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

IDEXX: Contributing to something bigger

Monique Y. Wells, VMD, MS, was set on being a veterinarian from a young age, but when she began her journey at the University of Pennsylvania School of Veterinary Medicine,  doubts of this pursuit began surfacing. However, when she persevered into her second year, she instantly fell in love with the niche field known as pathology. 

On this episode of The Vet Blast Podcast, Wells shared with Adam Christman, DVM, MBA, what ignited her passion, plus the nuts and bolts of being a toxicologic pathologist. 

“[What resonated with me in pathology] was getting to the bottom of things, so the exploration of the ‘final answer’ as to what was making an animal ill or dead, but also...what I knew about pathology at the time which was doing biopsies and necropsies and things like that. Just the visual aspect of it was so compelling to me," Wells said. 

Wells then touched upon the toxicology aspect of her career and how she focuses on understanding harmful chemicals. 

“Toxicology in the industry is focused on the development of chemical products…and all of those things that have a potential of causing harm, the toxicologic pathologist is looking at those entities—those chemicals—and seeing how much of them are required to cause harm, how they cause harm, and whether those harmful things can be reversed after a certain period of time.”

Listen below to hear more about Well's fascinating career and discover how she has been using it as a platform to help propel veterinary medicine in developing countries.

Podcasts

On this episode of The Vet Blast Podcast, Monique Y. Wells, VMD, MS, shares what inspired her to pursue veterinary toxicologic pathology, what her career entails, and more. 

A day in the life of a veterinary toxicologic pathologist 

One tool that Renee Machel, certified life coach, mindfulness and meditation guide, and cofounder of 

, uses in her day-to-day to help fight stress is practicing mindfulness. In a recent interview at the Fetch dvm360

 Kansas City conference, Machel broke down why mindfulness can be a helpful practice for stressed-out veterinary professionals.

“Mindfulness detaches you, in a way from being entangled or trapped from this stream of thoughts, these emotions that have a grip on us, these patterns of behavior that keep us in loops which oftentimes do not serve us,” Machel informed dvm360

“We have thoughts or beliefs or patterns of behavior that we have just because that is what we have always done and when we become mindful, we get to stop and say ‘Does this really serve me,’” she continued.

 By practicing mindfulness, Machel believes veterinary professionals can fight the day-to-day stress often faced in and out of the clinic by viewing the problem in a new light.

“[Mindfulness] can help other veterinary professionals because it stops that downward spiral of negative experiences, be it emotions, physiological effects from stress,” Machel indicated.

“It is a way we can hack our physiology and it is a way we can become more aware of our to our experiences but more importantly our responses to that because our response in life dictates what happens next,” she continued.

To learn more about the benefits of mindfulness, watch the full video below.

Videos

Renee Machel, cofounder of GetMotiVETed, sheds light on how (and why) practicing mindfulness can help curb stress and negativity in and out of the workplace. 

Why mindfulness matters

The tragic wildfires during the 2019-2020 Australian summers are estimated to have killed or displaced nearly 3 billion native animals.

 interview, Phil Tucak, BSc, BVMS, shared that since then, organizations have provided assistance to rehabilitate affected areas and have undertaken conservation programs to help impacted threatened species. 

“On Kangaroo Island, various organizations such as the Kangaroo Island Land for Wildlife have been working with the national Australian Wildlife Conservancy organization to develop…the Western River Refuge and this is really important for 1 species in particular which is a critically endangered little small mammal called the Kangaroo Island Dunnart," Tucak said.

"There’s been promising progress already…and it will also benefit several other wildlife species as well,” he added.

Tucak then noted that Sydney and Victoria were also impacted by the fires and have been receiving help from several organizations including NSW Wildlife Information, Rescue and Education Service Inc. (WIRES).

“There [was] a lot of donations at the time of the fires and so [WIRES has] been progressively funding different initiatives to help various wildlife conservation projects and that’s been ranging from helping wildlife groups to [animal] caretakers to veterinarians…and trying to set up a lot of systems so that way if anything like this happened again, that there’d be a lot more support in place,” he said.

For more of Tucak’s knowledge on how Australia is restoring its wildlife, watch the full video below.

Australia’s fires ‘killed or harmed three billion animals.’ 

. July 28, 2020. Accessed September 16, 2021. https://www.bbc.com/news/world-australia-53549936

In a recent interview, Phil Tucak, BSc, BVMS, offered an update on the strides Australian organizations have been taking to restore and protect wildlife affected by the 2019-2020 wildfires.

