The veterinary profession collectively wants to improve access to care for pets and seeking solutions. Better utilizing credentials technicians is one way that practices can expand their ability to provide service to more patients.

How to increase responsibilities for credentialed technicians and improve utilization of these veterinary professionals was discussed during a session at the 2024 Veterinary Meeting & Expo in Orlando, Florida. According to presenter Kara M. Burns, MS, Med, LVT, VTS (Nutrition), VTS-H (Internal Medicine, Dentistry), president of the Pet Nutrition Alliance; founder and past president of the Academy of Veterinary Nutrition Technicians; and director of veterinary nursing development for WellHaven Pet Health, a 2010 survey of technicians found many believe they can be doing more in practice.

“About 20% of respondents said they’re not feeling utilized. Our own technicians are saying that they’re not feeling utilized to their fullest potential. Another 20% said there’s nothing being done at their hospital to change that,” Burns said.

Burns then asked the veterinarians in her audience their key challenges to better utilizing technicians. They cited “education” and “trust” as barriers to delegating certain tasks.

Technicians also had their turn to address challenges to being better utilized in practice, and the audience called out some of their thoughts.

 “Veterinarians not knowing our true scope of practice,” said one attendee.

Burns noted that technicians want to be performing all the skills they’ve learned. “What happens if we’re not utilized properly?” she asked. Low wages, lack of respect, burnout and compassion fatigue, devaluing of credentials, underutilization, and lack of reciprocity were among the noted consequences.

Clarifying the technician role has benefit. Utilizing these professionals starts with a clear understanding of tasks, responsibilities and processes at work. However, Burns said, clarity is not limited to an individual’s own role but also includes the roles of colleagues.

 “[Role clarity] really is a precursor of productivity. Lack of role clarity causes stress and confusion,” she added.

Veterinarians are needed to help clarify the technician role and improve the utilization of their skills. They key is to delegate, Burns noted.

 “It’s about scope of practice, standardizing credentials,” she said. “We’re not feeling challenged. We do as we’re told… But you’re not all here because it’s just a job.”

Tasks that can be delegated to technicians range from those that require low skills, like cleaning kennels and restraint, to mid-range skills such as blood draws, charting, fluid therapy and patient monitoring to highly skilled jobs including team management, patient assessments and protocolized plans, according to Burns.

 “What we’re trying to get to autonomy and improve trust [for technicians], empowerment and collaboration. We are a veterinary team,” she said.

In addition to increasing access to care for patients, developing stronger relationships with clients and improving morale on a veterinary team, good technician utilization can benefit a practice’s bottom line. Burns noted that one study found that credentialed technicians each bring $93,000 to $103,000 in revenue to a practice.

According to Burns, there is also benefit to individuals whose technician skills are effectively utilized. One study found better utilized technicians were 3 times more likely to report an “excellent quality of life,” were 6 times more likely to be engaged at work and were 8% more productive across the board, she said.

Burns also addressed the need to build mutual trust and respect between veterinarians and technicians.

 “Get to know your teammates,” she said. Veterinarians should find out what technicians know and what they may need to be educated on, while technicians should talk to their doctors, let them know what they can do and then demonstrate it, she added.

“We should all be appreciating and respecting [one another],” Burns said. “It’s that lack of appreciation and respect that can cause a team member to leave.”

Burns KM. The veterinary technician’s role in expanded access to care. Presented at: Veterinary Meeting & Expo; Orlando, Florida. January 13-17, 2024.

NAVTA 2022 demographic survey results: pay and education have increased; burnout and debt are still issues. National Association of Veterinary Technicians in America. January 16, 2023. Accessed February 15, 2024. https://navta.website/2022DemographicSurvey

Fanning J, Shepherd AJ. Contribution of veterinary technicians to veterinary business revenue, 2007. April 15, 2010. Accessed February 15, 2024. 

https://avmajournals.avma.org/view/journals/javma/236/8/javma.236.8.846.xml

Articles

A talk at the 2024 Veterinary Meeting & Expo discussed how these credentialed professions can help increase access to care for pets

Utilizing veterinary technician skills can benefit patients, clients and staff

A survey conducted by Digitail, an all-in-one practice management software for hospitals, recently published 

AI in Veterinary Medicine: The New Paradigm Shift 

in collaboration with the American Animal Health Association (AAHA). The survey collected the perspective from 3,968 professionals to explore the current awareness, concerns, expectations, perception, and utilization with the adoption of artificial intelligence (AI) within veterinary medicine.

