January 28, 2025 • 28 mins
Discover innovative strategies for revolutionizing veterinary care as we tackle the complex issue of urinary tract infections with Drs. Kayla Sample, Jennifer Grady, Gregory Wolfus, and Claire Fellman. Learn how affordable, in-house bacteriuria screening tests, such as the SediVue, RapidBac, and in-houes cultures, can redefine practices in veterinary clinics, especially those catering to financially constrained clients. Kayla, Jennifer, Gregory, and Claire share their cutting-edge research from the JAVMA article, providing insights into cost-effective diagnostic methods that can significantly enhance antimicrobial stewardship while improving accessibility and quality of care.
This episode dives into the practical application of in-house urine cultures, revealing a tiered diagnostic approach that not only slashes client costs but also addresses the critical issue of antibiotic resistance. With Greg offering a strategic guide for implementing these practices in clinics, and Kayla, Jennifer, and Claire emphasizing the importance of educating future veterinarians on responsible antibiotic use, listeners will leave with a clear understanding of how to improve veterinary diagnostics. Tune in to learn about the utility of in-house screening tests for bacteriuria.
JAVMA open access article: https://doi.org/10.2460/javma.24.05.0307
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Sarah Wright (00:01):
You're listening to Veterinary Vertex, a podcast
of the AVMA Journals.
In this episode, we chat abouthow affordable in-house tests
for bacteria urea can improveantimicrobial stewardship and
access to care with our guestsKayla Sample, Jennifer Grady,
Gregory Wolfus and ClaireFellman.
Thank you all for being heretoday, so we're going to start
(00:22):
with some introductions.
So, Greg, can you kick us off?
Gregory Wolfus (00:27):
Sure.
Thanks for hosting us, Sarah.
My name is Greg Wolfus and I'ma veterinary small animal
clinician.
I'm also an associate professorat the Cummings School of
Veterinary Medicine at TuftsUniversity and I'm the founding
director of Tufts Tech CommunityVeterinary Clinic, which is a
teaching clinic where we partnerfourth-year veterinary students
with high school students andtogether they provide subsidized
(00:49):
veterinary care.
Sarah Wright (00:52):
Thank you so much, Claire.
Would you like to go next?
Claire Fellman (00:56):
Sure, I'm Claire Feldman.
I'm an associate professor atthe vet school at Tufts and my
discipline is small animalinternal medicine, and I'm also
a clinical pharmacologist, thankyou.
Sarah Wright (01:07):
Awesome.
And then, Jenny, how about you?
Jennifer Grady (01:12):
Thanks, Sarah.
My name's Jenny Grady.
I graduated from Tufts in 2012,and my background is in primary
care, traditional practice andalso community medicine and
shelter practice, and I've beena professor at Tufts with Kayla
and Greg since about 2016,working at Tufts at Tech.
Sarah Wright (01:34):
And last but not least, Kayla, take it away.
Kayla Sample (01:38):
Thanks, Sarah.
I am also at Tufts at Tech andan assistant professor at Tufts
University.
I also had the.
I was able to complete myinternship and residency at
Tufts EdTech, and so mybackground is primarily in
community medicine.
Sarah Wright (01:52):
Thank you so much.
All right, so let's dive rightinto it.
So, Kayla, your JAVMA articlediscusses how affordable
in-house tests for bacteria ureacan improve antimicrobial
stewardship and access to care.
Please share with our listenersthe background on this article.
Kayla Sample (02:09):
Okay, so, just as we began talking about, the
majority of my clinical practicehas been in community medicine,
and so I see a lot of thepatients that are coming in,
similar to many generalpractices in the area, and a lot
of these animals are presentingwith lower urinary tract signs,
and lower urinary tract signscan present clinically similar
(02:32):
for UTIs, for transitional cellcarcinomas, for stones and many
other presentations, and so whatwe were doing is really looking
for a way to sort of figure outwhich of these animals needed
to have antibiotics and which ofthese animals don't, and so,
clinically, we wanted to figureout a way to differentiate which
(02:52):
animals had bacteria and whichanimals did not, and so we would
traditionally do a urinaryculture with a sensitivity.
Unfortunately, if you're workingwith a population that has
significant financial barriers,those cultures can be
cost-prohibited for thoseclients, and we have to figure
out a different way and figureout what we should do for those
(03:13):
in particular animals, and soour clinic has been performing
in-house urine cultures where weare plating urine in-house for
many years, and when we werelooking for data, we couldn't
really find any data to supportthis practice, and so what we
were trying to do with the studywas to publish some data to
support this individual practice, and really we had two clinical
questions that we were hopingto answer, and so, one, what can
(03:36):
I do on the same day for thatparticular animal if I'm worried
about bacteria contributing totheir clinical signs?
And two, how can I avoidspending all of this money for
an animal that has a negativeculture?
And so an animal that has anegative culture, which really
is about 75% of the cases thatare being submitted, that animal
(03:57):
is still paying this or thatclient is still paying the same
price for that culture andsensitivity as if an animal was
positive, and so that was reallyfrustrating for us, and so we
wanted to figure out sort ofwhat can we do in-house to
prevent that negative culturefrom coming back and prioritize
client finances towards furtherdiagnostics or further treatment
if needed?
Sarah Wright (04:18):
I think this is a super, super awesome manuscript
and I think it's just soimportant.
It has really greatimplications for both
veterinarians and clients alike,so thank you so much.
So, what are some of theimportant take-home messages
from this JAVMA article?
Kayla Sample (04:34):
So some of the biggest take-home messages from
this were really that we lookedat three in-house ways of
detecting bacteria.
The first thing we did is anIDEX SETI view, which is really
a computer-analyzed urinalysis,and that is a really nice
product produced by IDEX,because it gives us little
pictures of the individual UAand so you're able to, as a
(04:56):
clinician, also look at thepictures as well as the readout
of the urinalysis.
And in addition to that sort ofjust running the regular UA, we
also paired that with theirbacterial confirmation kit,
which is provided through IDEXwith that same machine, and in
that bacterial confirmation kitis designed to make to dissolve
the rest of the cells and giveyou a bacteria confirmed or
(05:19):
there's no bacteria present, andso that's a really nice way for
busy practices to be able toevaluate urine, because it's a
very quick readout and it's donethe same day.
The second test that we lookedat was a rapid bag, which is a
really nice rapid amino assaythat uses monoclonal antibodies
to detect gram-positive andgram-negative bacteria in urine,
(05:40):
and that one was also very nicebecause it provided the same
day results and it could be readout quickly in a busy clinical
practice.