Stepping up to the plate: Australia works to restore wildlife impacted by wildfires

Vet’s Best Friend (VBF)—a group of veterinary practices located in the Northeast—is hosting a mental health talk for veterinary professionals in the New Jersey suburbs. Headlined by Kimberly Pope Robinson, DVM, the free event will not only extend support to battling burnout and stress within the industry, but will also offer attendees 2 Continuing Education (CE) credits in an engaging way.

“Vets have a demanding job to begin with, and with the added-on stresses of COVID-19 precautions, we want to make sure everyone has the tools to manage anxiety and also take care of themselves outside of the hospital setting,” said Cheryl Brocki, DVM, VBF’s vice president of veterinary relations, in the company release.

“We’ve teamed up with Dr. Kimberly Pope-Robinson, a well-known veterinarian, author of 

, and dynamic speaker to discuss her own path toward self-forgiveness, resilience, and maintaining a fulfilling career in the industry,” added Brocki.

The event will take place on Tuesday, September 21 from 6:00 pm to 8:00 pm EDT at the Seasons 52 in Cherry Hill, New Jersey (located at the Cherry Hill Mall), making it accessible to industry professionals in New Jersey and Philadelphia. Additionally, attendees are welcome to complimentary food and drinks, plus have the opportunity to network with the VBF operations and talent acquisition teams.

VBF's efforts in prioritizing its employees' mental health reflect the company's core mission to "take care of the people who take care of our pets.” According to the release, a few wellness initiatives VBF is rolling out includes a company-wide wide yoga series at the end of this month and additional regional discussions. Each team member is also provided free mental health counseling and above industry-standard paid time off and benefits.

Additionally, with the added challenges brought on by the COVID-19 pandemic, VBF stands firm on its dedication to exploring new options for promoting the mental health of its staff and the greater veterinary industry.  

Vet’s Best Friend to host mental health discussion for veterinary professionals. News release. September 9, 2021; Vet’s Best Friend. Accessed September 16, 2021. [email].

Articles

This free New Jersey event offers a suite of informative and engaging material headlined by a renowned industry well-being speaker and coach, plus offers the opportunity to earn 2 CE credits.

Vet’s Best Friend to host in-person mental health discussion

Cancer is the leading cause of death in dogs over 2 years of age and remarkably, 1 in 4 dogs will develop cancer in their lifetime. Pet owners and their families are urgently looking for new and better treatment options that not only extend their companion’s life, but also improve the quality of life. This article discusses a novel immunotherapy for dogs with osteosarcoma (OSA).

Osteosarcoma (OSA) is the most common primary bone tumor seen in dogs. Other bone tumors (chondrosarcoma, fibrosarcoma, hemangiosarcoma, metastatic tumors) are possible, but much less frequent. OSA most commonly occurs in middle-aged dogs, although there is a small population of dogs that will develop it at a young age of 1 to 2 years old. The cause of this cancer is unknown, but clearly there appears to be a genetic component. The most commonly affected breeds include Saint Bernard, Great Dane, Golden retriever, Labrador retriever, Scottish deerhound, and Rottweiler. Other proposed causes include microscopic injury to bones in young growing dogs, metallic implants, and trauma. OSA occurs most commonly within the distal radius, followed by the proximal humerus, distal femur, and proximal tibia; however, this cancer can develop in any bone. In dogs, OSA is characterized by destructive primary tumor growth, the presence of microscopic spread in up to 90% of cases at the time of diagnosis, and an aggressive course of disease progression with metastasis to the lungs in less than 1 year in untreated dogs.

The current standard of care treatment approach for OSA consists of local control (surgery) and systemic control (chemotherapy). Since most OSAs are located in the appendicular skeleton (aka the “long bones” of the limbs), full limb amputation is typically recommended. In certain cases, a limb-sparing surgery may be possible, where only the affected portion of the bone is removed and is reconstructed with another bone (allograft) or metal spacer (endoprosthesis). This type of surgery is generally reserved for patients with OSA affecting the distal radius and is associated with a high rate of post-operative complications (implant failure, infection, and tumor regrowth).

Stereotactic Radiotherapy (aka SRT, Stereotactic Radiosurgery/SRS, Cyberknife)

A non-surgical limb-sparing option is also available using radiation therapy, called stereotactic radiosurgery, and this can be used for OSA in any location. Stereotactic radiotherapy involves the precise application of >1000 beams of radiation aimed from various different angles in order to deliver a high dose of radiation to a designated tumor target, all while sparing the surrounding tissues (such as the skin). In some cases, such as Cyberknife, this treatment may be given by a robotic delivery system. Complications of stereotactic radiation therapy include fracture from radiation-induced bone necrosis and tumor regrowth. The early data was quite promising documenting survival times similar or better to that with amputation and chemotherapy, however, more recent studies suggest this may not be the case, with survival outcomes similar to those achieved with standard palliative radiation therapy.

