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The American Veterinary Medical Association (AVMA) announced earlier this week that the 2021 AVMA Convention will go virtual for the second year in a row amid ongoing coronavirus disease 2019 (COVID-19) restrictions and concerns.

“After thoughtful deliberation regarding the current status of the COVID-19 pandemic and careful consideration of all factors involved, the AVMA has decided to transition the 2021 AVMA Annual Convention originally scheduled to take place in Minneapolis to a completely virtual event,” said Lori Teller, DVM, DABVP, AVMA board chair, and Jon Pennell, MS, DVM, AVMA house advisory committee chair, in an email to the AVMA House of Delegates.

, the board of directors said their decision to go virtual was based on prioritizing the safety and well-being of attendees, speakers, and partners.

“We are a science-based, one-health organization, and the science continues to tell us that COVID-19 remains a serious public health concern,” the Board wrote in an email to the AVMA House of Delegates. “We care deeply about everyone that joins us for Convention each year, and our decision is based on serving the best interests of all attendees.”

Registration for the convention, which will be held online-only from July 29 to August 1, 2021, opens up on April 19, 2021. For more information about this annual event, go 

Articles

AVMA board executives decide to make this convention an online-only event due to ongoing COVID-19 concerns and restrictions.

The 2021 AVMA Convention goes virtual for second year in a row

We know how hard you work to provide the highest quality of care to your furry, feathery, or scaly patients each week. That's why we are dedicated to keeping you up to date with the latest industry news and headlines.

Jumpstart your weekend with this week's highlights:

recalls an incident that involves a lame horse, his cowboy owner, 

and a mistake that paid off in a mysterious way. 

Digital Empathy's CEO Robert Sanchez offers invaluable advice for 

implementing successful social media strategies at your practice

Watch this video featuring Get MotiVETed cofounder and relief veterinarian Quincy Hawley, DVM, 

who explains why changing your perspective is one of the primary building blocks to improving your well-being.

brand-new episode of The Vet Blast Podcast

, second-year veterinary student Christian Capobianco reflects on the magical moment that sparked his passion for zoological and exotic veterinary medicine. 

help promote operational excellence at your practice.

News wrap up: This week's veterinary headlines, plus a magical journey to wildlife medicine

Disney World is considered one of the most magical places on earth, and rightfully so. For second-year veterinary student Christian Capobianco, this enchanted place ignited his passion for zoological medicine.

On this episode of The Vet Blast Podcast, Capobianco shares more about his magical path to zoological and wildlife medicine and offers words of wisdom to pre-veterinary students.

“I remember distinctly the first time I knew I wanted to become a veterinarian, and it actually happened at Disney’s Animal Kingdom,” he tells Adam Christman, DVM, MBA.

Years ago, during a family trip at Disney World, Copbianco watched veterinarians perform a procedure on a lion at Rafiki’s Planet Watch in Animal Kingdom. That’s when the lightbulb went off for him. “From then on out, I was like, I’m going to become an animal doctor, and I’m going to work with those wild and weird creatures that no one else wants to work with,” he says.

When Capobianco, a native of Long Island, New York, was a junior in high school, he decided to attend North Carolina State University’s College of Veterinary Medicine due to its accredited exotics program. His family, in support of his pursuit, moved to North Carolina.

After receiving his undergraduate degree in Animal Science, Capobianco says he had a 6-month window before starting veterinary school and decided to apply for Disney’s veterinary and conservation education internships. He was convinced he would be selected for the veterinary scholarship but instead was selected for the conservation education one. At first, he was disappointed but soon realized it was the best thing that could have ever happened to him. The lesson learned? Not everything goes as planned, but in the end, your dreams can still come true.

Capobianco’s piece of advice to stressed pre-veterinary students uncertain about their future is to take it easy and trust that things will work out the way they’re supposed to. As far as applications go, he recommends highlighting what makes you stand out.

“I was one of those pre-veterinary students who—like many in the veterinary realm—was Type- A. I needed all my applications to be perfect and all my experiences documented,” he says. “You need to remember that they are seeing a lot of applications when you apply to school. So, you need to find that one thing that makes you special and different and make sure to hit on that in your application.”

Listen below for more on Capobianco’s magical path to zoological medicine, plus a fun fact about him.

Podcasts

On this episode of The Vet Blast Podcast, Dr Christman is joined by second-year veterinary student Christian Capobianco who reflects on the life-changing experience that inspired him to become a wildlife veterinarian and offers useful advice to pre-veterinary students.

Episode 48: A magical journey to zoological medicine

Heart disease is a common condition seen in daily practice. To help you continue to provide the highest quality of care to your cardiology patients, we've selected 3 informative articles that provide valuable information on a wide array of heart-related topics.

