RECOVERY AND RELAPSE

When Dr. Moskosky graduated from Texas A&M University College of Veterinary Medicine & Biomedical Sciences in 2009, he had chronic pain from years of football injuries, and he was an opioid addict.

“I went on to work at a mixed animal practice, and my addiction blossomed from there,” he said. “It wasn't long before my addiction came to light, and I was ultimately terminated.”

Dr. Moskosky went into treatment. When he was out, he started working at Dick's Sporting Goods and going to meetings for recovering addicts. Eventually, after approval from the Texas State Board of Veterinary Medical Examiners, he decided to dip his toe back into the veterinary world.

“I rigged out my (Ford) F-150 with an old Astoria veterinary box (and) solar panel and started a mobile veterinary practice,” he said. “As time went on, more money flowed in, and I got busier and busier. Work became an idol and my top priority, and my recovery took a back seat. My phone would ring, and my blood pressure would shoot up. I was burning myself out. … I relapsed. I had an order (from the Texas State Board of Medical Examiners) in place, and I was being monitored, but I used a medication that didn't show up on the drug screens.”

In February 2015, nearly two years later, the drug Dr. Moskosky was using showed up when he was randomly selected for a different drug screening.

“I had breached my board order, and I thought I would never be able to practice again,” he said. “But, by the grace of God and the Texas state board, they allowed me one last chance. However, only under strict guidelines. Among other things, I would no longer be able to be the Lone Ranger practitioner anymore. And with that, I watched the practice I'd worked so hard to build dissolve. “

SAFEGUARDING AGAINST THEFT

James Arnold, chief of the liaison section at the Drug Enforcement Agency's Diversion Control Division, spoke at the AAEP convention about how veterinary practices can assist the DEA in combating the opioid epidemic and described best policies for recognizing and handling addiction within a practice.

Arnold said veterinary offices across the nation are experiencing internal theft issues and having clients come in with their animals to try to obtain controlled substances.

“Addiction is an equal-opportunity employer,” he said in an interview with JAVMA News. “It doesn't matter what the profession is. … It is an issue for everybody.”

Arnold suggests six areas where veterinarians can improve security to better protect themselves, their practices, and their patients:

• • Keep controlled substances locked up.

• • Have a working alarm system, possibly with cameras.

• • Take inventory, and keep good dispensing records.

• • Implement standard procedures to deal with clients who come in demanding controlled substances.

• • Consider installing a panic button.

• • Report theft and losses to the local police and the DEA.

When Dr. Moskosky first got clean, he had someone else handle administrating controlled substances to his patients. Now, it isn't about access, it's about desire, he said.

“Of course, there are medications (at the practice) that I could get high off,” he said. “But the same is true at the dollar store or the liquor store down the street. For me, access is not the issue.”

One of the many elements aiding in Dr. Moskosky's sobriety is accountability.

“We have a lot of roadblocks and safeguards in place. … We do not keep a lot of controlled substances (at the practice). We only keep what we need,” Moskosky said. “We also have an open line of communication. My partner and employees know that I am in recovery, and so that adds to the accountability.”

Dr. Moskosky hopes his story will make a difference to someone who may need help.

“Veterinarians are not removed from this problem,” Dr. Moskosky said. “Those with substance-abuse disorders should not be ashamed and should know that they are far from alone. It is important for the veterinary community to know that addiction truly is a disease and that these are sick people that need help, and they can recover. … People should not be ashamed, and they should know that there is help (out there), and they can recover and continue to be competent, ethical, compassionate, and capable veterinarians if given the opportunity.”

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The session “Lifestyle & Wellness: Recognizing and Managing Addiction in Practice” during the 2018 annual convention of the AAEP included speakers (from left) Greg Gable, PsyD, executive director of the health care professional program at Caron Treatment Centers, and Drs. Rob Franklin and Matt Moskosky, co-owners of Fredericksburg Equine in Fredericksburg, Texas.

Citation: Journal of the American Veterinary Medical Association 254, 3; 10.2460/javma.254.3.307

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EMPLOYEE ENGAGEMENT SURVEYS CAN IMPROVE BUSINESS CULTURE AND PROFITABILITY

Dr. Mike Pownall, partner and co-founder at McKee-Pownall Equine Services in Ontario, uses his own practice as an example of how an employee engagement survey can benefit a practice.

“As veterinarians, we always think that our business challenges are unique and our problems are unique, but like all businesses, (our problems) are usually shared by other industries,” Dr. Pownall said.

“We gave the first survey to our staff, and it came back with a 77, which is good, but we noticed that our veterinarians were less happy. (They) were really tired,” he said. So, the practice implemented a four-day workweek.

The following year, “some of our veterinarians were saying, ‘I am actually enjoying being a veterinarian again,'” Dr. Pownall said.

Also, revenue was up 13 percent with 20 percent less veterinary capacity, he said.