And then the last thing we didwere we took our culture plates
that were in-house and so wecultured urine and plates in an
incubator that's here in theclinic for us and unfortunately
that result does not give us.
(06:01):
That test does not give us aresult on the same day, but the
results were available in 24 to48 hours and that is really a
very inexpensive test that takesvery little setup.
And so when we're looking atthose three specific tests, all
of those have very high negativepredictive values and actually
the negative predictive valuesfor those were all 89% or
(06:24):
greater.
And when we think about whatthat actually means because I
think we sort of like throw outthe words negative predictive
value and positive predictivevalue and all these things a lot
and I personally sort of needto think about what all of those
mean every single time and sowhat that means is if all of
these have a negative predictivevalue of greater than 89%,
really what that means is 89% orgreater, depending on which one
(06:45):
you're looking at of thepatients who test negative or
who do not have evidence ofbacteria on their results truly
do not have bacteria, and sothat's a really nice way for us
to truly rule out that bacteriais contributing to this animal's
clinical science.
Sarah Wright (07:02):
Yeah, those same-day tests too, I imagine
would be potentially a gamechanger.
Sometimes it's hard to havethat follow-up with owners who
might not be compliant, mightnot be able to like come back
into the clinic to get thoselike antibiotics if needed, etc.
So, Claire, how does thispublication contribute to
antimicrobial stewardship?
Claire Fellman (07:19):
Well, thank you for that question, and I think
when we talk about antimicrobialstewardship, it's important to
recognize that it's actually areally big field and so it
encompasses a lot of things,from infection prevention and
control all the way to drugselection and dosing.
But, as Kayla has been talkingabout, and I think with urinary
tract infections specifically, alot of what we're trying to
figure out is are these signsthat they presented for related
(07:40):
to bacterial infection?
Are antibiotics indicated?
And, as she just said, what weshowed in this paper is there's
several different tests that youcan figure out what is best for
your clinic, that you can havea lot more confidence in that
clinical decision making.
And really that's what we'retrying to do when it comes to
tests to support antimicrobialstewardship is if you can make a
prescriber feel morecomfortable, that antibiotics
(08:01):
don't need to be prescribed,that we can avoid that just in
case prescribing.
That's really the goal of thosediagnostics, and so I think
that's all really relevant andtimely and it's something a lot
of people are interested in iswhat is the best test?
What can we use?
And, as Kayla just said, any ofthese are going to make you
feel more comfortable that theretruly aren't bacteria there.
And I think the other thing,since you were talking about
(08:23):
same-day tests that it'simportant to recognize is, you
know, yes, it's nice that someof these were same-day, but, as
Kayla alluded to, one of thethings we wanted to do with this
study is look at in-houseculture, and that does require
waiting till the next day, but alot of the time that's okay.
You know, many of these patientshave had signs for more than a
day.
They're rarely life-threatening, and so in our study only about
(08:43):
25% of cultures grew, and so,if you think, you know, not all
of those patients would haveprobably gotten antibiotics,
because some were just havingcultures due to polyuria and
polydipsia and other things, butnonetheless, in the majority of
cases antibiotics are notneeded, and so if we can wait
the day to get that confirmationand have that security, really
what we're trying to do in thedirection of antimicrobial
stewardship is reduceunnecessary prescribing.
(09:05):
So there's some good optionsout there.
You can figure out what fitsfor you and just don't be afraid
of that day.
It is a little harder to get intouch with owners, but we found
in-house cultures to be reallyaccessible in our practice
setting.
Sarah Wright (09:18):
Yeah, thank you for clarifying that.
Really appreciate it.
This is going to be superimportant, I think.
Like I said, clients andveterinarians alike.
So, Jenny, how does thispublication contribute to
education and teaching?
Jennifer Grady (09:30):
Well, Kayla has her background blurred so you
can't tell, but she's currentlyzooming from the janitor closet
of a high school because that'sthe only space in our busy high
school, because that's the onlyspace in our busy small teaching
clinic, tufts of Tech, whereGreg, Kayla and I work.
That's not overrun withveterinary and veterinary
assisting students in any givenmoment of time.
(09:53):
So, we work the three of uswork in this really unique
teaching community medicineclinic that just has this whole
fleet of veterinary assistantsand veterinarians in training
and they're all plating thesein-house urine cultures
themselves and running the SETIview analyses and they can see
how much these simple techniquesare improving affordability and
(10:16):
access to care for the clients.
And so now they also have thispublication that can support
this practice and give someevidence base to doing this in
practice.
And so then they can take it totheir clinics wherever they go
in their professional lives andsort of disseminate that message
as well.
Sarah Wright (10:36):
It's always cool to see it paying it forward and
helping with the next generation.
So very, very cool.
And, Greg, what are thefinancial implications of this
publication on small animalgeneral practice clinics?
Gregory Wolfus (10:49):
The implications are potentially huge.
I'm a pretty strange duderunning this community clinic
but I'm also the veterinaryfaculty advisor for the VBNA for
our school, so I actually careabout these economic issues
greatly.
From a business perspective, ifyou consider a scenario where
you have a clinical caseload of1,000 UTIs per year,
(11:11):
understanding that I recentlyyesterday inquired to local
veterinary clinics how much theycharge for a mixed sensitivity
study where you send out a urineculture, and the average was
$256.
One of those clinics iscurrently charging $89 to do an
in-house urine culture,understanding that about a
(11:33):
quarter of all urine culturesthat are submitted end up
growing bacteria.
This means that if we ended updeciding to do these diagnostics
in a stage fashion where weperform the in-house urine
cultures first for a thousandcases, that would be eighty,
nine thousand dollars and only250 of those thousand cases
would be grown and sent out forthe 256 dollar out culture fee,
(11:56):
with mixed study to total anadditional 64k, meaning the
initial cost of the in-houseculture, 1,000 cases and the 250
grown cultures that are sentout would total the client cost
of $153,000.
This is, alternatively, if wedidn't have this tiered step and
(12:19):
we just went directly to outsend out mixed studies.
It would cost the clients$256,000 for that thousand cases
, understanding only 250 of themwould end up being positive.
So simply by adding this firststep of a lower cost screening
test in a urine culture, of anin-house urine culture, this can
(12:40):
easily save clients or theclinic $100,000 a year in that
scenario that I posted.
So from an accessible careperspective, I think it's really
important for the audience toknow that in-house culture
plates are dollars and anin-house incubator could be as
little as $500,000 or somewherealong that line.
And the staff necessary toplate an in-house urine culture
(13:04):
is minimal, so it really canactually be run for as little as
$20.
