PVMA Keystone Veterinarian Winter 2022

Winter 2022

Keystone

Official Quarterly Publication of the Pennsylvania Veterinary Medical Association

Itching in the Scratch: Ecto- and Endoparasites in Small/Backyard Flocks p. 13

What’s New in Companion Animal Anesthesia? p. 15 Finding Magic in Medicine p. 24

HERE WE GROW AGAIN! And we have YOU to thank for it

Since we opened our doors in 2019, with a unique approach to advanced dentistry (board-certified veterinary dentist and board-certified veterinary anesthesiologist), we have experienced consistent growth due to your confidence in us for the care of your patients. For that, we profoundly thank you.

Our clients come from all walks of life and many from miles away. But what they all have in common, is a beloved pet with oral cancer or significant dental and anesthetic needs. We are honored to help, and our consistent 5-star online reviews show our commitment to concierge-level care and service.

To accommodate our growth, please join us in welcoming our new team member, Dr. Marissa Berman: DVM: Western University of Health Sciences, College of Veterinary Medicine in Pomona, California Internship: Long Island Veterinary Specialists, New York Emergency Medicine: Five years at a private practice Residency in Dentistry: Private practice in Northern California In her spare time, Dr. Berman can be found with her family, a dog Tater Tot, husband Mike, and twin sons, Tyson and Saxon – preferably doing something on the water.

VDS is the only referral practice in the nation dedicated to advanced dentistry and oral surgery for pets where a full-time board-certified veterinary dentist and a board-certified veterinary anesthesiologist are on staff to ensure the safest and most comfortable experience… and the best possible outcome.

John Lewis, VMD FAVD, DAVDC

Marissa Berman, DVM (Residency Trained in Dentistry)

Elizabeth Goudie, DVM MS, DACVAA

Stephanie “Bryce” Dooley DVM, MS, DACVAA

455 Old Baltimore Pike | Chadds Ford, PA 19317 | (484) 775-0557 | chaddsford@vdsvets.com | vdsvets.com Practices also in Mount Laurel, NJ and Katy, TX

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PA: S����-������� - P������� ����� �������! ����, ����� ������ �������� ���� � �������� ����-���� �������� ��� ����� ��������� ��� ������. S���� ���� ����! ��� �������� ��� R��� ������ ��� ��� ����. (PA8Q8) PA: H��������� A��� - B��� ��� �������, ����� ������ �������� ���� ����, ������������ ��������, �� � ���� �������� ���� ���� ������. B��� ��� �������� ��� ��� ���� ������ ��� ��� ����. (PA919) PA: C������ - S���� ������� ����� ������ �������� ���� ���� ������ �� P���������, H���������, A������ ��� S���� C������. �������� M-F ���� ��������. G���� ����� �������� ���� �������! B��� ��� �������� ��� RE ��� ��� ����. (PA920) PA: W������ - E���������� 1-2 ������, ����� ������ �������� �� � ����� ��������!

W��� ���������� ��������. B��� �������� ��� ���� ������ ��� ��� ����. (PA102) PA: S�������- B��� ���� �������� ������� �� R������ ����. H����� �� �� ���������� 2600 ��. ��. �������� �� �� ��������� ��������. B��� ��� �������� ��� RE ��� ��� ����(PA129) PA: C������ - N���� �� H���������, 2 D�. �������� ���� � ���� ����� �� �����

�������. A ����� ������� �� ��� �������� ��������� �������� � ������ ������� ���� ����� �� ������ ����. G���� ���� ��� ��������� ���������. B��� ��� �������� ��� ���� ������ ��� ��� ����. (PA116) PA: N�������� - R������ �������� �����! S��� ����� ������ �������� ���� � ������ ��� ��������� ����. T�� ����� �� ����� �� ������ �� ��� �������� ��� ���� ������ ��� ���� ��� ����. (PA123) PA: N�������� - 1-2 ������ ����� ������ ��������. H����� �� � ����-�������� 3,700 ��. ��. �������� ���� �� ����-�������� ��� ����-����������. B��� �������� ��� ���� ������ ��� ��� ����. S���� �������� �� ����. (PA111) PA: N������� - S��� ����� ������ �������� ���� PA-NY ������. W���-��������, ���� ���� ��� ������. B��� �������� ��� RE ��� ����. (PA805)

www.simmonsinc.com The Confidentiality Agreement link is on the bottom of the home page. You can also register for the Simmons Practice Watch—when we have a new listing, a notice is sent to the Practice Watch list first.

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Winter 2022

Keystone

Official Quarterly Publication of the Pennsylvania Veterinary Medical Association

Subscriptions: The Keystone Veterinarian is mailed to PVMA Members at no charge as a member benefit.

Subscriptions are available to non-members for $30/year or $10 for a single issue. Please contact Editor@PaVMA.org if you’re interested in receiving the Keystone Veterinarian magazine.

Notice to Readers: Neither this publication, Hoffmann Publishing, nor PVMA assumes responsibility for material contained in articles and advertisements published, nor does publication necessarily constitute endorsement or approval of the advertiser, product, service or author viewpoint by the Keystone Veterinarian, its editors and publishers or the Pennsylvania Veterinary Medical Association. In addition, neither this publication nor PVMA guarantees the accuracy, reliability or completeness of any facts, views, opinions, recommendations, information or statements contained within this publication.

Reproduction in whole or in part is prohibited without the permission of the Pennsylvania Veterinary Medical Association.

w w w. H o f f p u b s. co m

Hoffmann Publishing Group Inc. 2669 Shillington Road, #438 Sinking Spring, PA 19608

For Advertising Information & Opportunities Contact:

Sherry Bolinger 610-685-0914 x202 Cell: 717-979-2858 Sherry@Hoffpubs.com

A Message from the President 6

8

PVMA Team Talk

10 Will You Help Us During

the Season of Giving?

12 Updates in Canine Chronic

Ulcerative Stomatitis

13 Itching in the Scratch: Ecto-

and Endoparasites in Small/Backyard Flocks

15 What’s New in Companion

Animal Anesthesia?

17 5 Ways to Improve

Relationships Between GP and ER Clinics

The Pennsylvania Veterinary Medical Association is dedicated to ensuring the vitality of the veterinary profession by promoting excellence in veterinary medicine, advancing animal health and welfare, and protecting and enhancing human health.

8574 Paxton Street, Hummelstown, PA 17036 717.220.1437 | Info@PaVMA.org | PaVMA.org EXECUTIVE COMMITTEE President Erica Wolbramsky, DVM President-Elect Dawn Fiedorczyk, VMD Vice President Kate Boatright, VMD Secretary/Treasurer Lloyd Reitz, Jr., DVM Immediate Past-President Delinda Zehner, DVM AVMA Delegate Tina Dougherty, VMD

19 How Can We Address the

Rural/Production

Veterinarian Shortage?

21 Getting Your Patients Back

on All Fours

23 Practice Pearls 24 Finding Magic in Medicine 26 The Career Path Less

Traveled

28 Flexible Staffing 29 Member News 32 Classified Ads

BOARD OF TRUSTEES District 1 – Katie Sharp, DVM District 2 – Jody Kull, DVM District 3 – Andrea Carr, DVM District 4 – Sean Smarick, VMD, DACVECC District 5 – Jennifer Koehl, VMD District 6 – Darcie Stolz, VMD District 7 – Marisa Brunetti, VMD District 8 – Kristin Fisher, DVM Veterinary Support Staff At-Large – Nicholas Rivituso, CVT, VTS (ECC) Academic Veterinarian At-Large – Dana Clarke, VMD Production Veterinarian At-Large – Rhett Proctor, DVM Equine Veterinarian At-Large – James Holt, VMD AVMA Alternate Delegate – Kate Boatright, VMD Veterinary Student At-Large – Allessandro Lamachia MAGAZINE STAFF Editor in Chief: Jennifer A. Keeler, CAE Senior Editor: Jaime Markle Editor: Kate Boatright, VMD Editorial Assistant: Julie Myers EDITORIAL CORRESPONDENCE Editorial correspondence should be sent to Editor@PaVMA.org.

A Message from the President

Erica Wolbramsky, DVM President, Pennsylvania Veterinary Medical Association

Vet Med beyond General practice When the theme of Veterinary Medicine Beyond General Practice came up, I wasn’t sure I had anything to contribute. I’m a general practitioner. My days are spent seeing only cats and dogs in a small clinic. I am as close to the caricature of a vet as possible.

My day often starts by going through my inbox. I read over the histopathology from yesterday’s mass removal. I get the radiology report back on the limping dog.

I check the referral reports of a Yorkie that saw a cardiologist and a pit bull that saw the dermatologist. I sign up for a CE about new advances in emergency medicine. Ten minutes into work, and my patients and I have been helped by half a dozen veterinary specialists. Then I call the owner of a pet I did a mass removal on and refer them to an oncologist for chemotherapy. They ask if I do that here. I say, no and that they need to see a specialist. The client is amazed that there are veterinarians who specialize in oncology.

Despite the well-known advances in specialization for human medicine, there is a prevailing notion that a vet is an all-in-one. As if being a veterinarian is one thing and we all do the same job each day in a standard offthe-rack veterinarian costume. It is the image of James Herriot seeing creatures great and small: down cow in the morning, vomiting dog in the afternoon.

While there are still vets who work this way, the tendency in all professions is toward specialization. As good of a vet as you may be, you cannot be all things to all patients.

6 | Keystone Veterinarian

Specialization has allowed us to provide more advanced care for our patients and better work-life balance for ourselves. Compared to James Herriot, I am a specialist.

We as Pennsylvania veterinarians have a legacy in specialty practice. Mark Allam, VMD, Dean Emeritus of the School of Veterinary Medicine of the University of Pennsylvania, is credited as the reason the American College of Veterinary Specialists formed. Dr. Allam assembled the organizing committee and served as the first ACVS Board of Regents chair as well as its first historian. The first elected president of the ACVS in 1966 was also a Pennsylvania veterinarian, Dr. Jacques Jenny, a professor of orthopedic surgery.

These veterinarians envisioned a profession in which those with specific passions and talents could focus their energies and advance the profession. Without them, the landscape of veterinary specialty practice would not be the same.

The fact is that there are many ways to be a veterinarian. Let’s not forget the vets who work outside clinics or who don’t see patients.

Vets who work in academia, politics, and research; manage companies; practice law; and countless others. Our fellow veterinarians are not letting the caricature of a veterinarian pigeonhole them. So, what is Veterinary Medicine Beyond General Practice? It is a constantly evolving, not easily defined, amalgamation of possibilities whose only bounds lie in the imaginations of its members.

THEIR LOVE IS UNCONDITIONAL, AND SO IS YOUR CARE

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Your clients depend on you to help guide them throughout their pet’s lives – as well as at the end of it. As a Paws & Remember provider, you benefit from our specialized staff training, quality education material, dignified cremation services, and memorial items that are tailored to the needs of the pet owner and their pet. These resources will help your clients cope with their loss and remember their beloved companions in a way that is meaningful to them.

Contact us for more information about how we can help you create a more personal memory for your clients.

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Registration coming soon!

Save the dates for the next Keystone Veterinary Conference: REIMAGINED

MAY 5-8, 2022 KeystoneVetConference.org Pennsylvania Veterinary Medical Association | 7

Team Talk

By Ashley Jones, PVMA Member Services Coordinator a challenging environment and difficulty scheduling all the pieces to come together. receive injections. Last year, he was successfully vaccinated without stress for all involved and without needing to use anesthetics.

Our future goals include working with the veterinary team to be able to draw blood through protected contact with voluntary participation. Many of our animals are currently being trained for similar procedures and we’re even going outside the box to attempt to provide treatment to relieve arthritic pain in our older animals through laser therapy.

The world of veterinary medicine covers a wide range of specialties, from tiny pocket pets to animals the size of elephants and many things in between. In addition to my role at PVMA, I have been a zookeeper for almost nine years. In this role, I have witnessed our veterinarians care for creatures as tiny as a bat to as large as our black bears. This has given me a unique perspective on one of the many fields of veterinary medicine.

One of the first challenges our veterinarians face is that not every animal is easily transported to an exam room.

Many of the initial observations are done at a distance and cannot be hands on.

This results in extra planning for their visits because many of our animals need to be under anesthesia for a hands-on examination.