The survey allowed management to see what problems staff members were experiencing and make moves to solve those problems. Staff members can only take care of customers when the business takes care of staff members first, Dr. Pownall said.

AN EMPLOYEE MANUAL CAN BE A VITAL COMMUNICATION TOOL

Dr. Amy Grice, a former partner in an equine referral practice and current owner of a business consulting firm for veterinarians, suggests that a practice owner can manage employees more easily when the practice has created an employee manual.

“Without an employee manual, it is very common for practice owners to simply react as situations arise, and then be unable to react consistently to the same situation, which puts them at risk for a lawsuit from a disgruntled employee,” Dr. Grice said.

She recommends the following essential sections for a manual:

• • Statements about workplace compliance with applicable laws.

• • Written-out company policies and procedures, including policies and procedures on attendance and leave, work performance, discipline, employee health and safety, employee benefits, and termination.

• • A page for employees to sign acknowledging that they have received the manual and understand it.

BE PRESENT TO PROTECT YOUR BUSINESS FROM COMMON CHALLENGES SUCH AS FRAUD

“It can be everywhere and anywhere,” said Tera Latham Nance, financial consultant at Summit Veterinary Advisors. “Fraud is an intentional deceit against another.”

There can be several reasons why an employee commits fraud or embezzles, but a lot of the time, it is because it is just too easy and people don't think they will get caught, Nance said.

Nance suggests practice owners watch out for several warning signs, such as having profits but low cash, discrepancies in bank records, and the bookkeeper not wanting the practice owner to see the books.

Nance also has the following tips for practice owners to try to avoid fraud:

• • Separate duties. One person collects the money, and a different person deposits it.

• • Institute a policy that only the practice owner can sign checks.

• • Limit access to company credit cards.

• • Be more involved with and aware of the day-to-day accounting. Ask a lot of questions, and make it obvious that you are paying attention and want to make sense of the numbers.

• • Use careful hiring practices.

• • Walk around the practice to be seen.

• • Talk to employees about company policies such as honesty and integrity.

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Dr. Amanda Donnelly speaks about building better teams at the AAEP convention, Dec. 1–4, 2018 in San Francisco.

Citation: Journal of the American Veterinary Medical Association 254, 3; 10.2460/javma.254.3.307

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BUILD BETTER PRACTICE TEAMS BY EMPHASIZING ACCOUNTABILITY

Dr. Amanda Donnelly, owner of ALD Veterinary Consulting LLC, believes that if management improves its communication skills and implements a few employee-focused policies, a team will function better.

Donnelly pointed to the following areas for management to focus on:

• • Build trust within the team by using qualities such as clarity, caring, consistency, and competence.

• • Focus efforts on employee development.

• • Use communication techniques and strategies to hold employees accountable.

• • Empower employees by implementing a process through which employees who come forward with problems are also expected to present possible solutions.

“(These) strategies can be implemented and improved at any point in time,” Dr. Donnelly said. But she recommends that managers start implementing employee development and accountability within the first few weeks of each employee's start date.

Q. TELL ME ABOUT YOURSELF, DID YOU ALWAYS WANT TO BE A VETERINARIAN?

A. My father is a veterinarian. He had a mixed animal practice in rural

Connecticut, and I went on calls with him as a child. My father's veterinary clinic and our house were one building. It was not abnormal to find my dad castrating some piglets in the kitchen. One time, he was de-scenting a skunk for a client, and the scent sac broke; we had to move out of the house and live in a hotel for three days.

Being around it, I think, it just sinks in. When I went to the University of Vermont for my undergraduate degree, I did preveterinary science, and it never occurred to me to do anything else. I was always interested in being an equine practitioner.

Some of my fellow students, during veterinary school, were nervous about the job market. But I think because my father was a self-employed veterinarian, it never occurred to me to be afraid of being self-employed. So, I was confident that it was the thing to do and it would all work out fine.

Q. WHAT WAS A PARTICULARLY CHALLENGING EVENT IN YOUR CAREER?

A. In 2009, I was diagnosed with a tumor on my spinal cord that required surgery.

My legs had been feeling abnormally heavy, and it seemed to be getting increasingly worse. I went to the Mayo Clinic in Jacksonville, Florida, and they performed a battery of tests. During the MRI, the technician said that the radiologist had requested that they continue the study higher on my spine, at which time a tumor was imaged at the level of the ninth and 10th thoracic vertebrae pressing on my spinal cord.

There was no choice, it had to be taken out. Fortunately, it was benign, but after the surgery I couldn't feel my left leg, and it took me months to learn to walk again. I was very active beforehand—running, fox hunting with my dad, and riding horses—but due to some nerve damage, I am not able to be as active.

It does impede me from certain types of equine veterinary practice as it is hard to get down underneath a horse. So, I currently work in Thoroughbred sales work, which includes examining the horse, evaluating the upper airway, and reviewing the radiographs and repositories that are provided by the sales company.

