 readers! Did you know that the dvm360 2024 Hospital Design360® Competition is now accepting entries until May 15, 2024? Hospitals and clinics that opened between January 1, 2018, and December 31, 2023, qualify for the contest to either win one of our Grand Prize categories or be named one of our merit winners. Be on the lookout for more information on the contest on dvm360.com and check out the 

 for more information and where to submit your entry!

As you prepare your hospitals for the submission, here is what was popular this week on dvm360.com!

 is now available on dvm360.com! This month, Boaz Man, DVM, addressed brachycephalic obstructive airway syndrome in general practice, now that the condition has been brought to the forefront since the French bulldogs became the top dog breed in America.

As the avian flu continues to spread throughout cattle, cats, and other mammals in the United States, multiple states have decided to implement 

, despite the World Organization for Animals advising against it.

Do you have patients that you know are experiencing chronic pain, but the owner is not convinced? On this week’s 

 of The Vet Blast Podcast, Adam Christman, DVM, MBA, and Michael Petty, DVM, discuss how chronic pain can impact pets' behavior, and how to communicate this with the client.

 pradofloxacin injection (Pradalex; Elanco) solution for certain respiratory diseases in cattle. The medication is a medically important antimicrobial in the fluoroquinolone class and can only be prescribed as a single injection by a licensed veterinarian.

 is now available! Check out the recent veterinary clinic openings within the United States from a new CityVet location in Virginia Beach to an at-home veterinary care service expanding to Atlanta, Georgia.

As clients begin to book travel plans for the Spring and summer seasons, be sure to warn them of potential dangers lurking in the walls of their pet-friendly Air BnB, especially after what happened to Soho the cockapoo in Pet Poison Helpline’s Toxin Tail 

Articles

Wrap up: dvm360 launches its 2024 Hospital Design360™ Competition and other veterinary news

Vetster, pet health platform and global veterinary marketplace, announced the launch of the Pet Friendly Workplace Certification, a new initiative for pet-inclusive employers. The certification will standardize safe environments for pets and regulate workplace policies and operations. Amazon, TribalScale, Spot Pet Insurance, and DECIEM are among the first certification recipients, recognized for their pet-inclusive approaches to physical and virtual workplaces, according to a Vetster news release.

Nicola Watson, HR Manager at TribalScale said, “Recognizing that our employees’ pets are integral parts of their lives, we proudly extend our cultural ethos to include them. Pets aren’t just companions; they’re valued members of our extended TribalScale family. By nurturing a pet-inclusive culture, we not only enhance the well-being of our employees but also strengthen the fabric of our global community, because when every member feels seen, heard, and supported, we all thrive together.”

According to the 2023-2024 APPA National Pet Owners Survey, 66% of households in the United States own a pet, which equates to 86.9 million households.

 Experts anticipate this number to rise since the younger generations are more likely to have a pet than a child. It is estimated that the millennial generation is less likely to own a house and have children than the generations before them and 58% of millennials said they prefer to have pets over human children.

 This is why Vetster is looking to help employers adapt to these societal changes and make their workplaces more pet friendly.

“The Pet Friendly Workplace Certification aims to recognize those companies already building programs to incorporate pets in the physical and virtual workplace, and help companies design programs that meet the needs of the modern employee,” said Cerys Goodall, COO of Vetster.

According to Vetster, the Pet Friendly Workplace Certification is open to companies of all sizes who demonstrate a commitment to pet-inclusivity and are evaluated across 4 key areas. These are the specific guidelines advised by Vetster:

 “Companies develop and incorporate pet policies throughout their people operations, including flex work strategies to accommodate pet care and exercise.”

 “Pet-inclusive cultures recognize the importance of pets to their employees and the benefits of stress release and community development, these companies create events, volunteer in their community, and actively engage pet owners in their needs.”

 “For those with physical office spaces, companies are committed to a healthy and safe office environment for animals and people including defined onboarding processes, pet-free zones, and employee training.”