"The survey findings revealed an interesting trend – increased usage correlates with a growing recognition of AI's advantages. Notably, the overwhelming majority of those veterinary professionals who have tapped into AI, are using these tools in their veterinary setting daily or weekly," said Sebastian Gabor, CEO at Digitail, in an organizational release.

According to the organizational releasee, 39.2% of respondents reported they use AI tools or software in their veterinary setting, 65.8% tried AI tools for professional tasks weekly or daily. The study also found a direct correlation between using AI tools and the level of enthusiasm for this technology.

When it came to when teams are using AI, the typical applications were imaging and radiology, administrative tasks, and voice-to-text transcription. The most common benefit of AI integration in veterinary medicine was an improvement in productivity and time saving, reducing workloads for administrative staff, and increasing efficiency when it comes to diagnosing and treating patients.

The survey also investigated concerns with AI in veterinary medicine, citing the most prevalent concern (70.3% of respondents) was whether the AI systems were accurate and reliable. Data security and privacy was another concern with 53.9% of respondents indicating this answer.

 With the pros and cons of AI listed in the study, almost 40% of veterinary professionals are interested in using AI tools at their practice and 15.5% expressed a clear resistance to use AI. The survey also found fear of job displacement, lack of training and knowledge, implementation, and regulatory or legal issues are among the issues veterinary teams currently have with AI.

While it is premature to state that AI is ready for universal implementation in veterinary medicine, it's evident that it currently serves as a viable tool with specific applications. Insights from the survey respondents, along with the feedback from Digitail's clients using Tails AI, have already allowed us to identify specific areas where this technology demonstrates reliability and positive impact for both staff and pet parents," concluded Gabor.

39.2% of Veterinary Professionals Use AI Tools in Their Practice - Digitail and AAHA Survey. News release. February 15, 2024. Accessed February 15, 2024. https://www.prnewswire.com/news-releases/39-2-of-veterinary-professionals-use-ai-tools-in-their-practice--digitail-and-aaha-survey-302062525.html

Danylenko G. AI in Veterinary Medicine: The next paradigm shift. Accessed February 15, 2024. https://digitail.com/blog/artificial-intelligence-in-veterinary-medicine-the-next-paradigm-shift/

The industry wide survey was conducted by Digitail and the American Animal Hospital Association to better understand the use of artificial intelligence 

Survey results show how veterinary professionals use AI Tools 

A new study from The University of Arizona College of Veterinary Medicine (CVM) analyzed the impact service dogs had on military veterans suffering from post-traumatic stress disorder (PTSD) by examining cortisol levels in veterans with a service dog vs a veteran without one.

 Ultimately, research showed that those with a service dog had healthier cortisol levels compared to those without a service dog.

 The study, funded with support from the Dogtopia Foundation, the National Institutes of Health, and Purina, aimed at demonstrating the benefits service dogs can have on veterans in need.

Led by Maggie O'Haire, PhD, associate dean for research and professor at the CVM, and Leanne Nieforth, PhD, the research assessed a total of 161 veterans who had PTSD; 88 who had a service dog and 73 who did not.

 Participates were recruited from non-profit service dog organization, K9 For Warriors. Cortisol, a stress hormone in saliva, was evaluated at 2 intervals, 3 months apart for each participant. Findings indicated that veterans with service dogs exhibited stress hormone levels more akin to those in non-PTSD-affected healthy adults, compared to veterans without service dogs.

"The goal of our research is to gain a robust understanding of the impact service dogs have on veterans and their mental health," said O'Haire, in a news release. "Science continues to evolve in our understanding of how service dogs may influence symptoms for veterans struggling with PTSD and their quality of life."

