Letter from the President – April 2020

Aleisha Swartz, DVM
HVMA President

I hope this finds you, your ohana, staff and colleagues in good health. I don’t think any of us would have predicted the rapid changes that have occurred across the planet since the January newsletter. Normal as we knew it and our regular daily operations feel like a bit of a distant memory right now. But thankfully in every dark cloud there are many silver linings.

Veterinarians, like other public health stewards, are trained problem solvers and we have been working hard to solve our problems, from those at home to in our businesses and in our communities. I have been amazed seeing the innovation and effort by Hawaii veterinarians as they work to protect their teams, ensure care for animals in need and service to the people of Hawaii and beyond.

The HVMA has been working hard on behalf of members and the animals and citizens of Hawaii during the pandemic. We have proactively and successfully advocated for more flexible use of telemedicine during this challenging time to maintain care for animals while keeping people safe. We have set up a Facebook group for Hawaii veterinarians to keep in touch and share with one another and have hosted weekly virtual meetings where we discuss the current knowledge about SARS CoV-2, its impact on animals and practices. We responded to a request for assistance from HI-EMA and City and County of Honolulu to support pet owners during this emergency. During this time, we have spent many hours each week participating in HI-EMA and Honolulu Department of Emergency Management calls to ensure animal needs are met. The HVMA was able to secure a grant from Greater Good of 22 pallets of dog and cat food and 4 pallets of litter to be used for COVID-related emergency sheltering or for pet owners in need due to financial hardship so many are currently facing. The shipping to Hawaii was graciously donated by a local business and The Salvation Army was instrumental in coordinating the food delivery from California. It has been delivered to animal shelters and human food service distribution partners on Kauai, Oahu, Maui and Hawaii Island. We will continue to seek support for pet owners in financial distress so that they can continue to care for their family members during this challenging time. We know the importance of the human-animal bond is perhaps more important than ever during this time of social distancing.

I encourage you to reach out to us if there is anything, we can do to support your work and businesses. More than at any other time it is essential that we are caring for ourselves and doing what we can to stay healthy. Get lots of sleep, eat good food, enjoy the beautiful outdoors when you can and make time for self-care. We cannot care for others if we do not first care for ourselves. If you have been contemplating taking up meditation for a long time now and need a reason this is a good one. Just sitting quietly and breathing for a brief time can work wonders to help manage the stressful times a little bit better. Take care of your families and colleagues as well. Be kind to one another and give thanks to all of those working so hard to keep us safe. I feel so fortunate to be in a state that has done so much to protect its citizens. I also feel so fortunate to be surrounded by peers in a profession that is critical to preventing and solving this and the next zoonotic outbreak. The importance and need for veterinarians is greater now than ever.

On behalf of the board I wish you health and well-being in the rest of 2020 and beyond. I hope to hear more from you on what we can do to support you as a Hawaii veterinarian.

Aloha,
Aleisha Swartz

New Board Members Wanted!

2020 is an election year and we are looking for anyone interested in bringing new ideas and energy to our organization. The positions open for nominations include Pres-Elect, VP, Secretary, Treasurer, Executive VP, Oahu Reps and Kauai Rep. Please don’t be shy and contact the nominating committee for more info!

SARS-CoV-2 Animal Testing

Routine testing of animals for COVID-19 is NOT recommended by the American Veterinary Medical Association (AVMA), American Association of Veterinary Laboratory Diagnosticians (AAVLD), National Association of State Public Health Veterinarians (NASPHV), or the National Assembly of State Animal Health Officials. Nor is it recommended by key federal agencies, including the CDC and USDA.

Current expert understanding is that SARS-CoV-2 is primarily transmitted person-to-person. There is currently no evidence that animals can transmit this virus to people. In rare instances, people have spread the virus to certain animals.

Veterinarians are strongly encouraged to rule out more common causes for clinical signs in animals before considering testing for SARS-CoV-2. The CDC, USDA, and other federal partners have created guidance, including a table of epidemiological risk factors and clinical features for SARS-CoV-2 in animals to help guide decisions regarding animal testing.

The decision to test an animal should be made collaboratively between the attending veterinarian and local, state, and/or federal public health and animal health officials after careful consideration of this guidance as provided.