One way we are improving this situation is through husbandry and medical training for the animals. This has become one of my passions, and I personally trained one of our mountain lions to voluntarily 8 | Keystone Veterinarian

I always feel extremely lucky to be involved in figuring out ways to make the veterinary care of our animals easier for both our veterinary staff and the animals themselves. It is a unique experience to observe the problem solving when it comes to procedures like dental work on a bear or neutering a bat that is only about 9 centimeters long and weighs between 25 and 40 grams.

Additionally, a lot of products and equipment on the market aren’t designed for wild animals, so I have observed our veterinary team learning and adjusting equipment designed for cats and dogs to be used on a variety of animals that don’t quite fit that mold. Occasionally, they’ve had to call in help from others to borrow equipment or have our animals visit another location. All of this can create

I know I have “bearly” scratched the surface on my observations of the many unusual situations our veterinary team faces to treat our animals, but I know our zoo staff is eternally grateful for the dedicated care the animals receive. We try to remind ourselves and our visitors just how lucky the animals in our care are to have such a great team committed to keeping them healthy!

Included are some images of me training Rainier or “Ray” for short. Ray is a 7-year-old mountain lion that was found orphaned in Washington state at

4 weeks old. After failed attempts to find his mother, he was deemed unreleasable due to the time he would spend in human care, so the search began for a permanent home for him. At 5-weeks-old, he was flown across the country and has been in our care ever since. I have been fortunate to have been a part of his care team since day one.

About the Author: Ashley Jones joined the PVMA staff in 2021 after having worked as a zookeeper at ZooAmerica in Hershey, PA for the last 8 years. A love of animals has always been part of who she is. She is a 2011 graduate of Shippensburg University where she earned a Bachelor of Science in Biology. At the zoo she joins her passion for training with the idea of creating a positive environment for the animals in her care to voluntarily participate in some of their own veterinary and husbandry needs. A native of the area, she currently lives in Lemoyne, Pennsylvania with her husband Adam, and two rescued animals, a dog named Dingo and a cat named Sky. In her free time, she enjoys volunteering and fundraising for animal rescues as well as traveling the world with her husband, especially visiting his hometown of Sydney, Australia.

Calendar of Events Check out these upcoming PVMA events!

January 20

Virtual Career Fair

March 28

Friends of Veterinary Medicine at the PA Capitol

May 5-8

Keystone Veterinary Conference

October 23

Bark in the Park 5K, 1-Mile Dog Walk & Pet Costume Contest Scan the QR code or visit PaVMA.org for the most up-to-date list of events.

hello WINTER Pennsylvania Veterinary Medical Association | 9

Will You Help Us During the

Despite the challenges that COVID-19 has brought us and the changes we’ve all had to make to adjust to the new way of living and practicing, one thing did not change – the need in our statewide community for the programs administered by Animal Care PA, PVMA’s charitable arm.

Henry’s Helping Paws Program, our FEED initiative, saw a significant increase in the number of senior citizens applying for pet food and veterinary care for their beloved companions.

The Last Chance Program, our CARE initiative, experienced higher than usual usage, with a large portion of applicants being those who were affected

by COVID-19 in some way.

The Scholarship Program, our EDUCATE initiative, had a new record number of applications received; however, we could only provide scholarships to a small amount of applicants.

While utilization of our programs increased during the year, donations and financial support are on the decline. We know this is a challenging time for everyone and we are relying heavily on donations during our Season of Giving to keep up with the demand for our community-based programs well into the new year.

Henry’s Helping Paws Program provides pet food and routine veterinary care for companion animals of senior citizens who demonstrate significant financial need. The pilot program, which started in Chester County, has expanded to include counties surrounding Chester. Our hope is to continue to expand the program throughout Pennsylvania in the coming years. Seniors receive food through several senior centers in their local communities or have it delivered directly to their homes through the Hills to Home program. Over 80 senior citizens are currently enrolled in the program, owning close to 150 cats and dogs. The program requires approximately $30,000 annually to support the current pet owners. With the expansion of the program across the state, we will need several times that amount to be able to help all of those in need.

My name is Mischief and I’m all of 16 months old. I can tell you for sure that my owner is more than grateful for Henry’s Helping Paws and the help we get. I got my name honestly by always getting into trouble and keeping my owner on her toes. My owner has Lymphedema in her arm and if I scratch her, I can put her in the hospital. So, I need my nails trimmed often. This is where Henry’s Helping Paws comes in. They pay for my nail trims every month. They also help with normal care vet bills and shots and pay for the exams I need. We are so thankful for Henry’s Helping Paws to be there when I need to see a vet! I know I have a very long life ahead of me and they’ll always be there for me! A sincere thank you from my owner too!!

Candie Ward with “Mischief”

AnimalCarePA.org 10 | Keystone Veterinarian

The Last Chance (TLC) Program works directly with veterinary practices to assist owners in need of financial help with unexpected care and emergency procedures when no other means exist to cover the costs. Often, the grant helped save animals that would have otherwise been euthanized due to financial constraints. Many of the situations this year were directly related to COVID-19 and job loss. There is no cost for veterinary practices to participate in the program. Animal Care PA would like to see more practices participating so that more animals can be helped when no other financial means are available.

We were out for our morning walk when Rayah slipped out of her harness and ran right for the road. Sadly, Rayah got hit by a car. We immediately went to the emergency vet where it was determined Rayah had a broken leg and would need a surgical repair that was very costly. We were now faced with the options of the costly fracture repair or a full leg amputation and at only 1 year of age, we were struggling with the decision. When I called Animal Care PA and spoke with Katie, she told me about The Last Chance grant program that would offset the cost to repair her broken leg! It was such a breath of fresh air in a challenging time, and it meant that I could more easily afford the repair. Her surgery went well, and Rayah is now on the mend, getting better every day! We are so thankful for ACPA and all they did for our sweet girl! Thanks again!

Alicia Brown (Rayah’s owner)

Animal Care PA also administers a Scholarship Program, providing aid to veterinary and veterinary technology students who reside in Pennsylvania. The Pennsylvania Veterinary Foundation, now Animal Care PA, was created with one sole purpose, to provide scholarships to students. Since then, the program has developed four scholarships: Veterinary Student Scholarship, Veterinary Technology Scholarship, Young Leadership Scholarship*, and a Diversity, Equity & Inclusion Scholarship*. Every year we see an increase in applications and would like to see more applicants receive these scholarships.

I am honored to be the recipient of the 2021 Animal Care PA DEI Scholarship. I’ve lived in PA my entire life, still holding a strong connection to my PA community as I continue my education at the University of Minnesota College of Veterinary Medicine. Being part of a minority group, especially in veterinary medicine, I’ve strived to work towards enhancing diversity, equity, and inclusion (DEI), not just in my hometown communities, but while pursuing veterinary medicine as well.

I’ve helped with educational events as well as events that reach out into the community. This scholarship will allow me to continue my education towards veterinary clinical pathology with externships in my 4th year but will also allow me to continue educational events and help with events based around DEI while feeling a smaller financial burden. I am immensely grateful to Animal Care PA for this scholarship and hope to continue my goals in clinical pathology and DEI work. I want to thank you again for this scholarship!

Em Adam (they/them)

WE NEED YOUR HELP! As you can see, the need is real. In order for these community-based programs that FEED, CARE, and EDUCATE to continue in Pennsylvania in 2022 and beyond, we need your help. Season of Giving is currently taking place, and the hope is to raise $20,000 to help continue the programs into the new year. This campaign will end on February 28, 2022. Please consider making a tax-deductible donation to ACPA. You can quickly and easily donate online at AnimalCarePA.org, scan the QR code below, or send a check to our office at 8574 Paxton Street, Hummelstown, PA 17036. On behalf of the hundreds of animals whose lives are made better and healthier and the students whose debt load is lightened a bit, we thank you for your commitment to our mission and your generosity in giving.

* A joint effort with PVMA

To donate

scan code with your smart device

Pennsylvania Veterinary Medical Association | 11

Updates in Canine Chronic Ulcerative Stomatitis (CCUS)

By Jennifer Tjepkema, DVM, DAVDC

CCUS is a poorly understood chronic autoimmune disease in dogs.1,2 It was initially believed to be a hyperreaction to plaque, but new studies suspect that the etiology is more complex.1,2 Clinically, erosions, ulcerations, or white striae can be observed in the mucosa opposing the dentition.1,2 Most commonly, lesions are observed in the labial mucosa opposing the canines, maxillary fourth premolars, and mandibular first molars or the mucosa of the tongue that contact the teeth. CCUS is thought to be similar to oral lichen planus (OLP) in humans. 1,2 OLP is a chronic immune-mediated disease that affects oral mucosa and skin in people.

Like feline chronic gingivostomatitis, this disease is chronic and can be approached medically or surgically. Neutered males are most commonly affected. Maltese, Cavalier King Charles, Spaniels, Labrador Retrievers, Greyhounds, and Terriers are the most commonly affected breeds.1,2,3 These patients are typically very painful on presentation and have a foul odor coming from their oral cavity. The primary goal of treatment is decreasing the bacterial load in the oral cavity. Accurate and early diagnosis is essential.

Differentials include lupus erythematous, pemphigus vulgaris, bullous pemphigoid, erythema multiforme, epitheliotropic lymphoma, and uremic stomatitis. 1,2 Each dentist approaches these cases differently, with some favoring medical and others surgical management.

Regardless of which treatment modality is favored; dentition with stage 2 or greater periodontal disease should be extracted. In my hands, I approach each CCUS patient differently, keeping in 12 | Keystone Veterinarian

mind plaque control as the number one goal. I look at the systemic and overall periodontal health of the patient, breed, age, and capability of the owner at performing at-home care and willingness to come back for follow-up. For example, in a young Great Dane with mild lesions only opposing the maxillary fourth premolars, I would surgically treat less aggressively and try medical management after a Comprehensive Oral Health Assessment and Treatment (COHAT).

Whereas, I would treat an older terrier with generalized stage 3 periodontal disease, multiple lesions, and extreme pain surgically more aggressively. In some patients, all of their dentition will need to be extracted. The stomatitis disease index (CCUSDAI) can be used to help guide response and therapy.

There are two medical protocols that are currently being used by some dentists and are listed below. These protocols are to be used in conjunction with daily brushing and at-home care. They are started after a professional cleaning and extraction of dentition with stage 2-4 periodontal disease.

Protocols: 1.

PDN protocol: These medications can be combined together in a liquid or a pill and are typically well tolerated: • Pentoxifyline 20 mg/kg PO BID • Doxycycline 5 mg/kg PO BID • Niacinamide 200-250 mg PO BID

2.

Atopica and metronidazole: Liver enzyme should be monitored when taking Atopica.

Atopica concentrations should also be checked to ensure achieving immunosuppression.

Gastrointestinal side effects are the most common.

• Atopica 5 mg/kg PO BID • Metronidazole 10 mg/kg PO SID

References: Anderson JG, Peralta S, Kass PH. Clinical and histopathologic characterization of canine chronic ulcerative stomatitis. J Vet Path.

2017;54(3):511-519.

1

Anderson JG, Kol A, Bizilova P, et al. Immunopathogenesis of canine chronic ulcerative stomatitis. PLoS One. 2020;15(1):eCollection.

2

Maxillary osteomyelitis in two Scottish terrier dogs with chronic ulcerative paradental stomatitis. J Vet Dent. 2011;28(2):96-100.

3

About the Author: Jennifer Tjepkema, DVM, DAVDC is a board-certified veterinary dentist who joined the Animal Dental Center in October 2017 after completing her residency in San Diego. Dr. Tjepkema enjoys all aspects of veterinary dentistry but has specific interests in endodontics and oral surgery. Her research has concentrated around odontogenic tumors, specifically Ameloblastomas. She is happy to announce the addition of a cone beam computed tomography (CBCT) to the York, PA, office.

She can be reached at the Animal Dental Center, 2615 Joppa Road, Suite 101, York, PA 17403, by calling 410.828.1001 or emailing Jennifer.Tjepkema@animaldentalcenter.com.

By Linnea M. Tracy, VMD, MPH, MAM, DACPV

Mites

Parasite awareness isn’t just for mammalian patients! As more backyard chicken flocks pop up across Pennsylvania, there’s no better time to refresh your knowledge of the little organisms that can be a big headache for birds. Parasitism contributes to decreased egg production, weight loss, behavioral issues, feather loss, and physical discomfort. If you don’t regularly see poultry in practice or have been lucky enough to avoid these creepy critters since the North American Veterinary Licensing Examination, here’s a quick refresher of just a few common chicken parasites for your small flock practice.

