8 things you probably didn't know about veterinary anesthesiology
Anesthesia Month is in full swing, and we look forward to continuing to bring you fresh content all month long! So far we’ve given a run-down of the various anesthesia services that are operated out of our facility in Waukesha, Wisconsin, and we’ve also offered an in-depth look at the team behind our complimentary Anesthesia Hotline. Today we move from the Midwest to the Deep South, and share a conversation we had with Jacob A. Johnson, DVM, DACVAA. Dr. Johnson is an associate professor of anesthesia and pain management at Alabama’s Auburn University, the oldest veterinary college in the Southeast. Additionally, he has logged 21 years of active and reserve service with the Army Veterinary Corps, where one of his roles is serving as a clinical consultant for anesthesia and pain management.
As you can imagine, through his experience with the United States military, his in-clinic work and his in-classroom work, Dr. Johnson has a robust and unique perspective on the specialty of veterinary anesthesiology. From common myths and misconceptions, to emerging technology trends and the various types of exotic species one can expect to encounter, chatting with Dr. Johnson helped us unearth the following 8 things about veterinary anesthesiology you probably didn’t know!
1. Military veterinary medicine is a thing
You don’t need to choose between serving your country and serving animals, because you can do both: military veterinary medicine is, in fact, a thing! While there are many military veterinarians, Dr. Johnson is currently the only board-certified veterinary anesthesiologist in the United States military. Curious about some typical duties of a veterinarian in the armed forces? According to Dr. Johnson, Army veterinary services include providing care to both privately owned animals and military animals. Other duties while deployed are food protection as well as research and development, with a specific focus on zoonotic diseases – diseases that are transmitted from animals to humans.
If at any time you should wish to make a career pivot toward private practice or teaching as Dr. Johnson did, you can always remain in the reserves – Dr. Johnson is currently in his 18th year as a member of the Army Reserves.
2. Anesthesiology is one of the only veterinary specialties that allow you to treat all types of animals on a daily basis
The variety is part of what drew Dr. Johnson to the specialty. He states, “I wanted a specialty where I could still continue to do all species. And there’s very few of them that provide that. Most of the time you’re going to either do large animal or small animal or you’re going to do one subset of patients. But I get to work in the large animal hospital and the small animal hospital. We have exposure to everything but Homo sapiens, so we have to be prepared to anesthetize pretty much anything that walks in the door, whether it slides, flies or crawls.”
Speaking of flying, Auburn University has an exotics and special species service and his team often encounters large birds of prey. Dr. Johnson explains, “Our animal mascots are eagles, and so we do the anesthesia for the Southeastern Raptor Center. We have a lot of exposure to raptors. If there are birds that require anything beyond basic anesthesia – a surgical procedure or a diagnostic procedure – we would be asked to provide the anesthesia.”
Birds aren’t the only thing flying around the specialty of veterinary anesthesia.
3. Myths and misinformation are common when it comes to veterinary anesthesia
Dr. Johnson must regularly combat myths and misinformation with education. He encounters these myths from incoming students as well as from pet owners during the six months each year he spends in-clinic. “Probably one of the more frequent ones that you hear from practitioners is breed-specific sensitivities to anesthesia, or to particular drugs. On this breed you use this particular drug, because they read on a website that it’s either good or bad for their particular breed,” Dr. Johnson shares. “With rare exception, those typically don’t exist.”
Dr. Johnson suggests that direct communication with clients is an effective way to alleviate concerns that stem from misinformation. “If a client has a special concern about anesthesia, we like to talk with them. Because again, a lot of it has to do with the myths and misconceptions that they’ve either read on the internet or have heard. We can usually spend the time to educate them and make them feel more comfortable about the process their pet is going to go through.”
The education process shouldn’t end with the client – read on to #4!
4. Educating your entire staff can lead to increased case acceptance for procedures requiring anesthesia
Dr. Johnson is passionate about the importance of an educated lay staff. “Ideally, the receptionist should be the highest paid employee in a general practice setting because they’re the ones that are going to interface with a client when they go price shopping. And it’s not just about, ‘This procedure costs X number of dollars.’ It’s ‘Yes, this is our typical fee for this procedure. But included in that is a, b, c, d, e and f.’ That shows clients that the practice is more progressive in managing patients.”
