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dvm360 hosts second virtual recruitment event

There are times in practicing veterinary medicine that you just need to stop and think for a bit about the patient you are examining. It is during these moments that a little peace and quiet would be nice.

For me, unlocking the mystery of upper hind end lameness in a horse often requires a tremendous amount of contemplation. I enjoy these cases, but have been known to just sneak off to my office for a few minutes to assimilate the accumulated clues to make a logical decision about what the problem is or what should be done. The more difficult the case, the more quiet I require.

One of my clients is a 5-foot barrel racer who has some world-class horses and is a blast to be around. When Tera shows up with a lame horse, it usually and requires my full concentration. The problem is…Tera is a talker.

When I say she is a talker, I mean this little gal can’t stand a moment of silence. It is almost like she has a pathologic aversion to being in the presence of others with no conversation occurring. She will see to it that something is being said at all times, largely by asking questions. This means that you have to be involved in the process of stamping out quiet with her.

One particular day found me working up a very difficult lameness case for her. I was digging deep into my gray matter trying to piece together the clues to why her 7-year-old gelding was 0.3 seconds off, but the answer was slow in coming. Every time I began to ponder the results of the last portion of the exam, she would sense that things were too quiet and hit me with a volley of questions.

The last thing I wanted to do, of course, was hurt her feelings by asking her to be quiet, so I began looking around for something that would occupy her for a little while as I thought about the problem at hand. She was rambling on about some horse she had ridden 10 years ago that acted a little like this one when it occurred to me that her constantly moving hands were a vital part of her talking arsenal. I began to wonder if the talking would stop if I could somehow still those hands.

As she entered her fifth or sixth paragraph about the horse from 10 years ago, I simply handed her an empty syringe case. She never stopped talking or moving her hands; she simply accepted the case and continued on with the story without so much as a comma. Next, I handed her an empty bottle of carbocaine, which she gladly accepted with her other hand and just rolled right on with the story.

This was actually getting kind of fun. I was beginning to wonder how many things she would hold before she actually looked down to see what they were. So, I handed her a hoof tester, which is used to determine the location of a painful area in the foot of a lame horse. The tester was heavier than the other items and Tera had no readily empty hand to hold it in. This stopped the chatter momentarily, but she simply took the instrument and placed it under her left arm and continued on with the story.

I maintained eye contact with her and made occasional head movements to make her feel as if I was listening intently, all the while handing her more things: an earpiece from an otoscope that was sitting on the counter, then an extension set (still in the package), followed by a digital thermometer and the case it came in. She was still going with the story but her tempo had slowed just a bit. It was now becoming almost impossible to move her hands, which obviously was causing the conversation cortex in her brain to sputter a bit.

I stopped handing her stuff for a second to see if she would notice all the things she was holding for me. Nope. Time to hand over some more. There was little room left to accept things. She had arranged them in various places to make holding them easier, but still had no idea what she was holding. I handed her a package of 2-0 Vicryl suture material, still in the plastic, then a pair of rubber gloves I had just taken off. Not enough? How about a 3-inch stack of 4×4 gauze?

Finally, Tera lost all ability to move her hands. She was now holding enough stuff that she had to mash some of it between her arms and tummy. When this happened, all talking came to a standstill. But she still had not looked to see all I had given her.

A few moments passed with no noise coming from either of us. I just stood there looking at her and finally couldn’t maintain a straight face. She asked what I was giggling about.

“Thanks for holding all that for me,” trickled out the corner of my now laughing mouth. When she looked down to assess what she was holding, Tera started laughing, too. Pretty soon we were both laughing so hard that others in the clinic came over to find out what was going on.

“I guess you figured out that I can’t talk if I don’t move my hands. Well, I was just getting to the good part of that story when you handed me all this stuff,” she said as she started setting it all down on the counter.

“Oh no!” I bellowed before she could get her hands empty. “You have to hold all that until I have had enough quiet time to figure out what is wrong with your horse. Then you can set it all down and start telling me the story again!”

Every time she comes to the clinic now, I greet her with an armful of meaningless stuff and tell her if she can’t be quiet, she is going have to hold it all until I am done.