Northern fowl mites, Ornithonyssus sylviarum, are the mites of greatest concern for most North American flocks. These hematophagous mites spend their entire lives on hens, so the best control strategy is to treat birds directly. If you suspect Northern fowl mites, check the area around the vent for erythema and scabs. You might notice that vent feathers are dirty from mite excreta, and you may even see some of the tiny, brown culprits scurry for shelter under feathers.

Tip-Offs Chickens, like other birds, are careful not to betray illness or infestation. Any of the following subtle signs should prompt further investigation in flocks, as parasites could be a cause: •

Behavior changes—increased anxiety, flightiness, increased vocalization, pecking self or others, depression.

•

Production changes—consistently decreased egg production or weight loss.

•

Changes in appearance—feather loss; reddened, scabbing areas around the vent or under the wings; thickening or raising of leg scales; poor feather condition; comb or wattle pallor; excreta adhered to feathers; loose or bloody stool; abnormally wet litter.

The key to mite control is prevention!

Exclude wild birds from your coop to prevent introduction and keep your coop clean with opportunities for dust bathing.

If you must introduce new birds to an established flock, quarantine newcomers for at least 14 days and regularly inspect them for signs of parasites before introducing them to your flock.

ITCH ALERT! Poultry bed bug infestations can cause significant anemia and drops in egg production.

While poultry mites only occasionally bite humans, both human and poultry bed bug species can infest people and can be carried home (or accidentally carried into a flock). Keep your coops clean and use designated clothing when tending to your birds!

Pennsylvania Veterinary Medical Association | 13

Itching in the Scratch: Ecto- and Endoparasites in Small/Backyard Flocks continued from page 13

EGGS-CUSE ME? Ascaridia galli, the chicken roundworm, is rarely spotted inside eggs. Piperazine usage, an off-label deworming agent that temporarily paralyzes nematodes, may contribute to causing these egg invaders. If a paralyzed nematode is expelled into the cloacal area and regains its movement, it may reenter the oviduct rather than the rectum and be incorporated into an egg.

If you have questions about poultry parasites, get in contact with your local vet school poultry department or state extension agent.

Coccidia Coccidian organisms may be too small to see with the naked eye but can cause flock-wide problems. These protozoa proliferate in the intestinal mucosa, causing loose or bloody stool, weight loss, dehydration, mortality, and failure to thrive. Poultry accumulate immunity to coccidia over time by low-level fecal-oral exposure, but by about 12 weeks of age, minimal oocysts should be found in a fecal flotation (unless you have used medicated feed).

Clinical signs coupled with a bloom of fecal oocysts are a strong indication of coccidiosis.

Treating with a labeled dose of amprolium in the entire flock’s drinking water or feed is typically the most effective method to medically manage coccidiosis. Amprolium’s efficacy may vary by coccidian species, so the best offense is a good defense: Keeping the scratch and coop floor dry, mucking out, and top-dressing the area with shavings can help to reduce coccidian sporulation and the flock’s access to feces.

Worms Intestinal nematodes and cestodes are a frequent refrain in client conversations about poultry. While heavy infestations are a concern for causing poor body condition, diarrhea, and production issues, the occasional intestinal parasite is quite normal for birds with access to outdoor scratch and forage.

Periodic fecal flotations using pooled, fresh flock droppings can be useful in assessing nematode and cestode burden when interpreted in tandem with the flock’s clinical presentation.

14 | Keystone Veterinarian

Sanitation is key in the prevention of endoparasites. Regularly mucking out the coop area and replacing shavings help to mitigate parasite loads, as does rotating your pasture. For cestodes, the single most effective means to reduce incidence is fly control. Place fly tapes or bait jars near, but out of reach of, your hens to decrease their consumption of flies that serve as intermediate hosts of cestodes.

Frequent prophylactic deworming of healthy small flocks is often unnecessary. The development of parasiticide resistance in poultry via overuse presents a real danger to our ability to medically manage clinically affected small and commercial flocks. Judicious use in small flocks should combine assessment of clinical presentation and informed interpretation of fecal flotation results.

About the Author: Linnea M. Tracy, VMD, MPH, MAM, DACPV, is a board-certified poultry veterinarian working with a commercial egg company based in Pennsylvania. She completed her poultry specialty training at the University of Georgia, where she gained experience in various poultry species and production styles before returning to Pennsylvania to practice. Dr. Tracy is passionate about poultry medicine and health education for veterinary professionals and students for both backyard and commercial-scale flocks. She can be reached at ltracyvmd@gmail.com.

What’s New in Companion Animal Anesthesia?

By Jenn Bornkamp, DVM

One of the best aspects of veterinary anesthesia is that even with new anesthetic drugs, techniques, and guidelines that come out, the basics of anesthesia stay the same. Overall, we want to produce an anesthetic experience for the patient that provides multimodal analgesia, unconsciousness, amnesia, and immobility in a safe and effective manner.

Since 2018, there have been various anesthetic and analgesic drug shortages especially with opioids, local anesthetics, nonsteroidal anti-inflammatory agents (NSAID), and anesthetic support drugs such as dopamine, atropine, and intravenous fluids. The Food and Drug Administration (FDA) has a comprehensive list of drugs that are in shortage at their website: bit.ly/fda-drugshortages.

There are several new additions to the veterinary anesthesia and analgesia market including alfaxalone, robenacoxib, and grapiprant. Alfaxalone (Alfaxan Multidose®) is an induction agent that entered the U.S. market in 2012. In 2018, a multidose bottle was introduced

to the U.S. market. Alfaxalone (10 mg/ mL) is a neurosteroid induction agent that provides smooth induction and recovery, has a wide safety margin and minimal cardiorespiratory depression. It can be used for up to 28 days after the vial is broached. It is labeled for use in dogs and cats and some minor species including reptiles, fish, and amphibians.

Robenacoxib (Onsior®) is a coxib NSAID that is approved for postoperative pain and inflammation in cats and dogs for up to 3 days. It can be given as an injection or tablet in cats > 5.5 pounds and > 4 months old; but is only available as an injectable for dogs currently. Grapiprant (Galliprant®) is a unique NSAID as it targets the prostaglandin EP4 receptor antagonist that is associated with the pain and inflammation of osteoarthritis only. It can be used in patients older than 9 months and over 8 pounds, but has not been studied in patients that have heart disease.

The use of local anesthetics and various locoregional techniques in addition to sedation and anesthetic drugs can improve peri-operative pain management.

The “old” local anesthetic and easy-toperform techniques like infiltrative blocks (i.e., testicular or ring blocks), dental nerve blocks, and epidural techniques are still the most commonly recommended techniques. New, advanced techniques like femoral/sciatic and brachial plexus blocks using nerve-stimulation or ultrasound-guidance are also available but require more advanced training.

A new local anesthetic that is improving postoperative pain management is Nocita®. Nocita® is liposomal bupivacaine, which provides immediate analgesia and extends it at the injection site for up to 72 hours. It is approved for use in dogs for cranial cruciate ligament surgery and in cats for onychectomy procedures. However, many hospitals also use it off-label under AMDUCA for other procedures including abdominal exploratory and nonmalignant mass removal, and has been a game changer for postoperative analgesia in total ear canal ablation and mastectomy procedures.

Pennsylvania Veterinary Medical Association | 15

What’s New in Companion Animal Anesthesia? continued from page 15

Many organizations have improved resources for the veterinary community about managing anesthesia in our veterinary patients. The 2020 American Animal Hospital Association (AAHA) Anesthesia and Monitoring Guidelines for Dogs and Cats are available for free at bit.ly/3c2KMWm. The website is full of information about anesthetic drug recommendations, local anesthetic techniques, and how to manage common anesthetic complications including hypotension, bradycardia, hypoxemia, and hypoventilation. The American Association of Feline Practitioners (AAFP) has several free resources available on their website at bit.ly/30eYdzK; some of my favorites are: • 2018 AAFP Feline Anesthesia Guidelines • 2013 AAHA/AAFP Fluid Therapy Guidelines • 2021 AAFP Feline Life Stages • 2021 AAFP Feline Senior Care The most interesting development in the world of anesthesia is the changing pet demographic. The geriatric population comprises 30 to 40% of the pet population. The increase in life expectancy is leading to an increased demand for anesthetic and surgical procedures for the geriatric pet population. However, these are not necessarily the straight forward cases 16 | Keystone Veterinarian

most veterinarians and nurses are comfortable anesthetizing as they tend to have comorbidities like hyperthyroidism, diabetes mellitus, chronic pain, obesity, and other diseases that increase the risk of anesthetic morbidity and mortality.

There are more resources being produced on this topic by anesthesiologists, and in January 2022, an updated version of the book Canine and Feline Anesthesia & Co-Existing Diseases will be released.

Overall, veterinary anesthesia has not changed a lot in the past few years.

Several new anesthetic and analgesic drugs have come onto the veterinary market including alfaxalone, robenacoxib, grapiprant, and liposomal bupivacaine.

The use of pre-visit medications like gabapentin and trazodone in addition to fear-free techniques decrease perioperative stress in our patients. In the next few years, I imagine these techniques will become more prevalent in our field as owners want to decrease stress in their pets. One big takeaway is that despite all the advances in the field of veterinary anesthesia, veterinary anesthesiologists are still adjusting to the new patient populations, demands, and challenges just like you are. Do not be afraid to reach out to a specialist in your area for assistance or visit acvaa.org to find one near you.

References: Grapiprant. Prescription Information. Aratana.

2016.

Robenacoxib. Prescription Information. Elanco.

2017.

Garcia ER. Local Anesthetics. In: Greene SA, et al. Veterinary Anesthesia and Analgesia. 5th ed. Ames: Blackwell Publishing, 2015:332-354.

Lascelles B, Kirkby Shaw K. An extended release local anesthetic: Potential for future use in veterinary surgical patients? Vet Med Sci. 2016 Aug 23;2(4):229-238.

Willems A, Paepe S, Marynissen S, et al. Results of screening of apparently healthy senior and geriatric Ddgs. J Vet Intern Med. 2017;31:8192.

About the Author: Jenn Bornkamp, DVM, graduated from Ross University School of Veterinary Medicine. She did a large animal internship at Iowa State University College of Veterinary Medicien and a residency in anesthesia and pain management at University of Florida College of Veterinary Medicine. She has worked in academia and private practice as a residency-trained anesthesiologist and has recently moved from PA to NJ. She has participated in the Power of Ten Leadership program with the Iowa Veterinary Medical Association and was an AVMA Future Leader. Keep an eye out for her Facebook page, The Anxious DVM, launching soon.

5 Ways to Improve Relationships Between GP and ER Clinics

It’s 4:30 pm on Friday, and you are a mere 30 minutes from closing for the weekend. Your appointments are winding down when the phone rings. Mrs. Smith has just come home and found that her dog Snickers has vomited multiple times. Your client service representative comes to you seeking advice. She has already advised Mrs. Smith that she should seek emergency care, but the two closest ER clinics to your practice are not accepting any non-critical patients for the remainder of the night. The next nearest hospital is an hour away and projects a 6-8 hour wait for stable patients, which Mrs. Smith is not happy about. What do you do?

This situation has become an all-toocommon reality in practices across Pennsylvania—and the country—over the past year. General practices are booking weeks to months out. Emergency clinics are overwhelmed with their normal emergency caseload and additional medical cases that can’t find a GP appointment. It seems no one has the time or resources to keep up with the demand.

for the management teams who have had to make these difficult decisions. No one wants to turn away patients or make them wait in their car for most of the night, but it is our current reality at all levels of practice.

By Kate Boatright, VMD

I have worked in both emergency and general practice during the pandemic. I have seen both sides of the issue, and I understand the frustration on both sides.

As a general practitioner, it used to be a comfort to know that emergency clinics were available to care for my patients on my off-hours. I also had a place to send my critical pets or those who needed more care than I could provide. But now those options are limited.

Emergency clinics have been faced with the difficult decision to limit patient intake, reduce their hours, or discontinue emergency services altogether in an effort to protect their staff from burnout and ensure they maintain the resources necessary to provide adequate care to their inpatients. I have the utmost respect

How did we end up here? It’s a complicated answer with many moving pieces that we’ve been debating for a while now. We can continue to have these debates, or we can start to find solutions.

On a recent episode of the Cone of Shame podcast, David Liss, MBA, CVPM, RVT, VTS, summarized the state of our profession perfectly: “It’s no one’s fault, but it’s everyone’s problem.”1 We aren’t going to solve case backlogs, staffing shortages, and decreased efficiency overnight.2 But there are things we can do in our local communities to best serve our clients and patients while protecting the physical and mental health of our valuable staff members.

