Antimicrobial resistance is growing, which leads to less effective antibiotic treatments. More resistant bacteria create a problem for human and animal health. Adam Christman, DVM, MBA, of 

, spoke with Andrew Rosenberg, DVM, DACVD, about the antimicrobial stewardship approach, which utilizes antimicrobial agents in a way that preserves their efficacy, as a potential solution for veterinarians.


What does it mean to use antimicrobial stewardship? How does this understanding lead us to be more prudent?

 Antimicrobial stewardship is responsibly using antimicrobials to decrease the risk of resistance occurring, and as a result allowing us to maximize our treatment. As resistance is growing we want to ask ourselves, why are these kinds of bacteria becoming more common? Sometimes, bacteria can transfer genetic mutations to other bacteria.

One of the hottest topics we’ve ever seen around antimicrobial resistance is biofilm. Biofilms are when groups of bacteria or yeast conglomerate together on the surface of the skin or even inside the ear, and they embed themselves in a slime layer. When embedded in said slime layer, they are resistant to lots of different antibiotics, physical stresses, and chemical stresses. You want to use products that can disrupt these biofilms and make it easier to kill microorganisms.

How do you approach the decision-making process for selecting an antimicrobial agent, taking into consideration factors such as culture and sensitivity testing as well as PCR (polymerase chain reaction) testing?

 I would start with topical antimicrobials that don’t have antibiotics, but rather antiseptic ingredients. These do not encourage resistance mechanisms to develop in the first place. Some products contain chlorhexidine. Newer products contain things like microionized silver, which can kill bacteria, yeast, and viruses, and disrupt biofilms.

When choosing an antibiotic, cultures and sensitivity testing can help us. There have been some studies on PCR cultures, some of which are not so favorable. I think it is good technology, but more advancements are needed before we use those on a regular basis.

Christman: Talk to us about some of the topical modalities that are available now.

 BioHex is a line of products that kill microorganisms in a multimodal fashion. It is a combination of chlorhexidine and miconazole—2% and 2% each—that has been shown to be a superior ratio for these two ingredients.It also has microionized silver and ceramides. Ceramides are important moisturizers for the skin that help increase skin barrier function. In most allergic dogs, they have a defective skin barrier, which can allow for more bacteria and yeast to get into that defective skin and create infection. Ceramides help prevent that.


How do we teach our clients about antimicrobial stewardship from our perspective?

 When educating my clients on what topical products to use, I say this isn’t just to treat infections; it is also to prevent new infections from occurring. I give them a reason why, not just tell them what to do. I will also say if we can use topical products in a good way, and we’re diligent about bathing their pet, we can decrease the need for antibiotics, even the heavy-duty ones.

How can a One Health approach enhance antimicrobial stewardship in veterinary dermatology

 Antimicrobial resistance is growing everywhere—on the human and veterinary side. If we can limit the use of antibiotics in veterinary medicine using increased topicals, then that benefits everybody.

Are there specific guidelines or resources for generalists when it comes to antimicrobial stewardship?

 There are 2 great resources out there. The World Association for Veterinary Dermatology has consensus guidelines for the treatment of methicillin-resistant 

. It is an open-source article that can be accessed without a subscription. Another resource is the Antimicrobials Working Group. They have robust guidelines on how superficial bacterial folliculitis should be treated in our companion animals.

Articles

Spearheading the path for antimicrobial stewardship 

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Introducing Inside The Clinic™--our new CE webcasts featuring clinical case videos in real-time action from practices across the nation. Chief Veterinary Officer, Dr. Adam Christman, tours veterinary clinics to capture what's trending in veterinary medicine. Learn what's happening now from the experts point of view, real time from inside-the-clinic! Sharpen critical thinking skills, boost your confidence, and advance your expertise for practical application, Plus earn RACE®- approved CE credit. Available exclusively on dvm360 Flex.

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Sounds like it's wonderful Dr. Penn that, you know, we have these offerings to hospitals, especially in areas where access to care is a really big concern. So, it's equally important to provide customization to our clients as well. So how has that landscape provided an opportunity for greater client communication and patient outcomes?

