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Mar/Apr 2014 Volume 8 • Issue 2

In Clinic Laboratory Testing FEAR FREE™ VET VISITS MEAN BUSINESS 12 STRATEGIC PLANNING: WHY THE OLD WAYS DONʼT WORK 16 Q&A: VETERINARY SPOTLIGHT 6

PUBLISHED BY WSVMA: BECAUSE BEING A VETERINARIAN IS MORE THAN JUST A PROFESSION. WSVMA.ORG


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ON POINT Adding practice managers and office staff as members.

PRESIDENT’S MESSAGE 2014 AVMA Leadership Conference.

VETERINARY SPOTLIGHT Practitioners’ perspectives on timely topics.

NEWSWIRE The latest veterinary news in Washington State.

BOARD BRIEFS Governance and the future look of your association.

FEAR FREE™ VET VISITS MEAN BUSINESS Nobody should dread a trip to the veterinarian.

Cover Story

IN CLINIC LAB TESTING

How do we ensure the results we receive are accurate?

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STRATEGIC PLANNING Why the old way doesn’t work anymore.

RELIEF VETS In-state directory of available relief veterinarians.

CLASSIFIEDS Careers & practice listings.


March/April 2014 • Volume 8 • Issue 2 A Washington State Veterinary Medical Association Publication

Editorial & Publications Committee

At the January meeting, the Executive Board voted to approve a change to the WSVMA Bylaws that allow for veterinary staff to become members. While veterinary technicians have their own association, practice managers and other hospital staff don’t have a local network to routinely learn, meet and discuss issues important to their profession. In so many cases, the hospital manager, or designated staff member, relies on the practice owner for information from the state or national associations. And while some may be sent to attend conferences, many just don’t have access to regular CE programs, the latest news, networking with or receiving mentorship from others who face the same challenges. Part of WSVMA’s mission is to raise the level of veterinary practice and contributing to the success of our important staff members helps to do just that. In March, the Executive Board will vote to set membership dues, which are expected to be approximately $75 annually. Membership benefits will include access to the members-only section of the WSVMA website, subscriptions to WSVMA publications, email and news alerts, the membership directory, and the ability to network with other practice staff through a listserv or discussion board or through local meetings. Educational opportunities will include a track at the annual conference on a range of topics as well as webinars and local CE. Currently, we’re partnering with Elanco and MWI on two local groups that meet monthly. We’re also in the process of determining how we can award CE credit for the CVPM through the Veterinary Hospital Managers Association. We’ve started a new committee made up of local practice managers to determine how to best move forward. There’s still room for three more committee members so interested staff should contact the office. To our members who are practice owners, consider signing up your practice manager or staff for membership so they can be of greater assistance to you. Employers must already be members or join at the same time as staff. More information will be sent out in the May/June issue.

Dr. Richard DeBowes Dr. John Cannon Dr. Angela Lehman Dr. Jim McCutchan Dr. Donna Mensching Lexi Scott Dr. Debora Wallingford Dr. Saundra Willis

Editorial Comments & Contributions Please send all comments and/or contributions to:

Washington Veterinarian Magazine 8024 Bracken Place SE Snoqualmie, WA 98065 Tel (425) 396-3191 Toll Free (800) 399-7862 Fax (425) 396-3192 info@wsvma.org Editorial comments and contributions must be received no later than the first day of the month prior to publication. Publication months are January, March, May, July, September, and November each year.

Advertising

Please refer to the Classifieds Section for classified advertising details, rates, and deadlines. For commercial advertising rates and deadlines, please contact the WSVMA office at (425) 396-3191 or info@wsvma.org

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WSVMA Executive Board Executive Vice President Candace Joy

Officers: President

Jocelyn Woodd, DVM

President-Elect Erin Hicks, DVM

First Vice President

Sincerely,

Lisa Parshley, DVM

Past President

James McCutchan, DVM

Spokane

Lakewood Olympia Snohomish

Executive Board: Michael Anderson, DVM Paul DeMaris, DVM David Gill, DVM

Region III

Katherine Hickey, DVM

Region IV

Maurine Fritch, DVM

Region V

Stephen Ruark, DVM

RegionVI

Brian Toncray, DVM Michael Burdette, DVM

Region IX

Diane Pinkers, DVM

Companion Animal Practice

Robert Holt, DVM

Specialty Practice

William Dernell, DVM

College of Veterinary Medicine Student Representative

AVMA Thomas Meyer, DVM Kim Nicholas, DVM Saundra Willis, DVM

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Equine Practice Production Animal Practice

Tamara Walker, DVM Matt Sammons

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Region VII Region VIII

Diana Thomé, DVM Chantal Rothschild, DVM

Candace Joy is the Executive Vice President of the Washington State Veterinary Medical Association. She can be reached at candacejoy@wsvma.org

Region I Region II

Exec. Board, Dist. XI Rep. Delegate Alternate Delegate


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2014 AVMA Leadership Conference

President’s Message By Jocelyn Woodd, DVM, WSVMA President

January is the chilly month in which the AVMA leadership conference is held annually in Chicago, Illinois. This conference is for leaders within the AVMA, the state VMAs and other veterinary associations, and it is also the biannual meeting for the House of Delegates. Washington state was represented by President Elect Dr. Erin Hicks, our Executive Vice President Candace Joy and myself. It was also attended by a chosen emerging leader, Dr. Brian Toncray. Both of our AVMA delegates Drs. Sandy Willis and Kim Nicholas were also present. We arrived January 9th at Chicago O’Hare International airport to 9° F weather and falling snow. Over the previous week the Polar Vortex weather pattern had Chicago in a state of emergency. We lucked out in missing this and were able to get settled into the cozy Westin hotel and prepare for the conference to begin. The morning session on the first day was invaluable training for officers of associations. It focused on communication within boards and committees and specific training for presidents and presidents elect. Important topics included how to stay relevant in an ever changing technological society, and how to hit the ground running as a new president. Some of the time was spent in small group settings with different officers from around the country. This was a time when one could learn from the experiences of others as to how their associations were thriving and gather different ideas that may be helpful. Overall, it seemed that the WSVMA functions very well in comparison to other VMAs. Following this was an inspiring talk from speaker Christine Cashen. The topic was “Get What You Want With What You Got.” She was hilarious as she covered wonderful topics such as understanding different personality types, how to handle conflict like a pro, and how to use humor to increase job satisfaction. One of her mottos’s was BOOGIE: Be Outstanding or Get Involved Elsewhere, complete with hand motions. She also suggested the 10 coin challenge where you put 10 coins in one pocket and place one in your other pocket every time you say a positive comment to anyone in your presence. Of course the goal is to have the first pocket empty early in the day! The House of Delegates District Caucus meetings were in the