Bo Brock, DVM, owns Brock Veterinary Clinic in Lamesa, Texas. His latest book is 

Crowded in the Middle of Nowhere: Tales of Humor and Healing From Rural America

Articles

When a client won’t stop talking for long enough to allow you complete your diagnostic evaluation, sometimes you have to resort to strange measures.

Quiet, please!

Merck Animal Health has completed its acquisition of US rights to Sentinel Flavor Tabs (milbemycin oxime/lufenuron) and Sentinel Spectrum Chews (milbemycin oxime/lufenuron/praziquantel)—products that target common intestinal parasites, according to a 

The announcement comes less than 2 months after Merck Animal Health and Virbac agreed on a price tag of about 

With this acquisition, Merck now offers a comprehensive range of products that address the seven most common parasites that affect dogs: ticks, fleas, roundworms, hookworms, whipworms, tapeworms, and heartworms.

“Our veterinary medicines, including parasiticides, and vaccines continue to transform the animal health industry and further solidify our position in the US Companion Animal category,” said Merck Animal Health President Rick DeLuca, in the release.

For more information about this acquisition, visit 

With the completion of this deal, Merck Animal Health now offers products that address all of the most common internal and external parasites affecting dogs. 

Merck completes acquisition of Sentinel parasite products

Nutrition is a common topic in veterinary practices, and rightly so. A pet’s nutritional needs change over time, and both age and health should play a role in diet selection. Diet trends are constantly evolving for both people and pets, and some of today’s owners are looking for a more “natural” alternative to kibble or therapeutic diets — namely raw, homemade, and vegan diets.

It’s important to be able to discuss both the positive and negative aspects of these types of diets with your clients so they are knowledgeable about the nutrients their pets need for optimal health. Due to the complexity of some patients’ health care needs, general practitioners may consider referral to a veterinary nutritionist as needed.

Some raw meat–based diets (RMBDs) are marketed as “complete and balanced,” and meant to serve as the sole source of nutrition without supplementation of other proteins into the diet.

Others are not marketed as complete or balanced, so they are typically fed as a rotation product rather than as the main diet. Both of these diet types are available commercially in fresh, frozen, and freeze-dried forms. In addition, pet owners can purchase individual raw diet ingredients rather than a branded diet.

Most clients feeding their pet a raw diet use a combination of RMBDs and traditional ingredients (eg, yogurt, eggs).

 This allows for supplemental feeding of carbohydrates, fiber, vegetables, and other sources of nutrition the pet needs.

In a 2019 survey study, 94% of 218 dog owners who fed their pets RMBDs named a shinier coat, increased muscle mass, and cleaner teeth as the primary improvements observed in their pets.

 These owners, the majority of whom used the internet as their primary source of information about RMBDs, said they believe raw foods are “absolutely safe” for dogs.

There are no scientific data to support the proposed benefits of feeding an RMBD over commercial kibble or a homemade diet. Data comparing raw vs. cooked meals in performance dogs showed a difference of less than 1% in protein availability.

 There is some published evidence of increased digestibility of specific raw diets compared with other specific diet types, but the practical advantage of this is unclear.

According to the Centers for Disease Control and Prevention, about one in six Americans becomes sick each year from contaminated foods or beverages, and 3,000 die.

Pets fed an RMBD may shed bacteria in their feces for up to 2 weeks after eating a contaminated product.

The risk to owners who feed RMBDs to their pets is highest when storing and handling the food, handling the pet’s feces, and using kitchen equipment to prepare pet meals.

 Because many owners are unaware of the risks involved, it is important to discuss them, especially when there are children, elders, or immunocompromised people living in the home. Pet owners should follow these guidelines

Thaw RMBD products in the refrigerator (maximum temperature of 50 °F), not on the counter.

Handle all RMBD products separately from food for human consumption.

Because RMBDs do not undergo proper treatment to reduce pathogenic organisms, the biggest concern surrounding them is the bacterial load they carry. Additionally, slaughter during feed processing poses a risk for high bacterial transmission as well. As a safety precaution, many veterinary practices segregate hospitalized pets on RMBDs from the rest of the patient population. Some hospitals refuse to store or handle RMBDs at all.