From how to detect cardiac tumors to an introductory guide to reading ECGs, there's something for everyone to enjoy. Happy reading! 

: Although rare in animals, cardiac tumors can cause life-threatening complications. Since presenting clinical signs in patients with cardiac tumors are usually nonspecific, a low level of suspicion often hampers diagnosis. Take a closer look at the considerations for the use of echocardiography for evaluating suspected tumors located in the heart.

: Congenital defects that affect the canine heart have hallmark signatures traceable on puppy exam

 Find out why it's crucial that you understand the subtle differences 

Reading ECGs in veterinary patients: an introduction

: Veterinary cardiologist Meg M. Sleeper, VMD, DACVIM (cardiology), explains why understanding the basic electrical principles of the heart

Check out these articles offering insight on congenital defects, cardiac tumors, and more. 

3 Must-reads on veterinary cardiology

Scott Neabore, DVM (images courtesy of Neabore Veterinary Clinic; photographer: Amanda Hall)

Like many new graduates, I started my career in veterinary medicine with a 1-year small animal medicine and surgery internship. I followed that up with 3 years as an associate veterinarian at a corporate practice. Early on, I realized that building lasting relationships with clients and their pets was the best way for me to provide high-value, individualized veterinary care.

Although there were some benefits to working for a corporate practice, I often felt hindered by the many things that were out of my control. I decided to take a leap and go solo.

In May 2019, just 4 years after graduating from Cummings School of Veterinary Medicine at Tufts University in North Grafton, Massachusetts, I opened my own independent veterinary practice, Neabore Veterinary Clinic, in Haddonfield, New Jersey. It wasn’t easy, but as we near the 2-year mark with about 1800 clients, I couldn’t be more sure that I made the right choice—both personally and professionally.

Here’s how I started my own practice from scratch.

Your “why” is your purpose—the thing that drives you. My why for starting a veterinary clinic was being able to practice medicine and business on my own terms. I also wanted to work as a small business owner in the community in which I lived. Knowing my why helped me develop a mission statement. This dictates everything we do as a business, from how we designed our exam rooms to what we post on social media and how staff members interact with clients.

I made sure I was in a good financial position

After making my first few student loan payments, I got a sinking feeling when I realized that fully half of my monthly salary was going toward paying back $200,000 in student debt. My wife and I quickly decided that paying off my student loans would be our top priority before doing anything else. It was a team effort: We cut expenses, lived on a meager monthly budget, and liquidated nearly all of our previous nonretirement savings and investments. I picked up lucrative emergency department shifts, often working weekends and overnights, on top of my regular general practice hours. My wife, a freelance writer, picked up extra gigs too. Through the experience of aggressively paying down student loan debt, I gained confidence and financial discipline that allowed me to quickly build up cash for startup costs and helped eliminate some of the financial stress and uncertainty around starting a business.

There are plenty of things to stress over when starting a veterinary clinic. Your personal finances shouldn’t be one of them. Before even thinking about taking the leap into practice ownership, I paid off nearly $200,000 in student loans. To keep interest from accruing on my business loan, I held off from borrowing as long as possible during the planning and construction process. I did this by investing about $30,000 of my own money into the business and banking another $40,000 to live off during the first few months of self-employment. As a startup, I prepared to go several months without drawing a salary. I took my first paycheck in month 5.

After initially considering a location in a strip mall next to a big-box store that would have provided good exposure and lots of space to grow, I decided on a smaller, more intimate storefront. It’s on the old main street that connects the walkable, vibrant business districts of 3 neighboring towns. I felt like this space better fit my why.

I designed the clinic to be clean, welcoming, and bright with features such as a big picture window in the main exam room. There are also many personal touches throughout the hospital, such as portraits of staff pets in the lobby created by a local artist.

Employee salary and benefits are a major expense. That’s why I started small—just me and 2 experienced technicians. I have since hired a third technician. We have no receptionist. We work around this with in-room, mobile checkouts. All 4 of us book appointments and answer the phone. Clients are pleasantly surprised when the doctor picks up.

I developed a (simple) marketing strategy

My marketing strategy is simple. Be good to people, and they’ll be good to you—and tell all their friends. Satisfied clients share recommendations with other local families by word-of-mouth and through social media. They give us 5-star reviews that have helped to enhance our online visibility. I share educational and entertaining social media posts via Facebook and Instagram several times a week. We promote other local businesses, and they promote us. Our paid advertising includes print and online ads in two local newspapers.