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afternoon covering a wide variety of issues in the various regions of the country. Saturday was again a very busy day beginning with a breakfast buffet at 7:30am. We then headed to the Plenary session of the AVMA. This is where anyone is able to stand up and voice concerns or opinions to the House of Delegates. Our very own Erin Hicks was quite vocal and brought up many excellent issues regarding governance of the AVMA. Following this, I attended a seminar on how to be an Ambassador to our profession, including how to speak to elected officials, the media, state regulators and community leaders. This was very interesting, and we learned five introduction sentences to use in these situations. The second series of workshops was entitled Flawless Strategic Planning. The strategic plan is the most important document of any organization. Ideally there are four to six strategic goals under the one mission statement of the association. Such goals as LEAP: Lead, Educate, Advance and Protect is one example. Then the various strategies to achieve those goals are developed. The current goals of the WSVMA are: Membership, Governance, Administration, Programs and Services, Public Relations and Marketing, Advocacy, Communications, and Career Performance. There are a number of strategies established under each of these goals. Currently, within the WSVMA we are recreating our mission statement, vision statement and strategic goals. Later in the afternoon the House of Delegates winter session convened to vote on various resolutions. Included were the AVMAs position on jerky treats, homeopathy and whether to discontinue accreditation of foreign veterinary schools. The final day session was a dramatic lecture by economist Dr. Lowell Catlett. He discussed that contrary to popular belief Americans have greater spending power than any other time in history. He states that in 2012, the U.S. became the worlds first 16 trillion dollar economy and is therefore poised for phenomenal growth in the business sector. As I left it was warming up to a balmy 45 degrees in Chicago, and I headed back to Spokane, where a frigid high of 38 degrees awaited. Its always good to be back in the great Pacific Northwest!


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Veterinary Spotlight

Practitioners’ Perspectives on Timely Topics

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Describe your favorite case in which the ability to do in-house diagnostics (excluding radiography) made a significant difference in the patient outcome?

Describe your favorite case in which a clinical pathologist’s review of a blood smear significantly contributed to reaching an accurate diagnosis and implementing appropriate therapy?

Gordon Jewett, DVM

Benjamin Hart, DVM

All Creatures Veterinary Clinic Spokane, WA

Fairwood Animal Hospital Spokane, WA



“It has been very interesting and rewarding to see the development and applicability of in-house diagnostic equipment over the course of my practice career. In the early 1980’s, practices which had in-house diagnostics were the exception rather than the rule. Having a nearby human hospital which would agree to attempt to perform hematology or chemistries was a definite advantage in improving patient care. Having a veterinary reference laboratory was pretty much confined to major population centers or at best one had to rely on time consuming carrier services. As companies began to offer in-clinic hematology and chemistry machines, the situation improved, but there were many frustrations associated with these developing technologies. Cost was a big factor, both upfront and continuing maintenance. The most frustrating factor was the inherent complexity of the equipment and quality control factors. Many who initially embraced the attempt at advancement were sorely disappointed, I being one of them. I resisted adopting the technologies until they became user friendly and reliable. Now I consider them to be almost indispensible in helping us to provide appropriate, timely, and cost effective medical and surgical care for our patients. The truly indispensable component is the human, in this case, the veterinary technician, who generally runs the samples, and in the case of the hematology results, contribute greatly in obtaining a true diagnosis. A recent case illustrates my point. A new patient, “Beebs,” a DSH NM, completely outdoors lifestyle, presented with the history of anorexia and lethargy of two days duration. Clinical examination revealed moderate dehydration, pale and slightly icteric mucus membranes, tachycardia, and moderate depression. He was afebrile. The in-house CBC revealed a severely decreased RBC count and HGB, no HCT value, multiple hematology error warnings, and a normal WBC count and distribution. The chemistry results revealed a moderately elevated ALT and TBIL, decreased CREA and CA. A slide review by one of our veterinary technicians revealed a suspected RBC parasite. Discussion with “Beebs” owner about our findings and potential diagnosis led to the owner declining referral to the local emergency clinic, and our submission of samples for a CBC and FELV-FIV testing to our reference laboratory.”

 “‘Beebs’ test results from our reference laboratory were significantly

more optimistic. His FELV-FIV tests were negative. His CBC revealed a RBC count of 2130, a HCT of 10.5, and a HGB of 3.7. The technician noted that Mycoplasma hemofelis were present. This was exciting. The first case we have ever seen! Final results were pending review by a clinical pathologist. Based on the preliminary results, we initiated tetracycline parentally, and prednisolone per os. This is where it gets interesting. The review by the clinical pathologist came back as “no rbc parasites noted.” A dilemma. Two experienced technicians versus one clinical pathologist. A quick call to the laboratory to visit with the pathologist revealed the original pathologist had been called away unexpectedly. A colleague, with no hesitation, offered to review the slides. “Beebs” had feline infectious anemia. “Beebs” responded rapidly to the initial therapy, and was placed on oral doxycycline elixir and oral prednisolone. A follow up CBC at the laboratory 4 days later revealed a HCT of 29.2, HGB of 9.1, and RBC’s 5330. He is doing great, but his owner still won’t make him a house cat. The equipment is invaluable, but ultimately it is the integrity and professionalism of the people who do the work, interpret the results, and don’t let inadvertent mistakes stand in the way of doing a good job day in and day out.”

 “The ability to perform quality in-house testing consistently improves

the quality of care we are able to provide to our patients at my practice. Having ready access to reliable CBC and biochemistry testing equipment increases pre-anesthetic testing compliance as well as giving us the capability to assess the vital parameters of critically ill patients within minutes. One of my favorite patients was 10 months old when he first came to my practice. I have always had a soft spot for upland bird dogs, and this liver-colored German Shorthaired Pointer reminded me of a dog I had growing up. That day, though, this pup was sick. He was losing weight, lethargic, and had recently started vomiting and having diarrhea. After routine in-house fecal testing yielded normal results, a CBC and chemistry panel was run in our hospital laboratory. I immediately noticed signs of dehydration (hemoconcentration and azotemia), but more importantly the Sodium/Potassium ratio was a mere 18 (n>27)! Even though he was very young, there were reports of a genetic tendency in his breed, and hypoadrenocorticism (Addison’s disease) was strongly suspected based on the results of the bloodwork. Aggressive supportive therapy was immediately started, and an ACTH response was performed and sent out to our reference lab. The pup responded well to his IV fluid therapy and we started corticosteroid supplementation while awaiting the test results. The next day, the reference laboratory confirmed our suspicion and we began treating with Percorten (DOCP) in addition to our other therapy. Treatment progressed favorably, and that ‘pup’ is now 4 years old, well-controlled on his medications, and by all accounts is as normal as a Shorthair can be! Hypoadrenocorticism is something nearly every veterinarian has treated and we all know how important early diagnosis can be to the succsss of treatment. These patients are often critically ill when they come to our hospitals and very often those first few hours can make all the difference. This case is a perfect example of how first-line diagnostics run in the hospital can guide successful therapy.”