1. Client Education There are increasing news reports and social media posts about the state of our profession that are helping to spread continued on next page > Pennsylvania Veterinary Medical Association | 17

5 Ways to Improve Relationships Between GP and ER Clinics continued from page 17

awareness, but we can do more at the clinic level. GP clinics can educate their clients through social media, signage at the clinic, and one-on-one conversations when referring to emergency clinics. Key points to include in client education are: • Expectations for wait times at the emergency clinic. Advise clients that their pet will be assessed at arrival.

If they are waiting, that’s a good thing—their pet is stable.

• Costs of ER care and prognosis. Too often ER clinics receive clients who cannot afford care and make the decision for economic euthanasia or leave without treatment. When possible, providing estimates and an honest prognosis to clients before they head to the ER can save time and heartbreak. Many clients would rather make the decision to euthanize with a staff and doctor they are familiar with than a stranger at an emergency clinic.

• Understanding a true pet emergency and distinguishing what can wait for GP availability.

• Preventive care to minimize the need for urgent visits (i.e., spay to prevent pyometra, vaccination to prevent parvovirus).

• Being proactive if pets are showing early signs of illness to schedule an appointment sooner rather than later before it becomes an urgent matter.

2. Set Boundaries with Clients While most of our clients are pleasant, patient people, we all have stories about the demanding, entitled clients who make everyone cringe. Why do we tolerate and continue to reward bad behavior?

If all clinics started implementing and enforcing zero tolerance policies for clients who are abusive toward our staff, become demanding when we are not able to fill a medication or return a phone call within the hour, or show up late and no

18 | Keystone Veterinarian

show to their appointments, we would begin to reduce that behavior overall.

3. Eliminate the “Us Versus Them” Way of Thinking It is imperative that we form partnerships between clinics in our local communities.

There are more than enough clients to go around. If we are unable to see a client, offering them a recommendation to another local clinic will not decimate our business. Reach out to clinics in your area to establish relationships.

Relationships are especially important between ER and GP clinics. Keeping open communication between GPs and our ER and specialty hospital partners is key to preventing resentment from growing.

Find out what the communication preferences are of your local ER and try to respect them.

If you’re in GP, a call is often appreciated to make sure the ER can take your patient before sending them. Make sure to send records, and if the ER doctor has time, ask if they want a quick case summary over the phone.

4. GPs: Get Comfortable with Basic Stabilization We need to work together and not expect our emergency colleagues to take care of everything. A patient may need to travel hours to reach an open ER, so we need to do some stabilization. Get comfortable with basic emergency assessment and procedures like chest taps, IV fluid boluses, and unblocking cats. Don’t be afraid to give a dose of pain meds for that hit-by-car patient or a dose of furosemide for the patient in heart failure. When in doubt, call the local ER clinic and ask what you can do for the patient in front of you before you transfer them.

5. ERs: Be Ready to Answer Some Questions If you want your GP colleagues to help with managing some of these cases,

you’ll need to be available to answer questions and advise them. You are the experts. Keep the lines of communication open. Provide tips and CE to your local colleagues. If you’ve got time, take the phone call to talk your GP colleague through the case, give an estimate, or confirm your availability (or lack thereof).

Some GPs are afraid of calling their local ERs because of previous experiences where they were brushed aside or felt they were being judged for their handling of a case. We need to repair these relationships by taking the time to have a conversation and understand the limitations that GPs have in available medications and equipment. Let’s work together instead of against each other.

References: Roark A. The new bad blood between GPs and ERs (Episode 90). Cone of Shame [Audio Podcast]. First aired July 22, 2021. Accessed October 25, 2021.

1

Salois M and Golab G. Are we in a veterinary workforce crisis? Understanding our reality can guide us to a solution. Available at bit.ly/3EFyL61. Accessed November 8, 2021.

2

About the Author: Kate Boatright, VMD, is a 2013 graduate of the University of Pennsylvania, and is an associate veterinarian, freelance speaker and author in western Pennsylvania. She is actively involved in the AVMA House of Delegates as well as the current Vice President of the Pennsylvania Veterinary Medical Association. She is a former national officer of the Veterinary Business Management Association. She can be reached at Hello@WritetheBoat.com or visit WritetheBoat.com for more information.

How Can We Address the Rural/Production Veterinarian Shortage?

By David Wolfgang, VMD, MPH In rural areas, a veterinary workforce shortage has persisted for years and appears to be worsening. The shortage appears to be more acute following changes in veterinary practices necessitated in response to the COVID-19 pandemic. National veterinary organizations have explored the issue in an effort to better understand and address solutions to this problem3. A study published in JAVMA ranked the factors that both attracted individuals to a first job as a rural veterinary practitioner/ practice (RVP) and why individuals were no longer in RVP6. This short article will suggest some starting points for discussions that could lead to measures the PVMA or Members could adopt to help ease the RVP shortage.

Both recruitment and retention efforts are necessary to encourage and keep veterinarians in rural areas. With increasing numbers of graduates, now approaching 4,000 per year1, fundamental factors that contribute to a shortage in the rural areas remain2. Large animal exclusive practitioners tend to have a high average salary, but they also tend to become specialists. A majority limit the focus of their practice to one species or even one sector of food animal production (e.g., dairy vs. feedlot)1.

Major changes have occurred in agriculture in the past few decades. Farm numbers have decreased while animal density on farms has greatly increased. Farm support infrastructure is contracting. This matches a model that fosters specialization for a relatively small proportion of the veterinary pool who serve a practitioner/consultant role in the cattle, swine, and poultry industries.

As an American Association of Bovine Practitioner’s study5 reported, most large cattle operations have sufficient veterinary coverage; the real challenge is distribution of veterinarians with a food animal skill set. This is especially lacking in regions with smaller and more diverse food animal herds and flocks. Many young veterinarians are intrigued by diversity in medicine and surgery. In fact, caseload and variety were the third highest ranked factors that attracted veterinarians to RVP. Other factors in the top five reasons for a first job in RVP were practice atmosphere, practice location, mentorship, and quality of facilities and equipment. The same study listed family concerns seventh, salary eighth, emergency duty tenth, and time off

twelfth6. At this time, a great many efforts have been aimed at encouraging more young veterinarians to enter RVP. This remains critical as a great proportion of the pool of candidates who enter veterinary school have little or no exposure to livestock or RVP. Examples for recruitment include exposing more youth to livestock through clubs, private practitioners encouraging youth to shadow them in practice, changes within veterinary colleges to include more food animal curriculum and faculty, scholarships, and in some cases, debt forgiveness. These are extremely important and should be continued and even expanded when possible.

However, it can be argued that the greatest challenge is retaining individuals in rural veterinary practice. For some time it has been known that as many as 80% of veterinarians who enter RVP leave within 5 years2. Similar veterinary service problems exist in Europe2. It is fine to acknowledge the problems; however, addressing and finding solutions has been difficult. In contrast to the factors that attract someone to RVP, the survey of factors also listed why individuals left RVP. This study listed these as the top five: emergency duty, time off, salary, family concerns, and practice atmosphere6. For those who have practiced in a rural, mixed animal practice, these factors as challenges ring very true. It is welcome that more young veterinarians wish to enter RVP, but until there are better solutions to resolve why individuals leave RVP, shortages and poor distribution of veterinary services will persist.

Retaining and enhancing rural veterinary practitioners would be good for the profession as well as enable the profession to better serve clientele in rural areas, improve animal welfare, enhance food safety on small farms, detect and help control emerging diseases, and increase profitability of small farms and ultimately the profitability of RVP. To date, the largest effort to address RVP retention has come via loan forgiveness and grants for training and equipment by the federal government. Specifically, these come from the U.S. Department of Agriculture’s National Institute of Food and Agriculture Veterinary Medicine Loan Repayment Program (VMLRP) and Veterinary Services (VS) grants (websites are listed in the continued on next page > Pennsylvania Veterinary Medical Association | 19

How Can We Address the Rural/Production Veterinarian Shortage? continued from page 19 references for those seeking to apply). Perhaps it is time for state and national veterinary organizations to take greater action and initiatives to address the problems that drive RVP shortages.

The following are offered as starting points for discussion where PVMA and veterinarians within PA can address the RVP issues.

It is hoped that these ideas can be debated vigorously with strategies, better ideas, and innovations emerging.

of bulls and rams, ultrasound for pregnancy in multiple species and back fat analysis, portable x-ray, endoscopic surgery for SA clients). Nearby companion animal practices could offer complete blood count and chemistry screens by adding large animal profiles to their lab repertoire. Such sharing could spread out the cost, improve medical care, and make equipment investments more profitable for all concerned.

First, the issue of profitability has to be addressed. There is no way to sugarcoat the problem of receiving adequate compensation for knowledge and service on many farms versus an equivalent amount of time and skill in companion animal practice. Small farms are very reluctant to pay for veterinary care at a rate commensurate with the medical skill provided. Single animal medical or surgical care is often viewed as a financial loss to the producer, even if the procedure is successful. The PVMA should work to help develop programs that enhance the veterinarian’s ability to teach or coach producers on how to spread the cost of one case into improved herd and/or flock productivity. This adds value even to an emergency call while providing an avenue to reduce future emergency calls. Such changes can increase preventative medicine visits and increase profitability for both parties (e.g., protocols, nutrition for small ruminants, pasture management, reproduction programs, avoidance of parasite and antibiotic resistance). This takes an adjustment in mindset along with additional training, marketing, persistence, and promotion. It is one thing to think about these practice changes versus actually implement them. Faculty at Penn Vet and Penn State Veterinary Extension can be recruited to assist this effort.

This is not an exhaustive list of suggestions on strategies to address the RVP shortage. However, it is hoped that these will serve as starting points for discussion and action. For decades, a shortage in the RVP workforce has been acknowledged. For the good of the profession, animal welfare, and the safety of our food supply, it is time for members of the PVMA to acknowledge and to act more intentionally to solve the RVP shortage.

Second, the PVMA could encourage and help develop a better system to track as well as encourage veterinarians willing to help with relief and part-time coverage. Family and time off concerns were highlighted as especially important to young veterinarians. There are a greater number of veterinarians willing to fill in for companion animals while the pool who are willing to do mixed practice or food animal is smaller. Making it easier to know who and how to contact someone willing to fill in part time could be a win-win for both those offering relief services and those needing part-time help.

Third, experienced mixed and food animal practitioners within the PVMA could serve as mentors to those new in RVP. The PVMA could develop a list of practitioners willing to share their collective knowledge and experience. Mentorship was listed as one of the top factors in attracting veterinarians to RVP. Longer term relationships and the combined knowledge of several experienced practitioners could enhance RVP vitality.

Fourth, equipment is expensive but newer technologies allow more sophisticated practice, which is expected by both companion animal and food animal clients. Equipment could be shared between RVPs. Alternatively, a practitioner could become proficient in a specific technology and serve as a consultant to other RVPs in that region (e.g., breeding soundness 20 | Keystone Veterinarian

Federal grant opportunities: •

National Institute of Food and Agriculture Veterinary Services Grant Program (VSGP) bit.ly/USDOA-VSGP

•

National Institute of Food and Agriculture Veterinary Medicine Loan Repayment Program (VMLRP) bit.ly/USDA-VMLRP

References: Ouedraogo FB, Bain B, Hansen C, Salois M. A census of veterinarians in the United States. J Am Vet Med Assoc. 2019;255(2):183-191.

1

Prince JB, Andrus DM, Gwinner KP. Future demand, probable shortages, and strategies for creating a better future in food supply veterinary medicine. J Am Vet Med Assoc. 2006;229(1):57-69.

2

Salois, M. Are we in a veterinary workforce crisis? J Am Vet Med Assoc.

2021;259(6):560-566.

3

Shortage of veterinarians in rural and remote areas. Federation of Veterinarians of Europe. July 2020. https://bit.ly/3kp3kVo 4

Summary opinion of the American Association of Bovine Practitioner’s Ad Hoc Committee on Rural Veterinary Practice. American Association of Bovine Practitioners. May 2011. https://bit.ly/3kqetWd 5

Villarroel A, McDonald SR, Walker WL, et al. A survey of reasons why veterinarians leave rural veterinary practice in the United States. J Am Vet Med Assoc. 2010;236(8):859-867.

