Dr Julia Miller explains common misconceptions surrounding veterinary diet trials

Video interview with Julia E. Miller, DVM, DACVD

Diet trials are a great resource for veterinary teams to utilize with a patient presenting with some type of allergic reaction. Despite the importance and benefits of diet trials, many pet owners and even some professionals could have misconceptions about how diet trials work, whether or not they are for every patient, and even the length of the trials. 

To help provide some clarity on these questions surrounding diet trials, 

 recently interviewed Julia Miller, DVM, DACVD, at the Fetch Coastal Conference in Atlantic City, New Jersey, where she explained common misunderstandings with diet trials for patients, and provided tips to help these trials be as successful as possible. 

: The other big thing with diet trials I think people forget, is you're going to need anti-itch therapy. So don't just send them home with the diet and not relieve the itch in the pet. You need to decide what you're doing to also help manage that pets itch 

 you start the diet trial. And then, last but not least, I think a lot of us think that diet trials needed to be done [and] have to be fed for a full 3 months. We've now learned that you don't necessarily have feed it for the full 3 months. You can actually get away with 6 to 8 weeks to feed a diet trial and then see how it's actually going, so routine checkups are really important.

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Julia Miller, DVM, DACVD, shares some of her biggest diet trial tips to help make tricky diet trials easier for all

Strategies for successful diet trials

“I believe that dogs… understand us at a much deeper level, more than we understand each other, and even more than we understand ourselves. And they have our backs,” Renée Alsarraf, DVM, DACVIM (Onc), said during her keynote lecture on Day 2 of the Fetch dvm360 conference in Atlantic City, New Jersey.

 Alsarraf, a veterinary oncologist with more than 30 years of experience, and author of the memoir

 Sit, Stay, Heal: What Dogs Can Teach Us About Living Well

, shared with the audience 6 life lessons that she learned from her canine patients and her own dog after her experience with battling cancer.

At the beginning of her talk, Alsarraf shared that she was diagnosed with endometrial cancer in 2018. Despite having no clinical signs and getting yearly checkups, by the time the cancer was discovered, it had already metastasized. She shared that her treatment journey consisted of a radical hysterectomy, 25 fractions of radiation therapy to her pelvis, and months of chemotherapy, in addition to the adverse effects of the treatment, which included hair loss, numbness in the hands and feet, and weight gain.

“I quickly learned, even though I had lived it every day for 30-some years, that our dog patients, or my dog patients, were my recovery role models. They actually set the bar higher for me, and they gave me hope and sort of a determination,” Alsarraf said.

Alsarraf led her lecture through the framework of her memoir, which celebrates the power of the human-animal bond by sharing an anecdote from a different canine patient in each chapter, detailing the lessons Alsarraf or the dog’s family learned from that animal companion.

The following are 2 life lessons humans can learn from dogs:

The first life lesson that humans can take from canine companions is that they do not judge, helping remind us to silence our inner critic. “We all have periods in our lives where it's hard to face another person, where we're embarrassed by this step or something foolish,” Alsarraf said, “but our 4-legged friends never judge us. Right? They experience many emotions, happiness, sadness, excitement, even fear. But their stares are never morally judgmental.”

“They don't care about our work history, our performance on the pickleball court, or if we put our foot in our mouth. They always love us and accept us where we are and how we are,” Alsarraf continued.

She explained that dogs never jump to conclusions, and they never put their human counterparts down. “I’m not sure we can say that about ourselves,” stated Alsarraf.

She shared her own experience with her dog Newton, who continued loving Alsarraf through her experience with cancer. “Despite my straggling chemotherapy hair plastered to my skull and wearing my pajamas for 4 days in a row, [which] if I'm being honest, probably had some chicken soup stained on them, [Newton] loved me just the same, and I was a whole person in his eyes,” Alsarraf shared.

Newton’s unconditional love for Alsarraf gave her the strength to continue pushing forward, she explained. He truly

 her and acknowledged and reminded her of her presence, passing forth the lesson to continue despite the circumstances, and to be one’s own cheerleader.