And that step of entry levelwould be huge because there's so
many clients that can't affordto send out urine culture.
Sarah Wright (13:18):
Thank you.
It's cool to have theperspective also from, like, the
economic side of things too.
It's something that we don'toften talk about actually on
this, too, in the literature, sothank you for sharing that.
So, kayla, what are the nextsteps for research in this topic
?
Kayla Sample (13:33):
As all of us have sort of alluded to.
We're all very excited aboutthis, and we really the goal is
to actually for everybody to dothis, and so what are?
What we're hoping to do now issort of create a how-to guide
for any clinics that areinterested in starting this and
sort of put together theresources in like a really
compact way so that any generalpractices could sort of pick up
(13:54):
a little guide and then they toocould start to begin to train
their staff, could purchase thenecessary supplies, and really
it would be able to bedisseminated to anybody who
wanted to begin to do this intheir clinic, and we're sort of
figuring out exactly what thatlooks like or how to best
disseminate that information.
But really the goal is astep-by-step sort of how-to
guide on how to make it possible.
Sarah Wright (14:17):
Ooh, I have an idea actually.
So I don't know if you guyshave heard about our technical
tutorial videos, but they arepeer-reviewed video manuscripts
and this could actually be areally cool one, I think, like
how to do an in-house like urineculture, like at your clinic,
especially if you have eagerstudents who want a publication
and want to assist in creationof said video.
It's definitely a good, I think, first step to like publication
(14:39):
opportunity for our nextgeneration.
So I'll send you someinformation after this about
that, but that could actually besomething nice, and then it can
also be cited in the future tooif you pursue future studies on
this topic as well.
So something about that idea.
Yeah, yeah, right, I was like,oh, that'd be perfect.
So we talked a lot about theimportance of antimicrobial
stewardship and how thismanuscript is also taking
(15:01):
strides to helping with that.
,So, J enny, what sparked yourresearch interest in
antimicrobial stewardship?
Jennifer Grady (15:09):
Well, I've spent most of my career working in
community medicine with clientpopulations who really
historically haven't had greataccess to high quality
veterinary care and generallythese are the people who aren't
going to be able like Gregalluded to, they're not going to
be able to afford the $250 or$300 send out urine culture and
(15:29):
sensitivity to the lab everytime their dog pees in the house
or whatever symptoms theirdog's having.
And I feel like a lot of timeswhen vets are seeing clients,
pets who have limited resources,their kind of knee-jerk
reaction is let's just give themantibiotics just in case or
because it's the easiest orcheapest thing to do in that
(15:50):
moment and it feels sort of likethe right choice when finances
are limited.
But in reality for a lot of thepets we're actually not solving
the problems.
You know we've talked about how75% of these canine urine
cultures they don't actuallygrow when you submit them and
actually I think for someanimals we're making things
worse for them over time whenthey do develop resistant
(16:11):
infections down the road whichwe see in community medicine,
and then all of a sudden weactually can't manage their
infections inexpensively justbecause of limited antibiotic
choices.
So for me, I'm reallypassionate about teaching
students and other vets how topractice good antimicrobial
stewardship without spending aton of client resources.
I think it's going to improvethe overall quality of care for
(16:35):
this client population that myteam is serving and really help
vets increase care accessibility.
Out in the quote unquote realworld.
Sarah Wright (16:47):
And Claire, how about you?
Claire Fellman (16:50):
Yeah, this is a field I'm really passionate
about also and I had had alongstanding interest in
antimicrobial resistance andjust not had a chance to really
dive in.
But I was super excited when Icame to Tufts that there were a
variety of people working inthis space and that's how I got
involved with the team at TuftsTech, and I think what's really
(17:10):
exciting about companion animalantimicrobial stewardship right
now is just that people arerecognizing that it's really
important.
For a long time, people havetalked about antibiotic use in
people.
They've talked about antibioticuse in animal agriculture, but
the thing about dogs and catsand exotic animals is that they
are in your house, they're inyour space and specifically for
dogs and cats, which are what Iwith most and we're using many
(17:31):
of the same antimicrobialclasses, often the exact same
drugs as what people are.
And there's a lot of recognitionnow that there's shared
carriage of multidrug-resistantorganisms with different
household members, so it can gofrom the pet to the animal and
vice, from the pet to the ownerand vice versa, and so it's
really important that we beasking these questions and
(17:52):
trying to work on this and itwas really rewarding and I'm
super excited to be able tocontribute to this effort to
improve access to care because,like Jenny said, it's so
expensive and it's hard topractice, it's hard to do the
test that you want, and so if wecan find in all cases and so if
we can find lower costalternatives, that's really
(18:16):
rewarding and this is really agreat example of One Health
where we're really benefitingand actively impacting the home
and the resistance that's foundthere.
Sarah Wright (18:23):
So, Greg, we talked about some of the
important findings from thisarticle, but what was the most
surprising finding?
Gregory Wolfus (18:30):
The most surprising finding is that
everyone isn't already runningin house urine cultures.
I want to give a shout out toan old friend of mine.
Dr Lori Klein was my firstmedical director after I
graduated from veterinary schooland she had a really strong
microbiology background and whenI started GP general practice
she was already growing in-houseurine patient cultures for
(18:55):
years before I had gotten thereand for my entire career I've
been doing this.
The group of people that youhave here are all amazing people
and I am so proud of them.
For each of the parts that theycontributed to this research
project because it's sorewarding for me to have a
research document that justifiesthis practice that we've been
(19:16):
doing for all these years.
And it's not rocket science.
There's high school kids in ourclinic that are plating
in-house urine cultures and thescience is based on that plating
culture experience.
So I'm not at all surprised bywhat the findings of the paper
showed us.
What I'm really surprised isjust that the world isn't doing
(19:38):
this already.
So now I'm here talking to theether and you kind folks hoping
to spread the good word.
Sarah Wright (19:46):
We're happy to give you a platform to do so.
So AI is a very hot topic rightnow.
Kayla, do you see a role for AIin this area of research?
Kayla Sample (19:57):
I thought a lot about this question and I think
it's important to sort of betalking about the hot topics.
That we've sort of talked aboutdoing is creating sort of like
a library of positive culturesand just making sure that
everybody feels comfortablereading the plates, determining,
like, which ones they think arecontaminants, which ones they
(20:18):
think are real growth, andreally thinking about the
different characteristics of thedifferent bacteria that are
grown on the in-house plates.
And so I think one role of AImight be to be able to upload a
picture of a positive plate andget some information about that
individual bacteria from an appor something like that.
Sarah Wright (20:38):
Yeah, super cool area.