6

About the Author: David Wolfgang, VMD, MPH is a 1982 graduate of the University of Pennsylvania School of Veterinary Medicine. He was in mixed animal practice in Shippensburg, PA, from 1982 through June 1993, and in Warriors Mark, PA, from June 1993 through October 1995. From October 1995 to August 2016, he was Director of Field Investigations and Extension Veterinarian in the Department of Veterinary and Biomedical Sciences at Penn State. From August 2016 through February 2019, he served as the PA State Veterinarian.

He retired in March 2019. He may be contacted at drwolfgang2@ comcast.net.

Getting Your Patients Back on All Fours:

By Robert Sullivan, VMD

Understanding Rehabilitation Medicine

As veterinarians, we took an oath that included, “The prevention and relief of animal suffering… .” Since becoming a veterinarian, the meaning of those words has evolved many times for me. They now include physical rehabilitation and integrated pain management.

Very quickly after learning how to repair ACLs and plate broken bones, I learned that knowing how to repair these maladies was only part of the healing process for our patients. We have to get our patients moving using physical rehabilitation along with appropriate pain medication. I enrolled in the Certified Canine Rehabilitation Program at the University of Tennessee (Knoxville) to learn more.

According to the American Association of Rehabilitation Veterinarians, “Physical rehabilitation is the diagnosis and management of patients with painful or functionally limiting conditions, particularly those with injury or illness related to the neurologic and musculoskeletal systems. The goal of rehabilitation is to achieve the highest level of function, independence, and quality of life possible for the patient.”

During the rehabilitation program at UT, we were introduced to methods to evaluate and measure our patient’s condition at the beginning of therapy and to track their progress during therapy.

Knowing these measurements and comparing them to norms not only help us to create a treatment plan, it gives us data to show owners to demonstrate their pet’s improvement.

Some of the measurements and tools we use include: • Goniometry measures the angles of flexion and extension of the joints.

• Tape measures measure the circumference of the limbs to show loss or gain of muscle mass.

• Video, especially slow motion, aids in determining which limb or joint is in need of attention.

• Force plates, either static or a runway, will digitally show which limb the patient is using less and on which limb the pet is placing more weight.

• Thermography can pinpoint an area of inflammation in a joint, muscle, or tendon.

As important as the objective measurements are, subjective, hands-on exams are essential to determine the source of lameness or pain. Observing the pet’s response, or lack of response, to flexion, extension, rotation, palpation, and pressure will help determine where you need to focus your attention.

Palpating each joint to feel for crepitus, effusion, or warmth will also aid in locating injury or illness.

Simple range-of-motion exercises can be done by the owner and are part of each rehab session in the office. Cross-legged extension, which involves lifting the leg opposite the injured limb to stimulate the pet to extend the affected limb, can be taught to the owner as well. Other exercises, such as wheel-barrowing, walking on hind legs, and sit-to-standto-sit-to-lie-to-sit will also be part of the treatment plan. If capable, the patient can be asked to walk an obstacle course, the easiest being cavaletti rails for the pet to step over.

Core strengthening exercises work on the whole patient, building up abdominal; epaxial; and the small, but vitally important, adductor muscles of the groin and thorax. Leaning, gently pushing the pet forward, backward, or side to side so the pet pushes back at you, are easy to learn and teach. Using exercise balls and balance boards can be added to increase the difficulty and will also allow you to pinpoint specific muscle groups.

Once the patient’s needs have been determined, a plan must be created to return the pet to normal function.

Owners must understand that this is not a short process. Explaining to the owner that a single session is not enough has proven to be our biggest hurdle.

The first, and sometimes hardest, step in rehab is to get the patient moving. For each day of immobility, there can be up to one week of rehab. Owners can play an important role in this stage of treatment.

Typically, when rehabilitation is mentioned, the image is of the underwater treadmill (UWT). The UWT is a wonderful tool for getting a patient to continued on next page >

Pennsylvania Veterinary Medical Association | 21

Getting Your Patients Back on All Fours continued from page 21

For More Information Veterinary Rehabilitation Associations • American Association of Rehabilitation Veterinarians - rehabvets.org • American College of Veterinary Sports Medicine and Rehabilitation - vsmr.org • International Association of Veterinary Rehabilitation and Physical Therapy iavrpt.org Veterinary Rehabilitation Training • Academy of Animal Sport Science academyofanimalsportscience.com » Animal Sports Therapy and Rehabilitation Certification • Canine Rehabilitation Institute caninerehabinstitute.com » Certified Canine Rehabilitation Therapist » Certified Canine Rehabilitation Veterinary Nurse » Certified Veterinary Acupuncture Therapist • Northeast Seminars/University of Tennessee - utvetce.com » Certified Canine Rehabilitation Practitioner Simple At-Home Care for Osteoarthritis • Weight control » Weight loss, weight loss, weight loss • Joint supplements » Chondroitin sulfate, glucosamine » Omega-3 fatty acids • Multimodal pain management » NSAIDs » +/- Gabapentin or pregabalin » +/- NMDA antagonists » +/- Antidepressants » +/- CBD (?)

• Keep those joints moving » Exercise promotes inflammation.

Inflammation is both beneficial for healing as well as detrimental. Antiinflammatories block the negative aspects.

22 | Keystone Veterinarian

move, but it is not required for rehab.

The UWT uses the patient’s buoyancy so the pet is walking while carrying less of its mass. A 100-pound dog in a treadmill filled up to the dog’s shoulder will only be walking on 35% of its usual weight, giving even a limb weak from prolonged disuse a better chance of supporting the pet. And the pet is moving in warm water. An alternative to UWT is to use a folding treadmill to help keep a pet moving.

A swimming pool can also provide weightless movement with a little resistance from the water.

In addition to getting patients moving, treatments that improve blood flow to the affected area are important for success and help to relieve pain. This can be done through warming the affected area with moist heat for 10 minutes prior to any exercise. Other warming modalities include therapeutic ultrasound to warm deeper into tissue and photobiostimulation (laser) therapy.

The skin needs to be shaved for these last two processes to be effective.

Appropriate use of massage will also loosen muscles and improve circulation. Myofascial trigger point therapy is another technique that is used to “release” or relax muscles in spasm.

Sometimes, either through extensive disuse or nerve damage, additional stimulation is required to get the patient to move a limb.

Electrostimulation (stim) uses numerous wave-forms, frequencies, and milliamperes to stimulate the muscles to contract and relax or

twitch to recruit muscle fibers and rebuild some muscle and nerve functions.

Through hands-on patient assessment and measurements, exercise, handson therapy and manipulation, and the use of various modalities, your orthopedic, neurologic, or otherwise motion-deprived pets can get moving again.

About the Author: Robert Sullivan, VMD, graduated from the University of Pennsylvania School of Veterinary Medicine in 1996, then moved to and started working in Montrose, PA. In 2005, he started Southtown Veterinary Hospital, and eight years later, built the current facility, which includes rehab. In 2014, Dr. Bob completed certification in Canine Rehabilitation at the University of Tennessee. He also has special interests in internal medicine, general and orthopedic surgery, and lately, pain management.

Dr. Bob is married to Rebecca and they have two wonderful children, Alannah and Lee John. Over the years, his pets have included ferrets, fish, horses, and rodents.

Currently, the Sullivans have a 12-yearold rescue dog, Hank, a Chesapeake Bay Retriever who spends most days with Dr. Bob at the office. They also have four cats: two pairs of orange siblings, Pumpkin and Blizzard, and Trick and Treat that were orphaned at 5 days old, bottle fed, and cared for by the family. When not in the office, Dr. Bob is tending to his flock of chickens, his beehives, or his garden.

Practice Pearls

By PVMA Partner, FocusHRO

Veterinary Medicine – Your Specialty.

Serving Your Business and Insurance Needs – Our Specialty.

What makes the partnership between PVMA and FocusHRO so special is our commitment to the veterinary industry. Now in our 4th year together, we have created special programs and services specific to the veterinary practices and their employees – and we’re just getting started. Stay tuned for more products and programs that you can only get through your PVMA membership starting in 2022. Great things are on the horizon!

Any good business will know their numbers. As a veterinary practice I’m sure you have a pretty good idea how many patients you see per week, how long you typically spend with each client, and you have enough data to make projections for the future of your business. We operate much the same, and we track how many veterinarian practices we help, the number of different insurances we offer in each practice, and we review these EACH YEAR with you. Having these figures gives us leverage when working with the insurance carriers to help create new programs that will give you an advantage, and having your policies reviewed each year helps ensure you have the best coverages at the best cost.

We wanted to share some of these numbers with you, and some feedback on what your colleagues are saying about the services provided through this partnership.

Since the partnership started in 2018, we have processed 630 deals together. A deal could be a group health plan, a workers’ compensation policy, a professional liability policy, a company handbook, and really any other insurance or employee benefit your company requires. In the past 4 years, we have lost only 2 deals to other providers (not including corporate acquisitions).

This makes our retention rate with PVMA partners 99.99%.

These two deals were lost back in the beginning of 2019 – which means we have successfully maintained and exceeded service levels for the past three years without losing a single client.

Yes, we like to answer the phone when it rings, and we also like to handle your emails/concerns as immediately as possible.

Our specialty is in the design of our business model to help you

as swiftly as possible, and we follow up on every task, every single time. We understand how valuable your time is and have streamlined our operations so you can spend less time with the administrative work involved with insurances and human resources, and more time with the patients under your care.

As mentioned earlier, there will be new programs announced in 2022, and our operations team will continue to develop and refine our processes so that we can be even more efficient in our response and service levels to you.

To learn more about the partnership between PVMA and FocusHRO, please visit FocusHRO.com/PVMA.

Here are some of the things veterinary practices/ clients are saying about the service provided through the partnership with FocusHRO: “FocusHRO makes my life so much easier. They’re very responsive and almost always answer their phone with a human on the other end! I know, crazy, right? Their research and analysis is invaluable. I highly recommend.”

“PROMPT, FRIENDLY, ACCURATE AND JUST AMAZING!!!!!!”

“Very easy to work with, replies immediately and goes out of their way to find answers.”

“Thanks for actually answering the phone!

Always prompt and professional.”

About FocusHRO: Your PVMA Membership gives you and your practice access to FocusHRO’s best programs and pricing. They’ve created “Business in a Box,” which takes the guess work out of running your veterinary practice and lets FocusHRO handle all your insurance, HR/compliance, accounting, and web/IT needs. These services help keep your veterinary practice running smoothly. Visit FocusHRO.com/PVMA or call 717.980.3330 to get more information.

Pennsylvania Veterinary Medical Association | 23

Finding Magic in Medicine: An Ophthalmologist’s Journey Through Cataract Surgery

By Kimberly Hsu, DVM, MSc, DACVO

As veterinarians, we share the goal of improving the quality of life of our patients and of strengthening the human animal bond. For me, as a veterinary ophthalmologist, cataract surgery has always represented my opportunity to, no pun intended, make a visible difference for a patient and their family. As I’ve progressed in my career, this surgery has continued to capture my imagination, challenge me, and inspire me.

Getting My Start: Chasing Magic and Happy Endings It’s cliché, but the day I decided on Ophthalmology specialization was the day I watched my first cataract surgery.

It was the first week of clinical rotations during my final year of veterinary school. I remember marveling in the beauty of the swirling, cloudy lens fragments being aspirated out of the eye.

It felt like magic and medicine had collided, restoring clarity and vision almost instantly. Furthermore, the transformation in our patient – from the nervous, tentative dog at drop-off to the tail-wagging, exuberant dog at pick-up – was dramatic and humbling. That moment where a previously blind dog recognizes its owner and leads the way towards them is nothing short of amazing. I knew that day that my calling in veterinary medicine was going to be to facilitate more joyous reunions.

Taking Flight: Finding My Breath I remember my first complete cataract surgery vividly. Much like playing scales on the piano, I had spent my entire first year of residency practicing each component step of surgery over and over. Despite this, under the magnification of the operating microscope, the trembling of my hands resembled a small earthquake. I tried breathing deeply. When that didn’t work, I tried holding my breath. Somehow, in spite of my nerves, I was able to successfully remove the cataract and place an intraocular lens implant. I think through the intensity of my focus, I forgot to stop and appreciate the significance of the moment. It finally hit me when to celebrate: our ophthalmology technicians made me a nametag sticker that stated in bold letters “I did my first cataract surgery today,” beside which they pasted a purple dog with big googly eyes. It felt like a literal badge of honor, and I wore it proudly.