 “Another one of my favorite patients is an 8-year-old, female-spayed

Cockapoo. This past year, she presented for acute onset lethargy and inappetance. Initial bloodwork was mostly unremarkable except for a mild non-regenerative anemia (HCT = 31%). Upon rechecking the CBC a short time later, it was found that the anemia had worsened markedly (HCT = 20%), and the Clinical Pathologist’s review of the peripheral blood smear showed moderate anisocytosis, polychromasia, spherocytosis, and occasional nucleated RBCs—consistent with Immunemediated Hemolytic Anemia. Radiographs, a coagulation profile, and a urinalysis were performed and were within normal limits. Standard immunosuppressive therapy with prednisone and azathioprine was started immediately. Unfortunately, despite treatment, the anemia slowly worsened over the next few days. Even though a week had passed since the initial diagnosis, no significant regenerative response was present. Cyclosporine was added to the therapy, and a bone marrow aspirate and concurrent bone marrow biopsy were performed. While awaiting results, the anemia continued to worsen and a blood transfusion with PRBCs was given. The ClinPath review of the BM aspirate and the histopathology were both consistent with an immune mediated response directed at the reticulocyte/metarubricyte stage of the erythrocyte. This explained the lack of a peripheral regenerative response. Fortunately, the cyclosporine worked to suppress the immune response and the dog stabilized. Now nearly a year later, she is doing well and has shown no signs of relapse.”


In memoriam Dr. Jeffrey Mitchell (IL, ‘78) passed away on September 4, 2013 at the age of 67. Dr. Mitchell was the owner of West Olympia Pet Hospital. After receiving a degree in economics from Duke University, Dr. Mitchell enlisted as an officer in the U.S. Navy. Following military service, he went to University of Southern Illinois and received his masters in animal husbandry, and subsequently his DVM degree from University of Illinois. During an internship in Oregon, he fell in love with the Pacific Northwest and opened his practice in Olympia in 1980. Donations can be made in his honor at the Thurston County Humane Society.

WSVMA Awards nominations

Veterinary Newswire The Latest Veterinary News in Washington State

Mandatory prescription bill reintroduced in Congress On February 10, Rep. Jim Matheson (D-UT4th) reintroduced the so-called “Fairness to Pet Owners Act” (H.R. 4023), which applies to drugs prescribed for domesticated household animals. Like its predecessor in the previous Congress, HR 1406, the bill would require a veterinarian to provide a client with a written prescription, whether or not requested by the client. The bill goes further, and would require the veterinarian to provide a copy of the prescription by electronic or other means, if requested by a pharmacy or a designee of the pet owner. Finally, the veterinarian would be prohibited from charging any fee for writing the prescription or asking a client to sign a liability waiver related to writing the prescription. At the time of the bill’s filing, there was only one cosponsor, Rep. Jason Chaffetz (R-UT-3rd). The bill has been referred to the House Commerce and Energy Committee. At the same time, the Federal Trade Commission (FTC) is working on a report with its findings and recommendations following a public workshop it held in October 2012, which examined the competition and consumer protection issues in the pet medications industry. Veterinarians and the AVMA participated as panelists throughout the workshop. It seems premature to consider a “solution,” such as this sweeping federal mandate, prior to publication of the report and clear identification of whether a problem actually

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exists. Please contact your House of Representatives’ member to voice your opposition to the Fairness to Pet Owners Act (H.R. 4023).

Pigs entering WA must be free of PED virus The Washington State Department of Agriculture (WSDA) has adopted an emergency rule requiring all swine entering the state to carry evidence the animals are free of the Porcine Epidemic Diarrhea (PED) virus, a disease which can make adult pigs ill and be fatal to suckling piglets. The new rule took effect February 20, 2014 and will remain in force for at least 120 days. There is no public health risk from the PED virus because it cannot be transferred to other animals or humans, nor can it be transferred through pork products. However, the disease can be fatal to piglets three weeks old and younger. The virus is responsible for the deaths of millions of suckling piglets since it was first diagnosed in the United States last spring. It is unclear how the virus entered the U.S., but it appears to be spread through a range of methods, not just on live animals. In addition to this new requirement, those planning to show their pigs in fairs or exhibits, including 4-H and FFA groups, must keep their swine apart during weighins and tagging activities before the events. For questions, visit WSDA’s webpage on the PED virus or contact the State Veterinarian’s Office at 360-902-1881.

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At the WSVMA Annual Conference September 26-28, 2014 in Yakima, the WSVMA will present awards to those that have contributed significantly to the veterinary profession in Washington. The 2014 awards that will be presented include Veterinarian of the Year, Distinguished Achievement, WSU Faculty Member of the Year, Distinguished Veterinary Staff, Humane Animal Welfare, Student-Recent Grad and Allied Industry. Please submit nominations to the WSVMA office using the enclosed form no later than April 1, 2014.

Congratulations to WSU/CVM’s VBMA chapter WSU’s Veterinary Business Management Association’s (VBMA) chapter recently won first place in the 2013 National VBMA Chapter Awards out of 32 national and international chapters. (VBMA) is a national student-managed organization intent on improving the veterinary profession through increasing business knowledge.

Member News and Moves Dr. James Roloff (WSU, ’74), has published a book chronicling his 37 years as a veterinarian. The book is titled, “Mending God’s Creatures,” a phrase that was on his Medical Lake Veterinary Clinic sign for 25 years, and is a collection of approximately 100 short stories about the misadventures of animals, their owners, and the humananimal bond that exists. Tate Publishing Co. releases the book on March 4, 2014.


Production Medicine The Veterinary Board of Governors will consider rulemaking to define the Veterinarian-Client-Patient Relationship in Washington Administrative Code. A task force was formed in order to gather input from all types of practice, particularly food animal medicine due to tightened FDA regulations when it comes to drug residues in food animals, including food animals in urban settings. WSU/CVM A new Teaching Academy at the CVM has been instrumental in raising the awareness and importance of teaching as well as raising the bar on effective teaching. The Academy hosts workshops utilizing the teaching talents of outside presenters as well as a regular string of in-house ‘brown bag’ seminars utilizing the talents of faculty who are leaders in changing the way we think about teaching. Finance Committee Fiscal year 2012 – 2013 ended with a net profit of $9,586. There was increased income from advertising, administrative services, directory, member programs, interest and the veterinary career network.

Board Briefs

Program Committee

The October 3, 2013 WSVMA Executive Board Meeting was held in Yakima in conjunction with the Annual Conference. Executive Committee Report Regional Animal Services of King County wants to require reporting of pet owners’ contact information for each cat or dog that receives a rabies vaccination in order to increase pet licensure. The WSVMA and Puget Sound VMA together met with county officials and so far have persuaded them not to mandate reporting. The January 23, 2014 WSVMA Executive Board Meeting was held in Olympia at the Water Street Café. WSVMA Mission Statement A new mission statement was approved. The new mission of the WSVMA is “To advance the cause of veterinary medicine and to better the lives of those touched by it.” A new vision statement will be coming soon. Strategic Planning Task Force Due to unprecedented changes in society, associations need to adapt new strategies to remain relevant and address paradigm shifts that affect how associations do business. A plan to restructure WSVMA governance to a small, nimble 5-6 person Board of Directors was presented along with a plan to use the strategic management model to keep organizational momentum aimed in the proper direction. The Executive Board will vote whether to approve the governance structure at the March 28, 2014 meeting in Ellensburg.