According to the Dogtopia Foundation, around 52% of veterans suffer from PTSD.

 "We've had the profound privilege of meeting many of the veterans we've supported through our fundraising efforts and hearing first-hand how these service dogs saved their lives," said Liz Meyers, executive director of the Dogtopia Foundation. "Their testimonials drive our commitment to support Dr O'Haire's incredible work, while we continue fundraising to support our veterans in need."

One success story from the Doptopia Foundation’s work comes from Anthony Torres who served in the United States Marines for 6 years. In a partnership with Next Step Service Dogs, Torres was joined with golden retriever, Tillman. “He’s that number one spot in my life, and I need to make sure he’s taken care of,” Torres told Doptopia.

This study further legitimizes the positive impact service dogs have on veterans with PTSD," said K9s For Warriors chief program officer, Kevin Steele. "Every day, K9s For Warriors has the privilege to witness the life-changing effect a service dog has on a veteran. Thank you to the Dogtopia Foundation, NIH, and Purina for supporting this crucial research, allowing us to continue changing veteran lives."

A deeper look at the cortisol study can be found in the 

 The study details methods used and exact numeric results of cortisol awakening response.

Nieforth LO, Rodriguez KE, Zhuang R, et al. The cortisol awakening response in a 3 month clinical trial of service dogs for veterans with posttraumatic stress disorder. 

. 2024;14(1):1664. doi:10.1038/s41598-023-50626-y

According to a new study, veterans with PTSD who had service dogs showed healthier cortisol levels compared to those without. News release. Dogtopia. February 13, 2024. Accessed February 14, 2024. 

https://prnmedia.prnewswire.com/news-releases/according-to-a-new-study-veterans-with-ptsd-who-had-service-dogs-showed-healthier-cortisol-levels-compared-to-those-without-302060923.html

Our worthy causes. Dogtopia Foundation. Accessed February 14, 2024. 

https://dogtopiafoundation.org/our-worthy-causes/#veterans

A new study showed veterans with PTSD benefited from having a service dog compared to those without one

Veterans report healthier cortisol levels from the support and companionship of service dogs

Happy Valentine's Day! In celebration of the holiday, Mike Natale, LVT, sat down with 

 host Adam Christman, DVM, MBA, to share some of the ways that he takes care of his wellbeing to hopefully help other veterinary professionals begin doing the same. 

: Every day I go to the gym, I wake up at 4:30 AM every morning, I go to a good ol' CrossFit workout for an hour and then start my day right after that. I start one of the jobs that I have and it keeps rolling throughout my day. In the middle of my day, though, I do try to take at least like a 30-minute break, get some fresh air, go outside, go for a walk. If not a walk, read a book. If not reading a book just sitting outside enjoying the fresh air.

So I just started, it's a challenge called '75 Hard' and it's a challenge for your physical and mental health. There's a list of things that you had to follow for 75 days. Those things [include] following some sort of diet. So ideally, you want to follow a healthy diet of some sort, or even if you want to cut something out like soda, maybe decrease your caffeine intake. Other things are reading books, you have to read a 10 pages a day of a self help book. And then you have to do 2 workouts a day; 1 indoor, 1 outdoor. And then the hardest part is no alcohol for 75 days.

Podcasts

This Valentine's Day, be sure to take care of yourself and your wellbeing

Wellbeing for everyone in the clinic 


A pair of adult Eastern hoolock gibbons, close relatives of the skywalker species.

A new study has found skywalker hoolock gibbons (

 living in Myanmar, after previously known to reside only in China.

 Although precise numbers are unknown, investigators have estimated these Myanmar primates to be the world’s largest population of the species, outsizing the fewer than 200 known Skywalker gibbons previously known to exist.

The Karen C. Drayer Wildlife Health Center at the University of California, Davis, led the study with field explorations carried out by partner organizations that included Nature Conservation Society Myanmar and Fauna & Flora International—Myanmar. “We were able to genetically identify 44 new groups of skywalker gibbons in Myanmar,” said Tierra Smiley Evans, the study’s senior author and research faculty at the One Health Institute in the UC Davis School of Veterinary Medicine, in a news release.