Holding Steady: Self-Care for the OR With time and practice, I have learned to steady my nerves and my hands. Similar to in a yoga class, during critical steps of surgery, I am acutely aware of my breath and can now control it even in moments of stress. We have all heard, particularly in times like these, that self-care translates into better patient

EXPERT TIP: Are there cataract emergencies? Although many cataracts are slowly progressive and elective cataract surgery can usually be scheduled without urgency, there are exceptions. Cataracts that are rapidly forming, intumescent or ruptured, such as those in young dogs or diabetics, often require aggressive medical treatment and prompt surgical removal.

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care. This is especially true in microsurgery, where finesse and precision are critical.

Like many in our profession, I am an admitted type A perfectionist. I have worked hard to get to where I am largely by working a little harder and a little longer sometimes pushing through exhaustion. This was especially true in my final year of residency preparing for my board exam, emerging from under my mentor’s wing, and learning to be a new mom. My life then, and admittedly sometimes now, was fueled by sheer determination and a lot of caffeine. Cataract and microsurgery days had to be different though. From a very early stage in my career, I learned that in order to bring my best self to microsurgery, I needed to be well nourished, rested, and relaxed.

Of these, sleep is the most critical and one where there just are no shortcuts. I sometimes think that my husband ought to be awarded some sort of prize for best supporting actor in my microsurgical career. Since the beginning, he has facilitated getting a full night’s sleep before surgery days despite the erratic sleep patterns of our tiny humans. Ultimately, I think that the lessons learned from microsurgery extend beyond the OR.

Changing Perspectives Like most newly minted DACVOs, I graduated residency wanting to be exactly like my mentors, for whom I have the utmost respect and admiration. I spent my first two years as a diplomate doggedly trying to replicate their approach to cataract surgery. This utilizes what is termed one-handed cataract surgery, a technique which is widely used across veterinary ophthalmology. To reuse the music analogy, I was like a piano student pounding out the same concerto over and over again. In this case, it was through a single incision utilizing one instrument at a time. I worked hard at my craft, and over time, gained speed and consistency.

Then, about two years after achieving Diplomate status, everything changed. My practice had just upgraded from an older, refurbished phacoemulsification machine to a new unit that is state of the art in both human and veterinary medicine. With this new unit, I had much greater control over machine parameters, which I could manipulate in an instant.

Around this time, I had the great privilege of hearing Dr. Barry Seibel, a renowned MD ophthalmologist, deliver a lecture on phacodynamics. Dr. Seibel explained that with an understanding of lens anatomy and of the forces exerted by the surgeon and machine during cataract surgery, we are able to more efficiently break up a cataractous lens. This required a two-handed approach to cataract surgery. Although a second tiny corneal incision is required, use of a second instrument enables the surgeon to mechanically break up part of the lens, thus reducing

the amount of ultrasound energy needed. The use of a second instrument also enables the surgeon to apply less stress to the fragile lens capsule, which envelops the lens, and to the thin zonular fibers, which tether the lens in place. Dr. Seibel argued that infusion, aspiration and ultrasound energy should be customized to the patient and to the task at hand. In the span of a two-hour lecture, it became clear to me that I needed to broaden my approach to cataract surgery.

Changing My Tune I bought Dr. Seibel’s textbook the instant I landed at home, and spent the next 6 months studying it. Shortly thereafter, I began attending human ophthalmology conferences as well as working with a wonderful local MD ophthalmologist. Watching and training with MD ophthalmologists was like falling in love with cataract surgery all over again. This time, the part that was captivating was in dissecting the surgeon’s approach. When the best human ophthalmologists perform cataract surgery, each movement is purposeful, deliberate, and perfectly coordinated with machine settings.

Applying the principles I’ve learned since residency have proven to be a game changer for challenging and higher risk cases. I love the process of planning my approach for the exact case at hand, and now have more tools to utilize when challenges present at the time of surgery.

I feel like a pianist who, by understanding the basics of music theory, can now create new harmonies and even take the piece off script, so to speak, when needed.

The Journey Continues I do not think that as I sat, awestruck watching my first cataract surgery, that I ever could have imagined the incredible journey this surgery would take me on.

For me now, cataract surgery has many more dimensions than when I first started. It is equal parts strategy, technique, challenge, fun, and inspiration. This is where I feel I’m living my best life professionally and where I continue to evolve as a veterinary ophthalmologist. I remain humbled and inspired to have found such an incredible opportunity to weave both mastery and magic into my medicine. Cheers to many more joyous reunions and happy endings!

About the Author: Kimberly Hsu, DVM, MSc, DACVO, is a veterinary ophthalmologist practicing at Blue Pearl in Malvern, PA. She is passionate about raising the bar, bringing new techniques into the veterinary space. She is one of only a few veterinarians accepted into the American Academy of Ophthalmology and trained to perform retinal reattachment surgery. Dr. Hsu can be reached at 610.296.2099 or kimberly.hsu@bluepearlvet.com.

Pennsylvania Veterinary Medical Association | 25

The Career Path Less Traveled How It Started I was always career curious, even as a student.

During my first year in veterinary school, I considered pursuing a PhD, that led me to participate in a National Institutes of Health summer research program. Three months using a microtome and immunofluorescent microscope, an expert did not make.

Beyond honing my scientific writing and public speaking skills, the experience did steer me to stick to a clinical path. During other summer breaks, I wanted to get a sense of real-world aspects of veterinary care, so I traveled to underserved communities in the United States, Caribbean, and Thailand, volunteering in vaccine and spay and neuter efforts.

These experiences gave me a unique perspective on the myriad of pet owners and barriers to veterinary care across different cultures. When selecting a major, I opted for a mixed animal track, wanting to get exposure to the breadth of species that I would be poised to care for. During my clinical rotations, I had a nascent desire to specialize in cardiology, so I carried out a small independent clinical research project evaluating a nonstandard radiographic measure of heart enlargement under the guidance of my de facto faculty mentor. As a newly minted veterinarian, I completed an academic rotating small animal internship to continue to get acquainted with different veterinary specialties.

To Practice Is to Pivot Not matching to a residency program served to fuel more fire to the embers of my career curiosity. First, I dove into full-time small animal emergency practice, both in corporate general practice and referral practice settings. On my off-days, I led vaccine clinics for companion animals. Then I practiced as a shelter medicine veterinarian. Later, I took on general small animal practice as chief of staff veterinarian that also bestowed me the opportunity to train new graduates. This variety of clinical settings gave me an arsenal of competency in my skills to diagnose, treat, and prevent disease in both individual and cohorts of animals. Furthermore, this range of professional settings gave me a daily opportunity to become a proficient task and time manager, better communicator and teacher to both my hospital team and clients and highlighted the link between good medicine and good business. I was thirsty for more and my curiosity persisted. I wanted to have an opportunity to dive deep into the latest data and research, but with my realworld perspective and clinical lens. I wanted to be part of the 26 | Keystone Veterinarian

driving force that brings new medications and protocols into clinical practice. I dipped my toe into applying to “industry” roles. I did not get the first, nor the second, role I applied for. The third time was the charm. I landed a professional services veterinarian position with an animal health company serving as the subject matter expert to practicing veterinarians on a portfolio of treatments, vaccines, and preventives, as well as a resource to practicing veterinarians. This industry job opportunity has been the catalyst to continued expansion of my veterinary career horizons.

How It’s Going I have been in industry now for four years and currently hold a technical marketing role where I get to utilize my clinical knowledge to inform the scientific and brand messaging of pharmaceutical products by working with all the teams that make development and launch of a medical treatment possible.

I am where I never imagined I would be and carrying out tasks that I did not consciously recognize I was capable—more than capable, in fact—of achieving. I hope to continue to challenge myself with the unexpected and to reach new limits.

All the Places Your Veterinary Degree Can Take You Outside private clinical practice, government (e.g., USDA, FDA, APHIS), academia, and public health are the more recognized career paths for veterinarians. Within the animal and human health industry, veterinarians can hold technical sales, technical marketing, drug safety (aka pharmacovigilance), research (laboratory or clinical trials) and development, regulatory affairs, medical affairs, outcomes research, data analytics, and even lobbying roles, among others, spanning across pharmaceutical, biologics, devices, biotechnology, diagnostics, and nutrition sectors. With more robust experience or training in business and marketing (e.g., MBA), veterinarians can hold roles within business development that include, but are not limited to, assessment of new research, product and technology opportunities, evaluation and implementation of go-to market strategies, strategic planning, market research, and so on.

Many of these tasks can be carried out by veterinarians as independent consultants and can also include lecturing, coaching, professional development, leadership and team training, and medical writing and editing.

If you are curious and seeking a career path less traveled, know that you have an arsenal of skills embodied by your veterinary medical degree and professional experiences. Dive in and proactively search. Network and ask peers for advice.

Be bold and visible on LinkedIn. Best of luck!

References: American Association of Industry Veterinarians: bit.ly/3D8ZAim

About the Aurthor: Joanelle Hernandez-Lopez, VMD, is a native of Puerto Rico and received her veterinary degree from the University of Pennsylvania in 2012. She then completed a companion animal medicine and surgery internship at Louisiana State University. Joanelle then spent 5 years in veterinary practice as a small animal emergency, shelter, and general practice veterinarian before joining Merck Animal Health in 2017. She held a field professional services role in the U.S. Companion Animal business before taking a global technical associate director role of pharmaceuticals with the Global Companion Animal marketing team. Joanelle has traveled within the United States, as well as to Thailand and the Caribbean to deliver veterinary care to underserved communities. She has served on the executive board of PVMA and actively mentors veterinary students. In her spare time, Joanelle enjoys spending time with her husband; two-year-old daughter; dog, Mattie; and likes to cycle to stay active.

Add your voice to the conversation by donating to our Political Action Committee today!

Contributions can be sent to:

Pennsylvania Veterinary Political Action Committee (PVPAC) 8574 Paxton Street | Hummelstown, PA 17036

Corporate checks are not permitted by Pennsylvania law.

PVPAC may only accept voluntary donations from individuals.

Please make your personal check out to PVPAC.

Pennsylvania Veterinary Medical Association | 27

Flexible Staffing Great for Veterinarians and Veterinary Hospitals

By Marisa Brunetti, VMD, Chief Medical Officer, IndeVets At IndeVets, we are on a mission to make veterinary medicine better. We unite top veterinarians and veterinary hospitals to deliver excellent patient care through what we call flexible staffing. As a veterinarian myself, flexible staffing is a new concept, but in my three plus years with IndeVets, it has become a way for veterinarians to improve their own wellbeing while decreasing the burden that our partner veterinary hospitals are facing.

As a profession, we have been on a rollercoaster since the beginning of COVID-19. We are one of a few industries that has done well despite the pandemic.

Survey responses from over 100 of our partner hospitals earlier this year showed 90% of respondents had an increase in appointments between March 2020 and March 2021 because of the demand from new pet parents (pandemic puppies!) and because of new client acquisitions from other veterinary hospitals that can’t fit in these appointments.

What Is Flexible Staffing?

Relief work is a component of flexible staffing. The difference is that a flexible staffing group has a team of full- and part-time veterinarians available to veterinary hospitals in need. Our team provides educational, financial, and emotional support to our veterinarians while they work in hospitals for short or long periods of time. This gives flexibility to veterinarians looking for more balance and coverage for hospitals during staff leaves, vacations, or times of increased demand.

How Can a Flexible Staffing Team Benefit Me as a Veterinarian?

Relief work can provide more flexibility in your schedule, but it will also produce more individual work such as finding 28 | Keystone Veterinarian

your own clients, and providing your own advertising, accounting, and benefits.

Working with a team like IndeVets provides the support you would expect as an associate veterinarian, without someone dictating your schedule:

hours because of COVID-19, consider using flexible staffing to decrease their stress and retain your staff. We need to open our minds to a new way of practicing medicine, and it involves helping each other.

Choose Your Own Adventure

Don’t think of flexible staffing as relief medicine that you use when your veterinarian is on vacation. Other ways to use flexible staffing are to experiment with new or expanded hours, help fill gaps left by a departing veterinarian, and for recurring, long-term staffing placement at your hospital. Outsourcing your workforce has become a more viable option. This gives you the veterinary help you need quickly, easily, and without the need to provide additional benefits.

Veterinary hospitals partner with IndeVets and post their needs. You balance your work around your life and get more c areer and personal enjoyment.

Collaborate With the Team Our Associate IndeVets have an internal communication network to post cases, get clinical and personal advice, change shifts, and meet up. When you work with one IndeVet, you are really working with over 100 veterinarians in multiple states.