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Bylaws Amendment The Executive Board approved a change to the Bylaws to award membership to Practice Managers and hospital staff provided their employer is also a member. Membership dues and benefits will be finalized at the March board meeting. Executive Committee The Executive Committee approved contracting with Mark Funk, public affairs and media specialist, who will work on retainer for issues that arise where the media might be involved. Mr. Funk replaces Charlie Powell who elected not to renew his contract for the new year. Executive Vice President CareCap and the WSVMA will put together a survey to determine how desirable preventive care plans are to the profession and to pet owners. Region 7 The Executive Board appointed Dr. Brian Toncray to the Region 7 position to replace Dr. Mark Shelton, whose second term ended at the end of 2013. Dr. Toncray is a 2013 Oregon State grad and is a small animal practitioner at Countryside Small Animal Veterinary Clinic in Wenatchee. Region 8 The Inland Empire Veterinary Medical Association (IEVMA) awarded a scholarship to WSU/CVM student Jessica Hansen.

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The Executive Board approved changing the name of the WSVMA Annual Conference to the Pacific Northwest Veterinary Conference. The conference continues to grow each year and the name change is part of the current efforts to rebrand the conference. Legislative Advocate A variety of new bills have been proposed by the Governor’s office that if passed will require new revenue sources to pay for them. This could affect the B&O tax rate, which is currently at 1.5%. There is support in the legislature to increase the minimum wage but such an increase isn’t likely to pass this year. There is a bill in committee to ban breed specific ordinances as well as a bill that would require all disciplinary boards to adopt cultural competency education. Efforts are being made to exempt veterinarians from that requirement. Public Health Veterinarian Through November 2013, a total of 12 bats were confirmed positive for rabies in Washington, four cases of Cryptococcus gattii were confirmed in animals (feline) in Washington state and there were 17 cases of canine leptospirosis in the state last year. State Veterinarian Rules are being changed to relax the requirement to TB test every dairy animal over six months of age regardless of state of origin. If coming from a TB-free state, the age requirement would increase to 20 months. AVMA The Executive Board approved support for Dr. Rena Carlson’s election to the AVMA Executive Board District 11.


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•• 38% of cat owners said just thinking about a visit to the vet is stressful •• 37% of dog owners said their beloved dogs hate going to the vet And a whopping 58 percent of cat owners said their cats hate going to the vet. Think about it. That means if you see 20 cats a day, eleven of them hate you. Worse than they hate dogs. Here’s something scary about those numbers. None of the top 10 things the Bayer study said veterinarians could do about the decline in visits by either cats or dogs involved lessening the stress of going to the veterinarian. And yet the results of that very same study should sound the call to Fear Free™ practices now!

Fear Free™ Veterinary Visits Mean Business By Marty Becker, DVM

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obody should dread a trip to the vet.

pets. The more I get into this, the more I see its potential and the more I see the results.

We can’t control all of the anxiety and fear of a pet owner taking a beloved dog or cat to the veterinarian. There’s the apprehension from the diagnosis or prognosis. Many days we must give bad news or mercifully end a life, we must write up a bill we know a client is not prepared to pay -- but what we can do, what we can control, is the fear.

All too often, I think we’ve come to see fear and anxiety as the way things are. Unavoidable consequences. The cost of doing business. But our clients don’t see it that way. They bring their beloved animals to us for healing, not for hurt. Fear and pain in our practices unavoidable. That doesn’t mean we can’t and shouldn’t do everything in our power to diminish them.

Hippocrates said it this way: ”Cure sometimes, treat often, comfort always.”

And the problem runs deeper than what our clients might think of us. We must also be concerned with what their pets think of us.

Our veterinary oath obligates us to provide the prevention and relief of animal suffering. We are bound by these two essential injunctions to never let an animal suffer. Yet we’re doing just that over and over and over across this country in all these practices in office visit after office visit. We’ve just been blind to it. I’m known for celebrating the humananimal bond. I’m known for fostering the human-animal health connection. I’m known as America’s Veterinarian. Heck, I’m known for those dang bandanas. But probably the biggest thrust, the one thing that I think can make the most difference for pets, people and the profession now – right now and forever – is creating Fear Free™ for

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The Bayer Veterinary Care Usage Study, as I’m sure you know, has been our own version of “fear” since 2009. It builds on survey research showing a consistent downward trend between 2000 and 2009 in visits to our practices. While dogs paid more visits to our practices than cats, despite being a smaller portion of the pet population, both dogs and cats came to see us less often each year--in significantly fewer numbers. And owners of both dogs and cats reported stress – their stress and their pet’s stress – as the key reasons they are not bringing them in to us for care. Let these numbers settle in for a second because they’re just so important. •• 26% of dog owners said just thinking about a visit to the vet is stressful

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What these numbers mean is simply that the pet community is not getting the veterinary care it needs and deserves. This is a tremendous opportunity for our profession. If we can master Fear Free™ visits, we can get health care to this huge underserved population. We’ll gather in all those people who’ve been hesitant to come in because it’s such a hassle for them and so painful for their pets. We’ll gather in all those people who just stay home and hope it gets better. This will not only increase our volume of business but also make waves in our practices that will ripple into the future. We’ll also be making waves against the biggest problem facing the animal population in this country. If fear were a disease and animals were people, a hue and cry would go up against it. We must galvanize our profession around this vision of Fear Free™ visits. We must focus our attention, our education, our enthusiasm and our actions on this revolutionary goal. The revolution must begin today, with you. This is the right thing to do for pets. It is the right thing to do for the profession. It’s not only an obligation; it’s an opportunity – a great opportunity. It’s an answer to many of the problems facing veterinary medicine today and many of the life and death issues facing the animals entrusted to our care in our communities. It’s the fix, and when you think about it, it’s a pretty easy fix at that. Nike says it best: “Just Do It!”

WA

Part II describing how to have a Fear Free™ Practice, will be published in the May/June issue of WA Veterinarian.

— Dr. Marty Becker is “America’s Veterinarian.” He can be reached at DrMartyBecker.com.


To us, being a veterinarian is more than just a profession. It’s who we are. Together we can make a difference. Come join us.