 “Supporting pets as part of the family, companies provide rewards, perks, health spending accounts, and pet health solutions as part of their total compensation strategy.”

“Creating a pet-friendly office can be very rewarding, benefiting the mental health and morale of both employees and their furry friends. Spot’s office culture revolves around many puppy playdates,” said Scott Taylor, president of Spot Pet Insurance. “By establishing clear policies and guidelines, I encourage other businesses to create a happy and productive work environment that embraces the presence of pets.”

Vetster launches The Pet Friendly Workplace Certification. News release. Vetster. April 11, 2024. Accessed April 12, 2024. 

https://www.businesswire.com/news/home/20240411228033/en

2023-2024 APPA National Pet Owners Survey. American Pet Products Association, Inc. 2023. Accessed April 12, 2024. 

https://www.americanpetproducts.org/news/News-Public-Relations/pet-industry-market-size-trends-ownership-statistics

Millennials prefer pets to children (Survey). ConsumerAffairs Research. June 1, 2023. Accessed April 12, 2024. 

https://www.consumeraffairs.com/pets/pets-are-family.html#:~:text=Previous%20studies%20have%20shown%20that,have%20pets%20over%20human%20children

Vetster launches the Pet Friendly Workplace Certification for employers

Is your workplace pet-friendly certified?

Brachycephalic obstructive airway syndrome (BOAS) is a well-established condition that historically has been overlooked. However, BOAS has gained more attention since the French bulldog became the most popular breed in America in 2023.

 Recent data from the American Kennel Club (AKC) show that approximately 1 in 7 of nearly 716,500 dogs registered in 2023 was a French bulldog.

It’s hard to imagine that French bulldogs were not among the AKC’s top 75 breeds just 25 years ago. Their popularity may be attributed to their prominence on social media and a slew of celebrity owners.

 In 2023, French bulldogs became the most-mentioned dog breed on Instagram, with more than 37 million posts featuring French bulldog hashtags.

 Celebrities who own French bulldogs, including Leonardo DiCaprio, Lady Gaga, and Megan Thee Stallion, also have helped promote the breed.

Boaz Man, DVM, with one of his patients. (All photos courtesy of Boaz Man, DVM)

The French bulldog dethroned the Labrador retriever, which had previously won the AKC popularity contest for 30 years in a row.

 With the popularity of this “extreme brachycephalic” breed, veterinarians share a great responsibility in educating pet owners about the specific medical needs of these animals. We have come a long way from being reactive health care providers to being proactive in regard to BOAS. In the past 10 years, close to 200 clinical studies have focused on BOAS, according to PubMed and the National Library of Medicine. Compare this with the prior 10 years (2004-2014) when there were only 30 BOAS studies.

In general practice, I used to be guilty of not doing enough to prioritize the obvious breathing issues of my clients’ brachycephalic pets. Too many times jokes were made about the breathing challenges these pets faced in the exam rooms because they were “expected for the breed.” As practitioners, we have often failed to tackle BOAS and address it at an early age. Too often we would accept the “let’s wait and see” conversation that was doomed from the start. It was more recently that I realized our responsibility is to either address these pets’ issues at our general practice or refer them directly to someone who would.

For many years, I was comfortable with routine soft tissue procedures that were considered predictable. After recently upgrading my old laser to newer surgical laser technology, I realized I could perform surgery with increased scalpel speed and a clear visual field because the new technology led to minimal bleeding and swelling. Although I used my laser to remove lumps, perform spays and neuters, and perform other elective surgeries, I did not initially entertain the idea of using it for BOAS as a soft tissue surgery.

Getting educated and generating awareness for clients

I had become comfortable with referring “less routine” surgeries to other surgical experts. Admittedly, I was fearful of taking on a surgical procedure that I had not performed on my own. The fears of treating patients with BOAS in general practice are multifactorial. They include the fear of dealing with the owner and their anxious pet who struggles to breathe, the fear that the respiratory-compromised pet could become a case of respiratory crisis, and the fear that having to deal with a respiratory crisis would disrupt everything else we needed to do at the clinic. These obstacles used to lead me to refer cases to other experts, but these popular pets need us all to overcome our fears.