Yeah, I think...thank you for the question, Dr. Christman. I think when we think about this, and we think about the Zoetis virtual laboratory, we have really as an organization said, "Hey, here's the challenges that veterinarians face every day, and really try to alleviate some of those challenges or help with workflow efficiency, consistency, those types of things. So, there's always a virtual laboratory as an umbrella, has the, the VetScan Imagyst, has our point of care diagnostic analyzers, has our ZoetisDx platform, which includes trending those results and, you know, access to clinical specialists for a complimentary consultation. And we really, when we think about the VetScan Imagyst, the VetScan Imagyst is sitting right there, it's a scanner that has the...it's really your window to artificial intelligence, which is kind of a buzzword right now. But you can do fecal analysis, you can do AI dermatology, cytology, skin impression smears, ear swabs, skin swabs, you can do AI blood smear to add that qualitative information to that quantitative information. And that's that kind of expert level AI that is there to provide those results that are comparable to results that a clinical pathologist would provide. But in addition to that, it's always backed up. That whole slide image is always able to be evaluated by an expert by a clinical pathologist, by a parasitologist, if you wish to add on that expert review, or if you've got some sort of sample, like a fine needle aspirate, a lymph node aspirate that you would like to send into it to a clinical pathologist, you can do that. So not only do you have the artificial intelligence, which provides you results for certain types of tests in 10 minutes, it's always backed up by the expert, you have the ability to send that whole slide image of really any tissue, any fluid, you can put on a slide from any veterinary species, send that to a clinical pathologist, and have those results back within hours. So, it really is just absolutely amazing. And it all feeds in, you know, we know that the presentation of this information is not only important for us to be able to trend those results, but also for our clients to be able to really say to that pet owner, here's exactly what we tested today. Here's what we saw on that on that microscopic slide. And here's kind of our plan moving forward. So, we get that presentation that we can provide that value to be able to communicate, to be able to educate to help with compliance. And that next step, if we say, hey, we want to have access to a specialist, the Zoetis virtual lab and can take care of that.

Yeah, so our consultation service, we have also taken the approach of really wanting it to be personalized, so the veterinarians that are using our service have access in a way that's convenient for them. So, we do offer both email consults, as well as Zoom consults that can be done via phone; they can phone into that. So that really can be about their time, that's so valuable, that they can really individualize. You know how that consult happens, so that it's convenient for them. But they're still getting that access to quality, additional resources. And then beyond just them having more control about the form of the consult, the timing of the consult, also providing reports so that they have that physical evidence to provide to the pet owner, so that that everyone is aware or a part of kind of understanding the next possible steps that can be involved. And so that really is a complimentary service that we are really trying to provide to our customers. So, they have that extra support in their busy practices.

Videos

Discover how the Zoetis Virtual Laboratory offers a full suite of diagnostic products and services

Zoetis Virtual Laboratory:  AI results backed up by the experts

And I want to talk more a little bit about the virtual lab Dr. Hann. So, the virtual lab has many offerings to it too. And they play a vital role in the way in which we practice medicine today. So, we know that adjusting to technologies such as AI can be scary. You think of AI for some reason we get scared of it too, and it's overwhelming, but you embrace it. So how helpful has this been for, you know, what your experience has been like? And how has this been for, you know, what you're seeing out there today?

The artificial intelligence is great, and definitely gives us additional diagnostics and quick access to certain answers. But it's a piece of the puzzle. There's a stepwise process that we go through for kind of each case of, you know, getting from "Okay, this is how they're presenting to this is the diagnosis," And then that after that the treatment process, the prognosis, the follow up care. And so, we can utilize specialists. So, we have our consultation service that can work hand in hand with a lot of these diagnostic tools to provide kind of more individualized care. And we're trying to do a couple things differently with our consultation service, so that we can provide very individualized personalized experience for our customers, which includes having the ability to consult with us in different ways, the ways that work best for their practice. So, email consults, Zoom consults, and then having access to different specialties. And then beyond just having the consult, we do consistently provide a written report, which is not always the case with consultation services. So that really allows them to tie in with the pet owner of they can provide that report. And so they know that they've had a specialist involved with the case, because I don't know that pet owners are always aware of what that there are specialists available in veterinary medicine or what that provides beyond the general practitioner. And so knowing that, that added value of kind of that relationship, and how we're all working together for that pet to get the best care possible.

Yeah. And just what you're both talking about, there's a global network of specialists, right? I mean, just to digest that for a moment, that's pretty impressive, knowing that you can have access to someone around the world. And I'm curious to get your thoughts on that. Dr. Wolfe. What has that experience been like for you?

I had specialists from multiple other countries. It's provided accessibility and under two hours, and it's been very...I've been able to understand, despite our time differences and language barriers, it's been very understandable and very, very informative.