AVMA-AAVLD-NASPHV-NASAHO Joint Statement on Animal Testing

Hawaii State Dept of Ag Guidelines on Animal Testing


Labs with SARS-CoV-2 PCR Animal Tests

In Remembrance – Joseph Herzog

Joseph Herzog, DVM

Dr. Joseph Herzog (Wisconsin ’97), 58, Kailua, Hawaii, died April 13 , 2020 of metastatic prostate cancer. Twelve years ago, Dr. Herzog moved to Oahu when his wife became a professor in Humanities and English UH West Oahu. He first worked at VCA Family and Oahu Veterinary Specialty Center, and then moved closer to home in Kailua at Makai Animal Hospital and part-time at Surf Paws Animal Hospital in Hawaii Kai.

Dr. Herzog was deeply involved in establishing, building, teaching in, and gaining AVMA accreditation for the first and only Veterinary Technician training program and associates degree in the state. In March 2020, the program dedicated the surgery suite in his honor.

He was active in the local veterinary community and volunteered at the Hawaii Humane Society. He served on the Board of the Hawaii Veterinary Medical Association as an Oahu Representative from 2018-2020, and Conference Committee member since 2017.

Dr. Joe always said he would see anything a client could bring through the door, and he treated beloved chickens, parrots, tortoises, and the occasional pot-bellied pig and pygmy goat in clinic. However, throughout his career he also treated bigger exotics. He served as the on-call veterinarian at the Santa Barbara Zoo and San Francisco Zoo, and he was the veterinarian of record for the Sea Life Park/Mauna Lani honu breeding and release program. He always enjoyed the challenge of a new animal and facing a new disease or injury.

Dr. Herzog is survived by his wife, Brenda Machosky, mother Rose Marie Farthing, father Ernest Herzog (Terry), brother Thomas Herzog (Jeff Kaufmann), and extended family in Illinois, New York and Virginia. He was predeceased by his beloved grandmother, Stella King, and step-father Howard Farthing. He is also survived by beloved dogs Bella, Potiki, and Fenway, and cats Huika and KoaKat.

Services will be announced at a later date. There is a memorial Facebook page that all are welcome to join: https://www.facebook.com/groups/1049974025388957/

Donations: Payable to UH Foundation with memo: Dr. Herzog Vet Tech Endowment, Account #206-2860-3, mailed to Donna Gutierrez, UH Foundation, 1314 S. King Street, Suite B, Honolulu, HI 96814, or online at: www.uhfoundation.org/HonoringDrHerzog

Submitted by Brenda Machosky

Becoming Antifragile

Author: Holly Sawyer, DVM, Human-Animal Bond Certified, works for GuardianVets, the only after-hours teletriage/telemedicine service to be endorsed by AAHA. The mission of GuardianVets is to keep the veterinary hospital in the center of the Human-Animal Bond while supporting the work-life balance of today’s veterinary professional.

If COVID-19 has taught us anything, it is that life can be wildly unpredictable. Veterinarians tend to be tidy, structured thinkers. That’s not to say we are all compulsive neat freaks. But our chosen profession demands that we master the art of pattern recognition. “Know your normal” becomes the mantra of every lecture and clinical rotation, and the aspiration of every new grad. So we gain expertise in “normal” and work hard to maintain it—in our patients and in our lives.

Duck and Pivot
The pandemic slammed us with a reality that was anything but “normal.” Overnight, we had to launch curbside care, rely on phone consultations and telemedicine, enact social distancing, and otherwise upend our historically stable profession. Let’s face it, a time-traveler from 1950 who walked into your clinic pre-COVID would have ogled at your pretty toys, but not the structure of the appointment, physical exam, or general administration of treatment. In a world of industry disrupters like Airbnb and Uber, consumer desire for choice and convenience is clearly king. In this moment of inertia within our profession, in which we are no longer the object at rest, but the object in motion, let us stay in motion. Just as the fighter in the boxing ring will fare better with quick feet and nimble reactions, we too can capitalize on the left hook that threw us off balance and now pivot into an upper cut that transfers all of that energy against the status quo.

