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Enhancing Early Disease Detection with BEAM Scores typography
Managing YOUR Pain Through Healthy Habits typography
Make Your Practice’s Success a Team Effort with “Open Book Management” typography
The Role of Wearable Technology in Veterinary Research typography

August / September 2024

A PRACTICAL GUIDE FOR PET HEALTH PROFESSIONALS

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August / September 2024

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Copyright August 2024. PetVet Magazine is published bimonthly by Barkleigh Productions, Inc, 970 West Trindle Road, Mechanicsburg PA 17055. Postmaster: Send change of address to Pet Vet Magazine c/o Barkleigh Productions, Inc., 970 West Trindle Road, Mechanicsburg PA 17055. No part of this publication may be reproduced without written permission of the publisher. Editorial offices: 970 West Trindle Road, Mechanicsburg PA 17055. (717) 691–3388 FAX (717) 691–3381 Email: info@barkleigh.com
Dr. Douglas Stramel: Paving the Way to Pet Pain Management article graphic
Above-Down, Inside-Out: Understanding the Chiropractic Connection the the Nervous System article graphic
ADVISORY BOARD

Meet our EDITORIAL ADVISORY BOARD!

PetVet’s advisory board is here to help ensure quality content to motivate & educate Veterinarians and their staff.
Picture of Courtney Campbell
Courtney A. Campbell
DVM, DACVS-SA
“My passions ultimately drove me towards becoming a veterinarian, but when I was growing up I briefly flirted with the idea of becoming a magician. As a veterinarian, the ability to save lives, keep animals healthy, and strengthen the human–animal bond makes me realize there’s nothing more magical than that.”
Picture of Jenifer Chatfield

Jenifer Chatfield
DVM, Dipl. ACZM, Dipl. ACVPM

“People should be so lucky as to get to be a veterinarian. The broad-based education empowers us to be successful in multiple fields and affords us the opportunity to choose how we spend our professional time.”
Picture of Julie Legred
Julie Legred
CVT
“I have worked in many areas of veterinary medicine and veterinary technology over the last thirty five years, and it is amazing how far our profession has grown and paved the way for the betterment of animals’ lives and happiness, as well as improving public health issues. It is an honor for me to be a part of this advisory board to offer additional education and opportunities to grow in our profession.”
Picture of Lisa Powell
Lisa Powell
DVM, DACVECC
“I have had the privilege of working with a variety of animals in my career and my passion has allowed me to be involved in teaching veterinary students, interns, residents and other veterinarians. I continue to enjoy going to work every day to help critically ill dogs and cats, and love the client interactions as well. I am proud to be a part of this advisory board to help teach and spread my love for this profession to others in the veterinary community.”
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Kathryn Primm,
DVM, CVPM
“Animals mean so much to the human condition. It is my privilege to make lives better every day! I cannot imagine myself in any other career.”
VETERINARIAN LIFE ADVICE
"Just like in human medicine, the pain level in animals should be a VITAL SIGN. Providing pain relief is just as important to healing as any other medical treatment at our disposal. Saying that animals feel pain is NOT anthropomorphism–it is SCIENCE!" typography

-Tamara Grubb,

DVM, PhD, DACVAA,
President of International Veterinary Academy of Pain Management (IVAPM)
CLIENT SERVICES
Enhancing Early Disease Detection with BEAM Scores
By Dr. Jeff Feinman
A

s veterinarians, the health of our patients is paramount, and one way to maintain their health and wellbeing is understanding and utilizing BEAM (Behavior, Energy, Appetite, Mood) scores. BEAM scores can greatly enhance our ability to detect early signs of disease in pets, leading to more successful treatment outcomes and, ultimately, happier and healthier animals. The following aims to provide a comprehensive overview of how veterinarians can use BEAM scores to detect disease, monitor pet health and optimize veterinary visits.

Understanding BEAM Scores
BEAM scores offer a straightforward method for assessing the overall health of pets. By systematically observing and recording changes in behavior, energy levels, appetite and mood, veterinarians can gather critical insights that may indicate underlying health issues.
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1. Behavior: Changes in a pet’s behavior can be a significant indicator of their health. For example, a dog that once greeted the client with barks and a wagging tail but now greets them with a low whimper or shows reluctance in getting up may be signaling discomfort or distress. Similarly, a cat that used to enjoy cuddles but now prefers solitude might be experiencing pain or illness.