Washington State Veterinary Medical Association 425.396.3191 • info@wsvma.org • wsvma.org


In Clinic Laboratory Testing How do we ensure the results we receive are accurate? By Sally Lester, DVM, MVSc, DACVP

W

e all want to provide accurate and precise results for our patients but have we really considered that in veterinary medicine the onus for this rests entirely with the veterinary clinic and not with the instrument manufacturer? The instruments used in most clinics are not those that are subject to the same regulations that apply to the instruments used in human reference laboratories. There are in fact no specific regulations that deal with the development of these instruments or that regulate their performance. Laboratory instruments although often marketed as “plug and play” require validation in order to provide the clinician with accurate answers. Instrument validation thus becomes the responsibility of the practitioner and is essentially covered by quality assurance programs. This requires time and effort and these factors need to be included within the financial considerations of the instrumentation. There are two possibilities with inaccurate results, one is that we will miss a disease that is present as the results we have are within reference intervals, or we will chase a disease that is not present as the results we received were outside the reference intervals. Either scenario will be detrimental to the animal and to our clients. For example with hematology, platelets are often not counted and may be clumped. This can reflect collection, species or an instrument problem. The simple solution for this is to do a slide evaluation on all CBC’s. There is no instrument on the market (reference lab or in house) that is capable of doing accurate differentials or evaluation of morphology on all the samples. So part of the hematology protocols for quality assurance would be to make a blood smear on every sample and do a manual differential. Other issues with hematology analyzers include discrepancies between the hematocrit and a machine PCV. Which is correct when you have a spun hematocrit of 24 and a machine PCV of 10? To answer that question you need to know:

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• Is the microhematocrit centrifuge serviced regularly and is the speed (RPM) checked with a tachometer? • Are the indices normal on the analyzer printout? If the hemoglobin is disproportionate to the red count or to the machine PCV there may be lipemic interference, or if the red count is artificially low due to agglutination you will have an abnormal MCHC. A review of the hematology slide will be helpful to sort this out, but there is no simple answer. You can not use the microhematocrit as the “gold” standard unless quality assurance procedures are in place and you know that the RPMs are correct and the tube was spun for the correct time interval. Issues with chemistry samples can be even more daunting. • A high potassium level (6-8) may simply be sample artifact as a result of platelet number increases and aggregation which will release potassium into the serum. Extensive evaluation to determine the reason for the high result can complicate your relationship with the client and subject the animal to more tests (ACTH response test, urinalysis, etc.) when a heparinized sample for chemistry would eliminate the effects of platelet aggregation. • An elevated bilirubin level in an animal that is not icteric is often the result of interference from sample color (hemolysis/lipemia) but if this is coupled with elevations in ALT the clinician may consider further investigations based on the test numbers. It is important to make sure that the sample color is recorded. Also ALT can increase with prolonged collection, so information regarding the site of collection and any problems with collection should also be recorded in the patient record. • Or a diabetic animal has a low P level; is this real or if the sample is icteric or hemolyzed it may just reflect the methodology and color interference.


•• It is possible to get normal enzyme results even though they are markedly elevated as substrate depletion occurs and may be interpreted by the computer algorithm as a “normal” result. For an example you may get an ALT or CK that are at the low end of the reference interval or record as “zero” when in fact they are exceedingly high. So how do we validate the instruments and how do we make sure that the results we receive are accurate? Quality assurance implies that we have done our homework and understand the machines we are using and have procedures in place that allow confidence in the machine results. There are many aspects to QA but they can essentially be broken down into standard operating procedures that cover each step of the laboratory testing process from

software and if so, who can modify results, who interprets the results and who has validated the release of the results. How long are different types of samples stored and where are they kept? Unfortunately veterinary schools do not provide sufficient training in Quality Assurance and many of the papers on this subject can be confusing or present a great deal of statistical information.

•• Journal of Veterinary Clinical Pathology: The quality of veterinary in-clinic and reference laboratory testing. 2012:41;91-109 •• Journal of the American Veterinary Medical Association: Quality control for in-hospital veterinary laboratory testing. 1999:215;928-929.

But there are initial steps you can take after you decide to establish a QA program.

•• Journal of the American Veterinary Medical Association: Current quality assurance concepts and considerations for quality control in-clinic biochemistry testing. 2013:242; 182 -192.

Read the manuals that come with each instrument. Understand how this instrument performs and what the computer is doing with the results (are parameters such as PCV calculated?)

Contact the academy of veterinary clinical pathology technicians. (National Association of Veterinary Technicians of America (NAVTA) avcpt.vts@gmail.com.

Contact the manufacturer of your

Quality control material is essential for a

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The first step is to make the commitment for your clinic/hospital to take the time and incur the expense to establish a QA system. collection of samples to release of results. The first step is to make the commitment for your clinic/hospital to take the time and incur the expense to establish a QA system. The next step is to designate the veterinarian that will be in charge of the lab and the technicians that will be using the instruments. Step three is to develop a QA manual which details what you are doing to establish the instruments and the personnel running the instruments or collecting the blood so that you are assured that they are adequately trained and that you can verify that the results are accurate and precise. This is essentially the “bible” for the laboratory. •• The details should include pre-analytical factors how are samples collected; how are samples labeled, how does the lab track these samples; what tests require what samples; how reagents are stored, validation of temperature for the reagents, etc. How are the personnel trained, and how is this documented? •• Analytical factors - what controls are run, how is this information kept, who looks after the interpretation of the controls, how is sample artifact- hemolysis/lipemia assessed; are reference ranges valid for your population and for these machines? •• Post analytical factors - can results be modified in the lab management system or within the practice management

equipment and ask them how many animals (male/female/age/ breed) were used to establish the reference intervals and where was the population from (kennels, shelters, dog or cat clubs). What factors will influence the test results and how this was determined? (lipemia, hemolysis, platelet clump interference, etc.) Ask always for the data and for the peer reviewed papers. Ask them if they have clinical pathologists that can assist you in developing a QA program.

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Seek assistance either through programs such as the Veterinary Information Network (VIN), which gives CE related to QA, conferences or through your local reference laboratories.

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Read the recent papers that deal with 4 Quality Assurance (these are a few of the papers but there are many more). You may also contact www.ascvp.org and view guidelines for all aspects of the veterinary laboratory. •• Journal of Veterinary Clinical Pathology: Quality Assurance Guidelines. 2010:39;264-277 •• Journal of Veterinary Clinical Pathology: ASCVP guideline: quality assurance for point of care testing in veterinary medicine. 2013:42;405-423 •• Journal of Veterinary Clinical Pathology: ASCVP guideline: allowable total error guideline for biochemistry. 2013:42; 435

quality assurance program. This control material can be used to help you to understand how the machine performs and to assist in determining the accuracy and precision of your instrument (either hematology or biochemistry). Once you have evaluated the instrument, at least two control materials should be run daily on each instrument and the results should be tracked. Standard Excel programs are adequate for tracking the controls. Assayed controls can be purchased through most medical laboratory supply companies, such as Fisher Scientific or Henry Schein but also directly through companies such as Bio-Rad or Randox. This is a complex process; the information presented is really a basic overview to hopefully make you consider the concept of QA as well as providing you with resources that may help to set up the program within your hospital. The onus for both the results and for their application relies on the veterinarian, as laboratory data is just one aspect of quality medicine, and the results must always be interpreted in light of the clinical history and physical examination along with other diagnostic aids. WA

— Dr. Sally Lester is the laboratory

director for Pilchuck Veterinary Hospital and Seattle Veterinary Specialists. She can be reached at slpathd@aol.com.