Lesson #2: The benefit of being a pack animal

Dogs are pack animals, and working together helps them survive in the wild, explained Alsarraf. These canines help each other find food and seek each other for warmth and safety. Research shows that having dogs offers many health benefits. These people have a higher likelihood of living longer and helps give people with special needs independence, boosting their confidence. Having a dog can also lower blood pressure, cortisol, heart rare, cholesterol, and improve emotions, according to Alsarraf.

Frannie, a bloodhound who helped the police in search and rescue had a gastric mast cell tumor. Her police partner and the precinct worried that the chemotherapy would affect her sense of smell. Still, Frannie received chemotherapy for more than a year, and ended up setting the New Jersey record for the amount of people that she found in her work.

“I believe that we are so much better as a pack… supporting each other, and there's sort of that inner circle of your pack and that outer circle of your pack. The inner circle of your pack, you might only need 1 or 2 or a few people in that, right? That outer circle, though, is all of us and we are so much more alike than we are different, but if we all knew that we had each other's back, that we're always there to lend a hand—even just a friendly smile sometimes—makes someones day more than you would ever know,” Alsarraf expressed. “We're designed to be connected.”

At the end of her session, Alsarraf explained that she believes dogs are placed in people’s lives at times when they are needed most by their human counterparts. Moreover, every dog brings a different life lesson, according to Alsarraf. Given the inextricable bond between humans and canines, as veterinarians serve dogs, they are also serving society, Alsarraf explained.

Speaking of her experiences with her canine patients, Alsarraf said, “I have learned from them all. Lessons I needed along the way.”

Alsarraf A. Treating yourself through a dog’s eyes. Presented at: Fetch Coastal; October 14-16, 2024; Atlantic City, NJ.

Articles

Dogs are so much more than pets; what can they teach us about life?

Life lessons from dogs

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Challenges surrounding mental health and burnout within the veterinary industry have been a growing area of research and discussion over the past decade. During the first part of her 2-part session, “Self-Care Isn’t Selfish: Essential Skills For Success,” presented at the Fetch dvm360 Conference in Atlantic City, New Jersey, Kate M. Boatright, VMD, an associate veterinarian at Penn Ohio Veterinary Services, and founder of KMB Veterinary Media, provided an overview of the current state of mental health in the industry, and advised practice managers how they can address the situation.

Boatright shared the results of the Merck Veterinary Wellbeing Study Series, which provided a detailed account of the state of mental health within the industry, over the past several years. In the 2017 study, 79% of veterinarians reported feelings of anxiety, burnout, and compassion fatigue over the course of the previous year.

 The next study, from 2020, demonstrated increased levels of awareness of mental health in the veterinary profession, though wellbeing remained largely unchanged.

The 2021 study found increased signs of psychological distress in veterinarians, which Boatright attributes—at least in part—to the COVID-19 pandemic. The most recent Merck data, released in early 2024, showed a stable level of psychological distress in the industry.

 Among those at higher risk for psychological distress are veterinarians who are new to the field, female, minorities, and younger than 35 years old.

 In her session, Boatright emphasized the important role that practices play in the industry’s mental health.

“[If you are experiencing burnout], you can stay in this profession, and you can still recover from burnout, you just have to recognize it and make the space and time for it,” Boatright said in her presentation. “But it’s even better if we can prevent people from getting into that state of burnout in the first place. So, prevention of burnout really has to happen at the organizational level.”

Boatright addressed the concerns of individual team members who recognize burnout within their clinic but fear their clinic’s management won’t care to take action. She recommends that, when starting that conversation with management, team members should “go with the money.”

“A lot of the time, especially when you’re talking to business-minded people, [mentioning money] could be helpful,” Boatright explained. “First of all, we have the impact to the veterinary team members. If you are burned out, then you are going to be less effective at your job. Other people are going to have to pick up your slack [if] you get to the point that you need to take a break and leave the clinic.”

She drew attention to a perpetual burnout cycle, which occurs when 1 team member takes time off because of burnout, other team members take on more in their relief, which results in them experiencing burnout, as well. “[If you’re experiencing such high burnout] that you need to leave the clinic, now you’re down a person as a veterinarian. That’s going to [lower] the number of appointments that you can see, unless you expect your other veterinarians to take over that same caseload, which [would] just perpetuate that burnout cycle.”