The best outcomes for dogs with OSA to date have been for those undergoing amputation followed by chemotherapy. Numerous chemotherapy protocols have been evaluated. Two studies suggested the best outcomes are achieved with a protocol consisting of 6 doses of carboplatin, given as intravenous injections every 3 weeks. Other commonly used protocols include a 4-dose course of carboplatin, alternating carboplatin and doxorubicin (3 doses of each), or doxorubicin alone (5 doses every 2 to 3 weeks). Side effects with such chemotherapy protocols are typically predictable, manageable with supportive therapies, and occur with rather low frequency. The financial commitment for chemotherapy for a large breed dog is not inexpensive and often approaches $4000-6000, depending upon geography.

For dogs whose owners elect not to pursue definitive therapy, general palliative care measures may include analgesics such as tramadol, gabapentin, and amantadine, non-steroidal anti-inflammatory drugs (NSAIDs) such as carprofen, deracoxib, or piroxicam, and alternative approaches such as acupuncture. Radiation therapy can also be used in a palliative setting, typically given in lower overall doses than that used for stereotactic radiotherapy. Protocols available include the administration of 2 sequential treatments on back to back days or once weekly treatments for 3 to 4 sessions. The huge majority of dogs will derive some analgesic benefit from radiation within the first 1 to 2 weeks, but typically only for a period of a few months. Oftentimes patients undergoing radiation therapy are also given bisphosphonates, which are “bone filler” medications administered as IV infusions and aimed at reducing bone destruction and pain.

The median survival time for dogs undergoing surgical tumor removal followed by conventional chemotherapy for OSA is approximately 10 to 12 months, with a 1-year survival rate approaching 50%. The 2-year survival rate for dogs undergoing surgery and chemotherapy ranges from 15-20%, depending upon the study referenced. Dogs that undergo radiation therapy +/- bisphosphonates/chemotherapy typically have survivals in the 4 to 8-month range, while dogs that do not undergo cancer-specific therapy typically are humanely euthanized due to uncontrolled pain within 1 to 2 months of diagnosis.

Negative prognostic factors include higher body weight (giant breed dogs), elevated alkaline phosphatase (ALP – measure of bone destruction on serum chemistry screen), elevated white blood cell counts, and proximal humerus location. Dogs with tumors arising on the mandible, ulna, and metacarpals/metatarsals/digits tend to have a slightly lower metastatic risk and longer survivals with aggressive therapy. With the increasing amount of research being devoted to adjuvant immunotherapies, the goal of veterinary oncologists has become to increase the proportion of long-term survivors, all the while ensuring that each patient maintains an excellent quality of life both during and after therapy. Surely, we have more to learn and there is plenty of room to improve patient outcomes.

NOVEL IMMUNOTHERAPY (ELIAS Cancer Immunotherapy (ECI®) (ELIAS Animal Health))

There is now a novel treatment option for canine OSA called ELIAS cancer immunotherapy (ECI®). ECI is a patented vaccine-primed adoptive cell therapy which targets the patient’s specific cancer. Autologous cancer cell vaccines are used to condition the immune system (T cells) to recognize the cancer neoantigens. Vaccine-primed T cells are harvested at apheresis for 

expansion and activation. Activated killer T cells are administered by IV infusion.

Data from a single-site, single-arm, open-label prospective trial of vaccine enhanced ACT using low-dose IL-2 in client-owned dogs with OSA at the University of Missouri Veterinary Health Center (MU-VHC) was recently published. The study was designed to determine the safety and efficacy of this immunotherapy as a treatment for dogs with OSA. It was hypothesized that dogs with OSA could be treated safely by 

-activated T-cells that were generated by autologous cancer vaccination and supported by low-dose IL-2 treatment, and that dogs would survive more than twice as long as reported for amputation alone. The primary endpoint of the study was survival fraction beyond 268 days (twice that of amputation alone) in a single-stage phase II assessment according to a previously described method. Eighteen dogs were assessed for eligibility with 4 excluded at screening (pulmonary metastasis n=3, bone metastasis n=1) leaving 14 dogs to enroll. All dogs underwent amputation and excised tumor tissue was used to create the autologous vaccine which was subsequently administered intradermally to all 14 dogs. Three dogs were excluded from the study post vaccination (safety evaluation n=1, pulmonary metastasis n=2). Eleven dogs underwent leukapheresis and mononuclear cell products were stimulated ex vivo with a T-cell-activating agent. Activated product was transfused and 5 subcutaneous IL-2 injections were administered q48h. Dogs were monitored for metastasis by thoracic radiography every 3 months.

