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IDEXX: Contributing to something bigger

The American Veterinary Medical Association announced that the American Association of Fish Veterinarians (AAFV) with support from the World Aquatic Veterinary Medical Association (WAVMA) began the process of developing a petition to have fish practice recognized by the American Board of Veterinary Practitioners as a veterinary specialty.

“The specialty is going to allow clients to identify veterinarians who have the knowledge and expertise that prepares them to provide high-quality veterinary care,” Johnny Shelley, immediate past president of the AAFV, said in the AVMA announcement.

With this new specialty can come better care for fish and the veterinarians who take care of them. Board certification will help aquaculture producers find a veterinarian that can provide the level of care fish need, plus government agencies can confidently hire veterinarians who have a better understanding of fish health-related issues.

Shelley also disclosed that several veterinary schools are beginning to realize the importance of fish care, and more continuing education opportunities are rising within this realm. There also recently has been an increase in externship opportunities and academic positions within fish medicine.

According to the AVMA, the organization will be accepting comments on the proposal through September 2, 2022. Anyone interested can email their comments to ABVS@avma.org.

Fish medicine specialty proposed. News release. American Veterinary Medical Association. June 24, 2022. Accessed June 27, 2022. https://www.avma.org/news/fish-medicine-specialty-proposed

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The process has begun to develop a petition for a fish medicine specialty within the American Board of Veterinary Practitioners


New veterinary medicine specialty proposed

Matthew Brunke, DVM, DACVSMR, CCRP, CVPP, CVA, provided an overview of nutraceuticals including the importance of evidence-based research demonstrating efficacy, and how some nutraceuticals are used to help manage osteoarthritis (OA), during a session—“Nutraceuticals for Mobility: What’s the Evidence”—at the dvm360

 Directions in Veterinary Medicine conference in Indianapolis, Indiana,.

Brunke kicked off his lecture by sharing the 2 definitions of a nutraceutical. He said the FDA defines a nutraceutical as “a product intended for ingestion that contains a ‘dietary ingredient’ . . . to add further nutritional value to the diet.” A ‘dietary ingredient’ may be any one or a combination of vitamins, minerals, herbs/botanicals, and amino acids.

Meanwhile, the North American Veterinary Nutraceutical Council (NAVNC) defines a nutraceutical as, “A non-drug substance that is produced in a purified or extracted form and administered orally to provide compounds required for normal body structure and function with the intent of improving health and well-being.”

Brunke expressed that the NAVNC’s definition is a bit clearer. “We're not here to talk about injectable things for joint supplements, we're strictly talking about orals that have been purified or extracted. But . . . since it's not a drug, there is no federal oversight on the veterinary market or on the human market,” he emphasized. 

Therefore, because these products aren’t FDA-regulated, he explained the importance of looking at research regarding nutraceuticals rather than marketing claims. He noted that studies should be prospective and include appropriate elements such as a double-blind placebo, third-party research, reputable sources, the scientific method, and force plates. On the other hand, marketing claims tend to include self-published research, catchy terms on a label (eg, “organic,” “natural,” etc), and they sometimes copy outside research.

According to Brunke, avocado/soybean unsaponifiables (ASUs)are extracts from the oil that inhibit inflammation. He spotlighted a study surrounding this nutraceutical and its efficacy for degenerative OA.

“They took 16 crossbred dogs in this, cut the cranial cruciate in the [right] knee of all the dogs. Eight [dogs] they put on a placebo, 8 they put on an avocado/soybean unsaponifiable. And then they sacrificed all those dogs and looked at them histologically. On the growth samples at necropsy, the dogs in the treatment group had fewer osteophytes. They had thicker, more robust cartilage and had a better calcified cartilage versus spongy stuff,” Brunke explained.

Brunke said that when researchers looked at the cartilage on a microscopic level for the placebo group, it was all fibrillated and irritated in both in the femur and the tibia whereas in treatment group, it was smooth which promotes less friction and less drag. “And then [the researchers] also pulled the joint fluid and compared to the placebo group, all the treatment groups had less metalloproteinase and other microscopic cytokines, so they showed on a macro and a micro level that this can be beneficial,” he added.

Therefore, this research overall revealed that treatment with ASUs can decrease the development of early osteoarthritic cartilage and subchondral bone lesions in the anterior cruciate ligament dog model of osteoarthritis.

Another nutraceutical Brunke highlighted was green lipped mussel extracts (GLMs). He noted its critical these mussels originate from New Zealand because only when those shells are grinded up does it result in green lipped mussel extracts.