The presence of zoonotic bacterial and parasitic pathogens in RMBDs may be a source of infection for both pets and their owners. The pathogens found most commonly in a 2018 study were 

In a 2019 study, the most common bacterial overload in RMBDs was that of 

 These researchers identified several studies that found pathogenic bacteria in RMBDs did not pose a risk to the canine immune system, unless the immune system becomes compromised by some other mechanism.

 Other studies report that this is a myth, however, and that animals repeatedly exposed to diets high in bacteria will and have become compromised and sick.

Because there is insufficient published evidence to support feeding RMBDs, many veterinary nutritionists do not recommend them, particularly for young pets and those that are immune compromised. Concerns about feeding an unbalanced and incomplete diet remain at the forefront of most research.

Owners may choose to feed their pets a homemade diet for a number of reasons, including mistrust of commercial diets. These diets may also be recommended by nutritionists for patients with comorbid conditions, including chronic kidney disease, diabetes mellitus, gastrointestinal disease, and cancer. Rechecks are often recommended 1 month after introducing a homemade diet, and any modifications should be reviewed with the veterinarian for best success.

Homemade pet food recipes can be found online, in magazines and books, and from veterinarians themselves.

 As with RMBDs, most pet owners get their guidance about homemade pet foods from nonveterinary sources.

 Unless they are formulated properly, however, homemade diets may not provide balanced and complete nutrition for the pet. Proper formulation relies on the provider and the owner preparing the food.

The advantages of feeding homemade diets are seen primarily in patients with conditions for which gut health is of most importance, such as chronic diarrhea or vomiting, diabetes, and cancer. In some cases, feeding a homemade diet has been noted to strengthen the human-animal bond.

 Client discussions about these diets should focus on the importance of essential nutrients (protein, fat, minerals, trace minerals, and vitamins). In cats, taurine should be supplemented as well.

 Neither cats nor dogs require carbohydrates, although carbohydrates may serve as a source of energy and help improve gastrointestinal health. Gut health is often what interests pet owners about homemade diets.

An analysis of 200 published home-prepared recipes for adult maintenance in dogs written by both veterinarians (64.5%) and non-veterinarians (35.5%) revealed at least one essential nutrient deficiency, according to National Research Council (NRC) or Association of American Feed Control Officials (AAFCO) guidelines, in the majority of diets.

 Another study of 27 homemade recipes for dogs with cancer found that none met all NRC or AAFCO nutrient recommendations for adult maintenance.

Nutritional secondary hyperparathyroidism has been reported in both cats and dogs consuming unbalanced homemade diets; clinical signs include spontaneous fractures, muscle twitching, seizures, and limb deformities.

 The nutrients that have been noted most frequently to be absent in homemade diets include calcium, phosphorus, and vitamin D, the lack of which may cause tetanic seizures, hyperthermia, and humeral osteochondritis dissecans.

 Due to their rapid growth, puppies and kittens are generally more susceptible to nutrient deficiencies than are older dogs. Owners should be advised to consult with a veterinary nutritionist regarding proper formulation of homemade diets, particularly for pets with chronic or terminal illness.

In the United States, about a quarter of vegan pet owners are interested in making a similar dietary change for their pets.

 Providing a complete and balanced vegan diet for pets can be challenging, however, because it requires that plant-based protein sources be fed to animals that rely on carnivorous proteins.

There are no real advantages to feeding dogs or cats a vegan diet because these diets may be deficient in a number of nutrients these pets need. In a study published earlier this year, four commercial vegan diets (three for dogs and one for cats) were found to be deficient to varying degrees in calcium, potassium, phosphorus, protein, and arginine.

Taurine deficiency was observed in the diets due to the high concentration of soybean meal. Whether this may lead to such cardiac abnormalities such as 

 is currently being studied. In addition, plant-based proteins have been shown to have lower digestibility compared with animal proteins, although this was not studied in this paper.

Some of the diets studied had copper and zinc concentrations higher than the limits allowed by the AAFCO and NRC. Copper transition can sometimes lead to oxidative damage such as liver cell abnormalities or cell death. One diet had iron supplementation above European Pet Food Foundation upper limits.