 “This is a huge resource and success story for Myanmar.”

Skywalker gibbons were first identified in 2017 with a confirmed population of only 150 primates, all in China. Based on the ecology of gibbons and the biogeographic patterns of large rivers, investigators first hypothesized that the Skywalker species likely extended into Myanmar in area west of the N’Mai Hka and Ayeyarwaddy rivers and the Salween River to the east. Although a skywalker gibbon was morphologically identified by a specimen collected in 1913, in Myanmar, and kept at the Natural History Museum in London, England, no live members of the species were confirmed in Myanmar over the past century. However, primate surveys have been historically limited in Myanmar because of civil conflict near protected areas and reserve forests, according to the study authors.

The discovery of new skywalker gibbon populations was made with help from acoustic monitoring systems in the field between December 2021 and March 2023. According to UC Davis, investigators listened each morning for love songs sung by these primates and recording their solos and duets. Field investigators then collected chewed plants and fruits using a noninvasive DNA sampling technique created by Smiley Evans, from which genetic analysis confirmed the species.

Although the discovery raises the population estimates for Skywalker gibbons, the species in Myanmar mostly lives in unprotected areas. Because these primates continue to be threatened by habitat loss, forest degradation, and human conflict in Myanmar, the study’s authors have suggested the species retain its status as endangered on the IUCN Red List compiled by the International Union for Conservation of Nature and Natural Resources. They also suggest having the Skywalker gibbons’ habitat in Myanmar receive a status as a protected area.

“We found skywalker gibbons in 2 regions of Myanmar: Kachin State and as far south as Shan State, in degraded forests and at much lower elevations than we expected, showing us they’re highly adaptable,” Evans said in the release.

 “There needs to be a protected area system there that focuses on them.”

The study was funded by Arcus Foundation, the IUCN SSC Primate Specialist Group Section on Small Apes, National Science Foundation and the International Centre for Integrated Mountain Development. Investigators included authors from the University College London, Zoological Society of London, German Primate Center, Livestock Breeding and Veterinary Department Myanmar, Myanmar Timber Enterprise, California National Primate Research Center, Sun Yat-Sen University and the IUCN Species Survival Commission (SSC) Primate Specialist Group Section on Small Apes.

Kerlin K. Love songs lead scientists to new populations of Skywalker gibbons in Myanmar. UC Davis. February 14, 2024. Accessed February 14, 2024. 

https://www.ucdavis.edu/climate/news/new-populations-skywalker-gibbons-found-myanmar

 Confirmation of skywalker hoolock gibbon (

) in Myanmar extends known geographic range of an endangered primate. 

. Published February 14, 2024. Accessed February 14, 2024. https://doi.org/10.1007/s10764-024-00418-6

Scientists identified skywalker gibbons in Myanmar

Love songs lead to discovery of new endangered primate populations

Do you feel that placing all your dental eggs into February, National Pet Dental Health Month, leaves the other 11 months of the year jealous? If so, consider embarking on a yearlong dental journey, dedicating each month to plunge into a specific dental subject. This, akin to eating a large meal 1 bite at a time, allows for a deeper understanding of each discipline’s complexities, evidence-based therapeutic strategies, and evolving paradigms.

An introduction to various areas of dental care with suggestions for each month are as follows:

Periodontal disease, incited by plaque, is the upregulation of inflammation leading to the progressive destruction of tooth support affecting 80% of dogs.

 Embracing diagnostics and therapeutic approaches tailored to each stage of periodontal disease will be time well spent, effectively managing and preventing this common ailment.

There are 4 recognized stages of periodontal disease, each with specific diagnostic criteria and treatment.

Using a diagnostic test alerting to the presence of thiols (caused by gram-negative oral bacteria) incorporated into every wellness visit will result in greater awareness (

The stages of periodontal disease are as follows:

Mild inflammation and redness of the gingiva; slight bleeding on probing.

Treatment: professional dental cleaning to remove plaque and calculus (tartar), followed by diligent home care with brushing (or wipes) and daily Veterinary Oral Health Council (VOHC)—approved dental product use.