Q. HOW DID YOU HANDLE THAT EXPERIENCE?

A. I think every time we are faced with the unknown, you can make your decisions based either on fear or on faith. I have a strong faith in God, and I believed that, essentially, regardless of the circumstances, everything would turn out fine, and so I placed my faith in that confidence.

Q. WHAT ISSUES AND MEMBERSHIP SERVICES WILL YOU FOCUS ON DURING YOUR PRESIDENCY?

A. The issues I will focus on are partly determined by the AAEP strategic plan as well as membership surveys that keep us focused on the needs and desires of the members.

The five goals of the strategic plan are as follows:

• • Enhancing member value.

• • Improving member communications.

• • Providing continuing education.

• • Wellness for members.

• • Promoting the equine profession.

In addition, I would like to emphasize the following two areas:

• • Helping to define what constitutes an appropriate level of therapeutic medication in competition horses, whether in racing, showing, sales, eventing, etc., within the current culture of overmedication.

• • Helping to create a culture of ethical equine veterinary practice and encouraging young associate veterinarians and interns in ethical behavior.

Q. WHAT ARE MEMBERS TALKING ABOUT?

A. More than anything, I hear members talking about ethical issues. It seems that in every equine discipline, whenever competition and money are involved, ethical issues are present.

Q. IS MEMBERSHIP GROWING, DECLINING, OR STAYING ABOUT THE SAME?

A. Membership remains about the same, although we have identified an at-risk group. The AAEP loses some members up to around five years after graduation. The AAEP is currently studying this problem, which seems to occur as a result of financial pressures, a perceived lack of mentorship, and perhaps some other, as yet unidentified, factors. An AAEP working group called the Young Professionals Task Force is currently looking at the issues that younger AAEP members have that make it difficult to remain in equine practice and will be making recommendations to the board of directors in an effort to help this group.

Q. IS THE AAEP FACING ANY IMMINENT CHALLENGES?

A. The AAEP faces many challenges. Many of them fall under the umbrella of continuing to be a respected source of information and to influence public policy in a society that is increasingly divorced from experience with and understanding of animals. A hundred years ago, people grew up with (farm) animals, and so they understood that when they were eating a steak, they knew where it came from. Now, people think it comes from the refrigerator case in the grocery store with a piece of cellophane over the top of it. People are not around animals anymore unless they are small animal pets. So, it is hard for people to understand how to take care of animals that they have no experience with. Owner education is necessary, but that is not going to impact society as a whole, just select horse owners who are interested.

Other challenges include the ever-increasing debt load that veterinary students are burdened with as they begin their careers as equine practitioners, lack of available funding for much-needed equine research, and a dearth of learning experiences for students as university hospital caseloads shrink.

Q. WHAT DOES THE AAEP DO TO ENCOURAGE VETERINARY STUDENTS TO CONSIDER CAREERS IN EQUINE MEDICINE?

A. The AAEP has an abundance of student programs designed to create an awareness of opportunities in equine veterinary medicine and educational programs exclusively for students as well as financial support in the form of scholarships through the AAEP Foundation. The Avenues Program is designed to provide students with the opportunity to participate in externships and internships with university teaching hospitals and private clinics.

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Dr. Jeffrey T. Berk works at Equine Medical Associates where, along with his domestic and international sales work, he does pro bono work for New Vocations, a racehorse adoption program. (Photos courtesy of AAEP)

Citation: Journal of the American Veterinary Medical Association 254, 3; 10.2460/javma.254.3.307

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The 2019 AAEP officers (left to right): Drs. Lisa Metcalf, treasurer; David Frisbie, president-elect; Jeffrey T. Berk, president; Margo Macpherson, immediate past president; and Scott Hay, vice president.

Citation: Journal of the American Veterinary Medical Association 254, 3; 10.2460/javma.254.3.307

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JOINT STATEMENT

The new joint statement on continuous monitoring follows up on a 2011 joint statement from the AVMA and FVE calling for responsible and judicious use of antimicrobials. The CVMA signed on to that statement in 2014.

“Antimicrobial resistance doesn't recognize borders, so efforts to combat antimicrobial resistance need to cross borders as well,” said Dr. John de Jong, AVMA president, in the announcement about the new joint statement. “This joint statement is an important step in recognizing ways we can work together to prevent resistance and ensure that antimicrobials continue to be used judiciously in animals.”

“As veterinarians, we oversee the appropriate and responsible use of antimicrobials in animals, thereby helping minimize the emergence and spread of antimicrobial resistance,” said Dr. Terri Chotowetz, CVMA president, in the announcement. “By working together, we are demonstrating our professional responsibility in supporting the overarching international strategy on antimicrobial resistance and use.”