Toxicity was minimal after premedication was instituted before activated cell therapy. With premedication, all toxicities were grade I/II, however, it is important to note that serious infusion reactions requiring medical management can occur (eg, cytokine release syndrome). The median disease-free interval for all dogs was 213 days. Median survival time for all dogs was 415 days with 5 dogs surviving >730 days (range 523-731). Interestingly, one dog developed cutaneous metastasis but then experienced spontaneous complete remission.

The median survival time of 415 days for dogs treated with amputation and immunotherapy in this study was longer than previously reported survival times using amputation and four-dose carboplatin. Here’s what the company says: “We (ELIAS) brought the technology over from a human health company with the hopes that we would be able to significantly improve the survival times and quality of life for dogs being treated for cancer. What’s really cool about the work we are doing is the relationship between human cancers and canine cancers. We believe our work will change the way canine and human cancers are treated in the future.” – CEO Tammie Wahaus. The study showed that 50% of dogs treated with ECI survived beyond one year and 36% survived beyond two years. Key experts in the field of veterinary oncology are impressed by the results from early study on this novel therapy: “I really think that there is strong evidence that the ELIAS procedure benefited these dogs substantially and on average, based on that median survival. I will also point out that every single piece of the ELIAS immunotherapy process is extremely well supported in the scientific literature across multiple species.” – Dr. Jeffrey Bryan

. “The T cell expansion is a huge component that to my knowledge, none of the other autologous products are even trying to replicate.” – Dr. Zachary Wright 

Although the early data is quite promising, one must keep in mind the small number of cases in the original study. Having said this, a large prospective randomized trial comparing the outcomes of dogs receiving adjuvant carboplatin vs. ECI has recently completed enrollment. If similar results are demonstrated, it is these authors opinion that ECI could become the new standard of care for canine OSA. ■

: Autologous prescription Product, Code 95A7.50 (unlicensed by USDA) and is pending full licensure. ECI is distributed as an experimental product under 9 CFR 103.3. For use under supervision/prescription of a licensed veterinarian. A randomized pivotal trial (Carboplatin vs ECI) has recently completed accrual and data is maturing.

Culp WTN, Olea-Popelka F, Sefton J, et al. Evaluation of outcome and prognostic factors for dogs living greater than one year after diagnosis of osteosarcoma: 90 cases (1997–2008). 

Fan TM, Charney SC, de Lorimier LP, et al. Double-Blind Placebo-Controlled Trial of Adjuvant Pamidronate with Palliative Radiotherapy and Intravenous Doxorubicin for Canine Appendicular Osteosarcoma Bone Pain. 

Farese JP, Milner R, Thompson MS, et al. Stereotactic radiosurgery for treatment of osteosarcomas involving the distal portions of the limbs in dogs. 

Knapp-Hoch HM, Fidel JL, Sellon RK, et al. An Expedited Palliative Radiation Protocol for Lytic or Proliferative Lesions of Appendicular Bone in Dogs. 

Martin TW, Griffin L, Custis J, et al. Outcome and prognosis for canine appendicular osteosarcoma treated with stereotactic body radiation therapy in 123 dogs. 

Liptak JM, Dernell WS, Ehrhart N, et al. Cortical allograft and endoprosthesis for limb-sparing surgery in dogs with distal radial osteosarcoma: a prospective clinical comparison of two different limb-sparing techniques. 

Flesner BK, Wood GW, Gayheart-Walsten P, et al. Autologous cancer cell vaccination, adoptive T-cell transfer, and interleukin-2 administration results in long-term survival for companion dogs with osteosarcoma. JVIM 2020 https://doi.org/10.1111/jvim.15852

Selmic LE, Burton JH, Thamm DH, et al. Comparison of Carboplatin and Doxorubicin-Based Chemotherapy Protocols in 470 Dogs after Amputation for Treatment of Appendicular Osteosarcoma. 

Skorupski KA, Uhl JM, Szivek A, et al. Carboplatin versus alternating carboplatin and doxorubicin for the adjuvant treatment of canine appendicular osteosarcoma: a randomized, phase III trial. 

a Quotes are from a recent KOL roundtable sponsored by ELIAS

A novel immunotherapy for dogs with osteosarcoma is discussed.

