Benita Altier, LVT, VTS (Dentistry), discusses the importance of good posture when caring for patients and how dentistry tools can help.

Maintaining good posture in patient care

Benita Altier, LVT, VTS (Dentistry), owner of Pawsitive Dental Education, provides professional dental instruction and consultation to veterinary practices and conferences, both in the US and internationals. Altier is president-elect for the Arizona Veterinary Technician Association as well as a past president for the Academy of Veterinary Dental Technicians.

Altier presented a continuing education (CE) session about lighting, magnification and seating, during the 2025 Fetch dvm360 Conference in Long Beach, California. In a 

interview, she discussed key points of this CE session including the importance of maintaining good posture while treating patients. This video is a portion of the interview.

The following is a transcript, lightly edited for clarity:

Why is good posture so important with dentistry care?

: Working in practice for 29 years and actually performing dental procedures, pretty soon you wind up kind of realizing that your body hurts. The things that really start hurting, and the things that I experienced, were things like my neck, my wrists [and] my hands. My back seems to be pretty good, but you know, people have those issues as well. And I started thinking, ‘Well, gosh, how is [it] that I'm dealing with this type of injury or chronic pain, and how could I potentially stop that from happening? And, how could I also help to prevent this from happening to other people?

I started really being more aware of why lighting and magnification was important. That's when I decided to get my first set of loupes, we call them, and light that will help to focus light on the area where I'm working. And when I started employing that, I realized that I was really suffering for no reason before that. I could now sit up [straighter], I can look down through the oculars. I could actually see what I was doing a lot better.

But the most important thing is wearing something like that corrected my posture, because I didn't realize [that] when you're trying to work on a patient, you're adapting your body to that particular animal, the height of the table, whatever type of seating you may or may not have like you're really having to kind of become a contortionist trying to get your head closer to the area where you can see and that's usually going to cause you to be in some sort of uncomfortable posture for a long period of time, which then leads to these sort of maladaptation. The human body can't adjust for that type of thing over a long period of time, and so then you wind up with, you know, injuries which can lead to permanent disabilities and things that could potentially even cause people to have to change industries or not do that kind of work anymore.

To read more news and view expert insights from Fetch Long Beach, visit

’s dedicated site for conference coverage at

https://www.dvm360.com/conference/fetch-long-beach

Videos

Erik Zager explains common congnitive biases and how to combat them

Cognitive biases that impact decision making

Cognitive biases quietly steer many clinical choices. In this 

 interview, Erik Zager, DVM, DACVECC, breaks down blind-spot, hindsight, false-consensus, and affective biases and offers practical steps to combat these intellectual shortcuts that may hamper proper decision making. 

: I think one of the first ones that comes to mind is blind-spot bias. Blind-spot bias is either not knowing how we are biased on a day-to-day basis or believing that we are not susceptible to the biases that everybody as human beings is susceptible to. Our brains work in a certain way. /they’ve evolved to take shortcuts to make things as easy as possible for ourselves. But unfortunately, when we get to more complicated issues those evolutionary advantages start to become disadvantages. And when we don’t believe that we are susceptible to those biases. When we don’t believe that we are the ones who will be affected by, you know, outcome bias, availability bias, etc, that is the first step in a losing battle where we are not going to make the right decisions for our patients.

My favorite bias, which I talk about probably on almost a daily basis in my hospital, is hindsight bias. This is when the outcome of a case determines how we feel about the decisions leading up to that outcome. In medicine, just like in life, there is no perfect solution and there is no perfect answer; things happen. We can do everything right for a patient and still have a poor outcome. That’s just the way things go. What we can’t do is start to beat up on ourselves and think we made the wrong decisions, that we’re bad people or bad doctors, even if we made all the right decisions leading up to a poor outcome. This one really affects our mental health as health-care providers. Because bad outcomes are inevitable, if we take every single one as some sort of personal failure—even if we can look back and say, “I did everything I could for this patient”—we are going to burn out very quickly.

This bias is also a barrier to learning. If we have good outcomes despite making poor decisions, we might not re-evaluate our thought process. In order to learn and grow as clinicians, we need to dissociate the outcome of a case from our judgment of the decisions that led to it and not judge ourselves as “good” or “bad” doctors solely by the outcome instead of by the clinical steps we took.