The joint statement makes 14 recommendations, summarized here:

• • All countries should have a robust regulatory system for the authorization and manufacturing of medicinal products and a legislative system to regulate distribution and sales of these products.

• • Illegal manufacturing, distribution, or sales of medicines should be prosecuted.

• • Antimicrobials that are critically important in human medicine should only be administered to animals with the oversight of a veterinarian.

• • A robust global network of surveillance and monitoring systems for antimicrobial use and resistance development should be established.

• • Easily available, effective, rapid, and standardized diagnostic tests should be available in order to carry out susceptibility testing. Results of these tests should be made available to facilitate evidence-based decisions about antimicrobials.

• • Sufficient funding should be available for further research on and development of rapid and affordable diagnostic tests.

• • Harmonized standards for measuring, evaluating, and interpreting data on antimicrobial use and resistance need to be developed. The AVMA, CVMA, and FVE will support the work of the World Organisation for Animal Health (OIE) and European, Canadian, and U.S. agencies in this area.

• • Veterinarians must retain access to effective antimicrobials for therapeutic purposes for animals suffering from a bacterial disease.

• • Record keeping at the patient or practice level is essential for the evaluation of the success of antimicrobial treatments.

• • The AVMA, CVMA, and FVE will contact all organizations working to address antimicrobial resistance at a global level to ensure that the AVMA, CVMA, and FVE are always consulted.

• • The AVMA, CVMA, and FVE will call on their members, veterinary organizations, veterinarians, veterinary technicians, and animal keepers to contribute to the collection of data on antimicrobial use in animal health and on the occurrence and spread of antimicrobial resistance.

• • The AVMA, CVMA, and FVE will call on decision-makers to ensure that trade standards take into account the monitoring of antimicrobial use and resistance and the stewardship of antimicrobials.

• • The AVMA, CVMA, and FVE will collaborate in promoting responsible use of antimicrobials in animal production and animal care in all countries and particularly in the developing world.

• • The AVMA, CVMA, and FVE will continue to take a leadership role in promoting global antimicrobial stewardship.

DEFINITIONS

A lack of clear definitions has led to confusion about therapeutic intent in antimicrobial uses and about whether various uses comply with principles of antimicrobial stewardship, according to background materials from the AVMA Committee on Antimicrobials.

In 2017, the World Health Organization released the WHO Guidelines on Use of Medically Important Antimicrobials in Food-Producing Animals. According to the guidelines, “We recommend complete restriction of use of all classes of medically important antimicrobials in food-producing animals for prevention of infectious diseases that have not yet been clinically diagnosed.”

A California law effective in 2018 says that antimicrobial stewardship includes a commitment “to use medically important antimicrobial drugs only when necessary to treat, control, and, in some cases, prevent, disease.”

According to the AVMA Committee on Antimicrobials: “Antimicrobial stewardship cannot be ranked by intent of use for prevention, control, or treatment. Strategic uses of antimicrobials for the purposes of prevention, control, and treatment of disease may each meet the requirements of antimicrobial stewardship. Stewardship is better defined by decisions that influence the need for antimicrobial therapy in the first place and that maintain the effectiveness of antimicrobials when they are used.”

Factors include the following:

• • Systems of husbandry that reduce the risk of disease.

• • Careful diagnostic evaluation.

• • Good decision-making to use or not use antimicrobials.

• • Prudent choice of drugs, dosage, and duration.

• • Records indicating appropriate follow-up and re-evaluation.

The AVMA Committee on Antimicrobials developed the definitions of antimicrobial use to minimize confusion regarding therapeutic intent in the context of individual animals or populations of animals (see sidebar).

Earlier in 2018, the AVMA House of Delegates adopted core principles of antimicrobial stewardship. The AVMA policies on antimicrobials and other resources are available at www.avma.org/antimicrobials.

POPULATION AND BREEDING

Veterinary parasitologist Dr. Susan E. Little said the ticks likely are here to stay.

“Once a tick is found on a diverse group of wildlife—different species of wildlife—it's next to impossible to eradicate,” she said.

Dr. Little is co-director of the National Center for Veterinary Parasitology and a professor of veterinary pathobiology at Oklahoma State University, where she leads research on zoonotic parasites and vector-borne infections. She also is a co-author of the November MMWR article.

Dr. Little noted that the tick survived winter in New Jersey to emerge in spring 2018, has been found on dogs after travel between states, and has been collected from deer, opossums, raccoons, sheep, foxes, and people. Faculty at the OSU Center for Veterinary Health Sciences have added the ticks to the core curriculum, she said.

The ticks are likely to spread, with limits in regions with cold climates, Dr. Little said.

In an article published online in December in the Journal of Medical Entomology, Rutgers University laboratory director and entomologist Ilia Rochlin, PhD, wrote that the Asian longhorned tick would be best suited to coastal regions in Canada and the U.S., from New Brunswick to North Carolina and southern British Columbia to northern coastal California. It also likely would be suited to central states and provinces from northern Louisiana to southern Ontario and Quebec, with the best of those habitats in the U.S. Midwest.

