Over the past couple of years I’ve had the real honor of working with colleagues and industry experts to produce and host a number of educational offerings on end-of-life topics. It’s been a very enlightening experience. I also have a heartfelt appreciation for the industry partners who’ve supported these endeavors - businesses focused in improving our caretaking as well as the end of life experience we provide for clients, our patients, and those of us doing the work. While working on these projects I often took pause to reflect back on personal experiences from my days working in both the general and specialty veterinary care practice settings. I found myself saying “if only I’d known then what I know now.” It wasn't self-criticism, as I practiced as I was taught and observed. Typical of joining any organization or being hired into a new workplace, we all tend (and are expected) to adapt to the culture of that place. Our onboarding usually includes learning about the organization's mission or mentality including “this is how we do things.”Working in the trenches – day in and day out – it’s often difficult to think outside of the box. I’ve seen that play out throughout my career working in private practice. People establish their habits and comfortable ways of doing things just to get through their busy days. Carving out the time or space to consider how or why we might do things differently – especially if we don’t perceive a need for change or improvement - is not top of mind. After all ... “if it ain’t broke, why would I fix it?”  Especially if that change might impact your routine and/or cost you a few extra bucks.  Right?!   When I first met Dr. Kathleen Cooney - CAETA's Founder and Director of Education - I was truly overwhelmed by her passion for advancing end-of-life care for our veterinary patients. I recorded a 3-part series with her on Euthanasia and the Human-Animal Bond, and during our time together found myself getting choked up on a few occasions - recalling less than pleasant euthanasia experiences from my days in practice, as well as personally - with one of my own pets.  From the onset I knew and believed in the importance of bringing this information to our audience, however the emotional tugs really cemented how vital it was to support colleagues, pet parents, and our patients during one of the most delicate of times - a beloved animal's end of life.  The more I delved into this project, the more I was surprised by the memories that surfaced.  Fast forward to this past month or so, and Alexandra Yaksich, AHT penned a 3 part series about the AVMA's new companion animal aftercare position statement. As I read her posts, again, memories surfaced of poor end-of-life experiences I had during my practice career. Aside from the heart-wrenching, sudden death of one of my dogs (and my perception of a poor experience provided by the hospital where she died), I thought back to what "aftercare" looked like when I was in practice (1989-2007). My active years in practice included working in the general practice setting, the university setting during my residency, and then private specialty practice. Without fail, but for the exception and rare instance in which an owner left the practice with their deceased pet, the disposition of dead animals invariably involved placing them in a black trash bag. I recall some practices that I worked at in which animals were not bagged, but were just tagged and placed in the freezer - in advance of an aftercare provider (e.g. crematory) coming to retrieve them. I recall that both of these methods never, ever looked or felt right to me. I never questioned it, though. I had seen this practice everywhere I had ever worked. I guess you could say that it was "standard." One of our Human-Animal Bond program sponsors - Euthabag - was unknown to me until recently. Dr. Cooney had introduced me to Dr. Celine Leheurteux - a veterinarian who created this product in an attempt to ante up in how we care for the bodies of our deceased patients. When I first heard about her product, one of the immediate thoughts that came to mind was "yeah, that's going to be a tough sell." Afterall, who's going to shell out more money - especially after a pet is dead? I then recalled an in-home euthanasia experience that I had over 20 years ago.  The first pet I owned on my own - as an adult - was a Doberman pinscher. She had many health issues throughout her lifetime and was also a wobbler. I came home on a late Saturday afternoon after work - the year was 1998 - to find her splayed out on the floor, in pain, and unable to rise. I knew that it was time to euthanize her. It was going to be very difficult for me to get her to the veterinary hospital, so I called on a couple of work colleague friends to see if they could help. They came to my place to perform an in-home euthanasia. They were so gracious, so kind. Without any discussion, they indicated they would take her body back to the hospital and place it in holding while I arranged plans for her aftercare. I recall that they gently wrapped her body in the comforter that had become hers, and then before exiting my apartment - to prevent "leakage" of bodily fluids - they placed a black garbage bag over her back half / hind end. It was as dignified and respectful as could be. I watched them exit my place and walk toward the elevator and can still recall that last visual of the black garbage bag. It was so sad and so surreal. And here, over 20 years later, I still vividly recall that visual and experience. As I got to know Celine and learn more about Euthabag, I became more curious about the product and asked if they would send me a sample. I received the sample and looked it over - it's simple, aesthetically clean, stores easily, and seems sturdy. I took out a stuffed toy to simulate what it would be like to place an animal into this body bag and zipper it closed. I set it aside on a table and just left it there. I took notice of it several times over the next couple