She points out that an alternative solution would be for managers to hire someone new, although that would involve cost to hire, which she says is about 50-75% of the annual salary of a position to replace that person. In total, burnout costs the veterinary industry an average of $1.93 billion in losses each year. In addition to the economic costs, she points out that burnout can come with emotional costs to the clinic, damaging preexisting relationships with patients or clients, and preventing the formation of new ones.

“Programs focused on changing individual behavior are much less effective than programs focused on teams,” Boatright said. She identified 6 main points to address burnout form an organizational level:

 Team members may feel that they lack control over their careers, including a lack of control over scheduling, which patients come into the clinic, or the volume of patients that come into the clinic.

 It’s important for team members to feel celebrated and appreciated. Some clinics hold a weekly reading of 5-star reviews, and others implement “kudos jars,” which offer small prizes to celebrate efforts that go above-and-beyond. 

 People should feel like team members within the workplace, and there should be a sense of community, team culture, and good connections. Otherwise, as Boatright cautions, team members could be on their way to burnout.

 There shouldn’t be members of the team that receive special privileges. Specifically, she provides the example of veterinarians who need to leave early to pick up their children from school. How can a practice make this fair to non-parents? “Are we asking only our non-parents to work on holidays?” Boatright asked. “Well, guess what? They have family and lives too.”

 If someone’s personal values don’t align with the clinic’s, that could serve as a trigger for burnout.

 Working too much can be the biggest contributor to burnout. Boatright explains that, while this is the only 1 of these factors that individual team members do have control over, managers need to proceed cautiously and ensure that team members are not being overworked.

“[Psychological safety] is a term that we’re hearing more and more in the profession,” Boatright said. “…and it’s multifactorial. Part of it is creating a safe space to have these discussions about mental health, creating an environment where you’re comfortable [expressing concern for a colleague’s wellbeing], and also comfortable coming up with new ideas.”

Team members should be able to admit their mistakes without fear of retribution. It’s not uncommon that admitting a mistake ends up as the difference between life and death for a patient. The workplace should also be a safe space for the discussion of mental health. The knowledge that your team has your back can go a long way in preventing burn out or other mental health challenges.

“Our team members right now are our highest risk individuals,” Boatright said. “Our younger veterinarians, technicians, younger professionals are at higher risk. We have to remember the significant impact that burnout has in the profession, and that we need to look at organizational change to prevent burnout.”

Boatright K. Self-Care Isn’t Selfish: Essential Skills for Success Part 1. Presented at: Fetch dvm360 Conference; October 14-16, 2024; Atlantic City, NJ.

Volk JO, Schimmack U, Strand EB et al. Executive summary of the Merck Animal Health veterinary wellbeing study. 

Tomasi SE, Fetcher-Leggert ED, Edwards NT, Reddish AD et. al. Suicide among veterinarians in the United States from 1979-2015. 

Volk J, Schimmack U, Strand E, Vasconcelos J et al. Merck Animal Health Veterinary Wellbeing Study II. Available at 

Volk JO, Schimmack U, Strand EB et al. Executive summary of the Merck Animal Health veterinarian wellbeing study III and veterinary support staff survey. 

Volk JO, Schimmack U, Strand EB et al. Work-life balance is essential to reducing burnout, improving wellbeing. 

Strategies that practices can implement to prevent veterinary burnout were discussed during a session at the 2024 Fetch dvm360 conference in Atlantic City

Preventing burnout at the organizational level

Behind every Batman, there is a Robin. Behind every Clark Kent, there is a Lois Lane. The same is true in veterinary medicine.

Behind every great veterinarian, there’s a credentialed veterinary technician (CVT) and a veterinary assistant. And although CVTs and veterinary assistants have different responsibilities, working alongside our veterinarians is critical to delivering high-quality, compassionate patient care. Most importantly, they can tackle a wide variety of more than 200 clinical and nonclinical tasks, helping share the workload and thus alleviate team burnout.

It’s no secret that there is a chronic shortage of CVTs and veterinary assistants—and that many are leaving the profession due to concerns about a lack of career development, empowerment, and compensation.