We actually have a artificialintelligence supplemental issue
coming out in AJVR in March.
So, to our listeners, staytuned for that.
That will be open access onlineonly.
And for those of you justjoining us, we're discussing how
affordable in-house tests forbacteria can improve
antimicrobial stewardship andaccess to care with our guests
(20:59):
Kayla, Jennifer, Gregory andClaire.
So, Jenny, how did yourtraining or previous work
prepare you to write thisarticle?
Jennifer Grady (21:07):
Well, pretty much all my time as a
veterinarian has been in thisweird intersection point of
academia ivory tower medicine,but then also this sort of
gritty in-the-trenches communitymedicine practice where we're
taking care of pets of peoplethat have pretty limited
(21:30):
resources and a lot of otherbarriers to care, and so I feel
like that, like breadth ofexperience and in my training,
has given me a pretty broadunderstanding of the spectrum of
care that's available for pets,and it's also motivated me to
figure out what are somecreative ways that we can
(21:50):
continue to practice some reallyhigh quality and evidence-based
medicine in this low-costprimary care setting.
I really also want to see thestudents to see that and to see
that being creative and beingflexible in their medicine, and
not just like cutting cornersand practicing poor quality
(22:11):
medicine, are what they're goingto be able to do to improve
access to care for their clientsin their future careers.
Sarah Wright (22:19):
I love hearing about all your different career
paths.
I think it's really cool to seepeople from different
backgrounds and area ofveterinary medicine comes
together to put this studytogether and then publish the
article so super fascinating.
Now this next set of questionsis going to be very important
for our listeners.
So, kayla, what is one piece ofinformation the veterinarian
should know about theseaffordable in-house tests for
(22:39):
bacteria and how they canimprove antimicrobial
stewardship and access to care?
Kayla Sample (22:45):
So one of the big takeaways that I want this paper
to sort of share with everybodyis that you can do this too.
So all of these tests aresomething that we've talked
about, we've said it before, butI want to say really clearly
that our high school studentsare running, and so these are
all tests that are veryreasonable for any practice to
consider incorporating intotheir daily routine.
(23:07):
And I want to focus for justanother second on the in-house
urine cultures, and so, as DrWolfess already said, really
we're talking about dollars foran in-house plate that you're
plating in-house, and when we'rethinking about that in-house
plate that has a negativepredictive value of 99% and so
(23:28):
that is really dollars to ruleout the fact that this animal
has bacteria that's contributingto their clinical signs.
And especially for many, manyconditions, we're thinking about
how, okay, how can I rule outbacteria?
And so we can think about thatfor things like incontinence,
for proteinuria, for stones, forazotemia, for diabetes.
(23:48):
Really there's many differentdiseases that make us want to
rule out bacteria being a partof the clinical picture, and so,
for dollars, you can rule thatout with a paper that says it's
going to have a really highnegative predictive value for
that individual animal.
And even if that test, thatin-house plate, ended up being
(24:12):
positive, as we proved in thepaper, you can also send out
that in-house plate.
And so it's really nice,because if you're pretty sure
it's going to be negative anyway, you can rule it out really
quickly.
And then, as we proved in thepaper, you can also submit that
in-house plate as well as thesaved refrigerated sample, and
so it's a really nice thing thatreally everybody can be doing.
(24:32):
And that's what I want thetake-home message to be is this
is an accessible thing thatanybody can accomplish.
Sarah Wright (24:39):
I can see this being a really powerful tool
also in like a busy ER settingwhere maybe everything costs a
little bit more.
And then if you have that onething that might give the
clients more wiggle room topursue some more advanced
diagnostics down the road thatcan actually help them get to a
diagnosis or better treatmentfor their animal, that would be
super helpful.
So on the other side of therelationship, Claire, what's one
thing the public should knowabout these affordable in-house
(25:00):
tests?
Claire Fellman (25:03):
Yeah.
So we've talked a lot about theyou know, the just-in-case
season of antibiotics and, likeJenny said, I feel like a lot of
people say, well, you know, I'drather just get the antibiotics
, I'd rather just be safe, andthat comes from both the
prescriber as well as the public.
You know they'd rather not dothe test.
And I think what is reallyimportant to recognize is in a
lot of cases there aren'tbacteria there, and so we really
do need to figure out what'sthe reason the animal is
(25:24):
presenting with those signs.
And so if we can do the testthat will confirm that bacteria
are not the reason, then we golooking for the actual diagnosis
and the actual thing that wecan treat and fix.
And so I think that's reallyimportant that you know those
few dollars spent can save you alot of money and time and
rechecks in the long run.
The other thing I think that'simportant to recognize when we
(25:44):
think about antibiotics is beingbenign it's not a big deal just
to do a few days of antibioticsis that every time we use
antibiotics we do causeresistance, and so I think
that's really a key point for usall to remember, and one of the
things we're recognizing moreand more now is the fact that
sometimes that's resistance inthe GI tract, and so that E coli
in the GI tract becomes moreresistant.
(26:06):
Sometimes that causes aresistant infection in the pet
later on, but it can alsotransmit to the person, and so
we really do have to think inthis One Health manner.
We have to think about the factthat we really need to reduce
unnecessary use ofantimicrobials, and that's
really where diagnostics andantimicrobial stewardship tasks
are trying to support thatdecision, and so keep in mind
(26:26):
that, yes, it is an expense, butantibiotics aren't free either,
and neither is the follow-uptesting, and so I think there's
a lot of times that Kaylapointed out where we don't think
bacteria are likely, and it's amuch better decision to do a
test to rule that out than togive antibiotics just in case.
Sarah Wright (26:44):
So now we've gone to the fun part of our podcast.
It's more personally.
Greg, what is your favoriteanimal fact?
Gregory Wolfus (26:53):
Uh, Sarah, my favorite animal fact is actually
the name of groups of animals.
For example, everybody knowsabout a pack of dogs and a
school of fish and a pod ofwhales, but did you guys know
that a group of rhinos is acrash?
Or a group of ladybugs is aloveliness, isn't that amazing?
A loveliness, um.
And a group of flamingos is aflamboyance.
(27:14):
Who doesn't want to be aflamboyance?
That's what I like.
Sarah Wright (27:19):
That's awesome.
We learn something new everytime we ask that question and
you're actually one of the firstpeople to not give an
octopus-based answer.
I don't know why, but a lot ofpeople have really fun facts
about the octopus
Gregory Wolfus (27:31):
Because they have three hearts dear.
Sarah Wright (27:34):
That has been shared before.
We've heard about their eyes.
We've heard about their brains,their hearts.