Low calcium levels and a calcium-to-phosphorus ratio below the minimum recommendation may result in secondary nutritional hyperparathyroidism in dogs and cats; none of the diets studied met the minimum requirements for this ratio.

 This is a very important consideration to make when feeding young and growing animals as well.

For owners interested in feeding their pets a raw, homemade, or vegan diet, it is incumbent on veterinarians to review the formulation for nutritional adequacy, advise the client, and/or refer the client to a veterinary nutritionist. Ask about feeding at home and educate owners about changes that may be needed to help create a healthy lifestyle for their pets. Based on available evidence, vegan, raw, and homemade diets are not recommended for long-term use in pets at this time. Further study is needed with regard to diet formulation and ingredient substitution.

Dr. Rinelli joined Mount Laurel Animal Hospital in December 2017. Her interests in veterinary medicine include surgery, behavior medicine, and rehabilitation. Dr. Rinelli is a member of the American Veterinary Medical Association, the American Society for Prevention of Cruelty to Animals, and the Veterinary Orthopedic Society.

1. Larsen J. Raw food diets for cats and dogs. Presented at: American College of Veteirnary Internal Medicine Forum; 2018; Seattle, WA.

2. Morelli G, Bastianello S, Catellani P, et al. Raw meat-based diets for dogs: survey of owners’ motivations, attitudes and practices. 

https://doi.org/10.1186/s12917-019-1824-x

3. Schlesinger DP, Joffe SJ. Raw food diets in companion animals: A critical review. 

4. van Bree FPJ., Bokken GCAM, Mineur R, et al. Zoonotic bacteria and parasites found in raw meat-based diets for cats and dogs. 

5. Hellgren J, Hästö LS, Wikström C, et al. Occurrence of 

6. Cline MG. Home prepared diets for health and disease. Presented at: Atlantic Coast Veterinary Conference; 2017; Atlantic City, NJ.

7. Burns KM. Alternative and raw food diets. Presented at: American College of Veteirnary Internal Medicine Forum; 2012; New Orleans, LA.

8. Stockman J, Fascetti AJ, Kass PH, Larsen JA. Evaluation of recipes of home-prepared maintenance diets for dogs [published correction appears in 

. 2013;242(11):1500-1505. doi:10.2460/javma.242.11.1500

9. Heinze CR, Gomez FC, Freeman LM. Assessment of commercial diets and recipes for home-prepared diets recommended for dogs with cancer. 

 2012;241(11):1453-1460. doi: 10.2460/javma.241.11.1453

10. Tomsa K, Glaus T, Hauser B, et al. Nutritional secondary hyperparathyroidism in six cats. 

. 1999;40(11):533-539. doi:10.1111/j.1748-5827.1999.tb03015.x

11. Kawaguchi K, Braga IS, Takahashi A, 

. Nutritional secondary hyperparathyroidism occurring in a strain of German Shepherd puppies. 

12. Hutchinson D, Freeman LM, McCarthy R, et al. Seizures and severe nutrient deficiencies in a puppy fed a homemade diet. 

. 2012;241(4):477-483. doi:10.2460/javma.241.4.477

13. Zafalon RVA, Risolia LW, Vendramini THA, et al. (2020) Nutritional inadequacies in commercial vegan foods for dogs and cats. 

https://doi.org/10.1371/journal.pone.0227046

14. CDC and Food Safety. Centers for Disease Control and Prevention. Published June 25, 2020. Accessed August 2, 2020. 

https://www.cdc.gov/foodsafety/cdc-and-food-safety.html#:~:text=CDC%20estimates%20that%201%20in,than%20%2415.6%20billion%20each%20year

A look at the advantages and disadvantages of raw, homemade, and vegan diets for dogs and cats.

  What you need to know about today’s veterinary diet trends 

COVID-19 turned my vision of veterinary school upside down. I had imagined classroom lectures, hands-on experience at our small and large animal hospitals and, of course, relying on my lab partner to have completed the pre-lab readings. And that’s mostly what was happening until everything came to an abrupt halt a few months ago. My veterinary education went from eight hours of classes at the University of Pennsylvania School of Veterinary Medicine to Zoom video conferences from my apartment.