Lead by Example Veterinarians are lifelong learners and educators. Working in multiple veterinary hospitals gives you the ability to elevate veterinary medicine, as well as learn new ways of practicing medicine and helping other people.

Mentor Others and Be Mentored in Return At IndeVets, veterinarians are led by other veterinarians. We mentor, shadow, and review each other’s medical records to ensure high-quality medicine and consistent care. We have veterinarians on our team with special skills like acupuncture, surgery, dentistry, and fearfree handling, that are shared with the team when help is needed.

How Can Flexible Staffing Benefit My Veterinary Hospital?

If your staff is feeling the burden of increased client demand with shortened

Plus, working with a flexible staffing team is easy, efficient, and consistent!

Our IndeVets are fully vetted before they join our team and are overseen by veterinarians if you have concerns. Posting your hospital’s needs takes less than 2 minutes on our online portal so you are in control of your hospital’s schedule.

Veterinary medicine is evolving, and many are looking for more balance and freedom to choose how and where they work. Let’s all work together to help as many animals as possible!

About the Author: Marisa Brunetti, VMD, was raised in PA and graduated from Penn Vet in 2010. Since graduation, she has worked in private and corporate small animal practice as well as shelter and forensic medicine. She has been helping IndeVets grow since 2018 and still practices in over 20+ veterinary hospitals in the greater Philadelphia area. Dr. Brunetti is the newest Board Trustee for PVMA, covering District 7. Please check out IndeVets at indevets.com, and contact Dr. Brunetti at marisa.brunetti@indevets.com.

MEMBER NEWS 2021 Keystone Veterinary Conference How Sweet It Is – to see over 400 veterinary professionals, speakers, sponsors & exhibitors at the 2021 Keystone Veterinary Conference in Hershey, Pennsylvania.

Transitioning from the all virtual 2020 KVC into a hybrid of InPerson/On Line/On Demand along with livestreaming was a program goal designed to deliver exceptional education and satisfy the meeting preferences of a variety of attendees.

Keynote Speaker Dr. Carrie Jurney opened the conference with a passionate presentation on mental health of veterinary professionals.

Education sessions kicked off at the Hershey Lodge and virtually with networking mask-to-mask or via the WHOVA app, the KVC event platform.

THANK YOU to our many exhibitors – your partnership with PVMA makes our events possible!

Welcome New Members Dr. Allys Maybank Dr. Shannon Brockmeier Dr. Concetta Buttacci Dr. Lauren Roginski Dr. Jacqueline Andree Dr. Leah Knode Mr. Maxwell Jackson Dr. Michelle Cowley Dr. Joyce Bendokas

Ms. Ashlee Crawford Ms. Chantel Bankert Dr. Lisa Knox Dr. Trina Mathis Mrs. Ashley Nebzydoski Dr. Allison Kachmar Dr. Anthony Rodriguez Dr. Mykela Pacurariu Dr. Hannah Rubasky

Dr. Chelsey Slater Dr. Rebecca Rosenthal Mr. Jesse Erway Dr. Jennifer Friend Dr. Don Heinert, DVM Mrs. Danielle Dianese Dr. Heidi Miller Ms. Krysta Metcalf Dr. Melody Conklin

Ms. Megan Baylor Mrs. Melanie Longo Mr. Eric Salevsky Dr. James Black Dr. Brian Hurley Ms. Kristen Folk Dr. Susan Sickle

Pennsylvania Veterinary Medical Association | 29

Obituaries In memory of…

Dr. Thomas Haas

(excerpt from newrockfordtranscript.com) Dr. Thomas (Tom) David Haas passed away unexpectedly from a short battle with cancer on September 12, 2021, at Geisinger Medical Center in Danville, Penn., surrounded by family and close friends.

Tom was born to Ernie and Darlene (Dodds) Haas on August 29, 1969, in Carrington, N.D. He grew up on a dairy farm near Warwick, N.D., and graduated from New Rockford High School in 1987. During high school, Tom worked numerous jobs, including a season of custom combining and working at Erling Rolfson’s stables tending racehorses. He enlisted in the Air Force after graduating high school and completed his basic training in Lackland Air Force Base in Texas. He was stationed in Germany, Cheyenne, Wyo., and proudly served a tour during Desert Storm. Tom was honorably discharged from the ActiveDuty Air Force to pursue his college career. Tom continued his military service in the N.D. Air National Guard and was honorably discharged in 1993, and further continued his service in the Air Force Reserve and was again, honorably discharged in 1995.

Tom attended Bismarck State College and received his Associates of Arts degree in 1993, followed by a bachelor’s degree from NDSU, and persevered to earn his Doctor of Veterinary Medicine (DMV) from Iowa State University in 2000.

After achieving his DMV, Tom practiced veterinary medicine in Chicago and then ventured on to Augusta, Ga. Tom worked hard his entire life to become the successful person he became; he is truly an inspiration to all who knew him.

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On December 11, 2001, Tom became a proud father to his son, Seth. Tom was a devoted father to Seth and therefore, relocated to Pennsylvania in 2006, to be close to his son, and started working at the Animal Emergency Center, which he eventually purchased in 2007. This was a huge accomplishment for Tom, one in which his family and friends were very proud of him. He received several awards throughout his veterinary career, including the PVMA Public service award of merit for his generous service and passionate dedication to helping countless animal rescues and clients, as well as the very distinguished AAHA accredited-standard of Veterinary excellence award. He was also a member of the American Veterinary Medical Association, the Veterinary Emergency and Critical Care Society, and the American Animal Hospital Association.

After years of hard work and good business decisions, Tom had built such a successful career that he was able to retire in June 2021 at the young age of 51.

Tom’s only concern was “what am I going to do next?” He was known for his love of life and also for his sense of humor, often playing “pranks” on family members as well as staff. Tom was also known for his mentorship of his peers, his work ethic, and also for being a “self-taught” guitar player. Tom loved many genres of music that matched his diversified personality.

He also had many hobbies, including riding motorcycles, ATV’s, and horses. He was a true “kid” at heart, and was quick witted with a funny joke.

Dr. Richard Alan Dubensky

leading community member since then.

Dr. Dubensky served on the planning board for Milford Township for ten years, was philanthropic to many organizations in town including the Pike County Library, Habitat for Humanity, GAIT Therapeutic Riding Center, the Delaware Valley School sports teams and scholarship funds, and was a regular attendee at the Milford United Methodist Church.

As a Veterinarian, Rich was a scientist who used his medical investigative skills to get to the root of the problem. He showed compassion to all animals, large and small, furry, scaly, and feathery. He also showed interest in every client, their hopes, fears, businesses, and leisure activities. He became an inventor and entrepreneur of several products over the last 15 years including beekeeping.

The son of the late Abraham and Mildred (Jaffe) Dubensky, he was born on September 17, 1951 in Lawrence, NY. He was married to Martha (Wood) Dubensky for nearly 40 years.

Rich leaves behind his wife, Martha Dubensky; daughter, Lena, her husband, Mohamad Masri, grandson, Zayd Masri; his son, Trevor Dubensky; and brothers, Mitchell of Washington, D.C. and his wife, Charlotte, and Peter of Bradenton, Fl. and his wife, Fay. He also leaves behind his niece, Caton; cousins: Lydia, Leslie, Pat, Julie, Allison, Phyllis, Ken, and Joyce; and his aunt, Celia; his mother-in-law, Dorothy Wood; brothers-in-law, David and Doug Wood and his wife, Winifred; and nephews Charles and Alexander.

Dr. David Blahna

(excerpt from legacy.com) Richard Alan Dubensky, 69, of Milford, PA, passed away on Wednesday, February 10, 2021 at Good Samaritan Hospital, Suffern, NY. Dr. Dubensky was a Veterinarian who established the Milford Animal Hospital, Milford, PA in 1986, and has been a

(excerpt from pennlive.com) David Gordon Blahna, 74, of Mechanicsburg, passed away unexpectedly on Wednesday, October 20, 2021. He was the son of the late Aldon H. and Barbara J. (Laughlin) Blahna, born

on November 29, 1946 in Bell, CA. He was formally known as David G. Blahna, DVM, PhD, MPH, but better known to his family, neighbors and friends as Dave. He had spent much of his adult life managing a veterinary practice and raising his sons in Minnesota before taking residence in Pennsylvania.

Dave was an accomplished academic, having earned several degrees.

Throughout his life, Dave loved to spend time in the outdoors. As a young man he hiked throughout the western United States and led youth trips. After his own sons were born, Dave instilled in them his same love of the outdoors, leading family camping adventures and teaching his sons to hunt and fish. Later in life Dave took up photography and enjoyed birding with his beloved wife Linda. He proudly honored his Shawnee heritage.

Dave and his brother John made a point of becoming enrolled members of the Shawnee Tribe. Additionally, he helped to extend equal employment opportunities for Native Americans. Dave was also fascinated with the history surrounding

the Civil War. Dave and Linda traveled to several battlefield sites across the United States, and he even became an active member in the Camp Curtin Historical Society and Civil War Round Table. When family and friends would visit, Dave relished the opportunity to lead them on tours through local Civil War battlefields. In retirement, Dave dreamed of volunteering as a guide at the annual Memorial Illumination at Antietam, traveling extensively with Linda, and becoming a grandfather.

Dr. John Fague

November 23, 2020 at his home. He was born Saturday, April 4, 1925 in Pittsburgh, a son of the late Charles and Dorothy (Cruser) Fague. Dr. Fague graduated from the Pennsylvania State College and went on to complete his studies at the University of Pennsylvania School of Veterinary, graduating in 1951.

He practiced veterinary medicine in the Shippensburg area since 1951. Dr. Fague was a trustee at the Shippensburg Public Library, Shippensburg Historical Society, and the Antietam Humane Society. He was a past president of the Cumberland Valley Veterinary Association, Pennsylvania Veterinary Medicine Association, American Veterinary Medicine Association, and Cumberland Valley Chapter of the Veterans of the Battle of the Bulge. Dr. Fague was also a WWII Army veteran and a Bronze Star Medal recipient. He served in General George S. Patton’s Third Army and in the Battle of the Bulge.

(excerpt from legacy.com) Dr. John W. Fague, 95, of Shippensburg passed away the morning of Monday,

Bark in the Park

5K Race | 1-Mile Dog Walk | Pet Costume Contest

October 23, 2022

City Island, Harrisburg OR Virtually

Register at BarkinthePark5k.org Scan QR code

Proceeds Benefit:



RUN | WALK | SPONSOR | DONATE Pennsylvania Veterinary Medical Association | 31

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32 | Keystone Veterinarian 28

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Banfield Pet Hospital | Parma, OH Banfield Pet Hospital is seeking Veterinarians in Parma, OH! Up to $100k sign-on bonus. Are you looking for industry leading compensation and benefits, cooperative and collaborative teams, comprehensive coaching and mentorship, and tremendous growth opportunities? Look no further, because Banfield Pet Hospital is hiring!

Contact: Gregory.Spunt@banfield. com or visit jobs.banfield.com today to learn more.

Johnstown Veterinary Associates Associate Veterinarian needed for a wellestablished AAHA-certified, 3.5-doctor small animal practice in Johnstown, PA 1 1/2 hours east of Pittsburgh, PA. Practice utilizes complete in-house diagnostics and laboratory, high-tech surgical suites, digital radiographs, dental radiographs, ultrasound, laser therapy, oxygen ICU unit, LigaSure, in-house and online pharmacy with medications and prescription foods and Intravet management software. We are seeking an associate who is caring, energetic and client-oriented. Very competitive salary and benefits package that includes paid vacation, professional liability insurance, medical insurance with vision and dental coverage, paid CE, 401 (K) retirement with profit sharing, paid membership dues, and VIN membership.

Contact: Please call Heidi Rizkalla at 814.536.5105 and/or email heidirizkalla@hotmail.com.

Monroeville Pet Hospital An AAHA-accredited, small animal hospital is looking for an experienced full- or part-time veterinarian. We are a fully equipped hospital with in-house lab diagnostics, surgical and dental suites, dental and full-body digital imaging equipment, managerial software and a therapeutic laser. Full-time veterinarians manage 32 to 35 appointment-hours per week (no afterhours emergencies).

You can expect 2 to 3 experienced technicians to assist you. Benefits include health insurance, paid vacation, matching simple IRAs, veterinary memberships, discounts and a generous CE allowance. We are a very profitable pet hospital which is potentially available for buy-in. Contact: Please call Alana at 412.372.1100 or email alanamph@ comcast.net or Dr.OsterMPH@comcast. net.

