remember the saying from “Field of Dreams”: “If you build it, they will come!” n
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IN PRACTICE I Have a Degree and Enormous Student Debt—Now What? A Guide to Ownership David King, DVM, CVA Simmons Southcentral Many moons ago, the recently graduated DVM had several options when deciding on a career path. Most of the time the path led to practice ownership; now, however, that may not be the case. Reasons may include a fear of taking on even more debt, watching a window slowly close on starting a family, or even just a lack of desire to take on the risks and responsibilities as a practice owner. However, for those without the above reasons who still see practice ownership as the path to independence and financial security, the path has become harder. This is due in large part to the ever increasing market share of corporate consolidators (CC). The consolidators are actively pursuing the multi-doctor, more profitable practices and thus options for the private DVM buyer are becoming more limited. Because of this, it is now vitally important to plan a strategy to obtain practice ownership. The path to owner ship includes three choices: 1. Start a practice; 2. Buy into a practice over time or 3. Buy out a practice. Each option has its own challenges, but with planning, anything is possible. Ownership Choices Start a practice Because of the high costs and the lack of income in the initial period, this option is becoming less common than in years past. This is due in part to the financial pressures created by large student loans, which were not present for veterinarians 20–30 years ago. As a result, it has become hard for young practitioners to have little or no income for any extended period. Also keep in mind that a start-up practice has to compete with the corporate consolidator for not only clients but staff as well. The consolidator can usually offer better pay and benefits than the new startup owner’s cash flow will allow. Starting a practice can still be done, but there is little room for any error. Buy in Buying into an existing practice, especially the practice where the associate is already employed, was a common way a young veterinarian could acquire a large profitable practice. This was low risk for both the selling owner and buying associate as each gained something as the ownership transitioned. Now, if the practice is profitable and desirable, it is in the cross hairs of the corporate consolidator and is challenging for the the associate DVM to make a competitive offer.
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Buy out With corporate consolidators making start-up practices more difficult and taking the buy-in off the table, the last option is to purchase a practice outright. However, even this has been influenced by the corporate consolidators. As with the buy-in, the consolidator has removed all the larger more profitable practices from any consideration by the individual buyer. This leaves only the smaller grossing practices, and practices not on the consolidation radar (mixed animal or less desirable locations) as options for the young buyer. Some might consider these as crumbs but they should be looked as at diamonds. There are many practices on the market that are not consolidation targets that would still make a sound investment opportunity for an individual buyer. Planning This changing landscape of practice ownership now requires the young entrepreneur to start planning even earlier and stay alert to opportunities. If the buy-in path is chosen, be sure it does not result in a dead end after several years of waiting. Too often an owner is swayed by the big payday of a buy-out from a corporate consolidator. While no one can blame the owner for taking the money, this is little comfort to the associate who now must fall back and make adjustments. The best plan may be to always keep an option open to purchase a practice that is not on the consolidation radar. Considering the 1–2 DVM practice that will be grossing less than $1.5M with average profitability can lead to a successful career. Of course, the definition of success is determined by the individual. Success may be defined as the rewards from acquiring this type of practice, serving the community, and providing for family and employees. Here, one may be able to compete with the corporate consolidator on a field where they don’t match up well: The smaller, more intimate practice. Of course, success can also be defined as growing the practice to a point where one day the exit is with a consolidator and that large payday. There is no right or wrong answer, no right way or wrong way to pursue a veterinary career. However, it is best to look ahead and plan, thinking about consequences of path choices and potential outcome. This becomes even more important to the potential practice buyer in this ever changing practice ownership landscape. Practice ownership can be not only achievable, but a rewarding and successful endeavor. n
CHART YOUR 2019 CVMA EXPERIENCE Explore topics that affect your practice, grow your skill set, and connect with your colleagues. CVMA offers you the support and education you need to thrive! July 18
How to Succeed with Demanding Clients
Professional Development Series: Soft Tissue Surgery – CVMA Office, Denver (makeup date from April 10)
How to Engage Callers
Chapter 6 Wellbeing Seminar – Littleton (all members invited!)
Convention 2019 – Keystone
Capture Compliance in the Exam Room
CE Southwest – Durango
It’s How Much? Show Value for Fees
BIG Ideas Forum: Harnessing the Power of CVTs – Breckenridge
Professional Development Series – CVMA Office, Denver
60 Client Service Ideas in 60 Minutes
How to Handle Challenging Callers
Webinar by Communications Solutions for Veterinarians – member discount available!
Listing does not include chapter events – check with your area representative for the latest events.
Learn more and register: colovma.org/ce-events
Health issues affect us all.
These issues can be treated and lives and careers can be saved.
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Services are offered to veterinarians and students as well as veterinary technicians.
If you or someone you know is experiencing problems because of alcohol or other drug use, mental health issues, physical issues, or emotional issues, call today.
Veterinarian Peer Health Assistance Program www.peerassistanceservices.org
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CVMA NEWS C O L O R A D O
V E T E R I N A R Y
M E D I C A L
A S S O C I A T I O N
Chapter Connections CVMA chapter visits are underway!