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Strategic Planning

Why the Old Ways Don’t Work Anymore

By Lisa Parshley, DVM, PhD, DACVIM

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very day our social, political, and economic world fluctuates driving us in new directions. Improvements in communications have created an interconnected world that further increases the speed of this change. In the era of instantaneous communication, it is not uncommon for shifts to happen overnight. Old methods of interacting with the world and predicting changes are increasingly unable to match the speed of this new reality. In order to remain viable, many organizations and businesses have begun to seek out and use new management styles. They are pursuing active, nimble, and engaging processes. The most common management method being instituted is called strategic planning. In this article I will review strategic planning, providing an insight into why the old ways won’t work today followed by a discussion of strategic planning. One hundred years ago political, social, and economic changes were small and incremental. Fluctuations in the socioeconomic environment were methodical in a large part because communication and connection between people was deliberate and intermittent. This was a world where gathering of information was based on the speed of ground mail, land line phones, radios, and then television. Where travel was initially by horse then trains and cars and finally air travel. Change and the response to change occurred at the speed of available communication and the types of personal interactions. It was easy to predict trends years or decades into the future. Businesses and organizations developed management processes, such as long range planning, to deal with the predictable changes in the world. Governance did not need to review these plans very often because everything moved at a stately pace. Associations or businesses originating during this period successfully used these processes for decades and decades. Why do we have to change, how we do business if it has been successful? It’s simple, to keep relevant. We stay viable when we have a relevance to those we serve. When the needs of a community or profession change, we must in turn transform. When these changes are aided by instantaneous communication we have to

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institute management or governance that is nimble and preemptive. The management process known as strategic planning can provide rapid, proactive, relevant and directed responses to an ever changing social, economic, and political environment. Understanding strategic planning is sometimes difficult because it is a paradigm change. Perhaps first we should discuss what it is not. In the past a strategic plan was developed at most once a year and then reviewed in yearly or multiple year increment. More often than not the plan was not accessed, assessed, or used as a guide for routine business. The strategic plan was seen as being detached from the management of the organization. It was a static document. Strategic planning process is not static, it is not visited once a year, and it is not separate from the management of an organization. Strategic planning is how an organization manages its daily practices. It starts with an articulated plan, contained within the mission and vision statements. The plan uses strategic goals and objectives to fulfill the mission and vision statements. Strategic planning requires a constant sampling and analysis of outside data (environmental scanning). This external and internal sampling supplies information about weaknesses, strengths, risks, and opportunities for an organization. The process then adjusts or focuses resources according to this information. The strategic planning process is a continuous cycle. It can give an organization the ability to adroitly predict and respond to the environment of the business. Essentially, strategic planning happens all the time, every day, it is a dynamic cycle; it is the management of an organization, not separate from it. Strategic planning begins by developing a mission and a vision statement. What is a mission statement? It is the “why” of your organization. A mission statement should define your business, what you do and where your resources are allocated. It should be inspiring and succinct. A perfect example is Google’s mission statement: “to organize the world’s information and make it universally accessible and useful.” A good mission statement should make people want to come in your doors; it should communicate what you do as a business or organization.


What is a vision statement? It is what you want to achieve over time as an organization. To create a vision statement first it must be decided where an organization wants to be in the future. This can be hard to articulate succinctly. Sometimes it helps to use the exercise called “the cover story.” It involves imagining five years from now your organization has become the focus of a feature journal article and is on the cover of the magazine. What would you want written as the title on the cover and what should be written in the first paragraph of the article. It should be daring and concise and very visible. Susan B Komen’s vision statement is an excellent example of how a vision can be audacious yet very descriptive; “to cure the world of breast cancer.” A vision statement is where you want to be in the future whether that is next year, in five years, or some undefined point in the future. The next step is to develop strategic goals. They should be designed to fulfill the vision statement. Once again using Susan B Komen’s vision as an example a strategic goal could be “to fund breast cancer research” or “to improve breast cancer awareness.” The trick when selecting strategic goals is to limit the number. Too many goals dilute resources reducing forward progress on the vision. Typically it is recommended that only five or six goals are established. Each strategic goal is advanced using strategic objectives. An objective is a specific task executed to further the goal. Objectives are the actual daily business of an organization. They are the action that expends the resources of the organization. For example if your veterinary clinic had a strategic goal of “to provide the best dental services,” an objective might be “send our technicians for dental prophylaxis continuing education” or “buy a digital dental radiology unit.” They should be achievable, specific, have measurable actions, and have a predetermined time period. Successful strategic planning requires continuous scanning of the business environment. It is what defines strategic in strategic planning. Scanning maintains tabs on relevance, achievement of objectives and goals, and it identifies both risks and opportunities. A simple list of ways to gather this data includes but is not limited to surveys, newspapers, journals, web sites, blogs, listserv sites, Facebook, tweet, personal interactions, legislative changes or trends, and phone calls to your place of business. Basically, every available piece of data pertaining to a business’s environment should be collected for analysis. It cannot be stressed enough that any information reflecting a trend or change, potential or real, should be collected. What makes a piece of data worthy of analysis? Sometimes it is the number of times the same information is repeated, sometimes it is the topic, and sometimes it is potential impact on your business. It is hard to predict in black and white terms what will rise in significance at any one time. A good strategic planning process remains open to considering any piece of information at anytime. Analysis of the information should be based on the impact to the mission and vision statements and more directly goals and objectives. Analysis might recommend no change to the current plan, it could stop one or more objectives, it might ignite new objectives, and it might cause a change in strategic goals. It will impact the allocation of the organizations resources. A well run strategic management will perform this process every day and every meeting will have a large part of the agenda devoted to strategic planning. Sometimes the hardest part of changing to strategic management is the necessary evolution of governance style. A good strategic planning administration is a small management team with a mandate to foster and further the strategic plan. Selection to the team should be solely competency based. This team is responsible for the periodic and timely analysis of environmental scanning data and adjustment of the objectives and goals. Lastly and very importantly, this team is responsible for clearly articulating the plan to the whole organization.

entire organization to engage in the plan. Communication should be both ways, allowing for good ideas to filter up as well as down. Transparency allows for accountability at all levels of the organization. A good strategic management team drives and fosters the plan through supporting an open atmosphere of strategic thinking. In sum, strategic planning is a process that uses a mission and vision statement to define strategic goals and objectives. These goals and objectives are the business of the organization. Their importance to the organization is determined by environmental scanning. Opportunities and risks to the organization are also predicted by a good scanning system. It requires a small nimble and open management team, which fosters and encourages organization-wide strategic thinking. In today’s ever changing socioeconomic world it is becoming clear that businesses and organizations need to leave behind the “old ways” to stay viable. Management styles must evolve to allow quicker, more nimble, proactive organizations. Of the new management models emerging, the most commonly used is strategic planning. It provides rapid responses, preemptive plans, and an adaptability to the rapidly fluctuating professional and business environments. WA

— Dr. Lisa Parshley is the owner of Olympia Veterinary Cancer Center in Olympia, WA. She can be reached at lisa.parshley@ovccpets.com.