of weeks. The more I looked at it and handled it, the more I realized the impact that this simple body bag would have in the end-of-life experience we provide. The aesthetic of the body bag alone, and doing away with the garbage bag, is a huge cultural shift. It shifts our mindset to one of truly providing a dignified death experience. And this impacts not only our client's experience but also that of the veterinary team. It truly honors the human-animal bond. And yet, it's just one cog in the wheel. The end-of-life experience begins before an animal's death, and the impacts of that experience can be felt for months and even years after the fact. Our pet loss support service is a testament to that - grief knows no timeline. One last thought about this body bag ... one day I had set a glass of red wine on the table next to the sample I had received. I accidentally knocked the glass over - red wine everywhere including all over the light grey body bag. I scrambled to do clean up and figured I would now have a sample with red wine stains. Not!  I cleaned up the mess and took the bag over to the sink to rinse it off. No red wine stains anywhere. Nice to know. ;)   

I'm thrilled to share this podcast with VetVine Members. Me and my colleague - Dr. Lori Kogan from Colorado State University - were interviewed by Allison White - a Licensed Clinical Social Worker - for her Animal Academy Podcast. We had an opportunity to chat about VetVine, the Human-Animal connection, and pet loss. It was a wonderful 36 minute conversation! I hope you enjoy.  If you can't play it here, you can also visit Allison White's podcast page.     This post was edited by Sheri Berger at October 22, 2020 6:30 PM EDT

A new puppy or kitten visit provides veterinary caregivers an opportunity of a lifetime. Literally. That first appointment is an opportunity to establish a partnership with the client to provide care through the lifetime of their new animal companion. When you think about it, that's a huge responsibility and it includes educating a client about the essentials to disease prevention (e.g. wellness exams and preventative care measures) as well as financial tools that can help pet owners manage the costs of that care over the lifetime of that pet. If we blow the opportunity and fail to establish a meaningful connection with that client, we stand to lose out on an income-producing opportunity (for years to come) and perhaps even worse, a client without someone partnered to ensure the best possible care for their animal. New puppy or kitten “packages” or wellness plans that bundle essentials such as vaccinations, endo- and ecto- parasite prevention or management, and preventative dental care help us to guide and support our clients in caring for their pets in healthy, happy times. At the end of life, however, we know that many veterinary practices miss the mark in guiding and ensuring a continuum of care for pets and their owners.  As an animal approaches the end of its life – whether naturally due to age or associated with a chronic or terminal illness – there are many opportunities for veterinary professionals to provide guidance, support, and to prepare clients for a good end-of-life experience (both for the client and the animal patient). A bad end-of-life or euthanasia experience can lead to client attrition. One statistic I’ve heard is that around 20% of clients will not return to a veterinarian with another pet after having a euthanasia experience that’s left them feeling angry or upset. I recently read the Pet Loss Best Practice Guidelines for Veterinary Teams (June 2020) published by Seneca College's Social Service Worker and Veterinary Technician Programs in collaboration with VCA Canada and funded by Seneca Innovation. They studied the client experience with veterinary teams during their pet's end of life. The project involved client surveys, a literature review on the pet loss experience in the context of veterinary practice responses, and interviews with industry experts. The purpose of this project was to establish Best Practice Guidelines to strengthen the industry's capacity to respond to clients' needs. "The strongest memories for a client are typically their first and last day with their pet.” This sentence – included in the Guidelines document - resonated with me personally and I took pause to contemplate that further.  While most veterinary professionals are not party to that “first” day, we are party to most “last” days of that relationship. As such, we are privileged to be entrusted by pet families to care for their animal companions during this time and we have a tremendous responsibility to provide for the best death experience possible. So how can veterinary practices ensure a continuum of care at the end of life? We do a pretty good job in early life with wellness plans and promotion of preventive care measures. How can veterinary practices raise the bar on the back end and do death well? I’ve been delighted to work with people involved in end of life care, training in euthanasia best practices, and in pet loss and grief support. I am especially proud of the work that VetVine is doing to support veterinary colleagues who are committed to learning more in these areas and in elevating the end of life experience that they provide in their practices: The Human-Animal Bond Program – approved for up to 8 hours of CE credit by AAVSB RACE and NY state can be viewed at no charge and compliments of our Sponsors including ASPCA Pet Health Insurance, BioResponse Solutions, Euthabag, and CAETA. VetVine’s Virtual Pet Loss and Grief Support Service is a resource for clients experiencing anticipatory grief or grieving the loss of their animal companion.  We are proudly partnering with veterinary and pet care professionals to serve as an extension of their practice or business to provide this important support and to ensure a continuum of care. Contact Us to learn more about how your practice or business can partner with VetVine in this regard.