On March 11, my university sent us an email that our campus would be closing due to COVID-19. Everyone in my lecture hall was shocked to say the least. We eventually received an official email from the dean stating how school would be run in the coming months. In the midst of all of this, I had a radiology midterm the next day because veterinary school is fast paced with little time for interruptions.

A “normal” day at school no longer existed. All of my lectures began at 9:00 am, sometimes 10:00 am. I had my alarm set for 7:40am on weekdays to allow ample time to get ready, make breakfast and feed my guinea pigs. Most mornings I found myself rushing out of my bed in a panic to scramble some microwaveable oatmeal together and set up my laptop in my living room. The rest of my morning involved sitting in my apartment on Zoom and annotating lectures on my iPad while eating breakfast and having my guinea pigs on my lap for some company.

We were always given a 10 minute-break between each lecture. I tended to use that time to slowly, but surely finish getting ready for the rest of my day. These 10 minutes used to be spent chatting with friends and classmates and stretching to try and keep the blood flowing.

While I had more time to focus on my schoolwork, like busting out study guides and practice questions, and updating my bullet journal, I missed socializing with my friends. I realized that I really enjoy being an on-campus student. I truly missed being able to go to happy hours and vent about our lives as veterinary students and just socializing with people.

All the work that comes with veterinary school was hitting me like a truck, even with added time of not having to go anywhere. Life-work balance did not exist. How could I focus on getting through the pandemic when I had all of these exams coming up? The short answer was, I just had to focus solely on taking these exams and forget about 

After day three of this, I started to get cabin fever and needed to go outside for a walk. Thankfully I had a close friend who would come with me to walk their dog. We stayed six feet apart through the neighborhood of University City in West Philadelphia. Going outside to just walk and take in fresh air was essential to my sanity. Sometimes, I would walk by myself or run, just to have something to look forward to each day during the Philadelphia stay-at-home order.

Aside from all the usual school stress, there was now this added anxiety of managing the little amount of money I had. Not to mention, stores were running out of essential supplies and I was literally just trying to figure out what was going on with the world!? Trying to use studying as my escape from all that anxiety was not feasible, as my concentration waned, and my stress-eating ramped up. I would ask myself, ‘Can I pay rent next month?’ or ‘I hope my Wi-Fi works efficiently given how much I use it for my education now—an education that I pay tens of thousands of dollars for in addition to being an out-of-state student from New York.’ I could just feel the cortisol tearing my body apart day by day, and I didn’t even have an infection to fight off.

With the world falling apart (as it seems), I thankfully have been able to keep looking on the bright side. These series of events made me rethink a lot about life and what’s important. Thankfully, I have a roof over my head, my family is healthy and the opportunity to study at an amazing university for my veterinary education. People have also reassured me that things will get better. I’m thankful for my classmates. Everyday we’ve been communicating and providing support to one another. This crisis has likely brought us even closer. The current pandemic is in fact something we are trained for in veterinary school under the OneHealth objective, and we cannot wait to help the world in the years to come.

A veterinary student shares some of the challenges he faced with virtual learning and social isolation during the pandemic.


Thoughts on online learning during COVID-19

COVID-19 has challenged businesses of all kinds across the country. Throughout the pandemic, veterinary practices have responded with innovative strategies to continue providing patient care, retain staff, maintain cash flow, and operate more efficiently — all while also donating personal protective equipment to our colleagues in human medicine and implementing strict guidelines to keep teams and clients safe.

Many veterinary business owners have made use of the federal government’s forgivable COVID-19 loan program, the Paycheck Protection Program (PPP). In fact, more than half of all US veterinary practices have benefited from PPP, according to data from the US Small Business Administration (SBA), which oversees the loans. This funding has played a key role in supporting veterinary care and keeping practices open during the COVID-19 pandemic.

Veterinary use of PPP: What the data show

AVMA analysts examined the SBA data on allocation of PPP funds as of July 6, and cross-referenced it with AVMA data on veterinary practices. Among the key findings:

— about 56% of practices nationwide — have used PPP loans as part of their strategy to maintain cash flow and keep their doors open during the pandemic.

more than 200,000 veterinary team members

More than 80% of the loans taken by the veterinary profession were for

PPP funds have been distributed among veterinary practices 

, plus the District of Columbia, Guam, Puerto Rico, and the Virgin Islands.

 as of early July. Although the SBA data aren’t detailed enough to calculate the exact total, AVMA’s economists estimated it based on the range of SBA data, which made clear that the loans totaled at least $1.6 billion and possibly as much as $2.6 billion.