CVMA has been hard at work hosting 2019 chapter visits. Thank you to all CVMA members who have come out to enjoy an evening of connection with your local colleagues and hear and updates from CVMA on the state of veterinary medicine in Colorado. Haven’t had your chapter visit yet? Watch your email for your chapter visit invitation to arrive! At a CVMA chapter visit, you will: • Enjoy an evening of hosted food, drink, and connection with your local colleagues. • Hear updates from the state veterinarian’s office, worth 1 CE credit hour! • Get up-to-the-minute news on topics including socially conscious animal communities, the latest on CVMA member benefits, and more. Questions about your chapter visit? Contact Ashley L arson, CVMA Chapter Relations Manager at firstname.lastname@example.org. See you on the road! Chapter 6 | Denver Area 2019 is off to a strong start for our members! On May 21, we hosted our first of two CVMA Chapter Visits for 2019 at the ViewHouse in Centennial. The Northwest visit will be held in the fall. We offered 1 CE credit for an update from our state veterinarian’s office, presented by Dr. Maggie Baldwin, and PAG E 3 4 | CV M A VO ICE 2019 : 2
CVMA presented an in-depth advocacy update. We also provided updates on 2019 Chapter 6 priorities: Priority 1—Continuing education with socializing • CE Roundtables with Socializing—6 per year. Minimum of one per Denver area (N, S, W, E, and Central). • On April 28, we held our first joint chapter event at the Wild Animal Sanctuary with Chapters 6, 2, and 7. We offered 3 hours of Practical Behavior Cases with renowned behaviorist Dr. E’Lise Christensen Bell. There was terrific group participation, discussion, and comradery and we are excited to collaborate on future multi-chapter events together. • June 28–30 will be our 2nd annual wellness camping retreat in Golden Gate Canyon State Park. • On August 18, we will host a 3 hour wellness symposium: Wellbeing in Motion: Making your action plan for personal and practice transformation! This symposium will feature Rebecca Rose, CVT and Dr. Laurie Fonken at Hudson Gardens in Littleton. Priority 2—Building community close to home • Spreading event locations across the Metro Area. You will still see 50% centrally located due to our large demographic area and venue availability. • You will see a split between weekdays and weekends based on 2018 survey responses. • Working on increasing relationships with community organizations, such as HABT, DFL, MDAWA, and Peer Assistance Services. • Hosting engaging social events scattered throughout the year. Most recent was the Denver Art Museum tour on May 19. Priority 3—Connect with our members! • New ways to communicate: Brand new private Chapter 6 Facebook group. Group will have discussions, notes from recent lectures, and calendar of events. • Get involved: Volunteer to join our leadership team, host an event, suggest a venue or speaker. This is your chapter, let’s make it great together! Our 2019 goal is to make your membership valuable and take pride in being a Chapter 6 member. Continued on next page
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CVMA NEWS Continued from previous page
As always this is YOUR chapter and we are open to your ideas and feedback. We hope you will join us for at least one of the remaining events for this year and hope you see the value in being a CVMA Chapter 6 member. —Dr. Michelle Larsen President, Chapter 6 Stay connected with news and chapter events—join the Chapter 6 Facebook group: facebook.com/groups/colovma6 Chapter 7 | Colorado Springs Chapter 7 is busy planning and hosting many CE events for members! Here is a brief recap of Chapter 7’s events from this past spring: April: Feline neurology meeting with Dr. Rainier Ko that was very well-attended! Dr. Ko presented case studies regarding feline cases he had worked with and took questions from the group.
May: Dermatology presentation with Dr. Jacquelyn Campbell, covering canine dermatitis mistakes to avoid and otitis externa treatments. June: Chapter Visit. —Dr. Genevieve Grammer Secretary, Chapter 7 n Stay connected with news and chapter events—join the Chapter 7 Facebook group: facebook.com/groups/colovma7
JANUARY 26 - 29, 2020 Vail, CO Learn more at colovma.org/skice
Gregory Ogilvie DVM, DACVIM (SAIM & Oncology), DECVIM-CA CVMA VOI C E 201 9 :2 | PAGE 35
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CVMA NEWS Invest in Your Employees, Save Your Practice From Costly Turnover Everyone knows how costly employee turnover can be. To help hospitals retain employees, CVMA is proud to recognize and certify the designation of CVMA Certified Veterinary Assistant (CVA) as a benefit exclusively for CVMA members. The CVMA CVA program provides continuing education for veterinary medical personnel, enabling them to become more informed, skilled, and trusted members of the veterinary medical team. Investing in your employees saves your practice from having to deal with turnover and costly replacement and retraining efforts. Now offering CVA levels I–III! For CVMA Premium and Core members, the $325 enrollment fee for the CVA program is waived as part of your membership! Learn more at colovma.4act.com. Questions? Contact Sara Eberhardt, CVMA’s Manager of Membership, at 303.539.7275 or email@example.com.
