Learn how IDEXX is enhancing the lives of animals, people, and the planet.

IDEXX: Contributing to something bigger

A woman shows her dog's teeth to a virtual veterinarian during a mobile telehealth appointment. 

A new mobile app by Vetster provides an alternative way for veterinary professionals to treat patients. The Vetster for Veterinarians app, compatible with Android and iOS devices, is an extension of the company’s fast-growing telehealth and pet care marketplace business and complements its’ existing web-app. The new app is available for veterinarians practicing on Vetster through the App Store and Google Play Store.

“Vetster is building the solutions veterinarians need to practice virtually—on their terms,” said Mark Bordo, CEO, and cofounder, Vetster.com, in an organizational release. “Our new mobile app is one more way we can provide veterinary professionals with a flexible platform to connect with pet parents in between appointments, traveling between clients, or from the comfort of home. With just a few taps on their mobile phone, veterinarians connect with pet parents with great video quality, and easy-to-use scheduling and follow-up features.”

A surge in pet adoption combined with a veterinary workforce shortage expected to continue until at least 2040 has left many veterinarians seeking alternative ways to meet demand, while also improving their work life balance.

 Fulfilling a gap in the market, the new platform affords veterinarians the ability to determine where, when, and how they practice, according to Vetster. Vetster veterinarians use the platform to provide tele triage, address nonurgent cases, and provide follow-up appointments, while offering proactive and preventative health care plans for pet owners.

According to the company, many veterinary professionals using Vetster are supplementing their incomes and alleviating student debt.

 “Vetster is helping to address both the barrier to access and the overwhelming demand for veterinary care,” said Jo Myers, DVM, a practicing Vetster professional, in the release. “For veterinarians looking to practice virtually, the Vetster platform provides a seamless user experience, with a user-friendly interface, high-quality video and the ability to capture medical records in-app.”

Designed for veterinarians, the app features the following

High quality video calls from an iOS or Android device.

Improved appointment management that allows users to set their own hours and pause availability to accommodate unexpected schedule changes.

Direct messaging functionality that allows veterinarians to correspond with clients after appointments to provide any additional support.

Electronic medical records for patients are captured and stored in-app for convenient referencing by both veterinarians and clients.

In the US, veterinarians can use VetsterRx powered by PetMeds to prescribe prescription and nonprescription medication that can be delivered directly to the client. In Canada and the UK, veterinarians can use the built-in prescription pad to provide an Rx or OTC recommendation that clients can fill at their local pharmacy.

Veterinarians can join Vetster by visiting its’ website and registering online. Once approved to practice on the Vetster platform, the Vetster for Veterinarians mobile app can be downloaded.

Vetster launches mobile app for veterinarians practicing virtually. News release. Vetster. November 17, 2022. Accessed November 23, 2022. 

https://www.prweb.com/releases/2022/11/prweb19024525.htm

Hot job! Shortage of veterinarians expected to last for years as pet ownership increases. 

. September 14, 2021. Accessed November 23, 2022. 

https://financialpost.com/fp-work/hot-job-shortage-of-veterinarians-expected-to-last-for-years-as-pet-ownership-increases

Articles

The Vetster for Veterinarians app is compatible with Android and iOS devices. 

New mobile app designed for virtual veterinary practice

Alongside every veterinarian is a veterinary technician to help care for our pets. Using their technical and scientific knowledge, they assist with tasks such as taking a medical history, preparing instruments and pets for surgery, performing laboratory procedures, grooming, and much more. In honor of National Veterinary Technician Week (October 16-22), 

 featured Michael Lark, CVT, and Deena Torres, CVT, LVT, veterinary technicians with Banfield Pet Hospital. They sat down with Adam Christman, DVM, MBA, the host and dvm360®’s chief veterinary officer, to share insights into their field, the current scope of the industry, and how Banfield supports their needs and careers.

Lark and Torres emphasized that patients are at the forefront of why they return to the hospital every day. “I think I speak for anyone who owns a pet that pets are like your family member,” said Lark, who cannot recall a time in his life when he did not own a pet. As bonds form with patients and clients, they work with their team to provide high-quality care for pets.

This quality is critical as there is a higher demand for veterinarians and veterinary technicians. To help meet the demand, technician appointments have grown within the industry over the past few years. Doctors can focus on patients that are sick or have underlying problems, while technicians can focus on the wellness components of a visit. “...I want to be utilized to my fullest capacity,” said Torres. “Everything the doctor wants me to do, I always want to meet expectations.”