Diagnosis/treatment: supragingival and subgingival scaling, polishing, and irrigation, followed by probing to assess pocket depths or attachment loss. Home care remains crucial to decrease the progression of the disease.

With tooth support loss, diagnosis can be made with probing and intraoral radiographs showing bone loss between the cementoenamel junction and the apex.

Treatment: advanced gingival surgery or extraction of the affected teeth.

Many patients experience tooth support loss diagnosed through probing and intraoral radiographs and through-and-through furcation exposure.

Early intervention and consistent daily (or better, twice daily) home care with VOHC-accepted dental wipes, water additives chews, and tooth brushing as well as twice-yearly dental checkups and care can significantly reduce periodontal disease progression and its associated health risks.

Most pet owners will have their animals examined semiannually to help them have longer and healthier lives.

 Tooth resorption affects approximately 30% of mature dogs

 Resorption becomes painful once the lesion progresses to oral cavity exposure.

Tooth resorption is progressive and classified with 5 anatomic stages

 and 3 radiograph types. The radiograph types dictate treatment.

Therapy options include follow-up, extraction, or coronectomy with gingival closure, depending on the clinical and intraoral radiograph findings.

Tooth resorption is considered to be progressive.

Root replacement resorption is diagnosed radiographically (

), with decreased root opacity compared to adjacent teeth and lack of periodontal ligament space. This type 2 root resorption can be successfully treated with coronectomy and gingival closure, isolating the root from the oral cavity, which allows continued replacement with bone. Extraction is the treatment for all other forms of root resorption (types 1 and 3) that have either compromised the tooth or are exposed to the oral cavity (

Marked generalized gingival and oral mucosal inflammation is termed stomatitis. Its etiology is multifactorial, implicating plaque. Extraction of the cheek teeth or all teeth and subgingival root fragments is curative in many cases in approximately 60% of cases (

). Carbon dioxide laser ablation and alternate-day prednisolone are often helpful in refractory cases.

When caudal oral cavity inflammation is present, the prognosis is guarded even with full mouth extractions.

Repository steroids and antibiotics are not indicated in the treatment of stomatitis.

The extraction of all teeth and subgingival root fragments is usually curative.

Peripheral odontogenic fibromas (POFs), gingival enlargements (

), and cysts are benign oral swellings. Peripheral odontogenic fibromas (formerly known as fibromatous and ossifying epulis) are benign, often slow-growing tumors arising from periodontal structures (gingiva, periodontal ligament, and bone). POFs can be further subclassified as peripheral odontogenic fibromas and acanthomatous ameloblastoma.

Figure 4: Multiple gingival enlargements in a boxer dog; the extensive left mandibular mass histopathology confirmed peripheral odontogenic fibroma.

Many oral masses enlarge over time, placing pressure and causing discomfort on the periodontal ligament space. Early intervention can be curative to alleviate the need for major oral surgery. 

Oral cytology examined before excision can create a surgical plan that alleviates the need for incisional biopsy.

Excision with at least 1 cm clean margins renders an excellent prognosis.

Oral melanoma, fibrosarcoma, squamous cell carcinoma, osteogenic sarcoma, and plasma cell tumors are the most common malignant oral tumors in dogs. Squamous cell carcinoma is the most common oral tumor in cats.

Oral neoplasia accounts for 6-7% of all cancers in dogs, and 3% of all feline cancers.

 Because of the aggressive nature of malignant oral tumors, early intervention carries the best prognosis.

Excision with at least 2 cm clean margins renders a guarded to good prognosis. (

Rostral tumors carry a more favorable prognosis than caudal tumors.

There is an oral melanoma vaccine administered by oncologists after debulking.

Follow-up radiation therapy is often indicated after excision to clean up residual cancer cells.

Figure 5: Curative excision with greater than 2 cm clean surgical margins in all directions.

Temporomandibular joint (TMJ) diseases in dogs and cats include ankylosis, luxation, osteoarthritis, congenital abnormalities, traumatic fractures, and neoplasia.