Things that I've liked about it in veteranary medicine, in vet schools, you're talking if you do CBC profile, urinalysis, blah, blah, blah...you're gonna get the diagnostic. You're going to have a black and white diagnosis. You're gonna know what it is. And what my young veterinarians, most of them come like "Well I was taught that if I did this, I would know what the problem is." That don't happen that often. If it is, it's almost always a bad guy. But if you don't have that, if you've got all this information from you, but you're not sure how to put it together, and you talk to a specialist, sometimes they can help clear my mind and say, "This is where you need to be looking." You may you gotta have some differential diagnosis, but at least you've kind of helped. You can sleep at night knowing you've done the best for that pet that you can. And that's a big deal too as a veterinarian. You know, I think that's one of the biggest problems we have is this ambiguity of what what's wrong with that pet? Because we were taught if we did XYZ, we know what the answer is. And that's not the case.

Yeah, it really is about interpretation of diagnostics. It's not just a result. There are certain diseases that you may get a very clear answer. But there are a lot of times where a diagnostic tool is only as good as the interpretation of it. And so we, as specialists can help in that process, put that puzzle together.

And sometimes it's only a CBC. You don't need...we made it to present the whole case to them, but you could present only a urinalysis finding. I have a protein losing nephropathy I'm working on and so we're just looking at that focused as well.

Yeah, I love that we're providing access to care not only to our clients, but to us, the veterinarian. So that's fantastic.

The one thing you haven't mentioned that's really important is if I was watching the show, okay, how much is it? How much is it?

Yeah, it's complimentary. Having access to the specialist is complimentary. I almost think of it like, if you use the Zoetis diagnostic offering, it's kind of like going back to veterinary school where you can get access to experts, not only fromclinical pathology where you can go down and knock on clin path's door. But if you get a result and you say, "Okay, well now I want to kind of know what I want to do next steps. "I can go talk to an internal medicine specialis.t I can go knock on an oncologist's door and I can get an individualized complimentary plan to move forward with the case.

Amazing. It really is. Well, great, thank you so much doctors. This is wonderful.

Find out how Zoetis’ complimentary consultation service puts the puzzle pieces together

A diagnostic tool is only as good as its interpretation

The Veterinary Emergency Team is shown during preparations for deployment to the Texas panhandle, where wildfires are burning. (Photos: Rachel Knight/Texas A&M University)

An emergency response team from Texas A&M University School of Veterinary Medicine and Biomedical Sciences (VMBS) has been deployed to the Texas panhandle, where a cluster of wildfires are affecting animals. The largest of 5 fires in the region, the Smokehouse Creek Fire, was spread over 850,000 acres on Wednesday, according to VMBS; and 60 Texas counties were placed under a disaster declaration by Gov. Greg Abbott earlier this week.

“Fires are unpredictable and often enter a community without warning; when this happens, more people and animals are likely to be affected,” Deb Zoran, DVM, PhD, DACVIM, Veterinary Emergency Team director, said in a news release.

 “In these situations, it’s critical that we begin helping to take care of affected animals and support the local veterinary community as quickly as possible.”

Natural disasters like wildfires can cause animals to become displaced, injured, or in need of temporary care with shelter and food. In the Texas panhandle, government agencies and other entities are assisting animals in need through a variety of ways. Animal supply points are receiving and distributing items, a hay hotline has been established by the Texas Department of Agriculture, and the Texas Animal Health Commission (TAHC) is working to reunite found livestock and stray cattle with their owners.

VET members load a trailer in preparation for deployment. 

The Texas A&M Veterinary Emergency Team (VET) aims to provide resident animals and search and rescue dogs with veterinary medical care, and support local animal shelters. Nine individuals, including 5 students, were deployed to the Texas panhandle on Wednesday. Additional members of the team—comprised of VMBS faculty, staff, and students, as well as other volunteers—are expected to join the deployed group today.

Among the working canines are a dozen dogs deployed with the Texas A&M Texas Task Force 1. “Working dogs are critical to the success of search and rescue efforts, and our role is to make sure they have the nutrition, post-work rehabilitation, and veterinary care they need to continue providing hope and answers to loved ones of those in the affected area,” Zoran said in the release.

For all species, the TAHC is urging the public to monitor their animals and consult with a veterinarian if signs of fire-related injury are presented. These signs may include distress, fatigue, lesions, and exertion.

Animal owners can also be advised about caring for their pets and livestock in areas where smoke caused by wildfires may affect their health. American Humane and the American Veterinary Medical Association recommend owners take precautions as follows:

Limit the time dogs and cats spent outdoors.

Keep birds indoors at all times when smoke or particulate matter is present.