AVMA economists also looked at geographic differences in PPP loan use, and connected that with our own research into COVID-19-related business strategies for veterinary practices and data on the incidence of COVID-19 nationwide. Here’s what we saw:

States with the highest rates of COVID-19 cases generally had higher rates of PPP loan borrowing.

States that got hit with COVID-19 later generally had fewer practices taking out PPP loans — less than a 50% borrowing rate compared with 80% elsewhere. That means these states may need more support in the future.

PPP is a loan program for small businesses that was created to provide relief from the economic impacts of COVID-19. It offers forgivable loans to cover up to 24 weeks of qualified expenses, including payroll costs (up to $100,000 per employee), mortgage interest payments, rent, and utilities. To have loans forgiven, at least 60% of the money must be used for payroll costs. Borrowers can choose which non-payroll costs to submit for forgiveness.

The loans have a fixed interest rate of 1% for any amounts that aren’t forgiven. Payments on principal, interest, and fees are deferred until the SBA makes its forgiveness determination for each loan and notifies the lender. Interest will accrue during this time.

When PPP was first introduced, most applications came from businesses in states that were being hit hardest by COVID-19 at the time. As infection rates increase in other states — particularly in the West and South — additional practices may need access to the forgivable loan offerings created by PPP.

The AVMA will continue to advocate for funding as circumstances require, so that veterinary practices will have access to these critical funds. We also are advocating for favorable tax treatment of PPP loan proceeds, and for a streamlined forgiveness process for loans below $150,000, which would include the vast majority of veterinary PPP loans. This is part of the work that AVMA’s government relations staff does to protect and promote the veterinary profession, and ensure the viability of veterinary practices, associates, and teams.

AVMA was instrumental in shaping PPP, and we continue to work on behalf of veterinary practices and teams to improve this program and others that support veterinary medicine. As I write this in early August, Congress is expected to pass another COVID-19 relief package, including measures that affect PPP. These could include additional funding and eligibility changes to the program.

For veterinarians who have taken a PPP loan, AVMA’s advice is to consider waiting to apply for loan forgiveness until after Congress decides whether to make additional changes to the program and additional SBA guidance is available.

Because policy discussions about PPP and the loan forgiveness criteria are ongoing, Congress may issue extensions and/or retroactive changes to the program. With loan repayment deferred until after you apply for forgiveness and the SBA rules on your eligibility, AVMA advises waiting to see whether the program rules continue to change. We also encourage you to remain in contact with your practice’s advisors as you explore the best options to seek forgiveness.

PPP isn’t the only loan program available to veterinary practices impacted by COVID-19. The SBA's Economic Injury Disaster Loan program provides small businesses with working capital to help overcome temporary revenue losses resulting from disasters. COVID-19 legislation expanded this program to provide for an advance of up to $10,000, distributed within 3 days, which can be used to cover payroll costs, rent, mortgage, and other obligations.

More information on both SBA loan programs can be found on 

). AVMA regularly updates the page regarding the laws and regulations affecting veterinary small businesses, veterinarians, and veterinary students during the pandemic.

Dr. Salois is chief economist and director, and Rosemary Radich is the principal data scientist of the AVMA Veterinary Economics Division.

Data about Paycheck Protection Program use among practices, advice for borrowers, and a look at what’s ahead.

How PPP is helping fund the veterinary profession

We know you're busy, so we're dedicated to helping you stay up to date with the latest pandemic news and coverage of the veterinary industry.

View the video below for this week's top veterinary headlines:

The American Association of Veterinary State Boards has announced that Florida and Kentucky are the 

44th and 45th states to accept the PAVE Certificate

 as a part of the licensure process for international veterinary graduates.

. This 19-member team of veterinarians, technicians, and other animal health experts will assist us with identifying key industry trends, suggest editorial and business opportunities, and serve as our ambassadors.

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