Becoming credentialed and maintaining their education allows veterinary technicians to continue to support veterinarians. If technicians are licensed in multiple states, they must know the differing laws for each one. Banfield helps their technicians by providing online resources and textbooks for anything they need a refresher on. They also help cover costs for their exams. Whether someone has a lot of experience or is just starting out, there is support to expand on skills critical for the job.

Technicians may advance their careers by taking on a supervisory role or by obtaining specialized certifications. They then have a more hand-in-hand working relationship with doctors. “[Banfield] encourages us to take on different roles, and whatever we feel comfortable in doing.... As vet techs, we could specialize in surgery.... We could also advance to being field directors; we could be practice managers,” Torres said. These career milestones add to the scope of being a veterinary technician.

However, it can be a challenge to find a job with a work-life balance and one with a safe environment for advocacy. Torres describes herself as a mom and a wife. Lark emphasizes the value of a positive and safe space as someone who is part of the LGBT and Black community. Both technicians believe they have found the animal hospital for them with Banfield’s accommodating nature for scheduling—for example, when something happens and you need to pick the children up from school—and emphasis on creating an inclusive workplace.

Being an integral part of the veterinary team, and bringing constant compassion to those they work with, can be stressful. At the end of the day, remembering why they became veterinary technicians keeps Lark and Torres motivated. “...We’re here for the pets. And it’s always very rewarding to come in every day at work and help these doctors treat these sick animals and take off the caseload for them to help these families,” said Lark.

Torres praised fellow technicians in the field for all the effort and hours put into loving their patients. “What we do, no one else does.... It’s rough at times, and it’s fulfilling most of the time. And we all love it.” With this attitude and resilience, pets everywhere are in great hands with veterinary technicians.

Two credentialed technicians share what they love about their career and the veterinary industry.

dvm360 Live! celebrates veterinary technicians

, or wherever you get your podcasts. This episode is sponsored by Nationwide.

On this episode of The Vet Blast Podcast, Adam Christman, DVM, MBA, welcomes back June Long, DVM, to answer some common spay neuter complication questions.

Below is a partial transcript. Listen to the full podcast for more.

: For me personally, and I am sure it differs depending on the surgeon, the most difficult [spay] would be a fatty spay no matter how big the dog is. I have had like Chihuahuas and Yorkies and they are so difficult because of their condition so everything is slippery, everything wants to rip, and I really have to take my time with those and I also watch them very closely post-op as well. As far as the type of spay I have seen that is a little more tricky when it comes to post-op complications, particularly hemoabdomen, are pregnant spays because all the vessels are bigger, you have to really tighten your ligatures, really tie to make sure you are getting that hemostasis. In post-op, the uterus is gone so everything shrinks so then your ligatures aren't always as tight as they were when you left them.

Podcasts

Dr. June Long answers your questions on spay/neuter complications 

Your spay/neuter complication questions answered

Happy Thanksgiving from dvm360®! To celebrate this occassion and make sure your pets stay safe this holiday, we have spotlighted 3 relevant pieces of content. Here's some advice on making your Thanksgiving happy and healthy:

 to share with pet owners to keep everyone healthy and happy this Thanksgiving. Her tips cover managing guests, pet-safe food, clean-up, and more.

 by limiting fear, anxiety, and stress with these helpful work-life boundaries you can set with family and friends.

Get in the holiday spirit and express gratitude with Sue Ettinger, DVM, DACVIM (Oncology), and Adam Christman, DVM, MBA, as they share 

how to set the perfect Thanksgiving table

To celebrate Thanksgiving this year, here are 3 holiday articles and videos

3 must reads for Thanksgiving

Rabbit endotracheal intubation can be scary and challenging. However, what if I told you it is easier than you think? What if I told you the only thing preventing you from doing it is the lack of a proper tool?

If you are reading this article, chances are you are seeking a solution to a problem you already have. You want to stop losing rabbits during anesthesia. That feeling in your stomach when the nurse tells you the rabbit stopped breathing is overwhelming. Having to tell the client their pet just passed away and you are not sure what happened is soul crushing. It makes you want to give up.

I am here to show you a different perspective, in hopes that you will see a solution to your problem, one that will enable you to persist with your passion for rabbit medicine and surgery. After all, we all deserve to do what makes us happy. However, there will be a little bit of tough love first.

First things first: We need to agree that endotracheal intubation should always be the standard of care. Not intubating a rabbit patient, in my opinion, is substandard medicine, and I would even go as far as to call it malpractice. I know, it sounds harsh, but you too know it to be true.