The cephalopods are fascinating, but thank you so much for
sharing that Super cool and justthank you all again.
This is important work, this ispractical work and I'm really
glad that we got to share thisto you on our podcast today with
(27:54):
our listeners.
So, thank you so much for beinghere.
Claire Fellman (27:55):
Thanks, Sarah
Sarah Wright (27:58):
Thank you and to our listeners.
You can read Kayla, Jenny, Gregand Claire's article in JAVMA.
I'm Sarah Wright.
Be on the lookout for nextweek's episode.
Don't forget to leave us arating and review on Apple
Podcasts or whatever platformyou listen to.
You're listening to Veterinary Vertex, a podcast
of the AVMA Journals.
In this episode, we chat abouthow affordable in-house tests
for bacteria urea can improveantimicrobial stewardship and
access to care with our guestsKayla Sample, Jennifer Grady,
Gregory Wolfus and ClaireFellman.
Thank you all for being heretoday, so we're going to start
(00:22):
with some introductions.
So, Greg, can you kick us off?
Gregory Wolfus (00:27):
Sure.
Thanks for hosting us, Sarah.
My name is Greg Wolfus and I'ma veterinary small animal
clinician.
I'm also an associate professorat the Cummings School of
Veterinary Medicine at TuftsUniversity and I'm the founding
director of Tufts Tech CommunityVeterinary Clinic, which is a
teaching clinic where we partnerfourth-year veterinary students
with high school students andtogether they provide subsidized
(00:49):
veterinary care.
Sarah Wright (00:52):
Thank you so much, Claire.
Would you like to go next?
Claire Fellman (00:56):
Sure, I'm Claire Feldman.
I'm an associate professor atthe vet school at Tufts and my
discipline is small animalinternal medicine, and I'm also
a clinical pharmacologist, thankyou.
Sarah Wright (01:07):
Awesome.
And then, Jenny, how about you?
Jennifer Grady (01:12):
Thanks, Sarah.
My name's Jenny Grady.
I graduated from Tufts in 2012,and my background is in primary
care, traditional practice andalso community medicine and
shelter practice, and I've beena professor at Tufts with Kayla
and Greg since about 2016,working at Tufts at Tech.
Sarah Wright (01:34):
And last but not least, Kayla, take it away.
Kayla Sample (01:38):
Thanks, Sarah.
I am also at Tufts at Tech andan assistant professor at Tufts
University.
I also had the.
I was able to complete myinternship and residency at
Tufts EdTech, and so mybackground is primarily in
community medicine.
Sarah Wright (01:52):
Thank you so much.
All right, so let's dive rightinto it.
So, Kayla, your JAVMA articlediscusses how affordable
in-house tests for bacteria ureacan improve antimicrobial
stewardship and access to care.
Please share with our listenersthe background on this article.
Kayla Sample (02:09):
Okay, so, just as we began talking about, the
majority of my clinical practicehas been in community medicine,
and so I see a lot of thepatients that are coming in,
similar to many generalpractices in the area, and a lot
of these animals are presentingwith lower urinary tract signs,
and lower urinary tract signscan present clinically similar
(02:32):
for UTIs, for transitional cellcarcinomas, for stones and many
other presentations, and so whatwe were doing is really looking
for a way to sort of figure outwhich of these animals needed
to have antibiotics and which ofthese animals don't, and so,
clinically, we wanted to figureout a way to differentiate which
(02:52):
animals had bacteria and whichanimals did not, and so we would
traditionally do a urinaryculture with a sensitivity.
Unfortunately, if you're workingwith a population that has
significant financial barriers,those cultures can be
cost-prohibited for thoseclients, and we have to figure
out a different way and figureout what we should do for those
(03:13):
in particular animals, and soour clinic has been performing
in-house urine cultures where weare plating urine in-house for
many years, and when we werelooking for data, we couldn't
really find any data to supportthis practice, and so what we
were trying to do with the studywas to publish some data to
support this individual practice, and really we had two clinical
questions that we were hopingto answer, and so, one, what can
(03:36):
I do on the same day for thatparticular animal if I'm worried
about bacteria contributing totheir clinical signs?
And two, how can I avoidspending all of this money for
an animal that has a negativeculture?
And so an animal that has anegative culture, which really
is about 75% of the cases thatare being submitted, that animal
(03:57):
is still paying this or thatclient is still paying the same
price for that culture andsensitivity as if an animal was
positive, and so that was reallyfrustrating for us, and so we
wanted to figure out sort ofwhat can we do in-house to
prevent that negative culturefrom coming back and prioritize
client finances towards furtherdiagnostics or further treatment
if needed?
Sarah Wright (04:18):
I think this is a super, super awesome manuscript
and I think it's just soimportant.
It has really greatimplications for both
veterinarians and clients alike,so thank you so much.
So, what are some of theimportant take-home messages
from this JAVMA article?
Kayla Sample (04:34):
So some of the biggest take-home messages from
this were really that we lookedat three in-house ways of
detecting bacteria.
The first thing we did is anIDEX SETI view, which is really
a computer-analyzed urinalysis,and that is a really nice
product produced by IDEX,because it gives us little
pictures of the individual UAand so you're able to, as a
(04:56):
clinician, also look at thepictures as well as the readout
of the urinalysis.
And in addition to that sort ofjust running the regular UA, we
also paired that with theirbacterial confirmation kit,
which is provided through IDEXwith that same machine, and in
that bacterial confirmation kitis designed to make to dissolve
the rest of the cells and giveyou a bacteria confirmed or
(05:19):
there's no bacteria present, andso that's a really nice way for
busy practices to be able toevaluate urine, because it's a
very quick readout and it's donethe same day.
The second test that we lookedat was a rapid bag, which is a
really nice rapid amino assaythat uses monoclonal antibodies
to detect gram-positive andgram-negative bacteria in urine,
(05:40):
and that one was also very nicebecause it provided the same
day results and it could be readout quickly in a busy clinical
practice.
And then the last thing we didwere we took our culture plates
that were in-house and so wecultured urine and plates in an
incubator that's here in theclinic for us and unfortunately
that result does not give us.
(06:01):
That test does not give us aresult on the same day, but the
results were available in 24 to48 hours and that is really a
very inexpensive test that takesvery little setup.
And so when we're looking atthose three specific tests, all
of those have very high negativepredictive values and actually
the negative predictive valuesfor those were all 89% or
(06:24):
greater.