Elizabethville Veterinary Hospital Full- or part-time, small or mixed animal veterinarian for mixed, predominately

Interested in placing a classified ad? Visit PaVMA.org/Classified-Ads for information on all classified ad placement opportunities. small animal practice in Central Pennsylvania. Experienced veterinarians and new graduates are welcome to apply. We have a fully equipped small animal hospital, farm visit vehicle and experienced team! Practice high-quality medicine in a beautiful area close to urban centers. Contact: Send resume and cover letter to Elizabethville Veterinary Hospital, 269 Camp Street, Elizabethville, PA 17023 or pinemeadowfarm@ comcast.net.

East McKeesport Animal Hospital We are seeking a Medical Director/ Managing Veterinarian with a vision to help grow our hospital, East McKeesport Animal Hospital, while advancing our quality of care. We are located in the Pittsburgh area of PA and are a fullservice animal hospital. We are in the process of a full hospital renovation and rebranding. Our new state of the art facility will include an updated surgical suite and dental suite. If you’re an experienced veterinarian who’s flexible, open-minded, and passionate about creating a vibrate practice, we want to hear from you! Contact: For more information please contact Kelli Dowhaniuk at 818.309.3709 or Kelli.Dowhaniuk@nva.com.

Morrisville Veterinary Hospital Morrisville Veterinary Hospital is a privately owned, small animal practice located in beautiful Bucks County, PA. We pride ourselves in providing compassionate care in a warm and friendly environment. We are currently seeking an Associate Vet to join our team. Responsibilities include: providing comprehensive patient work ups, diagnostic procedures and surgery, communicating and educating clients about all aspects of their pet’s healthcare, prescribing and approving patient medication and maintaining patient records. Candidates must be a DVM or VMD with a current PA veterinary license.

New grads are welcome! We offer a competitive salary and generous benefits

package! Contact: Please submit your resume or CV to the hiring manager at vethosphire@gmail.com.

Murrysville Veterinary Associates Murrysville Veterinary Associates is looking for a veterinarian to join our team. We are a new clinic, AAHA accredited and designed by Animal Arts, the pioneers in the Fear Free hospital concept. Our four doctors offer small animal medicine in a friendly collaborative environment that encourages professional development through peer mentorship. The clinic is equipped with digital radiology and ultrasound, two table surgery, isolation and a fully equipped digital dental suite.

Our team of experienced support staff is dedicated to fulfilling our mission of delivering exceptional state of the art veterinary care. We are located in Pittsburgh’s eastern suburbs close to the city, beautiful Westmoreland County and the Laurel Highlands. Our clients embrace the emergency coverage of AVETS and PVSEC, giving our staff a balanced lifestyle. We offer a competitive compensation package that includes a $10,000 signing bonus. Contact: For more information please contact Dr. Tamara Miller at tlzdvm@comcast.net.

Submitted 10/13/21 Small Animal Practice We are looking for an experienced doctor (at least 2 years out of school) to be a part of our well-established small animal practice. Our technician team is out of this world and make our doctors’ lives very manageable throughout the day. We also handle end of life care impeccably and care deeply about our community.

Our typical schedule is a 4-day work week with no on call, but we are flexible to your needs. If you have a skill set worth adding to the practice, we support the idea and can look into equipment if necessary. Contact: If you’re interested in this position, please email Kelli.

Dowhaniuk@nva.com.

The Animal Wellness Clinic Career Opportunity in Adams County!

Four day work week! Associate Veterinarian needed for AAHA accredited small animal privately owned practice.

The Animal Wellness Clinic offers a convenient location and competitive benefits package. Contact: Call Dr. Flake at 717.337.2785 FMI. The Animal Hospital on the Golden Strip The Animal Hospital on the Golden Strip in Williamsport, Pennsylvania is hiring a diligent and driven Managing Veterinarian/Medical Director. You will be responsible for providing medical leadership for a team of collaborative veterinarians and crafting an environment that fosters teamwork and quality medicine. You will also partner with the Hospital Manager to ensure the success and growth of the hospital and work with Divisional Leadership to accomplish hospital goals. Contact: If you’re interested in learning more and to apply visit bit.ly/3Ed07k2!

Leader Heights Animal Hospital Leader Heights Animal Hospital located in York, the heart of South-Central Pennsylvania, is hiring a passionate and self-motivated Associate Veterinarian to join our growing practice. You have the opportunity to enjoy a 4-day work week, with Sundays off and every other Saturday (until noon). Leader Heights is most proud of their commitment to a work-life balance, by allowing doctors to make their own schedules and respecting what areas of medicine the doctors are most interested in practicing. Contact: If you’re interested in learning more and to apply visit bit.ly/2XqqLFD! Animal Medical Hospital of State College Animal Medical Hospital of State College located in State College, Pennsylvania is looking for an energetic and teamoriented veterinarian to join our team!

We provide primary veterinary care, including wellness care, general surgery, orthopedic surgery, ultrasound, dentistry, continued on next page >

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clas sifie d ads continued from page 33 and oral surgery to small animals. Our facility includes 4 exam rooms, treatment area, surgery suite, in-house lab equipment, digital dental, and a complete pharmacy, to name a few. Benefits include a competitive salary, full health benefits, 401K with match, CE allowance and days, paid time off, and licensing/ professional dues to name a few.

Contact: If you’re interested in learning more and to apply visit bit.ly/3Chvisz!

technicians Morrisville Veterinary Hospital Morrisville Veterinary Hospital is a privately owned, small animal practice located in beautiful Bucks County, PA. We pride ourselves in providing compassionate care in a warm and friendly environment. We are currently seeking a Certified Veterinary Technician to join our team. You must be able to do: venipuncture, injections (SQ/IM/ IV), IV catheter placement, radiology, animal restraint, surgical preparation/ assistance, anesthesia/monitoring, reading fecals, and processing in-house laboratory specimens. Minimum one year of experience and knowledge of IDEXX Cornerstone software is preferred. We offer a competitive salary, signing bonus and a generous benefits package!

Contact: Please send your resume to the Hiring Manager at vethosphire@gmail. com.

practice managers Cat Hospital At Towson (CHAT) Cat Hospital At Towson (CHAT), a feline exclusive veterinary hospital located in central Maryland, is seeking a fulltime Hospital Manager. The successful candidate would have a bachelor’s degree in business management, CVPM is a plus. Five years’ experience is a must, and experience in managing a veterinary hospital a plus. Must be a self-starter, have a solid understanding of all aspects of management including operations, human resources, financial management, marketing and administrative duties such as but not limited to employee scheduling, hospital maintenance 34 | Keystone Veterinarian

management, etc. The ideal candidate would have strong human relationship abilities including thoughtful and effective communication, delegation, and organizational skills; be task and detail oriented and be able to prioritize tasks and projects, in coordination with regular operations; have knowledge of and or ability to learn veterinary software programs (aka PIMS- practice information management systems), Quick Books, and various practice efficiency tools and platforms; represent CHAT’s Core Values of Compassion, Competence and Commitment by demonstrating the ability to lead with positivity and promote a diverse and inclusive environment based in empathy and respect for coworkers, clients and the community. Contact: To apply please send your resume complete with cover letter and salary requirements along with references to: Shirley A. Lockhart, MBA: Slockhart@lockhartvetconsulting. com.

Centre Animal Hospital We are seeking a veterinary practice manager (VPM) to lead our growing veterinary practice and to help guide our team in a nurturing, positive work culture. The VPM must be able to administer all activities for our privately owned, six-doctor veterinary practice, either by performing duties personally or by delegation. The VPM will assume all the responsibilities of a veterinary office manager and will work closely with the owners to oversee strategy, growth, and daily operations. CVPM desired and/or B.A.; or 3-5 years practice management experience and/or training; or equivalent combination of education and experience. Must possess excellent communication skills. Contact: Please email connie@centreanimalhospital. com.

practices/Equipment For sale Blair County, Central PA Small animal exclusive practice with large animal potential, low hours (8-4 M-F,

some Saturdays) with high profit, soft tissue surgery and preventative medicine, no emergencies. Solar powered building, long term employees. Country area 2-3 hours from DC, Baltimore, Pittsburgh.

Safe low crime area, hiking, fishing, Lake Raystown. Come join the good life!

Contact: Please call or text 814.330.3394 for more information.

Easton, PA ULTRASOUND – Esaote MyLab40 $7500 OBO. System Software VET 13.20. System Licenses VET. Licenses: CARDIAC / OB-GYN / MSK / DICOM / CLIP / CMM / TVM / XVIEW / DOPPLER / CFM / PHASED ARRAY. PROBES – CA 421 VET and CA 123 VET micro-covex included. Manufacturer website: bit. ly/3GzvuFQ. Spec sheet from Davis Medical: bit.ly/3pQxDpW. Contact: todd@cummingsvet.com or cgcdvm@ cummingsvet.com.

Pittsburgh, PA PRACTICE FOR SALE – Small animal practice east of Pittsburgh grossing over $550K. Nice, well-equipped practice.

Practice and real estate offered at $499K. (PA-6050). Call for more information.

Contact: Dr. Kurt Liljeberg of Total Practice Solutions Group at 440.933.4522 or kurt@tpsgsales.com.

Various Locations, PA BUYING OR SELLING A PRACTICE – Buying or selling a veterinary practice? Confused about corporate consolidators? Count on the experience of Total Practice Solutions Group. See our display ad in the printed magazine. Contact: Dr. Kurt Liljeberg for a free consultation! 440.933.4522 or kurt@tpsgsales.com.

Kennett Square, PA Barely used Elsam III lift table by Technidyne. technivet.com. $2,500 Contact: 610.806.3363 or email gyro_ vet@verizon.net.

Shippensburg, PA Veterinary Facility for Lease – Franklin County, PA. A 4,700 square foot facility for rent in Shippensburg, PA. The 2,700 square foot section encompasses waiting

room, small animal surgery, kennel, prep area, lab, and pharmacy. The remaining 2,000 square feet is comprised of a large animal surgery area, 4 stall holding area, and storage. This location housed a mixed animal practice for 45 years and current client records are available. It could now serve as an outpatient large animal practice, small animal practice, specialty or emergency practice. Facility also suitable for grooming, boarding, or other commercial business. Contact: Dr. John Simms at simmsj@cvn.net or 717.262.5098.

Shippensburg, PA 3,200 square foot former mixed veterinary clinic available for rent. Reception area, exam rooms, kitchen, bathroom and large space in back for horses and large animals.

Adjoining kennels and paddocks, ample parking, easy access. Located on 100+ acre private farm. Five minutes from downtown Shippensburg. Building rental includes all

utilities plus driveway/snow maintenance.

Contact: Please call Brooke at 717.300.0882 and/ or email piaffepartners@gmail.com.

relief veterinarians David J. Henzler, DVM, PhD Dauphin, Lebanon, Berks, Schuylkill, Lancaster, Lehigh and York Counties RELIEF VETERINARIAN with 15 years of clinical practice experience, including 3.5 years as a full-time 24-hour emergency doctor. PhD in Veterinary Science.

Serving small animal and exotic practices in Dauphin, Lebanon, Berks, Schuylkill, Lancaster, Lehigh, and York counties.

Available to cover vacations, illness, maternity, and other needs. Energetic with a professional appearance and excellent communication skills. Integrous, dependable, and detailed. “I treat your practice like my own!” Contact: Call 717.341.4357 or email henzlerdvmphd@ aol.com.

Relief Veterinarian Job Opportunity Bensalem, PA Regulatory Relief Vets needed for Parx Racetrack. Please call for more info if interested. Contact: Phone 609.314.0136 Jacqueline Burke, VMD Berks and Bucks Counties 1987 Penn grad seeks part-time employment within 30 to 45 minutes of the Pottstown/Quakertown area.

Special interests in surgery, diagnostic imaging, exotics. Professional, reliable, neat appearance. Contact: Phone 610.754.1155 or email jacquib1018@ gmail.com.

you’re invited...

Friends of Veterinary Medicine Reception at the Capitol

RSVP at PaVMA.org

Join us as we honor friends of veterinary medicine who help us to advance the profession and animal health initiatives in the Commonwealth. See you there!

OR SCAN THIS TO RSVP

March 28, 2022

This event is co-hosted by the Pennsylvania Veterinary Medical Association and the University of Pennsylvania, School of Veterinary Medicine.

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