These often-painful conditions can severely hinder the ability of dogs and cats to eat, drink, groom, and vocalize, leading to chronic discomfort and a diminished quality of life. Early diagnosis and prompt treatment are crucial to avoid complications including jaw misalignment (

), bone erosion, and permanent nerve damage.

Figure 6: A 17-week-old kitten with traumatic malocclusion.

TMJ ankylosis involves surgical intervention to free up the rostral mandible from the affected joint.

Cranial dorsal TMJ luxation often can be cared for with a pencil or tuberculin syringe placed between the caudal cheek teeth accompanied by mouth closure to replace the luxated condyle in the glenoid fossa.

Dental and jaw fractures are common because of fights, automobile accidents, and hard chew products owners buy for their dogs to relish. Unfortunately, dentoalveolar trauma often leads to damage, infection, and pain.

Physical examination after mandibular trauma often reveals malocclusion resulting from the collapse of the rostral mandible toward the side of the injury in unilateral fractures. Dropped jaws (inability to close the mouth) occasionally occur from bilateral fractures.

Fractures of the mandibular bodies can be classified as favorable or unfavorable. Favorable mandible fractures run dorsocaudal to ventrocranial. The upward pull of the masseter and temporalis muscles and the downward caudal influence of the digastricus muscle compress the fracture. Stabilization of the tension surface may be required for bony healing (

Unfavorable mandibular fractures run from dorsocranial to ventrocranial, distracting the fracture fragments. The alveolar crest bone is considered the tension surface, while the ventral cortex is the compression surface. Fixation devices must be load-bearing since no natural mechanism for fracture reduction exists.

Figure 7: Noninvasive stabilization with suture and buttons.

Month 8 spotlights the interplay between oral health and inflammation (

), including gingivitis, contact mucositis, and stomatitis.

As in humans, oral inflammation in animals is painful. Chronic inflammation fuels bacterial invasion and threatens systemic health.

Gingivitis (no loss of tooth support) treatment includes dental scaling, polishing, and irrigation followed by daily home care.

For contact mucositis initial care, strict plaque control, pentoxifylline 20 mg/kg orally twice a day, and niacinamide at 250 mg orally twice a day are also helpful. Alternatively, extraction of the contacting tooth is usually curative.

Tooth fractures are classified as complicated (exposed pulp) and uncomplicated (enamel or enamel and dentin exposed). Some tooth fractures also extend subgingivally (crown-root fractures). Understanding what to do for patients affected with traumatized teeth can be challenging due to the variations of presentation. 

Complicated crown fractures create direct access of bacteria and oral debris to the pulp. Initially, the tooth will be sensitive.

When the pulp is not exposed, and the dog or cat is an adult, generally nothing needs to be done unless there is radiograph evidence of periapical pathology.

In a young—less than 2-year-old—dog or cat, the pulp is large, relatively close to the fracture site, and sensitive to heat, cold, and pressure. Tooth restoration is indicated in these cases.

When the pulp is exposed, and the dog or cat is an adult, vital pulp therapy can be performed if the trauma occurred within a 48-hour window.

Month 10: Choosing the right chew for your patients

Maintaining oral hygiene in pets requires a multipronged approach, including methodical home care. Dental chews have become increasingly popular as a convenient option for at-home oral care, promising to remove or at least decrease plaque and prevent tartar buildup. With many brands, textures, and claims on the market, we face a critical task: helping our clients navigate the dental chew maze to choose the most effective options.

The first step in making informed recommendations is understanding the types of dental chews and their mechanisms of action. Common categories include the following:

Abrasive chews, which typically feature complex textures, including rawhide, are designed to scrape away plaque and debris through physical chewing action.

Enzymatic chews contain enzymes like lysozyme, which help break down and loosen plaque for easier removal.

Dental treats often resemble regular treats and are formulated with plaque-reducing ingredients.

Veterinarians and staff can influence their clients’ choice of safe and effective dental chews.

The VOHC has accepted 72 dog and 17 cat products that decrease the accumulation of plaque or tartar.

Veterinary teams can incorporate oral health into their practice 1 evidence-based bite at a time