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2. Energy: Energy levels can reflect a pet’s general health state. A decrease in energy could signal conditions like heart disease or infection, while an increase might indicate issues like anxiety or hyperthyroidism.
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3. Appetite: Appetite fluctuations are often among the first symptoms noticed by pet parents. These changes can suggest a variety of conditions, from dental problems to systemic illnesses like diabetes.
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4. Mood: Just as with humans, a pet’s mood swings can reveal health complications. A mood change that leads to aggressiveness or withdrawal could be a sign of pain or illness.
By asking our clients to monitor these four key areas, pet parents can quickly notice when something is amiss. It’s important to remember that any significant change in BEAM score should prompt a thorough check-up and any specified diagnostic testing. Tests may be indicated even if the examination is normal, especially if the client intuitively feels that something is off with their beloved companion animal.
BEAM scores are not only tools for early disease detection, but are also essential in fostering a deeper understanding of the pets we care for.
Implementing BEAM Scores in Clinical Practice

Monitoring BEAM scores is a helpful and easy-to-implement part of veterinary assessments. Early detection of subtle changes can lead to timely diagnostic and therapeutic interventions. Here are some steps to integrate BEAM scoring effectively into veterinary practice:

  • Establish Baselines. Determine normal BEAM scores for each pet during regular check-ups to identify any deviations during future visits.
  • Educate Pet Owners. Inform pet owners about the importance of BEAM scores and how they can monitor these at home, empowering them to journal the scores and note any changes that will prompt them to seek veterinary care.
  • Encourage Regular Updates. Encourage pet owners to provide updates on their pets’ BEAM scores during routine visits or via digital communication tools.
  • Integrate with Physical Examinations. Combine BEAM score assessments with physical exams to provide a comprehensive overview of a pet’s health.
  • Use Technology. Leverage technology such as pet health apps or validated activity trackers to continuously monitor changes in pets’ behavior and energy levels, facilitating early intervention.
  • Present Case Studies. Presenting detailed case studies can help illustrate how changes in BEAM scores have led to the identification and management of early-stage diseases, encouraging owners to follow through with them.
The Vital Role of BEAM SCORES in Veterinary Medicine
BEAM scores are not only tools for early disease detection, but are also essential in fostering a deeper understanding of the pets we care for. Regular monitoring combined with professional veterinary assessments can dramatically improve the quality of life for our animal companions. By adopting BEAM scoring in our practices, we can enhance our diagnostic capabilities and provide proactive, personalized and participatory care to each pet, ensuring they remain happy, healthy and active for as long as possible. Remember, early detection is key to successful outcomes, and BEAM scores are one of the most effective tools we have to achieve this.
Jeffrey Feinman headshot
Jeffrey Feinman, BA, VMD, CVH, holds both molecular biology and veterinary degrees from the University of Pennsylvania. Dr. Jeff was the first dual degree recipient at Penn in the prestigious University Scholars program. In 1998 he further advanced his training and became the first Certified Veterinary Homeopath in the state of Connecticut. Dr. Jeff is devoted to teaching both pet owners and other veterinarians about homeopathy and optimal pet care. He and his wonderful wife (and practice manager), Amy, live with Coqui, a 15+ year old Standard Poodle and two Rex cats named Mia and Chi.
BEST PRACTICES
Planning for Retirement? Avoid These Costly Mistakes as a Small Practice Owner

By David Ranney

P

lanning for retirement is very personal. Some people prefer to manage their own investments and plans, whereas others would much rather hand over this incredibly important task to a trusted professional. Regardless of which side you are on, there are a number of common mistakes often made by individuals and small business owners, which have a profound impact. The key aspects to help you avoid these mistakes are keeping costs low, avoiding risk and understanding the importance of working with a fiduciary.

Keeping Costs Low

The 401(k) Averages Book found that employees at a ten-person small business could pay annual fees of up to 1.92% of assets under management (AUM) on their 401(k) account. The percentage you are charged is based on your total balance, and comes right out of your investment return or performance. As a result, fees of 2% will eat up a far greater portion of your investment return in any given year versus a more reasonable number for fees.
This also means that if the markets are flat or even decreasing, then your 401(k) balance declines at a much higher rate, regardless of how much you’re adding to your retirement plan. Therefore, fee reduction is an important goal for any small business owner or individual looking to keep more of their money working for them.

The largest U.S. firms enjoy total 401(k) fees or costs of under 1%; however, small businesses, like many veterinary practices, have historically found it difficult to compete with this—until recently. Thankfully, fundamental changes to the small business 401(k) market have brought in better, more modern approaches to retirement planning.

It is essential that any business owner review their plan and ask their provider if current fees are in line with the market. For example, if you are paying 3% of your assets under management every year in fees and it is reduced to 1% or lower, this directly translates to higher balances for you and your valued employees. With compound interest taken into account, this seemingly small change can have a dramatic impact on your financial future. And, these lower fees tend to lead to increased staff retention and satisfaction, as they see less of their retirement savings being withdrawn as fees on an annual basis.

Veterinarians with individual retirement plans should consider reassessing their fees as well. If you are paying fees 2.5%+ of assets under management while seeing poor returns, this may leave your savings stagnating rather than growing. There are many options for individuals in the market that sit under 1% of assets under management.

“By periodically investing in an index fund, the know-nothing investors can actually outperform moost investment professionals.”

– Warren Buffett

“By periodically investing in an index fund, the know-nothing investors can actually outperform moost investment professionals.”

– Warren Buffett

Avoiding Risk

Investing ideology makes an enormous difference in retirement planning. Investing in a broad range of EFTs/index funds and owning a share of the entire market, rather than individual stocks, is a far safer and often more lucrative method of investing.