And when we think about whatthat actually means because I
think we sort of like throw outthe words negative predictive
value and positive predictivevalue and all these things a lot
and I personally sort of needto think about what all of those
mean every single time and sowhat that means is if all of
these have a negative predictivevalue of greater than 89%,
really what that means is 89% orgreater, depending on which one
(06:45):
you're looking at of thepatients who test negative or
who do not have evidence ofbacteria on their results truly
do not have bacteria, and sothat's a really nice way for us
to truly rule out that bacteriais contributing to this animal's
clinical science.
Sarah Wright (07:02):
Yeah, those same-day tests too, I imagine
would be potentially a gamechanger.
Sometimes it's hard to havethat follow-up with owners who
might not be compliant, mightnot be able to like come back
into the clinic to get thoselike antibiotics if needed, etc.
So, Claire, how does thispublication contribute to
antimicrobial stewardship?
Claire Fellman (07:19):
Well, thank you for that question, and I think
when we talk about antimicrobialstewardship, it's important to
recognize that it's actually areally big field and so it
encompasses a lot of things,from infection prevention and
control all the way to drugselection and dosing.
But, as Kayla has been talkingabout, and I think with urinary
tract infections specifically, alot of what we're trying to
figure out is are these signsthat they presented for related
(07:40):
to bacterial infection?
Are antibiotics indicated?
And, as she just said, what weshowed in this paper is there's
several different tests that youcan figure out what is best for
your clinic, that you can havea lot more confidence in that
clinical decision making.
And really that's what we'retrying to do when it comes to
tests to support antimicrobialstewardship is if you can make a
prescriber feel morecomfortable, that antibiotics
(08:01):
don't need to be prescribed,that we can avoid that just in
case prescribing.
That's really the goal of thosediagnostics, and so I think
that's all really relevant andtimely and it's something a lot
of people are interested in iswhat is the best test?
What can we use?
And, as Kayla just said, any ofthese are going to make you
feel more comfortable that theretruly aren't bacteria there.
And I think the other thing,since you were talking about
(08:23):
same-day tests that it'simportant to recognize is, you
know, yes, it's nice that someof these were same-day, but, as
Kayla alluded to, one of thethings we wanted to do with this
study is look at in-houseculture, and that does require
waiting till the next day, but alot of the time that's okay.
You know, many of these patientshave had signs for more than a
day.
They're rarely life-threatening, and so in our study only about
(08:43):
25% of cultures grew, and so,if you think, you know, not all
of those patients would haveprobably gotten antibiotics,
because some were just havingcultures due to polyuria and
polydipsia and other things, butnonetheless, in the majority of
cases antibiotics are notneeded, and so if we can wait
the day to get that confirmationand have that security, really
what we're trying to do in thedirection of antimicrobial
stewardship is reduceunnecessary prescribing.
(09:05):
So there's some good optionsout there.
You can figure out what fitsfor you and just don't be afraid
of that day.
It is a little harder to get intouch with owners, but we found
in-house cultures to be reallyaccessible in our practice
setting.
Sarah Wright (09:18):
Yeah, thank you for clarifying that.
Really appreciate it.
This is going to be superimportant, I think.
Like I said, clients andveterinarians alike.
So, Jenny, how does thispublication contribute to
education and teaching?
Jennifer Grady (09:30):
Well, Kayla has her background blurred so you
can't tell, but she's currentlyzooming from the janitor closet
of a high school because that'sthe only space in our busy high
school, because that's the onlyspace in our busy small teaching
clinic, tufts of Tech, whereGreg, Kayla and I work.
That's not overrun withveterinary and veterinary
assisting students in any givenmoment of time.
(09:53):
So, we work the three of uswork in this really unique
teaching community medicineclinic that just has this whole
fleet of veterinary assistantsand veterinarians in training
and they're all plating thesein-house urine cultures
themselves and running the SETIview analyses and they can see
how much these simple techniquesare improving affordability and
(10:16):
access to care for the clients.
And so now they also have thispublication that can support
this practice and give someevidence base to doing this in
practice.
And so then they can take it totheir clinics wherever they go
in their professional lives andsort of disseminate that message
as well.
Sarah Wright (10:36):
It's always cool to see it paying it forward and
helping with the next generation.
So very, very cool.
And, Greg, what are thefinancial implications of this
publication on small animalgeneral practice clinics?
Gregory Wolfus (10:49):
The implications are potentially huge.
I'm a pretty strange duderunning this community clinic
but I'm also the veterinaryfaculty advisor for the VBNA for
our school, so I actually careabout these economic issues
greatly.
From a business perspective, ifyou consider a scenario where
you have a clinical caseload of1,000 UTIs per year,
(11:11):
understanding that I recentlyyesterday inquired to local
veterinary clinics how much theycharge for a mixed sensitivity
study where you send out a urineculture, and the average was
$256.
One of those clinics iscurrently charging $89 to do an
in-house urine culture,understanding that about a
(11:33):
quarter of all urine culturesthat are submitted end up
growing bacteria.
This means that if we ended updeciding to do these diagnostics
in a stage fashion where weperform the in-house urine
cultures first for a thousandcases, that would be eighty,
nine thousand dollars and only250 of those thousand cases
would be grown and sent out forthe 256 dollar out culture fee,
(11:56):
with mixed study to total anadditional 64k, meaning the
initial cost of the in-houseculture, 1,000 cases and the 250
grown cultures that are sentout would total the client cost
of $153,000.
This is, alternatively, if wedidn't have this tiered step and
(12:19):
we just went directly to outsend out mixed studies.
It would cost the clients$256,000 for that thousand cases
, understanding only 250 of themwould end up being positive.
So simply by adding this firststep of a lower cost screening
test in a urine culture, of anin-house urine culture, this can
(12:40):
easily save clients or theclinic $100,000 a year in that
scenario that I posted.
So from an accessible careperspective, I think it's really
important for the audience toknow that in-house culture
plates are dollars and anin-house incubator could be as
little as $500,000 or somewherealong that line.
And the staff necessary toplate an in-house urine culture
(13:04):
is minimal, so it really canactually be run for as little as
$20.
And that step of entry levelwould be huge because there's so
many clients that can't affordto send out urine culture.
Sarah Wright (13:18):
Thank you.
It's cool to have theperspective also from, like, the
economic side of things too.
It's something that we don'toften talk about actually on
this, too, in the literature, sothank you for sharing that.
So, kayla, what are the nextsteps for research in this topic
?
Kayla Sample (13:33):
As all of us have sort of alluded to.
We're all very excited aboutthis, and we really the goal is
to actually for everybody to dothis, and so what are?