As a visual learner, I know the importance of sharing online educational videos. I decided to post a short and simple video of a French bulldog’s breathing before and after BOAS surgery on Instagram. After all the years I had been active on social media, never did I imagine that it would become my first viral video. Shortly after this video had gained so much attention, I knew I needed to take a more proactive approach to addressing BOAS in our practice. Although the BOAS surgeries performed at my hospital were successful, I remained anxious about taking them on exclusively.

I decided to reach out to the team at VetScalpel. The veterinary surgical laser designer and manufacturer provided me with the tools necessary to successfully perform BOAS laser surgery in my practice. It was very shortly after I had performed my first BOAS laser surgery that I realized how important this procedure was for our brachycephalic patients. There is nothing more satisfying than to have a pet who was struggling to breathe go home later that day breathing easier after BOAS corrective surgery. The long-term improvement in quality of life is equally appreciated by the owner, the patient, and our entire veterinary team.

To address the medical needs of patients with BOAS, we must first understand some basic concepts.

Infantlike features (large forehead, large and low-lying eyes, bulging cheeks) are described in classical ethology as social releasers, simple stimuli that evoke a stereotyped response (in this case, nurturing). Researchers assessed the attractiveness of such features in the faces of dogs or cats, teddy bears, and human infants, and then related these preferences to the degree of attachment to a pet. Overall, pets that had faces with infantlike features were rated as more appealing than those without.

We must start by educating every owner of a brachycephalic pet about the symptoms of BOAS that signify an active problem. These include some or all of the following: noisy breathing, open mouth breathing, panting, snoring, wheezing, grunting, squealing, snorting, regurgitation, exercise intolerance, gagging, choking, abdominal breathing, and change in gum color.

Early and proactive surgical intervention should be discussed and scheduled. We also should tell owners that breeding affected pets is unethical and that affected pets should be spayed and neutered.

BOAS surgery improves a pet’s ability to breathe, reduces exercise intolerance, reduces secondary gastrointestinal diseases, and improves their overall quality of life. Most important is that we, as general practitioners, can effectively reduce the risk of life-threatening complications such as aspiration pneumonia, hyperthermia, laryngeal paralysis, heart failure, and collapse.

The patient is shown before (top) and after laser rhinoplasty (bottom).

When it comes to determining which patients are candidates for BOAS surgery, there are a few tools that are helpful. One is the BRisk Score, which assists with developing and validating a preoperative score to predict the risk of major complications in dogs undergoing corrective surgery. Appropriate screening is needed for brachycephalic breeds because it enables us to discover health concerns that may change our protocol or lead us to refer to another facility for postoperative monitoring or critical care. Included in my preanesthetic tests are an electrocardiogram, blood work, and a radiographic evaluation of the neck and thorax (upper and lower airways) and abdomen by a radiologist.

In screening many French bulldogs, I have found that they often have bradycardia and an atrioventricular block, so they may require preanesthetic atropine. Radiographs can help us confirm elongation and thickening of the soft palate and evaluate for other concerns such as tracheal collapse, pulmonary abnormalities, cardiovascular disease, pharyngeal/esophageal abnormalities, and hiatal hernias. As with any surgery, our goal is to minimize the risk of complications; the more we understand about the patient, the better the outcome will be.

Identifying BOAS-associated vomiting and regurgitation 

With high resistance in the airway, extreme effort is needed for brachycephalic dogs to expand their chests to increase airflow into their lungs. This extra-strong expansion of the chest can cause stomach content or the stomach itself to be sucked into the chest, which often leads to vomiting and regurgitation. When acidic stomach content flows back into the esophagus it becomes irritated and inflamed and creates discomfort and heartburn. Another problem these brachycephalic pets have is retention of food in the stomach for prolonged periods. Pooling of food in the stomach creates a sensation of nausea and again increases the potential for vomiting and acid reflux.