I’m proud of the business I’ve created in just a few years out of school. Practice ownership has perhaps become less common among recent grads than it once was, but for me the experience has proven extremely rewarding. I hope my story inspires other aspiring business owners. After all, spending your career working for someone else doesn’t have to be a foregone conclusion in veterinary medicine.

 in Haddonfield, New Jersey. He is also a board member of the 

Independent Veterinary Practitioners Association

I started my own practice 4 years after graduating from veterinary school. Here’s how.

 From new grad to veterinary practice owner

Diabetes occurs in dogs and cats and can be a frustrating disease to manage. During a recent 

virtual conference, Heather Kvitko-White, DVM, DACVIM, founder of KW Veterinary Consulting and 

, discussed key points veterinarians and pet owners should know about diabetes to make disease management as smooth as possible.

For canine patients, the presence of hyperglycemia and glucosuria is usually sufficient to diagnose diabetes. To avoid a delayed diagnosis when sending samples to an external laboratory for analysis, Kvitko-White recommends that an in-house blood glucose level be performed on all patients presenting with polyuria/polydipsia.

Diagnosing diabetes in cats is a bit more challenging. Kvitko-White notes that even blood glucose levels in the 400-mg/dL range might occur from transient stress hyperglycemia, making hyperglycemia and glucosuria alone unreliable for making the diagnosis. Even the presence of ketonuria does not confirm the diagnosis. In cats, a fructosamine level is the most reliable way to confirm the diagnosis.

Insulin therapy is the cornerstone of diabetes management in veterinary patients, so choosing the best insulin for each patient is crucial. Veterinarians should consider the insulin’s duration of action (short-, intermediate-, or long-acting), patient size and species, the owner’s ability to administer insulin and monitor the patient, and anticipated costs to the owner. Initial dosing should be based on the patient’s lean body weight and insulin type.

Kvitko-White discussed her personal preferences for insulin in patients of various sizes and species:

 Lente insulin (Vetsulin; Merck Animal Health) is an intermediate-acting insulin approved for use in dogs and cats. Vials should be replaced every 42 days.

 Insulin detemir (Levemir; Novo Nordisk) is a highly potent, long-acting insulin. This allows smaller doses for large patients, contributing to cost savings over time.

 Insulin glargine (Lantus; sanofi-aventis). Kvitko-White noted that published recommendations often list Vetsulin or ProZinc (Boehringer-Ingelheim) as the preferred insulin types because they are FDA-approved, not because they have superior control in cats.

The cost of insulin, especially the long-acting insulins such as detemir and glargine, can be alarming for some pet owners. Kvitko-White said that because vials of these insulins can be used for 6 months, owners of large dogs and cats will save money over time despite the higher up-front cost. For large dogs, shorter-acting insulins require higher doses, requiring frequent replacements, sometimes more than monthly. For cats, shorter-acting insulins are less effective and need to be replaced more frequently because of their shelf-life.

An alternative insulin for small- to medium-size dogs whose owners are cost conscious is generic NPH insulin. This is not Kvitko-White’s first choice for any patient as its duration of action is on the shorter side, typically only 4 to 10 hours. Because of this, diabetic control might be difficult to achieve, and the insulin sometimes needs to be dosed every 8 hours. However, these vials can be kept refrigerated for 30 to 60 days before needing replacement.

“When you diagnose a pet with diabetes, you have to prescribe 3 things: insulin, syringes, and a prescription diet,” Kvitko-White said. Diabetic diets are low in carbohydrates, especially simple sugars. They use complex carbohydrates and fiber to slow digestion. The goal of these diets is to minimize fluctuations in blood glucose, improve satiety, minimize pancreatitis risk, and promote weight loss.

Meal-feeding is important for dogs receiving short- to intermediate-duration insulins. They should consume at least half of their meal before receiving their insulin dose. For meal-fed dogs, snacks are OK if they are limited to less than 10% of the total caloric intake and are given in consistent amounts and at consistent times. Ideal snacks include apples, carrots, green beans, low-fat proteins, and sweet potatoes.

Dietary modification is crucial for feline patients to reach a remission state. Their diet should be high in protein and low in carbohydrates. For cats on long-acting insulin such as glargine, meal feeding is not necessary and grazing throughout the day with small, frequent meals may be ideal due to glargine’s slow onset of action. Canned food is preferred to dry food as it has more moisture and protein, which promotes satiety and weight loss.

The role of blood glucose curves in monitoring

Kvitko-White knows monitoring is “the frustrating part” of diabetes management. Just as there are numerous insulin options for veterinary patients, there are also many monitoring strategies. Her preference is to use blood glucose curves as the primary monitoring method obtained in the traditional way or by using continuous blood glucose monitoring systems, including the FreeStyle Libre system (Abbott). Curves allow identification of when the nadir occurs, how low the blood glucose goes at the nadir, the insulin’s duration of action, and average glucose during the day. The first curve should be performed within 1 to 2 weeks of starting insulin.