What we're hoping to do now issort of create a how-to guide
for any clinics that areinterested in starting this and
sort of put together theresources in like a really
compact way so that any generalpractices could sort of pick up
(13:54):
a little guide and then they toocould start to begin to train
their staff, could purchase thenecessary supplies, and really
it would be able to bedisseminated to anybody who
wanted to begin to do this intheir clinic, and we're sort of
figuring out exactly what thatlooks like or how to best
disseminate that information.
But really the goal is astep-by-step sort of how-to
guide on how to make it possible.
Sarah Wright (14:17):
Ooh, I have an idea actually.
So I don't know if you guyshave heard about our technical
tutorial videos, but they arepeer-reviewed video manuscripts
and this could actually be areally cool one, I think, like
how to do an in-house like urineculture, like at your clinic,
especially if you have eagerstudents who want a publication
and want to assist in creationof said video.
It's definitely a good, I think, first step to like publication
(14:39):
opportunity for our nextgeneration.
So I'll send you someinformation after this about
that, but that could actually besomething nice, and then it can
also be cited in the future tooif you pursue future studies on
this topic as well.
So something about that idea.
Yeah, yeah, right, I was like,oh, that'd be perfect.
So we talked a lot about theimportance of antimicrobial
stewardship and how thismanuscript is also taking
(15:01):
strides to helping with that.
,So, J enny, what sparked yourresearch interest in
antimicrobial stewardship?
Jennifer Grady (15:09):
Well, I've spent most of my career working in
community medicine with clientpopulations who really
historically haven't had greataccess to high quality
veterinary care and generallythese are the people who aren't
going to be able like Gregalluded to, they're not going to
be able to afford the $250 or$300 send out urine culture and
(15:29):
sensitivity to the lab everytime their dog pees in the house
or whatever symptoms theirdog's having.
And I feel like a lot of timeswhen vets are seeing clients,
pets who have limited resources,their kind of knee-jerk
reaction is let's just give themantibiotics just in case or
because it's the easiest orcheapest thing to do in that
(15:50):
moment and it feels sort of likethe right choice when finances
are limited.
But in reality for a lot of thepets we're actually not solving
the problems.
You know we've talked about how75% of these canine urine
cultures they don't actuallygrow when you submit them and
actually I think for someanimals we're making things
worse for them over time whenthey do develop resistant
(16:11):
infections down the road whichwe see in community medicine,
and then all of a sudden weactually can't manage their
infections inexpensively justbecause of limited antibiotic
choices.
So for me, I'm reallypassionate about teaching
students and other vets how topractice good antimicrobial
stewardship without spending aton of client resources.
I think it's going to improvethe overall quality of care for
(16:35):
this client population that myteam is serving and really help
vets increase care accessibility.
Out in the quote unquote realworld.
Sarah Wright (16:47):
And Claire, how about you?
Claire Fellman (16:50):
Yeah, this is a field I'm really passionate
about also and I had had alongstanding interest in
antimicrobial resistance andjust not had a chance to really
dive in.
But I was super excited when Icame to Tufts that there were a
variety of people working inthis space and that's how I got
involved with the team at TuftsTech, and I think what's really
(17:10):
exciting about companion animalantimicrobial stewardship right
now is just that people arerecognizing that it's really
important.
For a long time, people havetalked about antibiotic use in
people.
They've talked about antibioticuse in animal agriculture, but
the thing about dogs and catsand exotic animals is that they
are in your house, they're inyour space and specifically for
dogs and cats, which are what Iwith most and we're using many
(17:31):
of the same antimicrobialclasses, often the exact same
drugs as what people are.
And there's a lot of recognitionnow that there's shared
carriage of multidrug-resistantorganisms with different
household members, so it can gofrom the pet to the animal and
vice, from the pet to the ownerand vice versa, and so it's
really important that we beasking these questions and
(17:52):
trying to work on this and itwas really rewarding and I'm
super excited to be able tocontribute to this effort to
improve access to care because,like Jenny said, it's so
expensive and it's hard topractice, it's hard to do the
test that you want, and so if wecan find in all cases and so if
we can find lower costalternatives, that's really
(18:16):
rewarding and this is really agreat example of One Health
where we're really benefitingand actively impacting the home
and the resistance that's foundthere.
Sarah Wright (18:23):
So, Greg, we talked about some of the
important findings from thisarticle, but what was the most
surprising finding?
Gregory Wolfus (18:30):
The most surprising finding is that
everyone isn't already runningin house urine cultures.
I want to give a shout out toan old friend of mine.
Dr Lori Klein was my firstmedical director after I
graduated from veterinary schooland she had a really strong
microbiology background and whenI started GP general practice
she was already growing in-houseurine patient cultures for
(18:55):
years before I had gotten thereand for my entire career I've
been doing this.
The group of people that youhave here are all amazing people
and I am so proud of them.
For each of the parts that theycontributed to this research
project because it's sorewarding for me to have a
research document that justifiesthis practice that we've been
(19:16):
doing for all these years.
And it's not rocket science.
There's high school kids in ourclinic that are plating
in-house urine cultures and thescience is based on that plating
culture experience.
So I'm not at all surprised bywhat the findings of the paper
showed us.
What I'm really surprised isjust that the world isn't doing
(19:38):
this already.
So now I'm here talking to theether and you kind folks hoping
to spread the good word.
Sarah Wright (19:46):
We're happy to give you a platform to do so.
So AI is a very hot topic rightnow.
Kayla, do you see a role for AIin this area of research?
Kayla Sample (19:57):
I thought a lot about this question and I think
it's important to sort of betalking about the hot topics.
That we've sort of talked aboutdoing is creating sort of like
a library of positive culturesand just making sure that
everybody feels comfortablereading the plates, determining,
like, which ones they think arecontaminants, which ones they
(20:18):
think are real growth, andreally thinking about the
different characteristics of thedifferent bacteria that are
grown on the in-house plates.
And so I think one role of AImight be to be able to upload a
picture of a positive plate andget some information about that
individual bacteria from an appor something like that.
Sarah Wright (20:38):
Yeah, super cool area.
We actually have a artificialintelligence supplemental issue
coming out in AJVR in March.
So, to our listeners, staytuned for that.
That will be open access onlineonly.
And for those of you justjoining us, we're discussing how
affordable in-house tests forbacteria can improve
antimicrobial stewardship andaccess to care with our guests
(20:59):
Kayla, Jennifer, Gregory andClaire.
So, Jenny, how did yourtraining or previous work
prepare you to write thisarticle?