Why the Poiseuille law is important to BOAS

Using the Poiseuille law, it has been determined that a 50% reduction in airway radius results in a 16-fold increase in airway resistance.

 The consequences of this resistance to airflow include restricted breathing, increased negative intraluminal pressure during inspiration, tonsillar hyperplasia, pharyngeal hyperplasia, eversion of laryngeal saccules, and laryngeal and bronchial collapse.

We must take a proactive role in general practice to help pets who suffer from BOAS. BOAS laser surgery is a soft tissue surgery that you are capable of performing. Once you learn to remove a lump with a laser, the soft palate will become a walk in the park. You will come to learn that a staphylectomy is less complicated than a lumpectomy. The tissue in the nares is no exception to this rule. Both procedures have no layers to close, no sutures needed, as well as no postoperative e-collar. Additionally, they have an advantage of minimal to no bleeding that is easily controllable.

 is owner and medical director of Boca Midtowne Animal Hospital, the only Fear Free certified practice in Boca Raton, Florida, and is also accredited by the American Animal Hospital Association.

Rice J. French bulldog knocks Labrador retriever out of number one
spot, ending 31-year stay at the top. American Kennel Club. March 15,
2023. Accessed March 6, 2024. https://www.akc.org/press-releases/ french-bulldog-knocks-labrador-retriever-number-one-spot-ending-31-year-stay-top/ 

Peltz J. Beloved and debated, French bulldog becomes top US dog breed. Associated Press. March 15, 2023. Accessed March 8, 2024. https://apnews.com/article/ dogs-breeds-popularity-frenchies-bulldogs-labrador-retrievers-983c17969c8b3efaf1b- 02f55a0d8f24b

Werner B. What are the 20 most Instagramable dog breeds? List Wire. April 4, 2023. Accessed March 8, 2024. https://thelistwire.usatoday.com/lists/ what-are-the-20-most-instagrammable-dog-breeds/

Lorenz K. Part and parcel in animal and human societies (1950). A methodological discussion. In: 

Studies in Animal and Human Behavior. Volume II.

Archer J, Monton S. Preferences for infant facial features in pet dogs and cats. 

. 2010;117:217-226. doi:10.1111/j.1439-0310.2010.01863.x

Lee L. Airway management and ventilation. Western University of Health Sciences. Accessed March 12, 2024. https://www.westernu.edu/mediafiles/veterinary/vet-anesthe- sia-analgesia/airway-management-Ventilation.pdf

Trappler M, Moore K. Canine brachycephalic airway syndrome: pathophysiology, diagnosis, and nonsurgical management. 

Fawcett A, Barrs V, Awad M, et al. Consequences and management of canine brachycephaly in veterinary practice: perspectives from Australian veterinarians and veterinary specialists. 

An overview of French bulldogs and questions that should be considered for treating these patients

Addressing brachycephalic obstructive airway syndrome (BOAS) in general practice

Photos courtesy of Louisiana State University School of Veterinary Medicine.

BVetMed, PhD, FHEA, FCPP, FRCVS, DACVIM, DECVIM-CA, 

dean of Louisiana State University School of Veterinary Medicine and 

associate dean for Research and Graduate Education (right), congratulate Judy Pawlusiow, 

DVM (LSU 1992), MS (LSU 1981), DACVIM (SAIM),

BVSc (RSA), PhD (LSU 1987), DACVP, on their awards.

The Louisiana State University School of Veterinary Medicine (LSU Vet Med) has named its 2023 Distinguished Alumnus Award recipients. They are Jay Addison, DVM (LSU 1983); Cyril Clarke, BVSc (RSA), PhD (LSU 1987), DACVP; and Judy Pawlusiow, DVM (LSU 1992), MS (LSU 1981), DACVIM (SAIM).

