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New Revenue Source Just Under The Surface

Veterinary can now start to contemplate adding aquatic medicine.

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Veterinarians interested in adding a modality to boost practice revenue may want to consider aquatic medicine.

Aquatics is the fastest-growing discipline in veterinary medicine, says David Scarfe, DVM, Ph.D., assistant director of the American Veterinary Medical Association’s Scientific Activities Division.

Despite the growth, veterinarians hesitate to add fish to their patient list because they’re uncomfortable treating an animal that lives underwater, experts say. They may have questions about anatomy, drugs and how to perform surgery.

“To begin treating fish, all veterinarians need is a working knowledge of water quality and how aquariums work,” says Michael Stafford, DVM, of Fair Grove Veterinary Service in Fair Grove, Mo. “They need a continuing education course or a university class on basic fish health, a water testing kit, a few basic drugs and a client. Procedures are very similar to small-animal medicine.”

A client base is an obvious necessity. Communicating to potential clients that you have the expertise can be done by joining a local garden group and through online listings and the practice’s website.

Proper communication with the client is important, says Helen Roberts, DVM, of Aquatic Veterinary Services of Western New York in Orchard Park, N.Y.

“Poor husbandry is often a problem in aquatic medicine,” Dr. Roberts says. “Not feeding the right food and, similarly, feeding too much food that damages the environment is a common problem.

“Aquatics is an area of medicine that requires a good understanding of pH and water quality, which differs slightly depending on the type of fish. Poor water quality means a fish may not be getting enough oxygen. An owner of a dog or cat would know if there was an oxygen concern for their pet, so in aquatics you really have to know what questions to ask.”

AVMA Can Help

Veterinarians aren’t on their own when considering adding aquamedicine. The AVMA’s member outreach program, offers a website, AquaVetMed.info, to help veterinarians interested in practicing aquatic medicine. Dr. Scarfe says more than 3,300 veterinarians’ records are in the database, and information on more than 700 of those veterinarians is available to prospective clients.

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“Veterinarians initially became involved with treating finned fish by working for commercial farms, but divisions of aquamedicine, such as ornamental fish and aqua biosecurity, are growing,” Scarfe says. “Most countries require a veterinarian’s inspection and authorization prior to shipping aquatic animals in order to prevent disease transfer, so veterinarians interested in government work can work with fish at that level, too.”

The AVMA supports the idea that the final inspection and certification of aquatic animals should be left to U.S. Department of Agriculture-accredited veterinarians, state veterinarians and the USDA’s Animal and Plant Health Inspection Service.

Education

A specialty in aquatic medicine does not exist, but the American College of Zoological Medicine does have an aquatics track. Experts say the basics of treating fish were learned in college and the rest can be learned in courses offered at many universities and veterinary conferences.

“In the past, a veterinarian could graduate without having any hands-on experience treating an ill fish, but now many universities are offering classes to veterinary students and practicing veterinarians,” says Gay Zambrano, DVM, of Zambrano Consulting Mobile Services in Stanton, Calif. “Many veterinarians think it would be too difficult to treat a fish, and they wouldn’t even know where to start when it comes to surgery. A veterinarian interested in fish as a hobby would do very well expanding into aquatics in practice.”

Doing Surgery

An aquatic veterinarian does more than adjust water quality and medicate fish for the 10 to 20 common potential parasites. Surgery is commonly performed to repair lacerations, remove growths and hooks, and for eye enucleations and exploration.

“It’s simpler to perform surgery on some of the larger fish like koi, which can grow to be around 3 feet long,” says Bernard Levine, VMD, of Fish Medicine Diagnostic Services in Toms River, N.J. “Koi can live 20 years or longer, so why not try to give them a better quality of life and extend their lifespan?”

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Most of what a veterinarian knows about dogs and cats can be applied to the more than 30,000 species of finned fish, said Gregory A. Lewbart, VMD, Dipl. ACZM, of North Carolina State University.

“The only difference is the aquatic environment once you have the fish anesthetized,” Dr. Lewbart says. “An anesthesia is added to the water, which has to flow over the fish’s gills during surgery. Pain medicine can be given as well if necessary.

“Stitches can be placed to repair a laceration and is performed in the same way you would stitch a dog’s wound.”

Experts say the transition to working on fish may be easier if a veterinarian has experience with other exotics.

“One surgery I performed was on a piranha that ate a plastic plant,” says Susan Horton, DVM, of Chicago Exotics Animal Hospital in Skokie, Ill. “Foreign bodies aren’t uncommon, but water chemistry tends to be the biggest cause of problems with fish. A water chemistry kit and understanding of what  appropriate levels of ammonia and nitrate is necessary.”

Dr. Levine says he once anesthetized a catfish to remove a plastic plant container from its throat.

“Other surgeries I’ve done include tumor removal,” Levine said. “Pond fish, especially, get lacerations that can be stitched to improve healing and to prevent infection.”

During surgery, veterinarians monitor a fish’s gill movement and color. They attach a Doppler monitor to the breast plate on a large fish to monitor the heart rate.

Why Treat a Pet Fish?

Some fish owners forge close bonds with their pets and report that the animals exhibit personalities, recognize the owners and provide the same comfort a dog or cat can.

Veterinarians who treat ornamental koi say a fish selling for $10,000 isn’t unusual, but the price tag isn’t typically what propels the fish owner to walk into a clinic.

“It’s taken fish owners a long time to realize they could take their pet to a veterinarian for treatment when it is sick, but that line of thought is improving,” Dr. Zambrano says. “Many of my clients with aquatics won the fish at a fair or have had the fish for eight years or more. The fish are their friends and part of their routine and they want them to be healthy.”

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Pet Store Dilemma

Many aquatic veterinarians don’t see pet stores as competition for aquatic drug sales, but the vets say seeking an over-the-counter drug before consulting a veterinarian could delay proper treatment and in some cases lead to the fish’s death.

“One unique thing with treating fish is that one sick fish could mean 100 sick tank mates,” the AVMA’s Scarfe says. “So finding out what an illness is in one fish could mean saving many. Pet stores delay proper fish treatment because the medications they sell don’t typically work, and secondly the diagnosis process is completely skipped.

“We don’t want to alienate pet stores that carry drugs for aquatics, but those drugs are largely illegal by Food and Drug Administration standards. AVMA has taken the lead on trying to regulate these drugs through the Minor Use Minor Species [MUMS] Act.”

MUMS established regulatory procedures to increase drug availability for minor species and for uncommon diseases in major species. A provision in the act for non-food-producing minor species created an index of drugs that companies may market without completing the traditional approval process. The FDA lists drugs in the index on the satisfactory recommendation of external expert panels. The agency limits the index to non-food minor species—with an exception for certain early life stages of food animals, such as some fish eggs.

“When thinking about the importance of aquatic medicine, consider that almost half of all meats consumed in the U.S. are fish,” Scarfe says. “Looking at the U.S. trade deficit, $9.2 billion is from seafood. Imagine if we could farm all of that here in the U.S. and veterinarians helped make it possible.”

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