“GLMs have been shown in dogs to work in pathways of omega-3s, of chondroitin, so it's a little bit of a hodgepodge of the mechanism of action. It contains a lot of good things, but you can't just go and get regular mussels, you can't get the zebra mussels that are spreading throughout the United States… it has to be the GLMs out of New Zealand,” he noted.

Brunke shared key research displaying the significance of the dosage when it comes to these nutraceuticals

: “If [GLMs are] dosed at 25 mgs per kg, [there is] no difference, you have to dose [them] at least at 77 mg per kg per day,” he said.

Brunke also discussed undenatured type II collagen (UC II) from chicken sternums, which is essentially immunotherapy, he said. He described that it gets absorbed in the gastrointestinal (GI) tract and is an active modulator. Plus, it’s convenient because, regardless of an animal’s size, it is dosed at 10 mgs SID per patient.

“[UC II] is going to slow down the inflammatory response because this little protein here—undenatured type II collagen—stimulates the body at the level of the Peyer’s patches so then it starts to see this damaged collagen. And so, the white cells start to learn, and the immune system starts to learn that ‘Hey, this isn't good, let's make sure that this doesn't happen,’” Brunke explained.

“So, as it then starts to happen, naturally occurring inside the joint, the body blocks the overreaction of the immune system… so, it stops eating away more cartilage,” he added. 

Additionally, Brunke said there is evidence regarding UC II’s efficacy on its own and when it is combined simultaneously with glucosamine and chondroitin.

 The studies discovered that when these 3 nutraceuticals were used together, UC II didn’t work as well as when it was used alone. They found something in glucosamine blocks the absorption of UC II. “So, if your [pet is] on a glucosamine chondroitin supplement, you give that in the morning. Let's say, you give the UC II hours later, so that the gut is not being exposed to them both at the same time, otherwise you're not getting as robust of an effect,” Brunke said.

Brunke M. Nutraceuticals for mobility: what’s the evidence? Presented at: Directions in Veterinary Medicine; June 24-25, 2022; Indianapolis, Indiana.

Boileau C, Martel-Pelletier J, et al. Protective effects of total fraction of avocado/soybean unsaponifiables on the structural changes in experimental dog osteoarthritis: inhibition of nitric oxide synthase and matrix metalloproteinase-13. 

Bierer TL, Bui LM. Improvement of arthritic signs in dogs fed green-lipped mussel (Perna canaliculus).

. 2002;132: 1634S-6S. doi: 10.1093/jn/132.6.1634S.

Bui LM, Bierer TL. Influence of green lipped mussels (Perna canaliculus) in alleviating signs of arthritis in dogs. 

Hielm-Björkman A, Tulamo RM, Salonen H, Raekallio M. Evaluating complementary therapies for canine osteoarthritis part I: green-lipped mussel (Perna canaliculus). 

. 2009 Sep;6(3):365-73. doi: 10.1093/ecam/nem136.

Deparle LA, Gupta RC, et al. Efficacy and safety of glycosylated undenatured type-II collagen (UC-II) in therapy of arthritic dogs. 

. 2005;28(4):385-90. doi: 10.1111/j.1365-2885.2005.00668.x.

D'Altilio M, Peal A, et al. Therapeutic efficacy and safety of undenatured type II collagen singly or in combination with glucosamine and chondroitin in arthritic dogs. 

. 2007;17(4):189-96. doi: 10.1080/15376510600910469.

Research displays the effects of avocado/soybean unsaponifiables, green lipped mussels, and undenatured type II collagen for canine OA 


Studies highlight 3 nutraceuticals for canine osteoarthritis 

With the silver tsunami, veterinarians must find a way to sell their practices to secure their retirement. For some, that means selling to another veterinarian. Increasingly, veterinary practices are being sold to private equity firms, although many veterinarians are worried this will mean their practice focuses more on making money than helping pets and their owners.

One option that deserves consideration is employee ownership. Two companies, 1st Pet Veterinary Services—a 300-employee, 3-location veterinary practice based in Chandler, Arizona—and a startup, Galaxy Vets, have found this approach to be the optimal solution.

To employees or anyone else, a key consideration when selling a veterinary practice is if your state has corporate practice of medicine (CPOM) laws, which most, but not all, states have. These laws are designed to prohibit the ownership of a medical practice by non-professionals. In recent years, however, private equity has increasingly purchased medical practices by creating management service organizations (MSOs), companies that take on all the operational tasks of a practice as a separate corporation contracting with the medical practice. In states with strong CPOM laws, the MSO cannot hire physicians, in other states they can. In the “weak” CPOM states, the MSO can also make a variety of other business decisions while in strong states the physicians must have much more control. There are varying rules on how fees are split as well. These laws mean that sales to employees other than veterinarians have to be done through an MSO.