Your solution source For all your animal health needs. 800.824.3703
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CVA Graduates Please join us in congratulating the newest graduates of the CMVA Certified Veterinary Assistant program! Desirae Gonzalez, CVA I PPVM Pets Emergency Hospital Evans, CO Rheagan Eidinger, CVA I Career Center (supervising DVM at Amigo Animal Clinic) Grand Junction, CO Jennifer McConaghy, CVA III Buena Vista Veterinary Clinic, Inc. Buena Vista, CO Kelsey Franusich, CVA I The Meadows Veterinary Center Windsor, CO Shelby Hessenflow, CVA I Brooklyn Veterinary Clinic Castle Rock, CO n
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CVMA NEWS More Than 750 Pets Receive Complimentary Wellness Exams and Rabies Vaccinations during PetCheck 2019 Katie Kethcart, CVMA Communications and Content Manager Thanks to the generosity of CVMA members, more than 750 pets received a much-needed wellness exam and a rabies vaccination (if appropriate) during the 10th annual PetCheck, held April 6 and 7 throughout Colorado. PetCheck is a CVMA community service program that gives members the opportunity to help disadvantaged pets in their community that may not regularly see a veterinarian while also educating the public about the importance of preventive care. Thank you to all 46 member clinics across the state who participated and provided preventive exams and rabies vaccinations to more than 750 pets for PetCheck. In addition to the veterinarians, veterinary technicians, and administrative staff that made the program possible, CVMA would like to thank our generous sponsor, Boehringer Ingelheim—a
global leader in veterinary rabies vaccines—who provided rabies vaccine trays to each participating clinic. Lastly, we’d like to extend a special thank you to the CSU Veterinary Teaching Hospital, particularly CVMA member Dr. Rebecca Ruch-Gallie and her veterinary students for staffing a Community Outreach Clinic in the parking lot of the 9News studios in Denver. Thanks to our student volunteers, we saw more than 60 appointments Saturday morning! We were proud to see the next generation of veterinary medicine in action and pet owners were grateful for their service. n
We’re Good At Heart ONE PRACTICE. MULTIPLE LOCATIONS. COORDINATED, COMPREHENSIVE CARE.
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Veterinary Referral Center of Colorado (VRCC) 3550 Jason Street, Englewood, CO 303-874-2094
Practicing with Excellence, Compassion, Integrity, Approachability and Teamwork | RMVCcolorado.com
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CVMA NEWS Join CVMA and Your Colleagues in Colorado on Facebook!
other members of Facebook; only members of the group can post in the group and see what is posted.
Are you on Facebook? So are we! We’ve been hard at work the past few months polishing up the CVMA Facebook page and creating a closed, private Facebook group, just for you.
Why Join? This is your chance to connect with your colleagues and the CVMA community, 24/7, 365 days of the year! Joining the CVMA Facebook group allows you to:
What Is a Closed Facebook Group? A closed Facebook group is a private, invitation-only community on Facebook. Closed groups are designed to be used by communities of people with similar interests so they can share ideas, exchange information, and ask questions in a private setting. A closed group is different from a regular Facebook page as it is not open to the public and
• Meet other CVMA members and form bonds with new colleagues • See upcoming CVMA events and CE • Ask your veterinary colleagues for practice management tips or advice • Hear about CVMA news and veterinary updates n
Join us on Facebook! Join the CVMA members-only Facebook group: facebook.com/groups/colovma Like the CVMA Facebook page: facebook.com/colovma
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CVMA NEWS Find Jobs and Candidates in the CVMA Career Center Did you know? As a CVMA member, you can search for jobs for FREE in the CVMA Career Center! As a job-seeker in the CVMA Career Center, you have access to:
Ticks and fleas CAN turn my world
• Over 2,500 job listings (nationwide!) • Over 1,500 different employers • Free job alerts • Free posting of your resume • Free resume review
Are you an employer looking to post a job? The CVMA Career Center is the place for you! As a CVMA member, you receive a discount on job postings (call CVMA at 303.318.0447 or email firstname.lastname@example.org to receive your discount code). As an employer in the CVMA Career Center, you have access to: • Over 7,900 searchable resumes • Over 1,000 average views per job posting • Over 1,300 average monthly visitors • Ease-of-use with an email resume alert • Optional enhancements to help you expand the reach of your posting Visit the CVMA Career Center today: careers.colovma.org
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Mark your calendars for the fall Virtual Career Fair! Online Recruiting Event: October 3, 11:00 AM–3:00 PM ET Register to reserve your spot now: tinyurl.com/y4hcrd5r n
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Simmons & Associates has been helping Veterinarians get the most value for their practices for over 40 years. It is our unparalleled expertise and resources that have made us the leaders in veterinary practice transitions. Simply put, we have brokered the sale of more veterinary practices than any other organization. Give us a call and let us maximize the value of your practice.
Kathy Morris, CPA, CVA & David King, DVM, CVA Simmons Intermountain 303-981-7888 | email@example.com practice sales • practice appraisals • buyer agency • sales facilitation • exit strategy
The Cannabis Issue: Featuring how we are tackling cannabis in Colorado, CVMA's new position statement on no-kill, and more.