Jennifer Grady (21:07):
Well, pretty much all my time as a
veterinarian has been in thisweird intersection point of
academia ivory tower medicine,but then also this sort of
gritty in-the-trenches communitymedicine practice where we're
taking care of pets of peoplethat have pretty limited
(21:30):
resources and a lot of otherbarriers to care, and so I feel
like that, like breadth ofexperience and in my training,
has given me a pretty broadunderstanding of the spectrum of
care that's available for pets,and it's also motivated me to
figure out what are somecreative ways that we can
(21:50):
continue to practice some reallyhigh quality and evidence-based
medicine in this low-costprimary care setting.
I really also want to see thestudents to see that and to see
that being creative and beingflexible in their medicine, and
not just like cutting cornersand practicing poor quality
(22:11):
medicine, are what they're goingto be able to do to improve
access to care for their clientsin their future careers.
Sarah Wright (22:19):
I love hearing about all your different career
paths.
I think it's really cool to seepeople from different
backgrounds and area ofveterinary medicine comes
together to put this studytogether and then publish the
article so super fascinating.
Now this next set of questionsis going to be very important
for our listeners.
So, kayla, what is one piece ofinformation the veterinarian
should know about theseaffordable in-house tests for
(22:39):
bacteria and how they canimprove antimicrobial
stewardship and access to care?
Kayla Sample (22:45):
So one of the big takeaways that I want this paper
to sort of share with everybodyis that you can do this too.
So all of these tests aresomething that we've talked
about, we've said it before, butI want to say really clearly
that our high school studentsare running, and so these are
all tests that are veryreasonable for any practice to
consider incorporating intotheir daily routine.
(23:07):
And I want to focus for justanother second on the in-house
urine cultures, and so, as DrWolfess already said, really
we're talking about dollars foran in-house plate that you're
plating in-house, and when we'rethinking about that in-house
plate that has a negativepredictive value of 99% and so
(23:28):
that is really dollars to ruleout the fact that this animal
has bacteria that's contributingto their clinical signs.
And especially for many, manyconditions, we're thinking about
how, okay, how can I rule outbacteria?
And so we can think about thatfor things like incontinence,
for proteinuria, for stones, forazotemia, for diabetes.
(23:48):
Really there's many differentdiseases that make us want to
rule out bacteria being a partof the clinical picture, and so,
for dollars, you can rule thatout with a paper that says it's
going to have a really highnegative predictive value for
that individual animal.
And even if that test, thatin-house plate, ended up being
(24:12):
positive, as we proved in thepaper, you can also send out
that in-house plate.
And so it's really nice,because if you're pretty sure
it's going to be negative anyway, you can rule it out really
quickly.
And then, as we proved in thepaper, you can also submit that
in-house plate as well as thesaved refrigerated sample, and
so it's a really nice thing thatreally everybody can be doing.
(24:32):
And that's what I want thetake-home message to be is this
is an accessible thing thatanybody can accomplish.
Sarah Wright (24:39):
I can see this being a really powerful tool
also in like a busy ER settingwhere maybe everything costs a
little bit more.
And then if you have that onething that might give the
clients more wiggle room topursue some more advanced
diagnostics down the road thatcan actually help them get to a
diagnosis or better treatmentfor their animal, that would be
super helpful.
So on the other side of therelationship, Claire, what's one
thing the public should knowabout these affordable in-house
(25:00):
tests?
Claire Fellman (25:03):
Yeah.
So we've talked a lot about theyou know, the just-in-case
season of antibiotics and, likeJenny said, I feel like a lot of
people say, well, you know, I'drather just get the antibiotics
, I'd rather just be safe, andthat comes from both the
prescriber as well as the public.
You know they'd rather not dothe test.
And I think what is reallyimportant to recognize is in a
lot of cases there aren'tbacteria there, and so we really
do need to figure out what'sthe reason the animal is
(25:24):
presenting with those signs.
And so if we can do the testthat will confirm that bacteria
are not the reason, then we golooking for the actual diagnosis
and the actual thing that wecan treat and fix.
And so I think that's reallyimportant that you know those
few dollars spent can save you alot of money and time and
rechecks in the long run.
The other thing I think that'simportant to recognize when we
(25:44):
think about antibiotics is beingbenign it's not a big deal just
to do a few days of antibioticsis that every time we use
antibiotics we do causeresistance, and so I think
that's really a key point for usall to remember, and one of the
things we're recognizing moreand more now is the fact that
sometimes that's resistance inthe GI tract, and so that E coli
in the GI tract becomes moreresistant.
(26:06):
Sometimes that causes aresistant infection in the pet
later on, but it can alsotransmit to the person, and so
we really do have to think inthis One Health manner.
We have to think about the factthat we really need to reduce
unnecessary use ofantimicrobials, and that's
really where diagnostics andantimicrobial stewardship tasks
are trying to support thatdecision, and so keep in mind
(26:26):
that, yes, it is an expense, butantibiotics aren't free either,
and neither is the follow-uptesting, and so I think there's
a lot of times that Kaylapointed out where we don't think
bacteria are likely, and it's amuch better decision to do a
test to rule that out than togive antibiotics just in case.
Sarah Wright (26:44):
So now we've gone to the fun part of our podcast.
It's more personally.
Greg, what is your favoriteanimal fact?
Gregory Wolfus (26:53):
Uh, Sarah, my favorite animal fact is actually
the name of groups of animals.
For example, everybody knowsabout a pack of dogs and a
school of fish and a pod ofwhales, but did you guys know
that a group of rhinos is acrash?
Or a group of ladybugs is aloveliness, isn't that amazing?
A loveliness, um.
And a group of flamingos is aflamboyance.
(27:14):
Who doesn't want to be aflamboyance?
That's what I like.
Sarah Wright (27:19):
That's awesome.
We learn something new everytime we ask that question and
you're actually one of the firstpeople to not give an
octopus-based answer.
I don't know why, but a lot ofpeople have really fun facts
about the octopus
Gregory Wolfus (27:31):
Because they have three hearts dear.
Sarah Wright (27:34):
That has been shared before.
We've heard about their eyes.
We've heard about their brains,their hearts.
The cephalopods are fascinating, but thank you so much for
sharing that Super cool and justthank you all again.
This is important work, this ispractical work and I'm really
glad that we got to share thisto you on our podcast today with
(27:54):
our listeners.
So, thank you so much for beinghere.
Claire Fellman (27:55):
Thanks, Sarah
Sarah Wright (27:58):
Thank you and to our listeners.
You can read Kayla, Jenny, Gregand Claire's article in JAVMA.
I'm Sarah Wright.
Be on the lookout for nextweek's episode.
Don't forget to leave us arating and review on Apple
Podcasts or whatever platformyou listen to.
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