Change Your Perspective, Change the World
What am I talking about here? You could call it a fundamental change in thinking, a mental model that embraces stressors and unpredictability as a catalyst toward improvement instead of detriment. I am talking about becoming Antifragile. This term, coined by risk analyst Nassim Taleb[1], has been applied to systems as varied as bacterial resistance and human psychology. To understand it, we must first look at the other end of the spectrum.

Fragile systems are brittle. They have very little margin for error because they maximize efficiency of time and resources to achieve optimal outcomes. Our modern, globalized society has steadily pushed us toward this ideal. We benefit from cheap food, medical advances, and technological gadgets that rely on tight tolerances of sourcing, shipping, supply, and demand. Enter COVID, and suddenly dairy farmers are dumping milk at huge economic loss because restaurants and schools are closed, while pig farmers face euthanizing pigs before they can be sold due to meat packing plant shutdowns. In our imperfect world, even small stressors can break a system, like a porcelain plate that shatters when dropped.

Resilient (or Robust) systems have built-in redundancies to survive stress. They are the plastic food containers that bounce on the floor. The system survives in its original form despite unpredictable events, but even resilient systems will reach a failure point. NASA’s Space Shuttle Program has learned that the hard way. Twice. Antifragile systems get better with stress and volatility. They are the Hydra of Greek mythology. Lop off one head, two grow in its place. Expose a population of staphylococcus to methicillin, and soon you will have a thriving infection of superbugs. Bad for us, great for them. Likewise, the saying, “What doesn’t kill you makes you stronger,” describes the mechanism by which we ourselves become antifragile. When we succeed in the face of overwhelming odds, we tend to achieve greater feats the next time around. The opposite viewpoint “Avoid all risk at all cost”—in turn makes for a very brittle population that fears unpredictability because it doesn’t know what it can overcome. [2]

Choose Your Own Adventure
Veterinary Medicine is at a pivot point in the boxing ring right now. Instead of resisting change, let us grow through it to become better than we were before. It will take energy, patience, creativity, and a willingness to fail small in order to succeed big. Happily, our clients are particularly forgiving of experimentation right now, especially when it is for their benefit. We can establish a new and better normal if we provide our clients the care they want, how they want, when they want it, while reclaiming some work-life balance for ourselves. Offer a digital patient portal, an easy pipeline for communication to bond the client to your clinic, so you remain at the forefront of healthcare decisions before entrepreneurs with far less training fill that space. Schedule differently, cross-train staff to new tasks, and leverage your RVTs and CVTs to legally fill needs previously provided by DVMs. Treat life as an adventure instead of a race to perfection, and don’t panic when you don’t recognize the pattern ahead. That which you fear may become a game-changing opportunity.

[1] Taleb, Nassim Nicholas. Antifragile: Things That Gain from Disorder. New York: Random House, 2012.
[2] Lukianoff, Greg, and Jonathan Haidt. The Coddling of the American Mind: How Good Intentions and Bad Ideas Are Setting Up a Generation for Failure. New York: Penguin, 2018.

Panleukopenia Cases on Oahu

In recent weeks, several veterinary practices on O’ahu have reported seeing a number of feline panleukopenia cases. Below is a link to a summary on Feline Panleukopenia provided on the AVMA website for review. Veterinarians who have had patients suspected of dying from panleukopenia can contact Dr. Aleisha Swartz for information on further confirmatory testing including necropsy and PCR at president@hawaiivetmed.org.

AVMA article on feline panleukopenia.

Article on sanitation procedures.

Legislative Update – Jan 2020

HVMA has introduced HB 2528 and SB 2985 in the 2020 legislative session. These bills modify Hawaii’s veterinary practice act to 1) provide immunity in the absence of gross negligence to veterinarians who provide emergency care to an animal, and 2) clarify that the duty of a veterinarian includes reporting to law enforcement any cases of animal injury or death where there is reasonable cause to believe that it relates to dog fighting or animal abuse, while granting veterinarians immunity from any civil liability for such reporting. These additions to our veterinary practice act would put Hawaii in line with much of the rest of the United States. A big mahalo to Representative Hashem and Senator Baker for sponsoring the introduction of these bills to the legislature. Please thank them, particularly if you are from their districts!