Health authorities in New Jersey first identified the ticks in the U.S. in August 2017, but retrospective studies indicate they have been in the U.S. at least since 2010, when they were collected from a deer in West Virginia. In a scientific article published early last year in the Journal of Medical Entomology, public health authorities from Hunterdon County, New Jersey, described discovering the infestation in New Jersey. Hundreds of the ticks infested one sheep, which was the lone animal in a paddock.

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Counties and county equivalents where Haemaphysalis longicornis has been reported, August 2017-September 2018 (Image by CDC)

Citation: Journal of the American Veterinary Medical Association 254, 3; 10.2460/javma.254.3.307

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The investigators found engorged ticks all over the sheep, with the highest concentration of them on the animal's ears and face. Ticks crawled on the investigators’ pants soon after they stepped inside the paddock.

The investigators also found only one male tick in their samples, indicating the ticks may have come from a parthenogenetic population in which females can reproduce without males, which are rare in those populations.

TICK CONTROL

Tick control products used in the U.S. have been effective against the Asian longhorned tick in other countries, although none are labeled yet for that use in the U.S., Dr. Little said. Veterinarians in Australia, New Zealand, and Japan can control the ticks with isoxazoline-class drugs, which include U.S.-approved products Bravecto, Credelio, Nexgard, and Simparica.

“The products we're already using for dogs and cats will be effective against this tick, so that's reassuring,” she said. “And then the pyrethroids should work, and there's a lot of pyrethroid tick control use in large animals.”

Dr. Little also called for veterinarians to think about what types of ticks they are finding and how they can identify them. OSU is conducting a tick survey, at www.showusyourticks.org, and she said others are conducting tick surveys as well.

CDC officials also announced in November 2018 that about twice as many people in the U.S. had confirmed tickborne disease, compared with a decade ago. About 59,000 people had known tickborne disease infections in 2017, up 10,000 in one year and 27,000 in 10 years.

In 2017, more than 70 percent of those people had Lyme disease. The report also shows rises in anaplasmosis and ehrlichiosis, which were reported together, as well as spotted fever rickettsiosis, babesiosis, tularemia, and Powassan virus infection.

CDC authorities don't know why disease increased but listed possible factors including changes in temperature, rainfall, humidity, host populations, tick population densities, and health care provider awareness.

THOUGHT PROCESS

The 2018 AVMA Animal Welfare Assessment Contest took place Nov. 16–18, at Colorado State University College of Veterinary Medicine & Biomedical Sciences. The competition teaches students to use science-based methods and reasoning to assess the welfare of animals in a variety of settings.

In the first part of the contest, three species-based scenarios are presented. Each scenario consists of two hypothetical situations representing animals in typical environments. Scenarios may include physiologic data, video clips, photographs, behavioral responses, husbandry and housing information, and time budgets. After viewing each scenario, students are asked to rank the welfare of the animals presented. They are then provided time to prepare more detailed analyses they use to give a brief oral presentation to a panel of judges, arguing why one scenario demonstrates a higher level of welfare than the other. Knowledge of welfare science and the art of persuasion in the presentation are key factors used in scoring. The second part of the contest involves a live assessment of a real-world scenario.

Thirty-two teams from 22 universities participated this year. Among the three divisions, 19 undergraduate teams, 10 veterinary teams, and three graduate teams competed, plus 13 individuals. In all, 145 students entered the contest, representing mostly the U.S. and Canada, with one person from Italy. This year, scenarios involved dairy goats, egg-laying ducks, and green iguanas, and the live assessment involved polo ponies.

In addition to judging activities, programming included lecture sessions, which were taped for future use.

KEYS TO SUCCESS

Jenny Schefski, a third-year veterinary student at CSU, took first in the overall individual category in the veterinary division. She said the contest has enriched her education.

“Instead of memorizing lists of diseases and looking at animals as a bunch of body systems, it challenges participants to look at the animal holistically. I enjoy learning about the behaviors unique to each species and how we as veterinarians can use our understanding of them to improve production and other outcomes,” she said.

Schefski credited her win—and her team's fifth-place finish—to the weekly, two-hour-long journal club meetings with fellow veterinary students as well as animal science undergraduate and graduate students.

“I think most importantly, though, was that I chose to focus on how a given scenario could be improved, rather than all of the negative points. As a veterinarian, I want to help my clients improve the welfare of their pets by having a discussion about what they can do better and not get so focused on what they're doing wrong,” Schefski said. “Most of my speeches this year involved plans for how I would help a hypothetical producer improve the welfare of animals in a given situation. Small changes can make a huge difference in animal welfare, and focusing on what someone is doing wrong isn't going to make them feel encouraged or empowered to change things. Most people want the best for their animals. They just need a little guidance sometimes.”