One danger we can fall for is false-consensus bias, especially as doctors, because we are used to people agreeing with us. Our technicians or clients may sometimes feel intimidated and not want to disagree if we say something about a patient’s history or about a diagnostic impression that might not be accurate. If we do not create psychological safety for our clients and colleagues, we will have false-consensus bias: we’ll believe that everyone thinks the way we do more than is actually true. We need to make sure that every step of the process we are open to criticism, because that is how we grow. And we need to respect our colleagues and clients enough that, if they have questions about what we are doing, what our thought process is, or what our treatment plan is, we respond by explaining our reasoning and building a team-based approach.

Affective bias is almost in a category of its own because it is so dependent on our emotional and physical state. As medical professionals—like many jobs—we are constantly in situations where we feel, “I don’t have time for this,” or “I don’t have time for self-care.” Because some people think self-care is selfish, they skip it—but self-care actually helps our clients and patients, because we’re better able to make appropriate decisions if we are not tired, hungry, or ill. I’ve told staff before: “If you’re sick and have a fever, go home,” not only for your own sake but for the sake of the patients. If you’re hungry, try to eat something. Try to schedule at least five to ten minutes in your day to sit down, collect your thoughts, and be quiet for a moment—lock the door if people keep coming in and asking you things. You need that time for yourself, so you don’t succumb to affective bias, where your emotional and physical state negatively affects your decisions and patient care.

To read more news and view expert insights from Fetch Long Beach, visit 

’s dedicated site for conference coverage at 

Discover key insights on decision-making biases in veterinary care from Erik Zager, DVM, DACVECC.

How to beat cognitive biases and make better decisions

Monica Tarantino, DVM, MBA, highlights the importance of proactive chronic pain management in elderly dogs.

How veterinarians can proactively address chronic pain in geriatric dogs

Monica Tarantino, DVM, MBA, cofounder of the Senior Dog Veterinary Society in Alexandra, Virginia, shares the key takeaway from her session on strategies for managing chronic pain in geriatric dogs, presented at the New York Vet Show in New York City. She emphasizes that veterinarians need to be more proactive in addressing chronic pain in elderly dogs.

The following is a transcript of the video, lightly edited for clarity and cohesion.

 I'm Dr Monica Tarantino. I am a veterinarian and the cofounder of the Senior Dog Veterinary Society, and we're on a mission to advance the care of elderly canines in [veterinary medicine].

dvm360: What are some key takeaways you hope attendees gained from your session and go on to apply in practice?

 I think the biggest takeaway that I wanted for [veterinarians]...from [the] session was really to be more proactive with our approach. We talked about a poll that I had done online asking pet parents how many of them had heard about chronic pain from their [veterinarians], and almost half of them had never actually heard about it from [them].

And so, to me, that says there's a really big gap and opportunity for us to really bring that up in conversation more frequently and start letting [clients] know about it earlier on. The next thing I always suggest [to other veterinarians] when it comes to things we can do differently, is screening for [chronic pain]—literally having screening forms that we use or looking for signs of chronic pain. We have a really great download available on our website at seniordogvets.com that you can download and use with your patients. I use those at all of my senior wellness exams, and they're really helpful in kind of getting that conversation going between me and my [clients].

Erik Zager,DVM, DACVECC, is a board-certified emergency and critical care specialist and head of Emergency and Critical Care at Philadelphia Animal Specialty & Emergency (PASE). He also serves as vice president of Global Instruction for Veterinary Empowerment (GIVE), a nonprofit focused on expanding specialty-level veterinary education worldwide.

On day 1 of the Fetch dvm360 Conference in Long Beach, California, Erik Zager, DVM, DACVECC opened the event with a keynote focused on the “why” behind clinical choices. Through the lens of a case study on a schnauzer named Panky, he examined common cognitive biases that may lead to suboptimal decision making in veterinary practice. By being aware of these biases, clinicians can take steps toward preventing or correcting for them, busy clinicians can immediately benefit from clearer decisions that reduce unnecessary tests, lower client cost and anxiety, and focus clinic resources where they improve outcomes.