Ellen Addison (left) and Jay Addison, DVM (LSU 1983), celebrate at the Louisiana Veterinary Medicine Winter Meeting, where Dr Addison received his award.

The Distinguished Alumnus Award recognizes LSU Vet Med alumni for outstanding professional and personal achievements. Any graduate of the university is eligible for the award. Candidates are recognized for their accomplishments in veterinary medicine or science and/or contributions to the community through public service.

Clarke and Pawlusiow received their awards from Michael Graziano, MS (LSU 1981), PhD— LSU Vet Med’s first master’s graduate and a recipient the 2022 Distinguished Alumnus Award—on April 3, 2024, at LSU Vet Med in Baton Rouge. Addison was presented with his award earlier in the year by LSU Vet Med Dean Oliver Garden, BVetMed, PhD, at the LSU Vet Med Alumni Reception during the Louisiana Veterinary Medical Association Winter Meeting. The reception was held on January 27, 2024, in Shreveport, Louisiana.

Addison has become a prominent figure within equine veterinary medicine and environmental conservation over his 40-year career, according to the university. He works as a private equine practitioner and partner at Equi-Vet, LLC, based in New Orleans, using cutting-edge technology to contribute and advance the thoroughbred racing industry. He introduced the use of ultrasounds, digital radiology, and endoscopy, into the racing world at a time when these technologies were in their infancy. His impact extended beyond the clinic as he developed a unique relationship with the LSU Equine Health Studies Program, bringing clinicians, equine residents, and students to the racetrack, fostering mentorships and preceptorships. He continues to share his expertise through professional presentations on topics such as video endoscopy for detecting upper airway diseases in racing thoroughbreds and new techniques for correcting dorsal displacement of the soft palate.

Beyond veterinary medicine, Addison founded and served as CEO of Land Trust for Louisiana, a non-profit organization protecting and enhancing the state's land and water resources. His contributions to the establishment of the Cherokee Beach Research Forest and the Justin Addison Memorial Research Fund showcase his commitment to education and research in biological sciences. His extensive involvement in professional associations, such as the American Association of Equine Practitioners and the Land Trust Alliance, further attest to his leadership in the field. Overall, Dr. Addison's career reflects a multi-level commitment to veterinary medicine, environmental conservation, and community service.

Cyril Clarke, BVSc (RSA), PhD (LSU 1987), DACVCP

Clarke earned his veterinary degree from the University of Pretoria, South Africa, and earned his PhD in veterinary pharmacology from LSU Vet Med. After completing his doctorate in 1987, Clarke joined the veterinary faculty at Oklahoma State University (OSU) in Stillwater. He became the academic department head and then associate dean for academic affairs at the OSU Center for Veterinary Health Sciences. He became certified as a diplomate in the American College of Veterinary Clinical Pharmacology and completed a master’s degree in higher education at OSU. Clarke taught veterinary pharmacology while performing research and received the Pfizer Award for Research Excellence.

In 2007, he was appointed as the Lois Bates Acheson Dean of the College of Veterinary Medicine at Oregon State University. Dr. Clarke continued to teach veterinary pharmacology, receiving the Certificate of Excellence in Teaching Award and the Oregon Veterinary Medical Association’s President’s Award. He joined Virginia Tech in 2013 as dean of the Virginia-Maryland College of Veterinary Medicine and currently serves as executive vice president and provost of Virginia Tech.

Dr. Clarke's academic service includes the Board of Directors of the Association of American Veterinary Medical Colleges (AAVMC), membership on the American Veterinary Medical Association (AVMA) Council on Education, responsible for accreditation of North American veterinary medical institutions, president of the American College of Veterinary Clinical Pharmacology, as well as other prominent and important professional organizational leadership positions.