Let’s engage in a quick exercise that will allow you to see my point of view. Let’s change the word “rabbit” to the word “dog.” Imagine this was an article about anesthetizing a female dog for a spay, and I tried to convince you that anesthesia would be faster and easier if you just “masked the dog down” instead of taking the time to secure an airway with an endotracheal tube. “Don’t worry about intubation; dogs are known for dying under anesthesia; it is to be expected.” How would you react to that? Would you agree with me and proceed, or would you start writing a letter to the editor immediately, stating how absurd it is to have a publication recommending such a careless procedure?

Inhalant anesthesia (eg, isoflurane) is known to be hypotensive as anesthesia duration increases. We also know that ventilation will be compromised with anesthesia and positioning, even if the patient is breathing voluntarily, and will inadvertently lead to hypercapnia and hypoxemia. It is a known recipe for disaster, and we still engage in it. I will be the first to admit I have done it for years, and for years I blamed the species “rabbit” instead of my lack of skills, not to mention the health hazard of having environmental inhalant gas contamination. It didn’t even cross my mind that I could be the culprit until I lost a young rabbit during an orchiectomy. This was the way I had seen it done every time by really experienced colleagues. I was just repeating something without questioning it, even in the face of bad outcomes. The point is, it is not the rabbit’s fault—it is our naivety in expecting a different outcome. I am also not here trying to convince you that intubating rabbits is as easy as intubating dogs. There is a learning curve, and you do need additional equipment. However, I am here to tell you it is a short learning curve, and the lack of clinical skills should not be a reason to compromise patient care.

Last, but not least, there are other variables that will dictate the success of the anesthesia, such as having intravenous access; the use of multimodal anesthesia, including constant rate infusions to reduce isoflurane minimum alveolar concentration;

 heat support; and adequate premedication. Success will also depend on monitoring, including blood pressure, temperature, electrocardiogram (ECG), endtidal carbon dioxide, and partial pressure
of oxygen.

Now that we have established that rabbit endotracheal intubation is possible, let’s examine some key considerations.

General considerations (do not skip any steps)

To ensure the procedure is successful, always have all equipment ready to go and make sure you have all emergency drugs and reversals calculated—consider having glycopyrrolate, epinephrine, and reversals in predrawn syringes. Heavy sedation is highly recommended and will allow smooth placement of an intravenous catheter and less reliance on induction agents and inhalant anesthesia. Provide preoxygenation, because it reduces the risk of hemoglobin desaturation and hypoxemia during the induction process.

 Always connect the patient to monitoring devices prior to intubation (eg, ECG, pulse oximeter), and have a designated person to monitor anesthesia during intubation. That person should not be doing anything else but monitoring the patient: no fetching syringes, no holding the patient. They do nothing but monitoring.

Make sure to provide proper induction of general anesthesia. This is by far one of the main reasons people have difficulty intubating. Many challenges come from a patient that is not appropriately induced (too light) and is therefore chewing and moving, and with a strong jaw tone. For this technique to work, jaw tone needs to be absent, which means in your choice of induction agent you need to take this into account. “Masking a patient down” with inhalants, as we have previously discussed, is not an appropriate induction method and will not allow proper time for intubation, especially for the untrained clinician.

I understand there is a concern about inducing the patient properly, because there is an innate risk of apnea, and we are afraid we will not be able to intubate on time or intubate at all. The solution to this problem is simple: Always have the rabbit supraglottic airway devices available in all sizes. Those are good to have as a crutch. They are simple to place and allow you to properly ventilate the patient.

 They will not replace endotracheal intubation in all circumstances and can be difficult to maintain in place depending on the procedure. Therefore, it is still paramount that one becomes comfortable with intubating a rabbit patient.

On that note, it is important to highlight the need for capnography. This is the most important tool to guarantee you have properly intubated your patient, and to monitor carbon dioxide levels during the procedure. Just because a patient is breathing on their own, it does not mean they are ventilating properly, and you might need to breathe for them in cases of hypercapnia, which will allow you to have an uneventful anesthesia. In addition, when using a supraglottic airway device, capnography is a must. No skipping steps here.

Lastly, I want to cover some aspects that might make you nervous in the beginning. Don’t pressure yourself to intubate in a few seconds, or even in less than a minute. If you are following all the steps and the patient is being prop- erly monitored, you have some time. When you take a bit longer to intubate, your team might just need to repeat the induction agent titrating to effect; don’t be afraid to fail on your first attempts to intubate. I was not able to intubate the first 3 rabbits on my own. It is a learning curve for everybody and it will not be different for you. Expect failure, while guaranteeing patient safety, and do not give up. 