1/28 Update: First round of SUPPORT testimony needed on this measure by Thursday 1/30! Submit online testimony here. Contact us if you have questions or comments on this measure, or if you are able to go down to the capitol and testify in person.

Veterinarian Compliance with DEA and SUPPORT Act

Recently, DEA announced the launch of the Suspicious Orders Report System (SORS) Online, a new centralized database [https://deadiversion.usdoj.gov/sors/index.html], where DEA registrants, including veterinarians, must report suspicious orders of controlled substances. Reporting by practitioner registrants and creation of the database by DEA was required when Congress passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) last year. The DEA indicates that reporting a suspicious order to SORS Online constitutes compliance with the reporting requirement.

  • The reporting requirement applies to all DEA registrants, including veterinarians.  This is why veterinarians who are DEA registrants have been receiving communication from the DEA on the SUPPORT Act.
  • The circumstances under which it will impact veterinarians should be extremely limited, but the Act does apply to them.
  • All DEA registrants, including veterinarians, are required to design and operate a system to identify suspicious orders for the registrant and to report suspicious orders to the DEA.  The DEA advised that the plan should be in writing and could be requested during an inspection. 
    • Suspicious orders are defined as including requests for controlled substances of unusual size, deviating substantially from a normal pattern and orders of unusual frequency.
    • The DEA also said the definition is not inclusive and a veterinarian should report anytime there is something that makes the veterinarian suspicious. 
    • The AVMA is looking to develop a brief model plan that can be utilized.
  • The reporting requirement applies anytime a registrant, including a veterinarian, is requested to distribute/provide a controlled substance to another registrant under circumstances identified by the registrant as suspicious.  The example provided by DEA was where a veterinarian at one clinic asks to obtain a controlled substance from another veterinarian at a different clinic, such as seeking to obtain ketamine from a nearby clinic due to low inventory.  A veterinarian who receives a request to provide a controlled substance to another practitioner must be aware of the requirement to report the ‘order’ if the circumstances raise any suspicion to believe that the controlled substance will go for an illegal or diversionary purpose.
  • The reporting requirement and SORS Online database are solely for reporting transfers of a controlled substance from one DEA registrant to another DEA registrant that seem suspicious. Veterinarians are not to report to the SORS Online reporting system anything related to the administration, prescribing or dispensing of controlled substances that occur in the ordinary course of veterinary practice.  The SORS Online database is also not to be used for reporting suspicious or drug-seeking behavior of clients. 
  • If a veterinarian believes a request from another practitioner is suspicious, the veterinarian should not supply the controlled substance.  The veterinarian should register for the program on the DEA website and report the order to the electronic database (SORS Online).  A veterinarian only needs to register for the database at the time of the need to file a report of a suspicious order.
  • The DEA will be promulgating rules that will be published in the Federal Register. AVMA will review the rules and respond as appropriate.

Download the AVMA guidance and draft “system” for veterinarians here.

In Remembrance – Patrick Leadbeater

Patrick Leadbeater, DVM

The Hawaiian veterinary community has lost a familiar face and long time veterinarian in November 2019.

Dr. Patrick Leadbeater was born in 1943 in Sussex, England.  He was active in the Boy Scouts and loved the outdoors throughout his life. He graduated from the University of Guelph, Ontario Veterinary College of Veterinary College in 1974.  His first position was working with Dr. Robert Knowles in Miami, Florida. Dr. Knowles was instrumental in shaping Dr. Leadbeater’s practice.

He moved to Honolulu and worked at the the Animal Emergency Clinic which was located near the current Yanagi Sushi on Kapiolani Blvd.  He also worked as a staff veterinarian at the Honolulu Zoo.  In 1983, he opened the Veterinary Center of the Pacific on Koapaka Street near the Honolulu International Airport and continued working part-time at the Zoo.  In 1991, he purchased the Kahala Pet Hospital from Dr. Wayne Steckelberg and continued his veterinary career until late 2019.

Dr. Leadbeater was instrumental in advancing veterinary medical care in Hawaii.   He took on medical and surgical cases that other veterinarians referred to him.  This included  kidney transplants in cats, pacemaker implantation, TPLO, Total Hip Replacement surgery, and portal caval shunt implants, etc.

Submitted by Richard Fujie, DVM