Good communication and adequate transparency allows the

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Dr. Kimber C. Brawley KSU ‘89 SA & Exotics, Medicine/Surgery, some Orthopedics King & Snohomish (425) 367-1288 docb333@aol.com

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Dr. Frank Bousaid TAMU ‘95 SA, Acupuncture/Chinese Herbal Therapy Eastern Washington including Wenatchee, Moses Lake, Spokane (206) 683-3770 snohobear@gmail.com

Dr. Patricia Dorsey IL ‘84 Cats and Dogs (253) 851-8234 (Gig Harbor) reliefvet@dorsey.cotse.net (preferred contact)

Dr. Emily Jewell Liverpool ‘98 SA General Medicine & Surgery Seattle and surrounding, Walla Walla and surrounding (206) 579 – 1012 eajewell@hotmail.com

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All you have to do is email or fax the WSVMA offices with your information. If you are a current WSVMA member, your ad is free! Contact classifieds@wsvma.org or fax to (425) 396-3192 to get your ad started!

Dr. Michelle Gengler ISU, ‘05 Small Animal North King and Snohomish County Short notice OK (206) 920-0219 genglerdvm@gmail.com

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Dr. William D. Hougham UCD ‘75 SA Surgery and Medicine South King County and Pierce County (360) 825-1981 drbilldvm@gmail.com Dr. Elizabeth Hughs STG ‘09 SA (206) 992-1730 elizabeth.hughs@gmail.com Dr. Brian Hur WSU ‘11 SA, Medicine/Surgery/Dentistry, ER/CC Greater Seattle Area (206) 856-0928 brian.hur@gmail.com Dr. Julie Janiak Colorado State University ‘07 Small Animal Medicine, Surgery, Emergency and Acupuncture Internship trained Greater Spokane Area and nearby counties (970) 420-9556 jagej@hotmail.com

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Classifieds WSVMA 2014 Classified Advertising Rates WSVMA Members

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$65.00 $1.00 $5.00 $10.00

No charge for contact information. Rates are for two months on the website. Ad will be included in the next available print issue for an additional $10.00.

Non-Members

First 30 words Each additional word WSVMA Blind Box (one-time fee) Include ad in next print issue

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No charge for contact information. Rates are for two months on the website. Ad will be included in the next available print issue for an additional $20.00. Classified ad forms are available upon request. Call (800) 399-7862 or (425) 396-3191 or email classifieds@wsvma.org.

Deadlines for Classifieds

Ads for the May/June 2014 issue of the WSVMA Classifieds will be accepted until April 15, 2014. No refunds or changes will be allowed after the deadline has passed. The WSVMA Insight Magazine and WSVMA Classifieds are mailed to all WSVMA members.

Flyers

Flyers are accepted to advertise continuing education events only. These are included on a fee for service basis. Please contact the WSVMA office for additional information regarding rates and schedules. For further information on classified advertising, please contact: WSVMA Office (800) 399-7862 or (425) 396-3191 classifieds@wsvma.org

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May/June 2014 • April 15, 2014

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PT SA DVM wanted for 1-doctor Everett practice. 1-2 days per week, alternate Saturdays. Send CV/resume to everettvet@gmail.com. North Cascade Veterinary Hospital in SedroWoolley, is searching for a full-time veterinarian. We have a beautiful, well-equipped hospital, awesome staff who love working together and have been awarded numerous times as the best vet in Skagit County. We offer percentage-based pay, CE, IRA and other benefits. We are looking for candidates with a strong interest in exotics, naturopathic medicine and acupuncture. Visit us at www.northcascadevet.com. Please send CV/resume to ncascadevethospital@gmail.com or call Andy Porter at (360) 856-1809 for more information. Tacoma hospital looking for a FT Small Animal veterinarian. Congenial, well-regarded practice. Excellent clientele and staff. Modern, well-equipped facility. AAHA accredited, ABVP Diplomate owner. Seeking positive, progressive person with strong people skills to join our team. Must be OK with Saturday hours. Columbia Veterinary Hospital, 5916 Sixth Ave., Tacoma, WA 98406. (253) 564-7927 or columbiavet@nventure. com. Seeking compassionate, client-oriented SA associate for high quality AAHA practice in Thurston County, Washington with awesome staff and dedicated clients. Practice serious medicine in a fun and friendly atmosphere using up-to-date equipment. Ne grads welcome. Contact Dr. Snyder at (360) 438-9623 or email to rjm_llc@comcast.net. Graham - Associate for mixed practice with strong SA skills in med/surg, interest in equine and pocket pets as well. Focus on high quality care & client communication. Nestled on rural forested 11 acres with an energetic positive staff. This flexible position requires leadership skills and experience. In house lab, Dxray, US, IM3 dental, therapeutic/surgical laser, computer records & more. Contact & send resume to horsedoc@rainierconnect.com. Summit Veterinary Referral Center in western Washington is looking for an experienced emergency and critical care doctor. We are a 24 hour referral and emergency hospital. We have boarded specialists in critical care, internal medicine, neurology, oncology, radiology and surgery. Schedule will include overnight, swing and day shifts. We would prefer internship training, but strong experience in a referral/ emergency practice will also be considered. We offer competitive pay and benefits. crakunas@summitvets. com. FT ER Doc, Puget Sound Veterinary Referral Center. Positions now open for two additional skilled FT ER docs to join our busy 24/7 ER team in Tacoma! We offer great benefits, have an excellent support staff and a fantastic group of specialists! We are privately owned, owner-managed, and do NOT have a corporate agenda or atmosphere. Candidates need to be proficient

w a s h i ngton ve te ri nari an

in soft tissue surgery, possess great communication and diagnostic skills, and be team players. We are looking for doctors who want to dig in and develop a long term career in our growing practice! Visit our website: www.TheAEC. com and contact: Kobi Johnson, DVM at: kjohnson@ theAEC.com. Busy practice seeking self-motivated, personable, experienced associate. Competitive salary with shortened work week and some emergency call. Send resumes to drshort@sequimanimalhospital.com. Feline-only practice: FT/PT DVM. Busy, wellestablished clinic looking for a cat person with strong communication skills, a sense of humor, and the ability to work well under pressure. Leave the barking, drooling, and wrestling behind. p.gawley@comcast.net.