Zager drew on the work of Nobel laureate Daniel Kahneman, whose book 

Slow posits that human thinking is governed by 2 distinct modes: System 1 (fast) and System 2 (slow). System 1 is the fast, automatic, and intuitive mode. It handles effortless tasks like recognizing a friend's face or making snap judgments. System 2 is the slow, analytical, and effortful mode, which is engaged for complex tasks like solving a math problem or learning a new skill.

Cognitive biases are features of System 1 thinking. They are the shortcuts the brain uses to save energy and make rapid assessments. They are essential for navigating daily life, but they become problematic when people rely on them for high-stakes decisions that require the slower, more deliberate System 2. “Oftentimes our brain defaults to System 1 unless we are trying to dial up specifically System 2,” Zager said.

Anchoring bias is the tendency to rely too heavily on the first piece of information offered when making decisions. All subsequent judgments and negotiations are then adjusted based on that initial reference point, which can dramatically skew the final result.

: The first pieces of information the doctor received were "schnauzer" and "day after Thanksgiving." This immediately anchored the doctor's thinking to a common diagnosis for that breed after a holiday: pancreatitis. This anchor caused them to view all subsequent information through that specific lens.

Search satisfaction bias is the tendency to stop searching for answers once one finds an explanation that seems to fit the situation. Instead of treating the first plausible reason as one possibility among many, the brain accepts it as the answer, potentially causing the clinician to overlook more complete or accurate information.

 The doctor ran a quick, easy diagnostic test. The result was ambiguous, but it was enough to support the anchored idea of pancreatitis. Satisfied that an answer had been found, the doctor stopped the diagnostic search, ignoring other possibilities and calling the case solved.

Confirmation bias is the powerful tendency to search for, interpret, favor, and recall information in a way that confirms or supports pre-existing beliefs or hypotheses. It is much easier for people to accept information that reinforces their worldview than to accept information that challenges it.

: Believing Panky had pancreatitis, the doctor interpreted the ambiguous diagnostic test as "abnormal" because that result confirmed the pre-existing theory. Even though the test was objectively normal, the doctor's brain cherry-picked the data that fit the desired narrative.

Outcome bias is the tendency to judge a past decision based on its eventual outcome instead of on the quality of the decision at the time it was made. This is often driven by favoring information that supports a hoped-for outcome, which is different from confirmation bias, which supports what one believes.

: The doctor and staff felt stressed by Panky's aggressive behavior and the owner's financial constraints. The hoped-for outcome was to resolve the case quickly and get the dog out of the clinic. This desire drove them to choose the fastest, easiest diagnostic path, rather than the most thorough one, to reach that desired end result as quickly as possible.

Cognitive biases are a constant and natural part of how the human brain works, Zager said. The goal is to become aware of them so one can actively engage their more deliberate, System 2 thinking when it matters most. Awareness is the first step, but one can also use active "debiasing" strategies to improve decision-making. “I want us to develop or start at least start developing some of the tools that we can recognize certain automatic thinking and switch it over to a more purposeful thinking that is going to be less prone to these biases," Zager said. Here are a few of the tips he offered.

First, slow down. When a decision is important, consciously engage your "slow" thinking. The simple act of writing down your thought process, listing pros and cons, or explaining reasoning to someone else forces one to move from a gut instinct to a more deliberate analysis. I'm going to emphasize that effortful thinking that is also deliberate and is less prone to bias,” Zager said.

Share the mental burden by asking colleagues, friends, or partners for their perspective, as they may see things you've missed. Be especially open to those who might disagree with you, as they are most likely to challenge your biases. “It is too much to be thinking this much for every single one of our patients, so ask your colleagues,” said Zager. “And [when] I say colleagues, not just the other doctors, but your technicians, your CSRs [as well]. They might have gotten information from the owner out front that you might not have had."

Finally, anticipate risks. Actively consider how a decision could go wrong. Forcing yourself to think about potential negative outcomes helps counter the pull of confirmation bias and outcome bias, which make us focus only on information that supports our beliefs and hopes. “Forcing yourself to think about potential negative outcomes helps counter the pull of confirmation bias and outcome bias, which make us focus only on information that supports our beliefs and hopes," Zager said.

By knowing that these hidden shortcuts exist and actively working to question one’s automatic thoughts, clinicians can make clearer, more deliberate decisions in their work every day.

Zager E. Why and how we choose: Rethinking decisions in veterinary practice. Presented at: Fetch dvm360 Conference; December 5-6, 2025; Long Beach, CA.

