Snapshots of an emergency and specialty practice
JAVMA News shadowed veterinarians and support staff at Iowa Veterinary Specialties in Des Moines, Iowa, for a day to see firsthand what it’s like to work at a busy 24-hour emergency and specialty clinic on the verge of shifting from curbside service back to letting clients in the building 15 months after the COVID-19 pandemic began (see story). (Photos by Malinda Larkin)
Using telemedicine
Soon after COVID-19 hit, Iowa Veterinary Specialties switched to curbside service, which meant no clients were allowed in the building, even for euthanasia appointments. As an alternative, the clinic turned an examination room into a dedicated telehealth room. Dr. Angie Gearhart, medical director of IVS, said she taught herself how to do appointments using Zoom. It took a few tries before finding the best angle for client viewing.
Photo credit: Photo by Malinda Larkin
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Zoonotic threats
The veterinary hospital has holding runs for patients being evaluated or hospitalized patients that are becoming stable. This dog in the quarantine area had increased liver enzymes and was a suspect for leptospirosis, thus the “use caution” sign for zoonotic potential.
Photo credit: Photo by Malinda Larkin
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Preventing drug diversion
For controlled drugs, IVS uses a Cubex medication cabinet that has a fingerprint-based system. Drugs have to be ordered by the veterinarians, and only a small compartment opens for a specific drug when they go to retrieve it. A second person must sign off to ensure it’s the right bottle and the right amount.
Photo credit: Photo by Malinda Larkin
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Around the clock
During the week, IVS will have surgeries two to three days a week and serve exotics two days a week. Meanwhile, weekends and holidays are the busiest times for the emergency practice. On this Sunday, one dog was being shaved for ultrasonography. This 13-year-old Chow mix, which had a primary bone marrow condition, was in triage for rapid breathing and weakness at home. The owner elected to euthanize.
Photo credit: Photo by Malinda Larkin
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Inventory woes
Dr. Gearhart said the clinic goes through a tremendous supply of inventory weekly. The cost of inventory has fluctuated more recently, and the clinic has altered prices accordingly. Before COVID-19, Dr. Gearhart said, the inventory manager would get a heads-up from companies so the clinic could stock up. “Now we don’t know or they don’t tell us, so it’s a tremendous amount of work for the inventory manager,” she said.
Photo credit: Photo by Malinda Larkin
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Color coding
In the emergency room, the clinic codes patients by severity of disease process. Critical is always red, so no matter how busy they are, staff members always try to get the case done on time. There is a protocol for determining what qualifies as critical, but the veterinarians can always evaluate for themselves, too.
Photo credit: Photo by Malinda Larkin
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Gastrointestinal issues
Oscar, a 9-year-old Chihuahua mix, had vomiting and diarrhea for the past 12 hours. Dr. Gearhart suggested radiography, bloodwork, and an injection to stop the nausea. Oscar’s owner, Angela Sherwood of Des Moines, declined diagnostics but agreed to the shot. Sherwood said: “I wish I could go back with him. He’s scared when he’s not with me. But I understand. The doctors are really nice. They actually care about pets. They talk to you with respect. They give options and talk to you about care before they do it.”
Photo credit: Photo by Malinda Larkin
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Sitting and waiting
Caitlin Dozark, a receptionist at IVS, said in mid-June that she was ready for the building to open back up to clients rather than having them wait in their cars for curbside service. She is hoping reopening the building to clients will clear up the phones and reduce the wait time for clients, which can be hours at a time.
Photo credit: Photo by Malinda Larkin
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When you need to go
Velma is a 1-year-old American Bulldog who had vomiting and diarrhea with a possible urinary tract infection. The dog’s owner, Helena Anderson, had planned to make an appointment with her regular veterinarian later in the week, but Velma had been peeing in the house or would squat with nothing coming out. When Anderson tried going to the local BluePearl, they told her to go to IVS or Iowa State University’s veterinary teaching hospital instead.
Photo credit: Photo by Malinda Larkin
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All stitched up
Dr. Angie Blong, a board-certified specialist in veterinary emergency and critical care, is the emergency service leader at Iowa State’s veterinary teaching hospital but also helps at IVS when she can. Dr. Blong worked at IVS in high school and up until she earned her veterinary degree 10 years ago from Iowa State. Here she is treating a dog that sustained a laceration on the back of its foot after it had been running around and swimming.
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Tackling debt
Dr. Lena Ribby (left), an emergency veterinarian at IVS, graduated from Iowa State’s veterinary college in 2019. She recently joined the practice full time.
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Face to face
The emergency room at IVS sees many cases of dogs hit by cars, foreign bodies, and dog bites like the one Chance has. Brooke Michael, who works as a veterinary technician at IVS, says just as many cases they see are non-urgent cases or illnesses the animals have had for a few days but the owner has waited until the problem escalates to bring their pet in.
Photo credit: Photo by Malinda Larkin
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Hands-on experience
Liz Bartlett (left), a fourth-year veterinary student at ISU, and Dr. Shelby Mangus, an emergency veterinarian at IVS, work to unblock a cat. Bartlett had externships canceled this summer, so she hired on doing work as a veterinary technician at IVS to get hands-on experience and earn money in the process. IVS often has fourth-year veterinary students do preceptorships here, and even more than usual, 12, came this year because many other clinics stopped taking externs.
Photo credit: Photo by Malinda Larkin
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Under the microscope
IVS has its veterinary technicians do a lot of in-house laboratory work, including complete blood counts, chemical panels, urinalysis, and cytologies.