DVM Wanted, Eastern Washington Small animal or Mixed animal associate wanted for a busy mixed animal practice in Central Washington. Great opportunity to develop or expand in any area you desire. Contact: Ahtanum Veterinary Clinic, 1008 W. Ahtanum Rd., #6, Union Gap, WA 98933; harrahvet@aol. com. FT Associate Veterinarian wanted for rapidly growing mixed practice in central Washington. Reasonable schedule, competitive compensation package, shared emergency call. Practice is well equipped, beautiful location with numerous outdoor recreation opportunities. Email resume to: misenhart@ gmail.com. Wanted full time DVM for busy, non-corporate 4 doctor AAHA companion animal practice located in the Tri Cities. Quality care and client service a priority, special interests encouraged. Great staff and clients. No on call. Please contact us at tricitiesvet@gmail.com.

DVM Wanted, Out of State Associate veterinarian wanted for busy 6-vet hospital in beautiful Southeast Alaska. Experience preferred but not required. Competitive salary/benefits. For more information visit us at www.seavets.com or phone Tracye at (907) 789-7551.

Practice for Sale or Lease Yakima area SA practice with real estate for sale. Well established, growing practice with digital X-ray, in-house blood work capability and nicely computerized. No after-hour emergencies. LA potential. Contact Dr. Steve Correa (IBA) (253) 548-4578. WASHINGTON – Exceptional Potential - NEW LISTING: Puget Sound area, 1 DVM, SA practices. Grossed $380K in 2012. Facility is 3,000 sq. ft. includes additional 2 acres for expansion. Asking $450,000 practice and RE. Simmons Northwest 208.664.3100 (LWA54)


Find More Classified Ads Online at wsvma.org WASHINGTON – Coastal Location - GREAT LIFESTLYE: Washington’s southern coast, wonderful community, relaxing lifestyle. 2 DVM predominantly SA practice with 3,000+ sq. ft. Huge growth potential. Asking $1,100,000. $100,000+ to buyer after debt payments. Simmons Northwest 208.664.3100 (LWA51) WASHINGTON – Seattle Suburbs - POSSIBILITIES GALOR: Seattle Suburbs, many possibilities. 1+ DVM, SA practice in leased space. Grossed $585k in 2012 allowing $120k+ to buyer after debt pymts. Asking price $550,000. Simmons Northwest 208.664.3100 (LWA52) WASHINGTON – Desirable Area - GREAT OPPORTUNITY: Southern Washington. 1+ DVM, SA practice, highly desirable location. Grossing $825K with great opportunites to grow revenue and profit. Asking $700,000 for practice. Simmons Northwest 208.664.3100 (LWA53) OREGON – Destination Location - GREAT LIVING: Gorgeous coastal area in Oregon. 2 DVM, SA. $240k+ to buyer after debt! Priced at $2,150,000 includes both practice and RE. (LOR59) LA component listed separately. $100,000 (LOR60) Simmons Northwest 208.664.3100 ALASKA – Southern Region - HIGHLY PROFITABLE: Alaskan beauty, abundant nature, outdoor recreation. Highly profitable, 1 DVM, SA practice in leased space. Grossed $400k with $150k+ to buyer after debt pymts. Asking price $350,000. Simmons Northwest 208.664.3100 (LAK06) OR EQ Surgical Specialty facility. Many equine hospitalization stalls, large double surgery 21,000 SF and 15 acres. Contact Karl Salzsieder (360) 636-1228 or Karl@ TPSGsales.com Near Portland, OR - High net, SA high tech 1 vet $500,000 gross rev. yr. Contact Karl Salzsieder (360) 6361228 or Karl@TPSGsales.com North ID- SA, young practice & RE 3200 sq ft. 20% growth per year. Contact Karl Salzsieder (360) 636-1228 or Karl@TPSGsales.com Northwest WA Peninsula- Fast-growing 1 doctor SA grossing nearly $700,000 in 2012. Building lease, with possible option to purchase. Contact Karl Salzsieder (360) 636-1228 or Karl@TPSGsales.com NW WA – NEW LISTING - SA 1 DVM start up in Strip Mall. 1,350 SF, 2 exam rooms. Rev. $150,000 yr. Price $60K. Contact Karl Salzsieder (360) 636-1228 or Karl@ TPSGsales.com N. of Seattle, WA – Awesome 3,581 SF building, 1 DVM Practice w/ great potential to grow. Needs jump start, financing available. Contact Karl Salzsieder (360) 636-1228 or Karl@TPSGsales.com

Want to buy an established practice for FREE? Ideal opportunity for start-up. Take over 20-year practice for lease payment only. Excellent north Seattle location. Great freeway access. (206) 999-2909 or ahealingvet@ comcast.net

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Technician Wanted

Fortune Bank........................................................................3

Harbor Animal Hospital, a well-established, yet growing, small animal practice in Gig Harbor, is seeking a PT/FT LVT. No weekends. Wages based on experience. Benefits for PT/FT. Submit resume: harboranimalhospital@comcast.net.

Architectural Werks, Inc................................................ 23 CareCap............................................................................... 11

Simmons & Associates Northwest...............................9 Summit Veterinary Referral.............................................9 Seattle Veterinary Specialists.........................................5 Total Practice Solutions Group................................... 23 Veterinary Group Purchasing Organization.......... 11

Miscellaneous

WSU..........................................................................................5

FOR SALE: Bronze statue “Caring Call” by Larry Anderson, number 49/100. Stands 15 inches high and weighs 33 pounds. $2495.00 plus $80 s/h. Please contact Dr. Steve Shaff at (845) 266-8727 or wizarddiana@ hughes.net. Practice Sales Brokerage or Practice Buyer Representation. Increase profitability and Practice Sales price with Management Consulting. Practice Valuation and Employment contracts, buy-sells, startups, litigation support, representation before license board. Contact Karl Salzsieder, DVM, JD, AVA, (360) 5778115 or karl@salzsiederlaw.com.

Relief Technician Available Vet Tech Services – Let our experienced LVT’s keep your hospital running at full capacity. Please call Virginia Jones, LVT at (425) 330-5234

WSAVT Career Center (360) 273-7838 or ludeluh@yahoo.com

Let a professional help you buy or sell your practice. Steve Correa, DVM, MBA Licensed Real Estate Broker

steve@ibainc.com • 1- 800-218-4422

SE AK – 1 DVM SA practice. Contact Karl Salzsieder (360) 636-1228 or Karl@TPSGsales.com Leavenworth, WA - Beautiful Bavarian village, recreational paradise. Established 30+ years, 1+ vet, mostly SA clinic for sale. As package with real estate $425,000 or purchase business and lease real estate. Contact (509) 670-3421 or bavarianvet@frontier.com.

www.vpsg.com

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Yakima Convention Center September 26-28, 2014

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2014 Mar-Apr WA Veterinarian Magazine