Even Warren Buffett, one of the greatest investing minds in history, encourages investors large and small to focus on low-cost index funds. He famously declared, “By periodically investing in an index fund, the know-nothing investors can actually outperform most investment professionals.”

Working with a Fiduciary
It is also advisable to work with a fiduciary as opposed to a broker because a fiduciary has the legal responsibility to act in your best interest. They work for annual fees rather than commissions and offer advice and guidance with the goal of benefiting you, rather than themselves or their firms. Using broker-dealers to actively manage individual stocks and shares can increase the cost of your retirement planning, as they take a commission on anything bought and sold, and there are conflicts of interest rampant in these arrangements. There is overwhelming evidence that, in the long term, passive investing through index funds/ETFs with a low-fee manager leaves you with more money for your retirement. 

Being a financial advisor does not make someone a fiduciary, so make sure that you can confirm—preferably in writing—before deciding to work with a firm. This is especially important for veterinary practice owners that have a 401(k) plan for staff. If your plan provider is not a fiduciary, then it is you, the veterinary practice owner, not the 401(k) plan provider, who is liable for any breach of fiduciary responsibilities.

In the case of “legacy” 401(k) plans, it is unlikely that the provider will act as the fiduciary automatically, despite charging higher fees. This is almost certainly the case if your 401(k) provider is a payroll company or a large bank. The result of this could be that the veterinary practice owner is held responsible for restoring plan losses and costs associated with any inappropriate actions committed, even if these issues were caused by a stockbroker. Moving to a fiduciary structure will reduce your risk, ensure that the advisor is working in your best interest and should lower fees dramatically.

bar graph depicting hypothetical balances at retirement

Self-Management

If you manage your own retirement planning, consider the benefits of working with professional retirement planners. Letting go and having someone else control your money is hard, but you can save dozens of hours annually if you work with a fiduciary who will also manage IRS reporting and other compliance requirements. There is also evidence that those who take a hands-off approach to retirement planning and “set and forget” (set a percentage of their salary to go straight into their managed 401(k) plan) tend to outperform those who actively manage their own stocks and bonds.

Make sure that you have a financial plan and stick to it, cut your fees, and make sure that you are getting a good rate of return. If you commit yourself to planning for retirement today, your future self will surely thank you.

David Ranney headshot
As Vice President of Sales at Rebalance, David Ranney partners with small businesses across many industries throughout the country. He educates small businesses about how to avoid high 401(k) fees, how to optimize asset allocation, how to increase plan participation, and how to utilize retirement planning. The net result is higher employee satisfaction and greater employee retention. Prior to joining Rebalance, David spent more than two decades at Fidelity, driving innovation in workplace retirement investing.
petvet profile
Dr. Douglas Stramel
Dr. Douglas Stramel performing veterinary services on a dog
Dr. Douglas Stramel wearing protective equipment while performing veterinary services on a dog
vector outline of a dog with spinal issues
Paving the Way to Pet Pain Management
By Rebecca Shipman
Photos provided by Advanced Care Veterinary Services
“I

find that too many people think ‘my dog is just getting older’ or ‘my dog is more tired the older it gets’ and do not realize their pet is in pain. Older dogs should still remain active and not have a considerable ‘slow down,’” shares Douglas Stramel, DVM.

“So my passion is to treat painful pets like that and then hear the owner say ‘my dog is acting like a puppy again,’” he continues. “I love to be able to take on cases where other veterinarians say there is nothing more they can do and then be able to help the pet live a less painful life, and for the pet to still be around for the owner to enjoy longer.”

Dr. Stramel runs and operates Advanced Care Veterinary Services, a specialty practice limited to pain management and rehabilitation in Carrollton, TX. The majority of his patients are older adults or seniors, many of which are treated using regenerative medicine such as platelet-rich plasma or stem cells to help with mobility issues.

“We see dogs that are partially paralyzed and utilize acupuncture, photobiostimulation, and shockwave, among other therapies, to help them regain the ability to walk,” he shares. “We also see a lot of pets with cruciate ligament injuries that are not ideal surgical candidates and we help them regain function and use of the affected knee. We have even been known to treat a bunny or a chicken with acupuncture to help it with mobility issues.”

Dr. Douglas Stramel and a veterinary assistant performing scans on a dog
In addition to running his practice, Dr. Stramel also provides pain management consultations and education to other veterinarians in the Dallas/Fort Worth area.
In addition to running his practice, Dr. Stramel also provides pain management consultations and education to other veterinarians in the Dallas/Fort Worth area, is a published author, national and international speaker on the topics of pain management, and has participated in nine FDA clinical trials to help advance treatment in the field of pain management.

“By working with Zoetis and Elanco, I have provided continuing education presentations and wet labs on the topics of anesthesia and pain management to practitioners in north Texas and Oklahoma,” he adds.

Dr. Douglas Stramel and a veterinary assistant performing an inspection on a dog
dog doing physical therapy in a water tank
As a 1991 graduate from Kansas State University, it wasn’t until years later that Dr. Stramel discovered his niche for pain management. “Back in 1997 the owner of the practice I was working for had to take an unexpected leave of work for a couple days,” he recalls. “During that time, one of their good clients was coming in to euthanize their geriatric dog due to mobility issues.