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The 2018 AVMA Animal Welfare Assessment Contest took place Nov. 16–18, 2018, at Colorado State University College of Veterinary Medicine & Biomedical Sciences. Pictured is CSU's veterinary team (from left): Anais Rodriguez-Sanchez; Louana Cheung; Temple Grandin, PhD; Jenny Schefski; Haemin Park; and Sneha Krishnan. The team placed fifth overall in its division, and Schefski took first in the overall individual category in the veterinary division. (Courtesy of Jenny Schefski)

Citation: Journal of the American Veterinary Medical Association 254, 3; 10.2460/javma.254.3.307

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Dr. Pairis-Garcia, who has coached the OSU veterinary team that placed first overall in its division, has found that first-time participants tend to focus initially on health, vaccination, prevalence of disease, and treatment protocols. By the end of the contest, they learn to think about valuable components outside the health realm, such as the behavior of the animals, what they want to do and are motivated to do, their mental state, and ethical components.

Another unique aspect of the contest is the on-site assessment portion, Dr. Pairis-Garcia said.

“When students apply knowledge they learned in class to real-world scenarios, it solidifies the concept that you can do animal welfare as a career,” she said. “Plus, we have good scenario writers who make it complicated and frustrating. It's never black and white. There's never a clear answer,” similar to what veterinarians experience in practice.

THOSE LEFT BEHIND

Each spayathon location is managed and staffed by a small army of volunteers from veterinary and animal welfare organizations on the island and in the states. Dr. Frances Piñero is president-elect of the Puerto Rico VMA, which is staffing the Animal Control Center during the weeklong event. Dr. Piñero said no aspect of Puerto Rico went untouched by the Category 4 hurricane when it made landfall in September 2017. The impact on the island's animal population was especially severe.

“Honestly, it was just pure devastation,” she said. “We have all these stray animals before Maria, and then we have all these other animals left by their owners. Many did take their animals with them, but many others did not.”

As Puerto Rico continues to recover from one of the most devastating natural disasters in the island's history, veterinarians there are experiencing a new urgency to address the pet overpopulation problem and educate the public about responsible pet ownership.

Dr. Angel Ramos, a practice owner in the mountain town of Jayuya who volunteered at the center, recalled a surreal moment following the hurricane that, for him, underscored the seriousness of the problem. “Puerto Rico has always had an issue with strays, but you don't expect to see a purebred dog walking down the road. So, when you see a Great Dane coming along the road, you're wondering what's going on,” Dr. Ramos said.

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Representatives of the AVMA and Puerto Rico VMA met in November 2018 with Ricardo Rosselló, governor of the U.S. commonwealth, to discuss veterinary matters on the island. Pictured here are AVMA Board of Directors member José Arce, Gov. Rosselló, AVMA President John de Jong, and PRVMA President Javier Rodríguez Soto. (Photo by R. Scott Nolen)

Citation: Journal of the American Veterinary Medical Association 254, 3; 10.2460/javma.254.3.307

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ONLINE GALLERY AND VIDEO

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(Photo by R. Scott Nolen)

Citation: Journal of the American Veterinary Medical Association 254, 3; 10.2460/javma.254.3.307

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Additional images and a video of Spayathon for Puerto Rico are available at https://jav.ma/Spayathon.

Just how many pets were abandoned in Puerto Rico because of Maria is not known. Shortly after the hurricane, Puerto Rico Gov. Ricardo Rosselló signed an executive order authorizing the Humane Society of the United States and Humane Society International to assist animal-focused disaster relief work in the commonwealth. Ultimately, a memorandum of understanding was struck among the Puerto Rican government, HSUS, PRVMA, and Puerto Rico Board of Veterinary Medical Examiners to implement Spayathon for Puerto Rico with a goal of spaying and neutering more than 21,000 animals within an 18-month period.

VETERINARY SERVICES

All things considered, Puerto Rico's veterinary community weathered Maria relatively well. No veterinarian is reported to have been among the nearly 3,000 deaths attributed to the hurricane. Most practices were up and running within a few days, albeit without power. Dr. Ramos’ Jayuya practice had no electricity until mid-December 2017.

“That was one of the roughest things, in terms of trying to provide the same type of service without being able to turn on my equipment,” he said. “I had to move out everything from the refrigerator—tests, vaccines, medications—to a small cooler and add ice and ice packs to keep products in correct temperature. After a few days, a neighbor with a generator offered to give us an extension cord so we could run the refrigerator and microscope.”

“Even with no electricity, I opened the clinic because people were coming to my house with sick pets,” Dr. Ramos continued. “I would do as much as I could but ended up opening with limited hours and services so I could at least see patients that needed medical attention. I still did surgeries using a combination of IV and gas anesthesia, but it was very difficult to maintain a clean environment; it was very hot, so windows had to be opened, and we had no running water.”