In an ideal curve, blood glucose should be measured before feeding and insulin administration and then every 2 to 3 hours throughout the day depending on the type of insulin. Ideally, the patient is fed in the hospital and the veterinary team can observe the owner administering the insulin to ensure there are no errors. Because not all patients will eat in the hospital, some patients need to be fed and given their insulin immediately before arriving at the hospital. As far as how long we need to continue measurements, “In reality,” Kvitko-White said, “we need to find the nadir and 2 points on the upswing” before stopping the curve.

Because the timing of the nadir is unpredictable, spot glucose checks are unreliable values to use when adjusting insulin doses. In a shorter-acting insulin, such as NPH, the nadir can occur as early as 1 to 3 hours after dosing. For longer-acting insulins, such as detemir and glargine, a nadir may not occur at all or may occur immediately before the next dose.

At-home monitoring with AlphaTRAK (Zoetis) or 

 (Trividia Health) may be a good option for some owners. This may reduce the effect of stress hyperglycemia and can provide more data points if a 24-hour curve is needed. Kvitko-White does not recommend that owners use an at-home monitoring system to adjust insulin doses on their own, so owners should be selected carefully for this type of monitoring.

Other monitoring strategies such as fructosamine levels and urine glucose monitoring, can be used in some cases as ancillary diagnostics, but they cannot replace the wealth of information gained from a properly performed blood glucose curve.

Once data are collected through a blood glucose curve, the insulin dose can be adjusted. For patients who are underdosed, increase the dose by no more than 10% to 20% at a time. All dosing increases should be based on data. Kvitko-White reminded practitioners that pets that are experiencing a Somogyi effect due to insulin overdose can be just as clinical as an uncontrolled, underdosed patient, so clinical signs alone should not be used to adjust dosing.

For patients in which an overdose is suspected or proven, decrease the dose by 25% to 50% at a time. In extreme cases, some patients need to be taken off insulin for short time. The veterinarian may want to consider changing insulin types when insulin therapy resumes.

Clear communication is crucial to successful diabetes management. Preparing owners about what to expect at the time of diagnosis is the best way to establish a strong working relationship. For all pets with diabetes, it is important to stress the importance of insulin therapy. As of now, no oral medications will control blood sugar in veterinary patients.

Dog owners need to know that, with rare exceptions, diabetes—and thus insulin therapy—are forever. In most cases, owners should be prepared for initial control to take 4 to 6 weeks to achieve. But monitoring doesn’t stop there. “Insulin dose is not a shoe size,” Kvitko-White said, adding that requirements will change over time, making routine, long-term monitoring a necessity. Additionally, owners should be prepared for sequelae such as diabetic cataracts.

Education for cat owners should focus on the goal of reverting the pet to a non–insulin-dependent state. Dietary management and insulin therapy are both crucial components of treatment. Some cats, especially those whose diabetes is due to iatrogenic steroid use, can enter remission in as little as 2 weeks, making close monitoring essential.

Finally, Kvitko-White said, it is important for owners to hear that, “if an owner can’t commit to [insulin therapy] financially or they can’t commit to the time commitment of giving insulin twice a day every day for the rest of their pet’s life, it is OK to euthanize.”

“Diabetes is hard,” Kvitko-White said. Management can be frustrating, but she encourages practitioners to be patient. “I’m a big proponent of collecting data,” she said, because “we cannot predict how a certain insulin will act” in an individual patient.

When patients are not responding as expected, veterinarians should first check client adherence. How is the insulin being stored, handled, and administered? How old is the vial? What diet is the pet eating, and how is the pet being fed? If diabetes control remains elusive despite client adherence, she encourages veterinarians to not be afraid of changing insulin.

2018 AAHA Diabetes Management Guideline for Dogs and Cats

 are a great resource. Finally, she says: “Don’t forget to reach out to specialists. Sometimes you just need to hear someone else’s experiences.”

Kate Boatright, VMD, a 2013 graduate of the University of Pennsylvania, is a practicing veterinarian and freelance speaker and author in western Pennsylvania. She is passionate about mentorship, education, and addressing common sources of stress for veterinary teams and recent graduates. Outside clinical practice, Boatright is actively involved in organized veterinary medicine at the local, state, and national levels.

Successful management of diabetes in veterinary patients requires patience, data, and an individualized approach.

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IDEXX: Contributing to something bigger

Nominations now open for dvm360®/VHMA Practice Manager of the Year award