Avoid strenuous activity and exercise for all animals. This includes playing fetch, going for a jog, or taking a long walk.

Take your pet outside for short bathroom breaks and come immediately back inside.

Bring outdoor water bowls inside so it doesn’t collect airborne particles associated with the smoke.

If pets have to be outside, mornings are preferred, as the weather is cooler.

Livestock need a 4-to-6-week period to recuperate after the air quality returns to normal is needed. Attempting to handle, move, or transport livestock may delay healing and compromise these animals’ performance.

Through social media, the TAHC is also advising livestock owners to allow their animals to have movement. In a post on X (formerly Twitter), the agency suggested opening gates, cutting fences and herding livestock to help ensure the safety of these animals. 

Students deployed with the VET team are receiving real-world, hands-on experience in providing emergency care to animals and managing their safety during a crisis event. Funded largely by donations,

 this Texas A&M team is part of the VMBS emergency preparedness rotation that draws students from around the world. The rotation educates students about basic preparedness and threat analysis and includes a visit to a Texas county, where students conduct a risk assessment and collaborate with regional leadership to develop a disaster plan.

The VET team was previously deployed in Texas 19 times—and 26 times overall—responding to wildfires, hurricanes and tornadoes. In addition to working throughout Texas, the team's deployments have sent volunteers to California and Florida.

 According to Zoran, although no 2 deployments are the same, the team’s responses share similarities.

“When we deploy in response to wildfires, we know we’re going to see burn victims, we know we’re going to have to work hard to keep the search and rescue dogs safe, and we know that the hope we provide by supporting the search teams,” Zoran said, in the release. “Helping reunite a family with a beloved pet is invaluable and more than worth the hard work that goes into disaster response efforts.”

Knight R. Texas A&M veterinary emergency team deploys to Texas panhandle in response to wildfire. News release. Texas A&M University. February 28, 2024. 

Natural disaster: animal preparation and response. Texas Animal Health Commission. Accessed February 29, 2024. 

https://www.tahc.texas.gov/emergency/naturaldisaster.html

Knight R. Texas A&M Veterinary Emergency Team shapes how future Aggie veterinarians prepare to respond to disasters. News release. February 7, 2024. Accessed February 29, 2024. 

https://vetmed.tamu.edu/news/press-releases/vet-clinical-rotation/

. June 8, 2023. Accessed February 29, 2024. 

https://www.dvm360.com/view/keeping-pets-safe-from-wildfire-smoke

An emergency response unit has been deployed to the Texas panhandle to care for animals in crisis and support local shelters

Texas A&M veterinary team is helping animals affected by wildfires

We’ve met with veterinarians all over the United States who worry about their student loans. The turmoil for some is such that it literally keeps them up at night. On the other end of the spectrum are the veterinarians who simply choose to pay the minimums required and fully accept whatever fate awaits them in the future since the alternative would be to postpone nearly all semblance of fun in their financial lives to make a “dent” in the loans. The message of this article boils down to one thing: student loans are rarely going to be the financial cancer that they often are believed to be and when a veterinarian approaches them properly they can appreciate what their loans have done for them and not see them as an undue burden to their financial lives.

Side Note: There have been lawsuits filed against schools for predatory lending. I don’t have a lot of space to go into detail about this subject but feel free to search on Google whether your school has been involved in a lawsuit so you can apply for student loan forgiveness if that school was found to have engaged in predatory lending. You may be able to get some level of forgiveness on your loan if you apply through the proper channels.

During COVID there was a freeze on the interest that could accrue on student loans. That freeze lasted all the way until October of 2023. Nearly three years American veterinarians were able to sit on their student loans and delay payments. Some took advantage of this in different ways. Those who are not able to see past their loans and are deeply emotionally affected by them took advantage with the delay by paying as much as they could to reduce the principle knowing that at some point in the future the interest would start again. Others focused on building their assets by saving the money that otherwise would’ve gone to payments. Yet others did nothing at all and spent the money that would’ve gone to it anyway. It should be noted that each of these paths would’ve provided some upside to the individual thus we shouldn’t judge our past selves nor other people based on their decisions.

Which avenue was the best choice? It all depends on your personal situation. The hardest part of consulting clients on student loans is the only affective way to give them the appropriate option is to know all the intricate details of their balance sheet AND their personality. What do they have in their savings? What’s the balance of their student loans? Are they planning to buy a home? Get married? Have children? What is their income? What is their spouse’s income? Where do they live? What is their tax situation? Do they worry about their loans? Is there a chance that putting extra would benefit them in some way emotionally in the short term? Are there other emotions or family dynamics playing into the internal chaos they may feel about their loans? Even though it would be impossible for me to give direction to everyone reading this article, what I can tell you is that student loans rarely are as big of a deal as they seem and should be approached strategically.