The specialty practice in San Juan where Dr. Carlos Mongil is a small animal surgeon ran on a generator for three months. “Getting fuel was a huge ordeal,” he said. “We had to reduce our working hours so we had enough fuel for the following day. Our work days were cut short as there was a curfew and everyone had to be home by 7 p.m.”

“Communications were horrible,” Dr. Mongil continued. “It was really hard to communicate not only with pet owners but also with referring veterinarians about cases referred for surgery. Clients would just show up at the door without appointments, and neither the owners nor the referring veterinarians were able to communicate with us to coordinate the referral. The referring veterinarians would often come and bring us radiographs and consults as they were not able to reach us by phone.”

In the immediate aftermath of Maria, veterinary services in Puerto Rico entered a triage phase. “There were a lot more trauma cases,” Dr. Mongil explained. “The elective part of the profession was put on hold. We were dealing with only emergency cases and cases that required immediate attention.”

Given the large numbers of stray animals, standing water, and unsanitary conditions, the veterinary community quickly grew concerned about the likelihood of outbreaks of leptospirosis and rabies. Veterinarians fanned out across the island, vaccinating thousands of animals at no charge. Dozens of people are suspected of having contracted leptospirosis, and at least two deaths are confirmed to have been linked to the bacterial infection.

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Photos from Jayuya (Courtesy of Dr. Angel Ramos)

Citation: Journal of the American Veterinary Medical Association 254, 3; 10.2460/javma.254.3.307

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RESPONSIBLE PET OWNERSHIP

More than a year since Maria, things at Dr. Mongil's practice are nearly back to normal. “Our case distribution has gone back to being what it used to be, in terms of the proportion of emergencies and critical care procedures and elective procedures,” he said. “We're mostly back to where we were before the hurricane, but Maria did change the entire island. Everything is before Maria and after Maria.”

Dr. Ramos doesn't judge the people who fled Maria without their pets. He understands that when confronted by life-or-death situations, people instinctively think about their own survival. He suspects that many Puerto Ricans, especially in rural areas, thought Maria wasn't going to be as bad as it was. In early September 2017, Hurricane Irma “grazed” Puerto Rico after the storm was predicted to be much worse.

“A lot of people thought the same about Maria. It wasn't until, like, two days before that we realized we were going to get hit. That's when everybody started to panic,” Dr. Ramos said.

Many Puerto Rican veterinarians believe the island's stray animal problem is symptomatic of a general lack of understanding about responsible pet ownership. The attitude toward animals in Puerto Rico differs from that in the states, Dr. Ramos said. “I've worked in both places, and you can see that people here have a bit more of a learning curve to go in terms of the value of veterinary medicine.”

Dr. Mongil believes sterilization is a small part of the overall solution. “Education is the No. 1 thing that we need to work on,” he observed. “People need to be educated so that we can change the way they think about their pets. Things here have gotten a lot better in the last 20 years, but there's still a lot of work that needs to be done regarding what a responsible owner should do for their pets.”

Dr. Piñero, the PRVMA president-elect, wants the association to step up its outreach to the public and most especially children. “If we don't educate these young people, how are we going to be able to improve? We need to start at the beginning,” she said. “Obviously, we try to educate everybody, but our focus should be on those youngsters who are the future of Puerto Rico.”

WSAVA International Award for Scientific Achievement

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Dr. Colin Harvey

Citation: Journal of the American Veterinary Medical Association 254, 3; 10.2460/javma.254.3.307

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Dr. Colin Harvey, Haddonfield, New Jersey, for his work in highlighting the importance of veterinary oral and dental conditions in companion animals and developing tools to support the incorporation of dental procedures and dental preventive strategy into daily veterinary practice. A 1966 veterinary graduate of the University of Bristol in Bristol, England, Dr. Harvey was a professor of surgery and dentistry at the University of Pennsylvania School of Veterinary Medicine for more than 30 years prior to retirement in 2013. During his career, he introduced a vast range of oral and maxillofacial surgical procedures into his clinical, teaching, and research activities. These helped improve oral surgery reconstructive techniques used in cancer patients and in the management of oral trauma and congenital and acquired oronasal defects. Dr. Harvey is a charter diplomate of the American Veterinary Dental College and a diplomate of the American College of Veterinary Surgeons.