 According to research commissioned by Mars Veterinary Health, it would take more than 30 years’ worth of graduates to meet the 10-year industry need for CrVTs.

This grim outlook fueled my desire to be part of the team at VCA Animal Hospitals and design a program to support these unsung heroes. Through this provocation, we aligned on our program’s purpose: to create clear career pathways for sustainable professional development at VCA and retain the CVTs and veterinary assistants who have otherwise felt undervalued within the veterinary profession.

My role is not very common in the veterinary profession, so I often have to explain to others what exactly a regional technician director does. My standard response is that I am responsible for the mentorship, leadership, and medical upskilling of CVTs and veterinary assistants. My unique career journey was made possible by VCA, whose commitment to investing in its people is evidenced by the creation of roles like mine and supported by others who recognized the importance of the patient care perspective in leadership roles. As a result, I have developed a passion for the career development of CVTs and veterinary assistants.

As a former veterinary assistant and CVT, I was fortunate to have opportunities to grow professionally and to have a mentor who guided and encouraged me in my first supervisor job. But my professional journey was not without its challenges.

Although it was not easy, I loved and respected the path I needed to take to get to where I am today. If you were a CVT who wanted to advance, that was the way to do it. Because the veterinarians I worked with did not have the CVT point of view, professional development involved a lot of self-guided learning. When upward mobility is limited, knowledge becomes power, and competition can hinder learning opportunities and collaboration. Not everyone could have endured my career path.

Thankfully, the culture has shifted quite a bit in recent years. It is an exciting time to work in patient care, and it will only get better as veterinary technicians are increasingly allowed and empowered to practice at the top of their license and advance within the profession.

As part of the multidisciplinary team at VCA, I helped develop the career progression program.

 At its core, this program formally recognizes the skills of our nearly 14,000 CVTs and veterinary assistants while advancing their knowledge and skills through career development. By assigning career levels based on essential responsibilities, knowledge, and tactile and critical thinking skills, the program helps form a transparent career trajectory for our associates. This is huge for our profession. 

Although many factors are at play, we know that opportunities for advancement and better pay are key reasons CVTs and veterinary assistants leave the profession. The career progression program creates a supportive, collaborative environment where CVTs and veterinary assistants can grow and thrive across clinical roles. The program is not a cookie-cutter approach with narrowly defined roles at each level— everyone’s career path is different based on their interests and goals, and the program is already opening doors to new ways of supporting veterinary medicine.

Having patient care representatives share their perspectives and expertise as part of a leadership team is extremely valuable, and these roles are becoming more common. For example, within VCA’s North Atlantic Group, the senior vice president of hospital operations and 3 regional operations directors started their careers as CVTs or veterinary assistants. 

Patient care is not just a job; it’s a 

. CVTs and veterinary assistants work with veterinarians as part of a team, and we each have our own responsibilities when it comes to providing care. The only way we will be able to keep up with the growing demand for care is to enable and empower our CVTs to work at the top of their license and our veterinary assistants to perform at the top of their skills; this includes teaching professional skills.

Through my involvement with the Association of Veterinary Technician Educators, I have had the pleasure of speaking with and presenting to many program directors from colleges and universities with veterinary technician programs. One thing I always emphasize is the importance of making interpersonal skills part of their curriculum.

Developing and growing these skills, which encompass leadership skills, clinical communication, and emotional intelligence, helps everyone in a patient care position, regardless of their desire to grow into a leadership role. For example, all CVTs and veterinary assistants need to communicate well—within their teams and with clients—yet few technician programs offer this training. The good news is that we can teach and nurture these skills on the job through mentorship programs, internal training, and classes and seminars offered within and outside the veterinary profession.