Canine Osteosarcoma: Teaching an Old Dog New Tricks

Josh Herrman, AIA, DBIA, collaborating with designers and builders (Photo courtesy of Hutton).

 talk, Josh Herrman, AIA, DBIA, and Matt Byrum, AIA, LEED AP, explained that choosing which project delivery method to use is one of the key decisions to make when remodeling or building a hospital, as it affects many aspects of the project. They described it as “the combination of contract types and relationships used to take a new building or remodel from the first idea to final inspection.”

Typical project delivery methods in commercial construction include design-bid-build (DBB), construction management at-risk (CMAR), and design-build (DB). Herrman and Byrum insist that DB is the best approach. Learn about these options, and why Herrman and Byrum prefer DB.

Three most common project delivery methods

Led by an architect or engineer and occurring in 3 unique phases, DBB is a “traditional mainstay in the construction industry,” according to Herrman. The owner has a minimum of 2 contracts: One with the architect/engineer and one with the builder. This is most commonly awarded to “low bidder.” A differentiating factor of this method is that the architect/engineer seeks bids from general contractors (GCs) and those GCs choose the subcontractors they feel are best (usually the lowest bid to the GC). Typically the owner has no say in the subcontractors selected, nor what they really cost. Then the architect/engineer oversees the construction phase.

Construction management at-risk—“a service”

CMAR offers you more control. You still have 2 contracts to manage–1 with the architect and 1 with the builder–but 

 choose the GC up front, and they act as a partner, said Byrum. The CMAR often provides preconstruction services prior to bids. In addition, the construction manager is “at risk,” as they present a guaranteed maximum price (GMP) and accept the loss if the project goes over budget. Though you have a closer relationship with the GC, you are also banking on both architect and builder to work closely with each other for a successful result.

DB involves having only 1 contract because your designers, builders, and anyone else involved with the project all collaborate under 1 contract. This saves time and money, and ensures a highly collaborative, smooth, and stress-free process.

DB is the oldest and fastest-growing delivery method in the United States

 and that is no coincidence, noted Herrman and Byrum. Owners are spreading the word and sharing the benefits of this method, such as some of the ones listed below, with friends and associates.

Herrman and Byrum stressed that though DB is a type of contract, what distinguishes it is the mindset and attitude it generates. The designers and builders communicate effectively to serve your needs, including your budget and schedule. Additionally, DB enables you to make confident decisions and facilitates clear communication regarding results for the intended outcome.

There is value in signing 1 contract for a large investment according to Herrman and Byrum. DB projects often result in fewer changes, fewer claims, and less litigation. DB contracts decrease the risk associated with delegating responsibility to various project partners and provide the GMP assurance of the CMAR delivery method.

cited by Herrman and Byrum demonstrated that projects using DB are completed an average of 61% faster than CMAR and 102% faster than traditional DBB. Instead of separating the project into 3 phases (designing, bidding, and building), DB allows the 3 phases to be intertwined, speeding up the overall project timeline. Herrman and Byrum also mentioned that the days it often takes to communicate between multiple companies are reduced to hours and minutes with DB as all the project leaders are from the same firm.

Oftentimes, architects draw up a whole project unsure if the design is in line with the budget. On bid day, the design cost is often higher than the budget, Herrman and Byrum said.

Contrarily, a design-builder puts your budget first while designing and can work in office with estimators, materials experts, interior designers, and construction managers. DB also offers built-in accountability and built-in checks and balances, according to Herrmann and Byrum. This avoids you being overwhelmed by an architect who comes up with a design that is way over budget for you; thus, you can start the process off with confidence in your budget.

Building or remodeling a hospital is no easy feat but choosing DB as the project delivery method can help simplify the process and allow the hospital of your dreams to come to fruition. As there are various other components to this type of project, Herrmann and Byrum recommended that attendees check out the 

Design-build utilization: combined market study. FMI Corporation/Design Build Institute of America. June 2018. Accessed September 10, 2021. https://dbia.org/wp-content/uploads/2018/06/Design-Build-Market-Research-FMI-2018.pdf

New research shows design-build continues to deliver project most efficiently. 

 blog. November 9, 2018. Accessed September 10, 2021. 

https://dbia.org/new-research-shows-design-build-continues-to-deliver-project-most-efficiently/

dvm360® hospital design toolkit. dvm360®. November 2015. Accessed September 10, 2021. 

https://cdn.sanity.io/files/0vv8moc6/dvm360/6dc8f53ced8560e444468993927c66823f0a2dae.pdf

Three of the most common project delivery methods explained, plus why choosing design-build is the way to go. 