WSAVA Global One Health Award

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Dr. Edward B. Breitschwerdt

Citation: Journal of the American Veterinary Medical Association 254, 3; 10.2460/javma.254.3.307

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Christopher W. Woods, MD

Citation: Journal of the American Veterinary Medical Association 254, 3; 10.2460/javma.254.3.307

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Dr. Edward B. Breitschwerdt (Georgia ‘74), Raleigh, North Carolina, and Christopher W. Woods, MD, Durham, North Carolina, for their work on atypical manifestations of bartonellosis in humans, particularly in veterinary professionals. Drs. Breitschwerdt and Woods have developed tests to more easily diagnose bartonellosis in humans and discovered chronic disease associations, including headaches, blurred vision, fatigue, and polyarthritis, that can be confused with Lyme disease. Dr. Breitschwerdt is a professor of medicine and infectious diseases at the North Carolina State University College of Veterinary Medicine. He also directs the university's Intracellular Pathogens Research Laboratory in the Institute for Comparative Medicine, co-directs the Vector Borne Diseases Diagnostic Laboratory, and directs the Biosafety Level 3 Biocontainment Facility. Dr. Breitschwerdt serves as an adjunct professor of medicine at the Duke University Medical Center. He is a diplomate of the American College of Veterinary Internal Medicine. Dr. Woods received his medical degree from Duke University in 1994 and serves as a professor of medicine and global health and chief of the Division of Infectious Diseases at the Duke University School of Medicine. He also co-directs Duke's Hubert-Yeargan Center for Global Health and serves as an adjunct associate professor of epidemiology at the University of North Carolina Gillings School of Global Public Health and in the Emerging Infectious Diseases Program at the Duke-National University of Singapore Medical School.

WSAVA Meritorious Service Award

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Dr. Amilan Sivagurunathan

Citation: Journal of the American Veterinary Medical Association 254, 3; 10.2460/javma.254.3.307

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Dr. Amilan Sivagurunathan, Kuala Lumpur, Malaysia. A 2002 veterinary graduate of the University of Pretoria in South Africa, Dr. Sivagurunathan is a veterinary ophthalmologist and practices at Animal Medical Center in Kuala Lumpur. A past president of the Malaysian Small Animal Veterinary Association, he established a pharmaceutical working group to enable MSAVA to work with representatives from the livestock industry and discuss policies and regulations established by the pharmacy board of the Malaysian veterinary industry. Dr. Sivagurunathan is a member of the technical working committee of the Malaysian National Animal Welfare Foundation and has helped raise standards of companion animal welfare in the country.

WSAVA Hill's Next Generation Award

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Dr. Guyan Weerasinghe

Citation: Journal of the American Veterinary Medical Association 254, 3; 10.2460/javma.254.3.307

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Dr. Guyan Weerasinghe (Queensland ‘11), Mount Coolum, Australia. Dr. Weerasinghe practices small animal medicine at Greencross Vets Caloundra in Caloundra, Australia, also serving as a veterinary officer with the Department of Agriculture and Fisheries of the state of Queensland, Australia. Dr. Weerasinghe is involved with animal disease surveillance and response, collaborates nationwide on one-health projects, and promotes continuing education. He is a diplomate of the American College of Veterinary Preventive Medicine and is a past president of the Sunshine Coast branch of the Australian Veterinary Association.

WSAVA Award for Companion Animal Welfare

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Dr. Nalinika Obeyesekere

Citation: Journal of the American Veterinary Medical Association 254, 3; 10.2460/javma.254.3.307

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Dr. Nalinika Obeyesekere, Colombo, Sri Lanka. Dr. Obeyesekere was the first recipient of this award, recognizing veterinarians who have made significant contributions to companion animal welfare. A 1991 veterinary graduate of the University of Peradeniya in Sri Lanka, she co-founded and serves as a director of PetVet Clinic in Colombo. Dr. Obeyesekere also co-established Blue Paw Trust, an organization aiming to enhance human health and advance animal welfare. As a co-founding member of the Society of Companion Animal Practitioners of Sri Lanka, she has helped develop continuing education and advocates for higher standards of veterinary practice and adoption of the one-health approach. Dr. Obeyesekere promotes behavioral therapy with both veterinary teams and owners.

BUSINESS

The WSAVA launched its new Animal Welfare Guidelines for companion animal practitioners and veterinary teams. The guidelines aim to bridge differing perceptions of animal welfare around the world and help veterinarians tackle the ethical questions and moral issues that impact animal welfare. They also offer guidance to ensure that, in addition to providing physical health advice and therapy to their patients, veterinarians can advocate for patients’ psychological, social, and environmental well-being.

OFFICIALS

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Dr. Shane Ryan

Citation: Journal of the American Veterinary Medical Association 254, 3; 10.2460/javma.254.3.307

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Dr. Siraya Chunekamrai

Citation: Journal of the American Veterinary Medical Association 254, 3; 10.2460/javma.254.3.307

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Drs. Shane Ryan, Singapore, president; Siraya Chunekamrai, Bangkok, vice president; Walt Ingwersen, Dundas, Canada, immediate past president; Michael Day, Cheddar, England, honorary treasurer; Renee Chalmers Hoynck van Papendrecht, Den Helder, Netherlands, honorary secretary; Nicola Neumann, Bray, Ireland, congress liaison officer; and Ellen van Nierop, Quito, Ecuador, board member