Here are some COVID-19 resources that may be helpful to colleagues ... there is an abundance of information out there! On the topic of "change" - provided by Gina Fortunato: HRDQ:  Mastering the Change Curve William Bridges:  Transition Model   On finding the positive and empowering teams - provided by Dr. Wendy Hauser: Scott Berinato - Harvard Business Law. That Discomfort You're Feeling is Grief Creating Sustainable Success: Scenario Planning for Coronavirus & Future Disruptions Webinar hosted by Anders Sorman-Nilsson AVMA COVID 19 site (updated daily) For ideas about how to structure merit based bonuses (Today's Veterinary Business) COVID 19 in Veterinary and Animal Group Health Settings: Protecting People and Animals Empowering and protecting your family through the COVID-19 Pandemic    

In her presentation on the topic of Maintaining & Enhancing the Human-Animal Bond Through Telemedicine Dr. Charlotte Lacroix, DVM, JD discussed how telemedicine can serve to connect veterinary professionals with pet owners, and best practices for implementing telemedicine in the context of current legal concerns and standards.We contacted Dr. Lacroix to comment further in light of the current environment and the coronavirus crisis, as veterinary practices are needing to try and maintain relationships and provide continuity of care and services to clients. Here is what she had to say:"Check and lobby your states to allow the adoption of the American Association of Veterinary State Board’s interpretation of “sufficient knowledge” so veterinarians can - on a case by case basis - determine whether they can provide medical advice without a physical examination. considering softening the physical examination requirement of the required VCPR. Below is from Pennsylvania which suggests out of state health care professionals could provide telemedicine to Pennsylvania residents. The implications still need to be clarified. Also the FDA has relaxed certain of its guidelines" ... >>>  FDA pushes telework visits for veterinarians to encourage social distancing In an effort to encourage social distancing between veterinarians and owners of sick animals, the Food and Drug Administration announced Tuesday that it would waive portions of the federal veterinarian-client-patient relationship (VCPR) that requires in-person visits. Typically, the federal VCPR definition requires that veterinarians physically examine animal patients or visit the locations where the animals are kept. The FDA said that under the relaxed guidelines, the owner of a sick dog could share a video with a veterinarian and the veterinarian could prescribe a drug not approved for use in pets (when other drugs are not readily available). Or the a vet could remotely examine and diagnose a group of farm animals, and then authorize the use of certain drugs in the animals’ feed. “We need to provide veterinarians with the latitude to expand the use of telemedicine in the care of animals, not only pets but also the animals that produce our food,” FDA Commissioner Stephen Hahn said in a statement. “The FDA is providing flexibility that will help veterinarians maintain the health of animals during the pandemic, while allowing for the social distancing that is so important in limiting the further spread of coronavirus disease across the country and the world.” The agency cautioned that veterinarians still need to consider their state and local VCPR requirements. <<<   CONTACT your state board to get the answer for your state.