Dr. Johnson points out that for clinics that take the extra steps of monitoring patients during the anesthesia process, placing an IV catheter for intravenous fluids, providing oxygen during the procedure, and using balanced anesthesia methods, “those efforts require extra time, money and training. So they need to make sure clients are aware of the extra steps that they do take, so that they can charge them accordingly for that. Unfortunately, anesthesia is not something that you make money on in a practice, so there have to be other aspects as far as patient care and patient welfare that you can use to build a practice.”
5. Pain management is not always treated as a critical component of anesthesiology
It may come as a bit of a shock, but it’s still very common for veterinarians to perform major surgeries without providing pain medicine to a patient. Pain management advocacy is the thread that pulled Dr. Johnson from private practice into teaching. “I was in emergency and critical care for a year and then went to a general mixed animal practice for three years. And it was during that time that I developed the interest in the specialty and it was primarily in the realm of pain management. At that time, and what I still see today, is that the pain management provided for animals was insufficient. I made some simple changes in the practice we were at, and we saw a huge benefit as far as patient welfare. And my thought was, well, if I went back to school and specialized, maybe I could teach others how to do this.”
Teaching students the value of providing pain management remains a laser focus for Dr. Johnson, but he also seizes every opportunity to educate individual pet owners. “I can remember a case where a woman brought a Great Dane in to have the stomach tacked down to prevent it from twisting. She had a printout from the Great Dane Breeders Association that had been written by a veterinary technician and reviewed by a general practitioner, but never anybody with a specialty in anesthesia. She said, ‘This is exactly what you need to use on my dog.’ And I said, ‘We’re happy to use all of those, but I want you to see that there’s no pain management involved in this plan. And I’m sure you wouldn't want to go to the hospital and have surgery done without pain medicine.’ She said, ‘Well, of course not.’ And I told her ‘Well, I would like to do the same thing for your dog and make sure that they’re comfortable.’ And then it was “Well, yes, of course, yes, we need to add that in.’ So it’s just a matter of communication.”
6. Ultrasound is the 'it' anesthesia technology
Local and regional anesthesia procedures are on the rise and with that has come an increase in the use of ultrasound technology for regional anesthesia. “It’s just been within the last five or 10 years where the clarity and definition of the ultrasound make it clear enough where we can actually see individual nerves and watch as we’re blocking or putting the medication around those nerves,” shares Dr. Johnson. “And I think you’re also seeing a point where ultrasound is becoming more standard of care and is being used in the general practice facility for basic exams. It used to be that only specialty practices had them.” Dr. Johnson also expressed his wonderment at the size and portability of modern ultrasound technology, musing, “The technology has gotten small enough where people now have ultrasounds the size of their iPhones.” (In related news, we have those!)
7. As a veterinary anesthesiologist, your client is often the surgeon
As a general practitioner, your clients are pet owners. For anesthesiologists, however, the client is often the practice owner or surgeon. Dr. Johnson explains, “My primary client is the clinician and the other services in the hospital that require us to do anesthesia. So, if it’s a patient that needs soft tissue surgery, the main person that I consider my client is that surgeon.” Of course, you’ll still talk to pet owners from time to time. “We make it very clear to the other services in the hospital that if a client has a special concern about anesthesia, we would like to talk with them.”
Regardless of the practitioner/specialist/client structure, it always comes down to the animal. “I want to make sure that I’m taking care of his patient and that he has a successful outcome at the end of surgery.”
8. Veterinary anesthesiology specialists are in extreme demand
If a specialty in veterinary anesthesiology is something you’re considering, know that this skillset is in very high demand. Dr. Johnson shared that there aren’t enough residency-trained anesthesiologists at this point to satisfy all the positions that are available.
What sort of individual would be well-suited toward this specialty? Dr. Johnson offers his take on the matter: “They tend to be people that are detail oriented and can manage. A lot of our skillset is in management. I’m responsible for the patient flow for the hospital for the day, and there are multiple services involved, so they have to enjoy that part of it.”
Those thinking about this career path must also be technically savvy, as some of the responsibilities include recognizing problems with equipment and fixing them. (Our Anesthesia Hotline can help with that!)
As for Dr. Johnson, he has no regrets about choosing to pursue this specialty. But, he also doesn’t take all the credit for the choice, stating “God put me on a really straight path and opened doors for me along the way, and I never really sensed that He was closing a door. So I knew that He had a reason for me to be in this profession and you know, it fits me well. I like working with the students and being able to teach. And I like to educate others that are already in the profession.”