Articles

Erik Zager, DVM, DACVECC, kicks off Fetch Long Beach with an evidence-based framework for everyday clinical decision-making.

4 Cognitive biases that are short-circuiting your decision making

Kailana and her siblings when they were younger, would play and roughhouse with each other, like puppies do. When Kailana was 6 weeks old, one of her littermates pulled her down when she was trying to climb out of their enclosure, and she could not move over around 30 seconds. Her owners assumed it was ‘just a stinger, and it appeared to clear up quickly. However, as she continued to grow over the following weeks, John Hartmire and spouse Christine Pobanz-Stelter, Kailana’s owners, noticed she develop abnormalities in her gait.

Kailana received a corpectomy at the William R. Pritchard Veterinary Medical Teaching Hospital at UC Davis after it was discovered she had vertebral malformation. (Image couresty of UC Davis College of Veterinary Medicine) 

“We started noticing her back leg splaying outward, and she would drift as she was running,” said Pobanz-Stelter, in an organizational release.

They brought her to her veterinarian where an X-ray was performed and showed a malformation in her spine. Kailana then had a follow-up with a neurologist, who could not confirm if her condition was from the fall or congenital. He did state that he does not feel it was a hereditary abnormality because none of her littermates experienced any such complications. She was then referred the William R. Pritchard Veterinary Medical Teaching Hospital at UC Davis and was examined by its Neurosurgery Specialty Service.

During her examination at the hospital, Kailana was able to walk independently, but presented with a uncoordinated hind end gait and reduced awareness of where her hind limbs were position in relation to her body.

 The team then brought in the Anesthesia and Diagnostic services to perform a CT, which showed multiple vertebral anomalies from her 4th thoracic vertebrae (T4) to her 9th thoracic vertebrae (T9) (most severe from T5 to T8). This caused marked spinal curvature and spinal cord compression at ^t to T7, and in narrowing of the spinal canal. After learning all of this information, the neurologists now believe her condition is more likely congenital rather than traumatic.

“Given the progressive nature of Kailana’s condition, she would likely lose the ability to walk within a few months,” said Ji-Hey Lim, DVM, PhD, DACVIM (Neurology).

“However, surgical intervention could prevent further neurologic decline and provide long-term improvement in her mobility.”

Believing they could help Kailana walk again, Lim, Adrien Dupanloup, and Vishal Murthy teamed up to perform her surgery.

When Kailana turned 6 months old, Lim proceeded with the surgery. The surgery was a 7-hour operation that involved a corpectomy at the site of the most severe spinal cord compression, which was then followed by stabilization of the spin using pedicle screws and rod. According to the organizational release, corpectomy for congenital vertebral malformations is an especially demanding procedure. The spinal cord is extremely thin at the stenotic site and the bone requiring removal is very close to the this fragile tissue. One small error could cause severe spinal cord damage and paralysis.

Kailana’s surgery was a success, but she was slightly weaker immediately following the surgery. Three days later, she had steadily improved and was discharged home to be on crate rest with restricted activity for a month.

“She’s a 6-month-old puppy so, of course, she wanted to ‘go!’ from the very beginning of her recovery,” said Pobanz-Stelter, explaining the difficulty in keeping her on inactivity and rest. “Keeping her down was near impossible. As soon as we got the go ahead for her to resume activity, she never hesitated.”

Kailana recovery also involved physical therapy where she worked on developing core strength and muscle development. She is doing well, but her owners are still working on it. Now, she enjoys spending time ‘romping’ through the backyard and chasing other dogs, wrestling, and playing fetch.

Warren R. Dog on Brink of Paralyzation Walks After Neurosurgery at UC Davis. School of Veterinary Medicine. November 24, 2025. Accessed December 5, 2025. https://www.vetmed.ucdavis.edu/index.php/news/dog-brink-paralyzation-walks-after-neurosurgery-uc-davis

Successful neurosurgery restores mobility to dog facing paralysis

Health Canada has approved relfovetmab injection (Portela; Zoetis) for alleviating pain associated with feline osteoarthritis (OA). The therapy is designed to reduce OA pain for 3 months with a single injection.