“A brand new product was just released called Rimadyl,” Dr. Stramel continues. “It was the first FDA-approved NSAID for dogs to treat pain and inflammation. After doing my exam, I thought I could help the dog with the use of this product. The dog, Molly, responded very well and I was able to keep Molly comfortable for the next two years. This was my first and most important step in getting into the pain management field.”

Following his initial discovery of his passion for pain management, Dr. Stramel says he took a few detours, but ended up finding the International Veterinary Academy of Pain Management (IVAPM) around 2007 and became very involved with them. From 2010-2013 he was Chair of “Advisory Council on Pain Management,” which is dedicated to publishing pain management guidelines in the field of veterinary medicine, was the Treasurer from 2013-2019, President-elect from 2019-2021 and President from 2021-2023.

“There are a lot of brilliant minds involved with both IVAPM and many universities that are continuously looking at new ways of treating pain,” Dr. Stramel says. “The newest product we have is not even a drug per se; it is a monoclonal antibody that targets the pain associated with osteoarthritis. I look forward to what all will be released in the next few years, as there is quite a bit in the works.”

Dr. Douglas Stramel with a fellow colleague in front of a sign for the International Veterinary Academy of Pain Management
There are a lot of brilliant minds involved with both IVAPM and many universities that are continuously looking at
new ways of treating pain.
– Dr. Douglas Stramel
In 2009, he received the credentials of Certified Veterinary Pain Practitioner through IVAPM, and is the first and only veterinarian to receive this credentialing in the Dallas/Fort Worth area. But, his credentials in this specialized sector don’t stop there. He is certified in Western Medical Acupuncture through Colorado State University (now known as CuraCore) and has received training in dry needling therapy for release of myofascial trigger points through Myopain Seminars.

Even with his many accomplishments and specialized training, Dr. Stramel has proved that the sector of veterinary pain management is complex and always changing. However, he goes on to say that there are additional measures that general practice vets can take to identify and treat pain in their patients.

“It starts with thoroughly palpating the pets for a good musculoskeletal examination,” Dr. Stramel advises. “There have been numerous times, after I examine a pet, the owner states that no one has ever touched their pet so much during an examination. Without thorough palpation it is quite easy to miss important details about the pet’s pain.

“It is also crucial to utilize a validated pain scale for both acute and chronic pain,” he continues. “There is an amazing product called Pain Trace. This unit will show real-time pain levels that are acquired using skin-mounted sensors that process a direct pain biosignal generated by the nervous system. This is an underutilized device in most general practices.”

While his days in practice are dedicated to managing pain in pets, Dr. Stramel still finds time to enjoy his home life with his family on their Texas ranch.

“Most of my free time is used by my eight-year-old daughter and her barrel horse, Jackpot,” he says. “My wife runs an amazing boutique horse hotel and Airbnb so I have plenty of chores to do around the ranch. Lastly, I make time for my daughter and I to go fishing, explore the woods, and ride the four-wheeler.”

Dr. Douglas Stramel examining a cat
Dr. Douglas Stramel holding a small kitten
The joy and satisfaction I experience when I witness the transformation of a pet, from a state of pain and discomfort to renewed vitality and happiness, is incredibly rewarding.
– Dr. Douglas Stramel
To conclude, Dr. Stramel summarizes why he is so passionate about this very important and rewarding role that he plays in the vast industry of veterinary medicine: “The joy and satisfaction I experience when I witness the transformation of a pet, from a state of pain and discomfort to renewed vitality and happiness, is incredibly rewarding,” he expresses. “The moment you see that certain look on a client’s face after their paralyzed dog takes its first few steps, when the client was told that they had to either euthanize the dog or pay over $10,000 for spinal surgery, is one that you will never forget. We see cases like this several times a year, and being able to give the clients hope and another option is the best feeling in the world.”

The specialty sector of pet pain management is oftentimes one that is taken for granted; to treat a pet for its symptoms—which often include pain—is veterinary care. However, identifying the source of pain and choosing the proper method of treatment are areas that require skill and a depth of knowledge, and this is certainly a specialty that Dr. Douglas Stramel has mastered, relieving his patients from pain and putting their owners at ease knowing their pets are no longer suffering.

To learn more about the International Veterinary Academy of Pain Management, visit www.IVAPM.org

BUSINESS TRENDS
The role of wearable technology in veterinary research
By Asaf Dagan, DVM
Photo provided by PetPace
I

n the ever-evolving field of veterinary research, staying ahead means embracing innovation. That’s why advancements in wearable and mobile health technologies have sparked a revolution in how animal health is monitored for research.

Wearable Technology: Advancements in Remote Measurements
Wearable technology has emerged as a vital tool for researchers, offering a glimpse into the lives of pets outside the confines of a lab. By enabling the remote monitoring of multiple pets simultaneously, researchers can observe animals in their natural environments for a more reliable and authentic picture, avoiding the “white coat effect” or the interference of measurements on the measured parameters. In turn, wearable technology enables projects to efficiently increase in scale by monitoring many subjects at once.