Judy Pawlusiow, DVM (LSU 1992), MS (LSU 1981), DACVIM (SAIM)

Pawlusiow was the second student to graduate from the LSU Vet Med master's program in 1981 and has since built a strong and lasting connection with the school. Among her accomplishments is the establishment of the Pawlusiow Scholarship, which is an endowed program for out-of-state students with financial need.

After earning her master’s degree in toxicology of veterinary clinical science in 1981 and her DVM in 1992 at LSU, Pawlusiow completed an internship and her residency for small animal internal medicine and surgery in 1995 at The Ohio State University, Columbus. Pawlusiow then received diplomate status in the American College of Veterinary Internal Medicine in small animal internal medicine. She also is an active member in several veterinary medical associations and an instructor in training programs for veterinary technicians, veterinary medical students, and area veterinarians who wish to gain more ultrasound skill and experience.

She has more than 25 years of experience as a small animal internal medicine veterinarian and works as the founder of Advanced Veterinary Mobile Diagnostics, PC, in Long Island, New York. This diagnostic service provides ultrasound, echocardiography, and endoscopy at veterinary hospitals. Pawlusiow is also owner and founder of BAER Mobile Testing Service, an evaluation system for deafness among canines and felines. Using brain auditory evoked response testing, the service is on-site for breeders and pet owners.

LSU Vet Med announces Distinguished Alumnus Awards. News release. Louisiana State University School of Veterinary Medicine. April 11, 2024. [email]

Three veterinarians were recently presented with the 2023 Distinguished Alumnus Award.

LSU names veterinary education alumni honorees

Tartar Shield Pet Products Inc is a leading manufacturer and distributor of pet dental health products and aims to streamline the purchase process of dental products for veterinary clinics. To combat this, Tartar Shield is launching Direct2Vet, an online portal designed to simplify the way veterinary professionals and students purchase pet dental products.

Ordering on Direct2Vet allows veterinary professionals to access exclusive pricing and an expansive library of clinical studies, research materials, and educational product resources. These resources can keep veterinary professionals up-to-date on new products or solutions in veterinary dentistry.

To start using Direct2Vet, veterinary professionals must register and wait for approval. Once approved, purchasing can begin immediately and most orders on the portal will ship within 24 hours and delivered between 3-10 business days.

The Direct2Vet program is not limited to a specific set of veterinary professionals, and it extends its services to students studying life sciences, especially those interested in veterinary medicine. There are 2 different accounts available on the portal:

An individual account for professionals who use, recommend or sell our products. This account gives users access to exclusive marketing materials, product information, and research not typically accessible to the general public and pet owners.

A company account for veterinary clinics or retail partners wishing to place orders for our products at business pricing.

“Veterinary professionals have countless daily demands,” said Lisa Hoover, president of Tartar Shield, in a news release.

 “Our Direct2Vet portal offers the most convenient, fast ordering of our popular Tartar Shield products, getting the products to the vet, and then onto the customer sooner than ever. The educational resources should also be helpful, as pet dental health advancements and best practices continue to evolve. We want to help our customers stay on top of that so their customers can also be better informed about what at-home products make the biggest impact to their pet’s dental health.”

Tartar Shield’s popular products include rawhide chews, food toppers, and dissolvable water-additives. The dental company is committed to providing products that are clinically proven to clean teeth, freshen breath, reduce plaque and tartar buildup, and help prevent and manage periodontal disease.

 Plus, there are dental products designed specifically for canines and felines.

Tartar Shield launches Direct2Vet portal for easier purchasing by veterinary professionals. News release. Tarter Shield Pet Products Inc. April 10, 2024. Accessed April 11, 2024. 

FAQs. Tartar Shield Pet Products Inc. Accessed April 11, 2024. 

Tartar Shield launches Direct2Vet to streamline dental product purchases

Online portal for veterinary dental purchases

The stories are all too common. Buffy should have blood work, Calvin should be on long-term medications, Spike needs a progress exam...and their owners are dragging their feet or outright declining. The team is frustrated with the lack of adherence to their recommendation and is on the edge of a downward spiral, from blaming their colleagues to vilifying the clients. Can you right this ship? Can you identify what is misaligned and get patient care back on track? You can—not by using strong-arm tactics on clients or team members, but by understanding the root causes of nonadherence and building client relationships and trust.