Photo credit: Photo by Malinda Larkin
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Soon after COVID-19 hit, Iowa Veterinary Specialties switched to curbside service, which meant no clients were allowed in the building, even for euthanasia appointments. As an alternative, the clinic turned an examination room into a dedicated telehealth room. Dr. Angie Gearhart, medical director of IVS, said she taught herself how to do appointments using Zoom. It took a few tries before finding the best angle for client viewing.
Photo credit: Photo by Malinda Larkin
Slide 1 of 14
The veterinary hospital has holding runs for patients being evaluated or hospitalized patients that are becoming stable. This dog in the quarantine area had increased liver enzymes and was a suspect for leptospirosis, thus the “use caution” sign for zoonotic potential.
Photo credit: Photo by Malinda Larkin
Slide 2 of 14
For controlled drugs, IVS uses a Cubex medication cabinet that has a fingerprint-based system. Drugs have to be ordered by the veterinarians, and only a small compartment opens for a specific drug when they go to retrieve it. A second person must sign off to ensure it’s the right bottle and the right amount.
Photo credit: Photo by Malinda Larkin
Slide 3 of 14
During the week, IVS will have surgeries two to three days a week and serve exotics two days a week. Meanwhile, weekends and holidays are the busiest times for the emergency practice. On this Sunday, one dog was being shaved for ultrasonography. This 13-year-old Chow mix, which had a primary bone marrow condition, was in triage for rapid breathing and weakness at home. The owner elected to euthanize.
Photo credit: Photo by Malinda Larkin
Slide 4 of 14
Dr. Gearhart said the clinic goes through a tremendous supply of inventory weekly. The cost of inventory has fluctuated more recently, and the clinic has altered prices accordingly. Before COVID-19, Dr. Gearhart said, the inventory manager would get a heads-up from companies so the clinic could stock up. “Now we don’t know or they don’t tell us, so it’s a tremendous amount of work for the inventory manager,” she said.
Photo credit: Photo by Malinda Larkin
Slide 5 of 14
In the emergency room, the clinic codes patients by severity of disease process. Critical is always red, so no matter how busy they are, staff members always try to get the case done on time. There is a protocol for determining what qualifies as critical, but the veterinarians can always evaluate for themselves, too.
Photo credit: Photo by Malinda Larkin
Slide 6 of 14
Oscar, a 9-year-old Chihuahua mix, had vomiting and diarrhea for the past 12 hours. Dr. Gearhart suggested radiography, bloodwork, and an injection to stop the nausea. Oscar’s owner, Angela Sherwood of Des Moines, declined diagnostics but agreed to the shot. Sherwood said: “I wish I could go back with him. He’s scared when he’s not with me. But I understand. The doctors are really nice. They actually care about pets. They talk to you with respect. They give options and talk to you about care before they do it.”
Photo credit: Photo by Malinda Larkin
Slide 7 of 14
Caitlin Dozark, a receptionist at IVS, said in mid-June that she was ready for the building to open back up to clients rather than having them wait in their cars for curbside service. She is hoping reopening the building to clients will clear up the phones and reduce the wait time for clients, which can be hours at a time.
Photo credit: Photo by Malinda Larkin
Slide 8 of 14
Velma is a 1-year-old American Bulldog who had vomiting and diarrhea with a possible urinary tract infection. The dog’s owner, Helena Anderson, had planned to make an appointment with her regular veterinarian later in the week, but Velma had been peeing in the house or would squat with nothing coming out. When Anderson tried going to the local BluePearl, they told her to go to IVS or Iowa State University’s veterinary teaching hospital instead.
Photo credit: Photo by Malinda Larkin
Slide 9 of 14
Dr. Angie Blong, a board-certified specialist in veterinary emergency and critical care, is the emergency service leader at Iowa State’s veterinary teaching hospital but also helps at IVS when she can. Dr. Blong worked at IVS in high school and up until she earned her veterinary degree 10 years ago from Iowa State. Here she is treating a dog that sustained a laceration on the back of its foot after it had been running around and swimming.
Photo credit: Photo by Malinda Larkin
Slide 10 of 14
Dr. Lena Ribby (left), an emergency veterinarian at IVS, graduated from Iowa State’s veterinary college in 2019. She recently joined the practice full time.
Photo credit: Photo by Malinda Larkin
Slide 11 of 14
The emergency room at IVS sees many cases of dogs hit by cars, foreign bodies, and dog bites like the one Chance has. Brooke Michael, who works as a veterinary technician at IVS, says just as many cases they see are non-urgent cases or illnesses the animals have had for a few days but the owner has waited until the problem escalates to bring their pet in.
Photo credit: Photo by Malinda Larkin
Slide 12 of 14
Liz Bartlett (left), a fourth-year veterinary student at ISU, and Dr. Shelby Mangus, an emergency veterinarian at IVS, work to unblock a cat. Bartlett had externships canceled this summer, so she hired on doing work as a veterinary technician at IVS to get hands-on experience and earn money in the process. IVS often has fourth-year veterinary students do preceptorships here, and even more than usual, 12, came this year because many other clinics stopped taking externs.
Photo credit: Photo by Malinda Larkin
Slide 13 of 14
IVS has its veterinary technicians do a lot of in-house laboratory work, including complete blood counts, chemical panels, urinalysis, and cytologies.
Photo credit: Photo by Malinda Larkin
Slide 14 of 14