With advancements in miniaturized sensors, modern smart collars can house several measurement devices within a single device that can be worn as a normal pet collar. Due to this streamlined design, smart collars can now collect real-time data across a variety of vital signs and biometrics, including temperature, pulse, HRV, respiration rate, posture, activity levels and more.

Big Data: Capturing High-Frequency Data Collection
The continuous feed of data enabled by remote wearable devices allows for the collection of large and detailed data sets. With data being collected continuously, thousands of data points are collected each day, which are then uploaded to the cloud to be stored in online databases. Given streamlined access to unprecedented amounts of precise data, researchers are able to quickly access and effectively analyze the information to unlock key insights.
Artificial Intelligence: Unlocking the Power of Machine Learning
Advancements in machine learning technology have enabled AI models to compare a wide range of data points to identify insights that could otherwise go unnoticed. In addition to basic measurements, such models can help identify larger health trends such as pain, sleep quality and overall wellness.

As with any use case, AI models become more powerful when provided with more data to learn from. Therefore, when data is collected from an animal over a longer period, AI can better identify baselines unique to the animal and can help discover potential diseases before they would otherwise be noticed. By leveraging advanced machine learning technology, researchers can identify anomalies and learnings like never before.

in surgical centers, veterinarians are using smart collars to manage post-op care.
Use Cases: The Role of Wearable Technology in Veterinary Research
Modern smart collars enable researchers to collect unparalleled insights across a range of applications. In pharmaceutical research, scientists are using wearable technology to remotely track the vital signs of animals during clinical trials. In surgical centers, veterinarians are using smart collars to manage post-op care. Even in the world of dog training, animal behaviorists are using smart collars and AI technology to identify when dogs are stressed to help improve training methods.

Another area that’s a growing trend is TeleVet Medicine. In the U.S., the TeleVet Medicine market is $137M annually and projected to reach $900M in just a few years. Wearable smart collars can help triage the pet while on a virtual visit, allowing the vet to make decisions based on objective data rather than subjective information from the pet owner. This elevates the TeleVet experience for better outcomes.

Wearable technology is reshaping the landscape of pet health research. By providing researchers with the tools they need to gather real-time data from animals in their natural environments, this technology is unlocking new possibilities for understanding and improving pet health.

Asaf Dagan headshot
Asaf Dagan is the Chief Veterinary Scientist & Co-Founder at PetPace™. Dr. Dagan is a Diplomate of the American Board of Veterinary Practitioners (ABVP), specializing in Canine and Feline medicine. He is also certified in veterinary acupuncture by the International Veterinary Acupuncture Society (IVAS). In addition, he successfully completed advanced training in diagnostic ultrasound, laser surgery techniques, and orthopedics. Dr. Dagan graduated with honors from Tufts University School of Veterinary Medicine and was admitted to Phi-Zeta, the Veterinary Honor Society. He practiced small animal veterinary medicine in esteemed veterinary hospitals in Massachusetts, Connecticut, and Israel, treating a variety of health issues, diseases, surgical and emergency/trauma cases.
TEAM MANAGEMENT
a woman wearing scrubs and a stethoscope sits at a laptop, colorful graphics of a pie chart float around her
Make Your Practice’s Success a Team Effort with “Open Book Management” typography
By Louise Dunn
T

he day starts like any other. You check the weather report, you check your watch for your fitness stats, and you check your texts and emails. You check the numbers, note the trends and plan your day. You go to work and most likely hear your colleagues talking about their “numbers” and what they need to do. Most of us have trained ourselves to look at the numbers and adjust accordingly. Can the same apply to the veterinary team and business numbers?

Imagine if the veterinary healthcare team participated in looking at some business numbers. If you gave the team specific stats, would they be interested? If they saw a negative trend, would they talk about how to change the numbers? Probably. All it would take is explaining why and what to do. So how do you make this happen? Enter Open Book Management…

Open Book Management (OBM) involves sharing data (i.e., business performance and financial information) with the team and training the team to use the information in their daily work. It encourages team members to take responsibility for the business’s success and think as if they own the business and are investing their resources into it. It promotes the feeling of having a part in the business’s growth, success and reputation.

OBM is more than just numbers tossed out to the masses. It is about the numbers that are important to the operational success of the business of treating pets. It is about interpreting those numbers and developing plans for changing them. It is about the team seeing how their actions and decisions affect the business, patient care and their paycheck. Ultimately, it is about strengthening the circle of care and not permitting the circle to be broken.

The basis of using OBM is to give team members information that helps them do their tasks effectively and efficiently, focusing on things they are directly involved in. In the book The Great Game of Business, Jack Stack lists some basic rules for OBM: Teach team members the metrics, keep score to monitor improvements, and provide a stake in the outcome.