Before laying the blame at anyone’s feet, take a moment to evaluate the communication between the team member and the client. This does not mean accusing anyone of failure. No, this evaluation should be a systematic process of sequential steps to determine where the barriers to adherence occur. These steps help the veterinary team understand where to begin the conversation with the client when there is a barrier.

Step 1: Is my client aware of the problem?

If not, start your communication here and do not assume the client understands the issue. Consider providing educational materials (via text, email, or printed copies) on the disease process while they wait for diagnostics or the next steps.

Step 2: Is my client involved in the problem?

Does your client seem committed to learning how to change their pet’s lifestyle? Are they concerned about cost? Education can help them see that treatment can involve small steps, but it takes their involvement.

Step 3: Does my client want to do something about the problem?

Turn the client from a passive information processor to an information seeker (ie, they need more information or clarification).

Step 4: Is my client confident that they can do something to solve the problem?

Does the client believe they have the ability to complete the task? Brainstorm solutions, show the client success stories, and encourage them.

Step 5: Does my client have the tools they need to solve the problem?

Give them basic information and point them to some educational resources to learn more about the disease, diagnostics, and treatment. Acknowledge the client’s right to defer to a specialist or other resources.

Step 6: Are there financial constraints, cultural and/or language barriers
that keep them from committing?

It is essential to remain nonjudgmental and offer clients solutions that suit their needs but still honor our oath to provide patient care. Open communication helps to manage expectations when there are limitations to care.

Behavior change (eg, client adherence) can be achieved once all the steps are actively addressed. This change does not always happen overnight. It may require professional development of veterinary teams, updating medical protocols, building relationships with clients, and understanding barriers our veterinary clients face when making decisions about their pet’s health care.

The sequential steps help the team present information about the pet’s medical condition. It is easy for the team to skip steps because they are already knowledgeable about medical conditions. However, the client needs information. Many team members start a conversation with “Calvin has _________ and needs to be on this medication every day. We will see how he is doing in 6 months.” The veterinary team knows the condition is manageable with daily medication, so it should be an easy solution—case solved. But the client balks. What is the problem? 

EXAMPLE: Calvin has osteoarthritis (OA) and needs daily medication.

 Is my client aware of the problem? Maybe the pet was in for an annual wellness exam, so the diagnosis surprised the client. Don’t assume the client knows about the problem.

 Is my client involved in the problem? If the pet is not visibly ill, the client may not consider this a serious concern and is willing to wait and see. This is commonly seen in cases of OA. The client doesn’t feel that the pet is in pain because the pet is not vocalizing or limping every day. This is an opportunity to educate clients and ask specific questions about their pet’s activity levels.

 Does my client want to do something about the problem? Is the client responding to your call to action or merely taking in what you are saying and planning to get back to you? Maybe the client is confused and needs time to assess and clarify the information you are giving them. Veterinary team professionals must ask the client: “Are there additional questions or concerns you have with the treatment?” This is paramount with chronic disease processes.

 Does the client lack confidence or self-efficacy? The client may not be able to administer the medication twice a day. What if the client hates wrestling the pet to administer the medication or is frequently out of town and relies on others to care for the pet? If oral medication is not an option, then compounded medicines in other forms may solve the problem. Some veterinary hospitals offer technician appointments for outpatient treatments as a last resort. Also, we must understand that not every patient is the right candidate for certain types of care. These conversations allow clients to know their options, which can improve adherence.

 Does the client have the required tools and skills? This could be the skill of administering the medication, knowledge about the medical condition, and a commitment to attend follow-up visits. Don’t let Dr Google give the tools; have the team regularly communicate with the client and have the necessary resources available.