It is gratifying to help bring much-needed solutions to CVTs and veterinary assistants. I look forward to seeing how the profession evolves as we create sustainable career paths for these critical roles. As our patient care teams are the largest subset of the veterinary workforce and vital partners in patient care, investing in them only stands to improve patient care in our hospitals, now and in the future

Stay, please: a challenge to the veterinary profession to improve employee retention. American Animal Hospital Association. 2024. Accessed September 11, 2024. https://24051120.fs1. hubspotusercontent-na1.net/hubfs/24051120/Stay_Please_ AAHA_Retention_Study_2024_02182024.pdf

Lederhouse C. Study: fair pay, appreciation for work top factors in employee retention. American Veterinary Medical Association. March 4, 2024. Updated May 2, 2024. Accessed September 11, 2024. https://www.avma.org/news/study-fair-pay-appreciation-work-top-factors-employee-retention#:~:text=The%20 average%20annual%20turnover%20rate,AAHA)%2C%20 told%20AVMA%20News.

Tackling the veterinary professional shortage. MARS Veterinary Health. August 2023. Accessed September 11, 2024. https://marsveterinary.com/ tackling-the-veterinary-professional-shortage/

VCA Animal Hospitals’ career progression program empowers 14,000+ credentialed veterinary technicians and veterinary assistants. News release. VCA Animal Hospitals. October 20, 2023. Accessed September 11, 2024. https://vcahospitals.com/ press-center/vca-news/career-progression-program

A bold, new initiative that would increase access to care in a way never before seen in veterinary medicine.

Are career path programs the solution to a clinician shortage in veterinary medicine?

Bash Halow, LVT, CVPM, shares the top 3 things to remember during emotionally charged conversations in the clinic

Bash Halow 3 Things to Keep in Mind During Emotional Conversations

In his session, "Navigating Emotionally Charged Conversations," delivered at the 

, Bash Halow, LVT, CVPM, walked attendees through difficult interactions in the clinic, with both clients and coworkers. In an exclusive interview with 

, Halow shared 3 things to always keep in mind when having these conversations. His recommendations were:

Understand why you're feeling the way that you are about the situation.

Be careful not to make personal comments or attacks. 

The first is, you should understand why it is you're feeling the way it is you're feeling. So, if you're about to go in and have a conversation, and you're worked up into a lather about it, you need to get real about why it is you're worked up into a lather. One time, I was working with this doctor, and she got worked up in a lather about a client, and her comment was, "You know, you're just not you're just not supposed to talk to women that way." And, I don't really think her beef was that this guy was talking to women that way. That wasn't her beef. Her beef [had to do with] the way that he was talking to her. It was insinuating that she wasn't smart enough to do the job. That's what the real [problem] was. And, I think that when you call a spade a spade, when you understand why it is [that] you're... feeling what it is you're feeling, that button is less likely to be as reactive when you're in the room. So, know why you're worked up into a snit, is number 1.

Bash Halow, LVT, CVPM, lists the 3 most important things to keep in mind during emotional conversations with clients 

3 things to remember during emotionally charged conversations

Dr Mara Tugel answers commonly asked questions about Zenrelia 

Video interview with Mara Tugel, DVM

Now that Elanco's Zenrelia has received FDA approval and hit the veterinary market, there are veterinary professionals out there that are interested in learning more about the product, especially gaining a better understanding of the label added to the Zenrelia box. 

Mara Tugel, DVM, veterinary technical marketing-companion animal therapeutics for Elanco, provides some clarity into the most common questions that are out there about Zenrelia. 

The second question that we get most commonly is around why there's a boxed warning on this product, and what does this mean? So there is a boxed warning on the Zenrelia label that is around concurrent use with vaccines, and there's a holding period described in this boxed warning where you're supposed to discontinue use of Zenrelia for at least 28 days to 3 months prior to vaccination and at least 28 days after this, of course, is of major concern to general practitioners. The dermatologists say, I don't even know when dogs are getting vaccinated, but for general practitioners, this is something that we understand they need more information about. 

The box warning is specifically related to the results of a vaccine response study in which dogs that were under 12 months of age were treated with 3 times the label dose of Zenrelia. We know that all of these immune modulatory drugs, including Jak inhibitors, can be immunosuppressive when they're dosed at higher than labeled doses. 

Interested in learning more about treating pruritis? Fetch Coastal will feature sessions presented by Joya Griffin, DVM, DACVD, and Natalie Marks, DVM, CVJ, CCFP, Elite FFCP-V,s. Learn more and register 

Mara Tugel, DVM explains why veterinary clinics could need multiple JAK inhibitors, and why is there that label on the Zenrelia box