With all the talk about employee satisfaction and employee engagement, why not have a system that actively involves your team members in monitoring and changing metrics that they have direct contact with? Establish critical numbers and encourage creative thinking, teamwork, and a sense of partnership to engage your employees and promote the success of the business, world-class patient care and excellent client service.

The basis of using OBM is to give team members information that helps them do their tasks effectively and efficiently, focusing on things they are directly involved in.
The first step is to answer the question, “Why?” Why involve the team in OBM? Why is information being shared with the team? What is the team supposed to do with that information? Every practice is different, but some good reasons to consider are that OBM:

  • Brings every team member to the decision-making table
  • Shows how everyday decisions impact patient care, client service and business performance
  • Answers the age-old question of why we must cut costs or why we need to be more productive
  • Opens the door to ideas, initiatives and insights from others
  • Builds trust through the transparency of data sharing
  • Improves team member engagement

Once the “why” is addressed, the next step is forming scorecards and assigning teams. Remember, this is about your strategic plan for the year, so focus on what is essential to your practice goals as you build the scorecards. Teach the team about OBM and how to use their assigned scorecard to improve patient care, client service and business performance.

Here are some steps to follow to set up a team to use OBM:

  • Create a scorecard with Key Practice Indicators with that team.
  • Assign roles of “information gatherers” to team members who will be responsible for gathering data (this may be asking the manager for specific numbers from Quickbooks or having access to a PIMS report).
  • Gather information and present to the team at a monthly meeting.
  • Discuss trends with the entire team and allow them to give ideas and feedback.
  • For numbers that are doing well, use Appreciative Inquiry and see if techniques can be applied to other KPIs that are not doing as well.
  • For numbers that are not doing well, discuss ways to make changes.
  • Be sure to celebrate successes (catered lunches, bonus pay, etc.).

Here is an example of how the above steps could work:

A strategic goal is to improve the care of the older pet population. Metrics to put on the scorecard are the number of older pets, the percentage of those pets receiving eye exams, senior wellness tests and other vital services beneficial to an older pet. Put that team in charge of tracking the trends and talking to the rest of the team about what works well and what doesn’t when making a recommendation. Now for the spark of innovation—the “old pet” team will see areas of strengths and weaknesses in the program, think of solutions, and be responsible for discussing ideas with management and implementing change.

In addition to pet care, business performance can benefit from OBM. For example, everyone always hears that inventory is the second largest expense after wages. Since the team has its hands all over inventory, why not create a scorecard and assign some “eyes” to it? Income-to-expense ratios (especially lab, food, pharmacy and designer drugs) are valuable metrics for identifying possible problem areas.

There will not be one cookie-cutter scorecard for every practice. There are certain numbers that every practice wants to monitor, but some initiatives are unique to you and translate into specific numbers you wish to monitor. The following is an example of a scorecard:
scorecard for practices
The purpose of scorecards is not to measure everything and understand nothing. We want to set goals in the practice and then develop scorecards to help us reach those goals. It is important to realize that while the scorecards may continue to be tracked, it is easy to forget the purpose of these cards in the first place. Be careful about tracking things that were meaningful 10 years ago but have no bearing on what the practice is trying to achieve today.

OBM enables you to strive for a partnership with your team, which means that there is value in the efforts and ideas of each person. The team sees the scorecard and how their action contributes to the practice’s mission and the business’s success.

It is hard to keep your finger on the pulse of the business. We are inundated with information regarding client numbers, the number of visits, cat versus dog visits, repeat visits, new visits, etc. After hearing all these studies and reports, do you have the time to look at your numbers? Do you have time to track trends in the past quarter, the past year or the past three years? With OBM, you can have teams involved in the tracking. Set up a scorecard, be clear about the target to aim for and let the team start to monitor.

Using OBM, your team can see the changes—rather than just hearing you complain about client or pet numbers. Now you have something to talk about, to get ideas about and to try to change with the help of the entire team. Ideas tried can be monitored and results evaluated; keep with the idea or tweak it and see if it affects the numbers.

Remember, you can’t lead the band and play all the instruments. So while OBM is sometimes thought of as sharing financial information with the team, it is really about leadership, team development, communication, client service, performance improvement and profitability improvement. With Open Book Management, the attention to practice performance is made available to those team members who can make a difference and affect the numbers. Responsibility for the success of the practice is now a team effort.

Louise Dunn headshot
Louise Dunn is a renowned award-winning speaker, writer and consultant. She brings over 40 years of in-the-trenches experience and her business education to veterinary management. Louise is founder and CEO of Snowgoose Veterinary Management Consulting. SVMC works with veterinarians who want to develop a strategic plan that consistently produces results. Most recently Louise received many awards including the WVC Educator of the Year numerous times and VetPartner’s The Life Time achievement Award in January 2016.
INDUSTRY NEWS
Above-Down, Inside-Out typography

Understanding the Chiropractic Connection to the Nervous System

digital illustration of black dachshund dog standing on its hind legs with tan markings on snout and paws

By William Ormston, DVM

“A

bove-Down, Inside-Out” is a statement of chiropractic philosophy. It means that the brain is the control center of the body; the “Above.” The control of the body then travels “Down” the entire body on the “Inside” and finally flows “Out.” It is a very simple phrase born at the turn of the 20th century to express a very complex process. It refers to the functioning of the nervous system and all its manifestations.