 Are there any barriers to consider with the standard of care? Are there financial concerns with continued follow-up? Some clients may have brought in their pet but step 4 is the barrier. Maybe step 5 is the barrier because the client is interested in holistic treatments, which is not something you offer. Are there cultural differences in why a client won’t pursue a treatment option? Are there language barriers? All of these must be addressed.

Another potential barrier is health literacy, the degree to which an individual has the capacity to obtain, communicate, process, and understand health information and services in order to make appropriate health decisions.

 Health literacy is not the same as illiteracy, although they are often related. People who read well and are comfortable using numbers can experience health literacy issues.

How often do you see clients unfamiliar with medical terms or how their pet’s body works? Can all your clients evaluate the risks and benefits affecting their pet’s health? When you deliver a serious pet diagnosis, do any of your clients become scared or confused? How great is client adherence when the pet’s health condition requires complicated at-home care? The National Assessment of Adult Literacy reported in 2017 that “just 12% of Americans possess competent health literacy skills.”

 Health literacy is a priority issue in human medicine, but it extends beyond human health care into veterinary health care.

Low health literacy skills can affect pet health. Consider the following prescription labels: “Give 2 tablets twice daily for 14 days” or “Give 1 tablet today, 2 tablets tomorrow, then 3 tablets daily until finished.” These sound like simple labels for any medication dispensed to treat a pet’s condition. However, in a study of human patients receiving a group of labels as examples for their medication, 46% did not understand the instructions and 38% with adequate literacy skills misunderstood at least 1 label.”

 Think about your clients and what they could be missing on their pet’s prescription bottles, which makes them appear nonadherent to your recommendations.

Low health literacy skills affect more than understanding prescription labels. According to the Agency for Healthcare Research and Quality, and the CDC, low health literacy also may appear as follows:

Inability to name medications and explain their purpose or dosing

Identifying pills by looking at them (color, size, shape), not by reading the label

Inability to give coherent, sequential history

Lack of follow-through on tests or referrals

Not receiving treatment or receiving treatment too late

Not giving medication correctly or making other dangerous mistakes

Treatment and other services needed to a greater extent than those with good health literacy 

Are any of your clients represented by any of these red flags? Could some of your clients be nonadherent because of low health literacy skills?

The FDA has an animal health literacy website with a section called “Medications for Your Pet...Questions for Your Vet.”

 Spend a team meeting reviewing the questions and guide your team on ways to overcome any barriers to medication adherence.

Nonadherence by clients can be multifactorial, but with a strategic approach and a committed team, you can identify the root of it and implement solutions to ensure the best outcome. It is critical to get the support and expertise of your team, as each will play a role in improving client adherence. Involve them and create goals for your hospital so that you can have sustainable success.

 is the owner of Snowgoose Veterinary Management Consulting in Winston-Salem, North Carolina, and a former practice owner. She has taught practice management workshops at 10 veterinary schools and publishes and speaks nationally. She is a founding member of VetPartners and a member of other professional organizations.

What is health literacy? Centers for Disease Control and Prevention. July 11, 2023. Accessed March 6, 2024. https://www.cdc.gov/healthliteracy/learn/index.html

Helping patients improve their health literacy: effective strategies for nurses and nurse managers. Bradley University. May 1, 2017. Accessed March 6, 2024. https://onlinedegrees.bradley.edu/resources/articles/helping-patients-improve-their-health-literacy-effective-strategies-for-nurses-and-nurse-managers/

Davis, T. Health literacy: hidden barriers and practical strategies. Agency for Healthcare Research and Quality. US Department of Health and Human Services. https://slideplayer.com/slide/4900269/

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Medications for your pet…questions to ask the vet. FDA. February 20, 2024. Accessed March 12, 2024. https://www.fda.gov/animal-veterinary/animal-health-literacy/medications-your-pet-questions-your-vet

Uncovering the root causes can help resolve clients’ concerns