Don’t be so afraid of laryngospasms if you are following the technique as described here. As long as you are being delicate and seeing what you are doing (we will discuss the use of an endoscope later), you should be fine. Because you can see the larynx at all times, you will be able to tell if it is becoming inflamed or edematous. Lidocaine sprayed on the larynx will also help with that.

Don’t be afraid to abort the procedure. We always pressure ourselves so much with being perfect and not failing. It is OK to abort the procedure if you must. Patient safety comes first. In the beginning, I always had this conversation in advance with the owners. Set up expectations and you will not have issues.

Finally, practice on cadavers first. The learning curve to using the equipment can be completely addressed in cadavers. That way, you will be confident and comfortable with the equipment when you have a real patient. Cadavers can be purchased (preferably from sources that acquire cadavers that were euthanized in shelters or different institutions), or you can request permission from owners when you have an euthanasia case. Set yourself up for success. Practice as much as you can on the cadavers. Become familiar with your landmarks, positioning the patient, and handling and using the scope. With all of that in place, you will be more confident and less anxious when intubating your patients.

I have laid out the reasoning and considerations for learning rabbit endotracheal intubation. Stay tuned for part 2 in an upcoming issue, in which we will discuss the technique, equipment, and process.

Laila Proença, DVM, PhD, MV, MSc, DACZM

, has always been passionate about veterinary medicine. She is the first South American veterinarian to become a diplomate of the American College of Zoological Medicine, with an emphasis on zoological companion animals. She is coeditor of the 2015 exotic endoscopy issue of Veterinary Clinics of North America: Small Animal Practice, and has been actively participating in the zoological medicine community, leading wet labs and giving national and international lectures, courses (including on endoscopy), and masterclasses.

Barter LS, Hawkins MG, Pypendop BH. Effects of fentanyl on isoflurane minimum alveolar concentration in New Zealand White rabbits (Oryctolagus cuniculus). 

. 2015;76(2):111-115. doi:10.2460/ajvr.76.2.111

Schnellbacher RW, Carpenter JW, Mason DE, KuKanich B, Beaufrère H, Boysen C. Effects of lidocaine administration via continuous rate infusion on the minimum alveolar concentration of isoflurane in New Zealand White rabbits (Oryctolagus cuniculus). 

. 2013;74(11):1377-1384. doi:10.2460/ajvr.74.11.1377

Tearney CC, Barter LS, Pypendop BH. Cardiovascular effects of equipotent doses of isoflurane alone and isoflurane plus fentanyl in New Zealand White rabbits (Oryctolagus cuniculus). 

. 2015;76(7):591-598. doi:10.2460/ajvr.76.7.591

Johnson DH. Endoscopic intubation of exotic companion mammals. 

. 2010;13(2):273-289. doi:10.1016/j.cvex.2010.01.010

Comolli J, Schnellbacher R, Beaufrere H, et al. Comparison of endoscopic endotracheal intubation and the v-gel supraglottic airway device for spontaneously ventilating New Zealand White rabbits undergoing ovariohysterectomy. 

. 2020;187(10):e84. doi:10.1136/vr.105746

An expert demystifies rabbit intubation to ensure these animals can receive the same standard of care as cats and dogs

Rabbit endotracheal intubation: Yes, you can do it (Part 1)

Melissa King, PharmD, director of manufacturing at Epicur Pharma, dives into the proposed USP guidlines on beyond-use dates. To learn more about this topic, read her article that appeared in the November 2023 issue of 

Drug expiration dates: Information your practice needs for less risk, higher margins

Below is a partial transcript. See the full video above for more:

: The United States Pharmacopoeia (USP) will be changing, or has proposed changes, to beyond-use dates on regularly compounded 503A products, those beyond-use dates are significantly shorter than what they previously were. And they also do not allow the pharmacy to establish longer dates, even if they have sufficient evidence to prove or support a longer beyond-use dates. That's going to lead to a lot of issues, specifically with prescriptions that are acute or one-off prescriptions. And unfortunately, they keep pushing off these regulations. However, it does seem at some point they're gonna go forward with them. So, it's important for veterinarians and even the pharmacies to be very mindful of how we're going to move forward, once these changes go through.

Videos

Melissa King, PharmD, explains the difference between beyond-use dates and expiration dates and how upcoming USP changes may impact inventory

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