The more you know about the nervous system, the more you can appreciate the phrase. If we remember that healing comes from “Above-Down, Inside-Out,” then the importance of the spine becomes clear. The body was designed from day one for the brain to be in control of everything—from regulating movement to healing.

Nervous System Function

All but two nerves exit the brain at the back of the skull, and most of these go through the foramen magnum. Lack of motion causes “SHaRP,” a phenomenon every student studying to become a doctor learns. SHaRP is an acronym that stands for Swelling, Heat, Redness, and Pain. If this occurs at the base of the skull because of a subluxation at the level of the atlas, every nerve will be affected in some way.

We know that the central nervous system is constantly reorganizing in response to changes in sensory input. During every second of every day, animals’ brains monitor and integrate all incoming sensory information. This allows them to accurately formulate and execute the motor commands they require based on what they choose to do at any one point in time. This integration of sensory information to perform movements accurately is known as “sensorimotor integration.”
Throughout animals’ lives, their activities, thoughts and behaviors will lead to specific molecular, biochemical, electrophysiological, and structural changes in their brains and central nervous systems. These adaptations and changes are, in fact, the mechanisms for learning, memory and recovery from injury. The results of research studies have indicated that vertebral subluxations (those dysfunctional spinal segments) lead to changes in the information that the spine sends to the brain.1
The Spinal Connection
To start with, instead of the brain receiving information that the subluxated spinal segment is moving as it should, it may get information that the segment is moving more than normal, not moving much at all or just moving differently from normal. That seems obvious, but for now, remember that any change in information to the brain can lead to changes within the brain itself.

When a spinal segment doesn’t move properly, it appears to influence how the brain perceives and responds to all other sensory information. Spinal function seems to be one factor the brain uses as part of its processing and integration of all information. This may cause some animals to be afraid of shadows, lights and noises that a subluxation-free animal would ignore.

Spinal adjustments can restore normal movement patterns in these spinal segments, which will restore a more natural pattern of input from the spine to the central nervous system. In turn, this will allow the spinal cord, brainstem, and brain to process incoming information in a more coherent and meaningful way. Therefore, seemingly unrelated events are corrected by the animal that is under chiropractic care.

The Role of Mechanoreceptors
Veterinarians learn about the mechanoreceptors in the neck, which enable the righting reflex, therefore allowing us to safely keep a large animal lying down after surgery or other procedure. These receptors are important because they communicate with the vestibular system in the ear canal to help all animals maintain balance and proper movement. A disruption in this communication will alter an animal’s ability to maintain balance while turning.

This function is very important in our athletic animals. It has been shown that the number of muscle sensors are remarkably high in the deep, small upper-neck muscles (those around the atlas and base of the skull). These deep upper-neck muscles seem to act primarily as proprioceptive sensors in the body, rather than playing any significant role in actual movement of the head and neck.

White Noise in the Brain
A New Zealand researcher has shown that chiropractic care—adjusting the spine to restore spinal function—actually changes the way the brain functions.1 Their research shows that one adjustment in the spine causes the brain to handle all white noise in the brain differently.

White noise is a constant background noise or processes in the brain. With over three trillion bits of information reaching the brain every second and the conscious mind only handling about 50 bits per second, that leaves a lot of stuff going on in the background; things like breathing, cellular metabolism, blood circulation and immune system function. The subluxation of the atlas affects every function in an animal’s body.

digital illustration of black dachshund dog side profile with tan markings on snout and paws

The four key functions of the vagus nerve are: 1) sensory, 2) taste, 3) motor function for the muscles in the neck responsible for swallowing and speech, and 4) parasympathetic functions that control the digestive tract, respiration and heart rate.

The Vagus Nerve
The vagus nerve exits the skull at the base near the foramen magnum and travels down into the abdomen. The four key functions of the vagus nerve are: 1) sensory, 2) taste, 3) motor function for the muscles in the neck responsible for swallowing and speech, and 4) parasympathetic functions that control the digestive tract, respiration and heart rate. Its functions can be broken down even further into seven categories. One of these is balancing the nervous system.

The nervous system can be divided into two areas: sympathetic and parasympathetic. The sympathetic side increases alertness, energy, blood pressure, heart rate and breathing rate. The parasympathetic side (where the vagus nerve is heavily involved) decreases alertness, blood pressure and heart rate. It helps with calmness, relaxation and digestion. As a result, the vagus nerve also helps with defecation, urination and sexual arousal.

The vagus nerve communicates with the diaphragm. With deep breaths, an animal feels more relaxed. The vagus nerve sends an anti-inflammatory signal to other parts of the body. If the vagus nerve is overactive it can lead to the heart being unable to pump enough blood around the body. In some cases, excessive vagus nerve activity can cause loss of consciousness and organ damage. Proper vagal tone is important in lowering the heart rate and blood pressure.