“Health Canada’s approval of [relfovetmab injection] marks a significant step forward in managing osteoarthritis-related pain in cats,” Rob Polzer, PhD, executive vice president and president, research and development for Zoetis, said in a news release.

Zoetis is anticipating relfovetmab injection to be available on the commercial markets in both Canada and Europe in 2026. The therapy received marketing authorization from the European Commission in October 2025. 

A monoclonal antibody (mAb), relfovetmab injection works by targeting anti-nerve growth factor (NGF), a mediator of OA pain and inflammation. “Thanks to [relfovetmab injection’s] long-lasting antibody and its unique binding site to NGF, veterinarians and cat owners in Canada now have a new, innovative way to address osteoarthritis pain,” Polzer said.

Up to 40% of all cats and up to 90% of felines older than 12 years are clinically affected by OA, a common, chronic and progressive joint disease.

 OA leads to inflammation and breakdown of joints, with negative consequences to gait and movement, as well as sleep, relationships and cognition affected by OA-associated pain. Therapies can help reduce pain and mobility issues caused by the disease and improve quality of life for patients.

“[Relfovetmab injection] is…designed to support long-term comfort and mobility for cats—with the added benefit that pet owners only need to bring their cats in for an injection once every 3 months," Richard Goldstein, DVM, DACVIM, DECVIM-CA, global chief medical officer and head of medical affairs at Zoetis, said in a news release.

 "We look forward to providing veterinarians with another innovative tool, adding to our wide feline portfolio, to help them improve the quality of life for the cats in their care."

In earlier 2025, Health Canada also approved Zoetis’ canine mAb therapy designed to reduce pain for 3 months: izenivetmab injection (Lenivia). Like relfovetmab injection, izenivetmab requires a single administration.

Additionally, in November 2025, Zoetis received marketing authorization in Europe for izenivetmab.

 The authorization followed a positive opinion from the Committee for Veterinary Medicinal Products (CVMP) of the European Medicines Agency.

A 9-month field trial in Europe demonstrated effectiveness for relfovetmab injection in alleviating OA pain. Published by the International Renal Interest Society, the study found the therapy to be well tolerated, including by cats identified with kidney disease at IRIS stage 1, 2 or 3.

Zoetis receives Health Canada approval for Portela (relfovetmab injection) to alleviate pain associated with osteoarthritis in cats. News release. Zoetis. December 5, 2025. Accessed December 5, 2025. 

https://news.zoetis.com/press-releases/press-release-details/2025/Zoetis-Receives-Health-Canada-Approval-for-Portelarelfovetmab-injection-to-Alleviate-Pain-Associated-with-Osteoarthritis-in-Cats/default.aspx

Crossley KC. Long-acting therapy for relieving OA pain in cats receives European marketing authorization. 

. October 29, 2025. Accessed December 5, 2025. 

https://www.dvm360.com/view/long-acting-therapy-for-relieving-oa-pain-in-cats-receives-european-marketing-authorization

Enomoto M, Mantyh PW, Murrell J, Innes JF, Lascelles BDX. Anti-nerve growth factor monoclonal antibodies for the control of pain in dogs and cats. 

Slingerland LI, Hazewinkel HAW, Meij BP, Ph. Picavet, G. Voorhout, Cross-sectional study of the prevalence and clinical features of osteoarthritis in 100 cats. 

. 2011;187(3):304-309. doi:10.1016/j.tvjl.2009.12.014

Crossley KC. Novel therapy for canine OA pain gains momentum in global markets. 

. October 16, 2025. Accessed December 5, 2025. 

https://www.dvm360.com/view/novel-therapy-for-managing-canine-oa-pain-gains-momentum-in-global-markets

Crossley KC. Long-acting drug for reducing canine OA pain receives European marketing authorization. 

. November 26, 2025. Accessed December 5, 2025. 

https://www.dvm360.com/view/long-acting-drug-for-relieving-canine-oa-pain-receives-european-marketing-authorization

International Renal Interest Society. IRS staging of CKD. International Renal Interest Society. 2023. Accessed December 5, 2025. 

https://static1.squarespace.com/static/666b9ecb4064a156963b4162/t/66a6dbc90ca6986e1b5c06bd/1722211273243/2_IRIS_Staging_of_CKD_2023.pdf

The monoclonal antibody from Zoetis previously received marketing authorization in Europe.