I don’t want to downplay the emotional aspects of this. Emotions shouldn’t be ignored when it comes to making financial decisions. If there is anything psychology can teach us, it’s that the more you ignore emotions the more those emotions play into our subconscious decision making and affect other aspects of our lives. This doesn’t mean we should make decisions based solely on emotions – merely, that taking them into account can teach us about ourselves and about the solutions that can enhance our lives as individuals. Emotions provide windows that can allow us to learn about ourselves in ways that can open up opportunities and possibilities completely outside of our purview.

Let’s run through some numbers. Firstly, so that we can utilize math to see objectively that the impact of student loans can be mitigated quite easily. Secondly, in hopes to diminish the emotional havoc that some may be experiencing. This is going to be great news for a lot of veterinarians!

When I speak to someone who is just out of vet school, typically, their income is around $100,000 per year. Obviously, some make less (Like around $65,000) and some make more (like around $200,000). I am going to use an example of someone making $100,000 so that you can do quick math by being able to plug your income into this model as a percentage of $100,000 (being 100%). In other words, if your income is $150,000 a year then you can just take all the numbers below and multiply them by 1.5 since your income is 50% higher than $100,000.

Hypothetical example for illustrative and educational purpsoes only.

When I project out what someone making $100,000 the day they get out of vet school, assuming they work for 30 years before they retire, with a growth rate of 5% annually, the total amount of money they would end up making during that time period would be $6,643,885! Now, when I look at their loan amount today of $250,000, it appears insanely small compared to the amount of income they will make during their career. If they end up working 35 years that number goes up to $9,032,031!

I don’t want to downplay the effect on the student loans to their income. Some of our financial models show that a $250,000 student loan can reduce the income they will enjoy from that $9M to nearly $8M instead. But this shows that even though the impact is high, it’s not going to complete bankrupt a veterinarian making $100,000 who has a student loan balance of $250,000.

Often, we will meet with clients where their student loan balance is four to five times their annual income. In other words, for every $1 that they make per year they hold $4 to $5 of student loan balance. This would mean someone making $100,000 can sometimes have a student loan balance of $400,000 or $500,000. In those instances, the income-based repayment programs that are available will provide relief in their cash flow temporarily, but unless their income grows dramatically they will need to take advantage of some sort of student loan forgiveness in the future.

There is still a chance though that their incomes will outpace the student loan payments and they may be able to pay them off quite easily. When we review historical growth rates of incomes for clients over 30 to 40 years, we will sometimes find that their income grew at astounding numbers. Annual growth rates have been calculated to be 8% in some instances. This would mean that if someone is making $100,000 out of school the total income they would’ve made over 35 years would be over $16,500,000!

Practice ownership is also another way that veterinarians have been able to increase their income to outpace their student loans. I, myself, have personally seen many veterinarians make huge progress paying off their student loans by becoming successful practice owners just within the last decade.

All this to say that even though student loans may have scary balances they were essential to getting veterinarians through to the other side of being able to serve their communities in the best possible way for them: being veterinarians. Student loans should be approached from a financial position of emotional strength and hope, and not be an added stress to the already stressful lives that we veterinarians live.

Of course, we are always here to discuss your individual needs should you want to explore strategies for your own financial success.

Material discussed is meant for general informational purposes only and is not to be construed as a recommendation or advice. Please note that individual situations can vary therefore, the information should be relied upon only when coordinated with individual professional advice.

Securities products and advisory services offered through Park Avenue Securities LLC (PAS), member FINRA, SIPC. OSJ: 4200 West Cypress Street, Suite 700, Tampa, FL 33607, 813-289-3632. PAS is a wholly owned subsidiary of The Guardian Life Insurance Company of America (Guardian), New York, NY. The individuals associated with Florida Veterinary Advisors do not maintain specialized licenses or qualifications for the financial services provided to veterinary professionals. Florida Veterinary Advisors is not registered in any state or with the U.S. Securities and Exchange Commission as a Registered Investment Advisor. Florida Veterinary Advisors is not an affiliate or subsidiary of PAS or Guardian. 2024-170220 Exp 3/26

The hardest part of consulting clients on student loans is that giving the best option requires knowing details of both their balance sheet and personality