The vagus nerve also sends information from the gut to the brain. This information is linked to dealing with stress, anxiety and fear. Heart rate variability (the evenness of the heart rate) has been shown to decrease with chiropractic adjustments. Lower heart rate variability indicates a more relaxed individual or animal.

Most animals are being brought to the clinic because they are having difficulty with some organ controlled by the vagus nerve. Therefore, it’s important to check the movement at the base of the skull to see if a chiropractic adjustment would benefit them.

Following the Above-Down, Inside-Out concept, chiropractic care may be just what is needed for patients in your veterinary practice.

References:
  1. Haavik, H. (2016). The Reality Check: The Quest To Understand Chiropractic From The Inside Out. Haavik Publishing.
Dr. O headshot
Through animal chiropractic, Dr. O has found a sense of belonging, as well as an opportunity to help animal patients resolve their ailments.  He continues to find innovative ways to help animal chiropractors grow their practice.  He is the author of the book “Yes! It is Really A Thing” and currently teaches at Animal Chiropractic Education Source.  Visit him at www.animalchiropracticeducation.com
LIFESTYLE
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Managing YOUR Pain Through Healthy Habits typography
By Renee Machel
B

eing a veterinary professional is a labor-intensive job. You’re on your feet for long hours and often in odd positions drawing blood, performing surgery or restraining an animal. When it comes to your body, aches and pains tend to come with the profession—but it doesn’t have to be so bad. Here I will share with you some of the things I’ve found to be helpful in reducing inflammation and managing chronic pain.

Yoga Poses

Simple yoga poses can be done throughout the day instead of adding it on to your already full schedule. These poses help you notice and correct things that might later manifest into stronger pains or require medical interventions. They will also help you feel refreshed after hours on your feet with the weight of gravity pulling you down. Here are two simple poses to try:

  1. Mountain Pose: Stand with your feet hip distance apart. Lift and spread your toes, then lower them back down and connect with the ground.
  2. Forward Fold: Stretch your arms forward away from your shoulders and hinge at your hips to bow forward with your torso.
Diet Choices
Did you know that “blue zones” are areas where people live to be centenarians, reaching 100 years old? Scientists have studied blue zones for years and found that part of their secret is getting higher amounts of key nutrients, which can be found in some foods that have been labeled as “super foods” or “anti-inflammatory foods.”

The following are three of the top anti-inflammatory foods and some simple ways to incorporate them into your diet.

We are creatures of habit, and we balk at change, so connecting new habits with existing ones helps your brain tie the neural tracks together.
turmeric powder
Turmeric
Making your own taco or sloppy joe seasoning and adding turmeric helps you gradually increase your intake of the spice. Cooking with homemade seasonings—as opposed to buying the prepackaged pouches—also cuts out the “added-flavor,” which often includes yeast that can inflame the body, and high sodium or sugar contents, which again work against you.

Turmeric also comes in health “shots” found at the supermarket. Paired with other herbs and spices, these can boost your immune system. Turmeric and immune-boosting supplement combinations are also available in a capsule form, which can be easier for busy professionals—and you don’t taste the strong flavors. You can also travel with these, which is a game changer for recovering.

tea cup filled on a saucer and flower
Tea
Try a wide variety of teas—warm and cold, prepared for you, bottled or prepare them yourself so you can modify the ingredients to your liking. Try using stevia or another healthier alternative instead of sugar if you desire a little sweetness to your tea.

If you are new to the land of tea, steer away from floral flavors, sticking with fruitier flavors. For existing tea drinkers who are ready to up your game, aim for green tea or matcha tea for the best health benefits.

bowl of strawberries
Berries
Getting berries when they are in season enhances the flavor, especially if they are locally sourced. If berries are not your favorite, try incorporating them with oatmeal or yogurt to offset the tartness. Adding them to smoothies, either fresh or frozen, is also a great way to include them in your diet.
Creating Habits
As busy professionals, it’s best to automate what you can so you don’t have to add to your mental load. This is crucial when creating new and effective systems that work seamlessly with your life as it is. We are creatures of habit, and we balk at change, so connecting new habits with existing ones helps your brain tie the neural tracks together.

For example, if you make coffee in the morning, put the blender right beside it. If you prep your coffee the night before, do the same with your supplements or smoothie supplies. Or, when you reach for the door handle to examine a patient, do a mental check and readjust your body into mountain pose.

Before you know it, these small changes will become second nature. And if you stray from a previous health commitment, gently remind yourself to move toward that direction once again. For the most part, you can’t see or feel the benefits of incorporating these new practices straight away, but your cells will thank you as they recover from daily stress.

Renee Machel headshot
Renee Machel is a nationally recognized wellbeing speaker, certified life coach, CYT 200 yoga instructor, mindfulness, and meditation guide. As the co-founder of Get MotiVETed she aims to provide a positive impact on people’s wellbeing and enhance the culture within organizations of vetmed. She has spent nearly 20 years in the veterinary industry as a hospital leader and technician. She shares her personal story of overcoming wellbeing struggles along with key teachings in managing both personal and professional development.
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