Randy Spencer, DVM, the prior owner of 1st Pet Veterinary Centers, didn’t have to worry about CPOM issues because Arizona does not have these rules. His focus was about legacy. “We’ve created a great, caring culture and I didn’t want to lose that to a big corporation, I also wanted to reward those who have helped build this practice and provide a good retirement opportunity for long-term employees.”

Spender used an Employee Stock Ownership Plan (ESOP) to do the sale. An ESOP is a kind of retirement plan, similar in some ways to a 401(k) plan. 1st Pet set up an employee stock ownership trust to acquire shares for the employees. The company funds the trust out of its tax-deductible future profits. The company can contribute cash to the plan to buy shares over time or it can have the trust borrow money, with the company paying it back. Employees do not buy shares. The company can deduct the cost of buying the shares, the seller can defer capital gains tax on the sale by reinvesting in other securities, and if the company is a 100% ESOP, like 1stPet, it pays no taxes.

ESOPs include most or all employees in the plan. They have substantial set-up costs and make sense only for companies with at least 20 or more employees. Because the trust is the legal owner, in a state with CPOM laws, the ESOP trust must own shares through an MSO. Details on SOPs can be found on the website of the non-profit the National Center for Employee Ownership.

A new venture to acquire veterinary practices into an employee-owned company could provide a pioneering template for employee ownership growth. Galaxy Vets is looking to buy veterinary practices with the veterinarian owners getting 50% of the sale price in the form of equity in the Galaxy Vets parent operating company. An MSO will hire the doctors. Individual practices will be rolled up under a parent operating company. Meanwhile, Galaxy Vets will be creating an ESOP for all the practice employees in the parent corporation, with a goal of 40% ownership and another 35% owned by veterinarians, managers, and veterinarians who sell to Galaxy. The rest will be held by investors. Galaxy already has a number of investors, including the founder, providing initial capital.

Galaxy aims to buy 10-20 practices in a contiguous geographic area. It plans to build a new surgical and emergency hospital with its own reference laboratory, creating a vertically integrated veterinary healthcare system.

Galaxy founder and CEO Ivan Zakharenkov, DVM, MBA, told Dallas Innovates

that “As a burned-out vet in the past, eradicating this chronic illness of our profession has become a very personal goal for me. For the past decade, veterinary medicine has been taken over by private equity capital which is completely detached from the realities of our profession. Forced to generate revenue for investors, traditional consolidators often fail to fulfill their promise to improve the businesses they acquired, including better care for the veterinary teams. Every organization must make their employees’ well-being an absolute priority, and that’s how it’s going to be at Galaxy Vets.”

Corey Rosen is the founder of the National Center for Employee Ownership.

Galaxy Vets is launching an employee co-owned vet healthcare system in North Texas. Dallas Innovates. September 7, 2021. Accessed June 24, 2022. https://dallasinnovates.com/galaxy-vets-is-launching-an-employee-co-owned-vet-healthcare-system-in-north-texas

The success 2 companies have found with this ideal solution 

Is employee ownership an answer for veterinary business succession?

Happy Monday everyone! We hope that all who attended our Directions in Veterinary Medicine (DIVM) conference over the weekend had a great time and learned at least one new thing. While you rest up from a weekend of learning or reading some of our conference coverage, we are continuing to provide, not only the latest from DIVM, but news within the industry as well.

Check out what you will find this week on dvm360.com:

In a recap from Gianluca Bini, DVM, MRCVS, DACVAA, at the Directions in Veterinary Medicine conference, learn the latest on epidural anesthesia, primarily focusing on which technique and equipment are ideal, along with different drug options, volume calculations, indications, and more.

Sari Lieberman, LVT, will make her second appearance on The Vet Blast Podcast to talk more about veterinary entrepreneurship, and Carrie Jurney, DVM, DACVIM (Neurology), president of Not One More Vet, Kai-Biu Shiu, DVM, DACVIM (Oncology), and Mariana Pardo, BVSc, MV, DACVECC, join Adam Christman, DVM, MBA to discuss suicide awareness in veterinary medicine.

During his session at the DIVM conference, Matthew Brunke, DVM, DACVSMR, CCRP, CVPP, CVA, discussed how canine degenerative lumbosacral stenosis is the leading cause of early retirement in working dogs, plus treatment options

A 7-year-old Mastiff named Henry became the first animal at the Texas A&M Small Animal Teaching Hospital to ring its “BTHO Cancer” bell to celebrate his end of chemotherapy treatment.

A joint lecture with Brunke and Kirsty Oliver, VN, RVT, CCRP, VTS (Rehabilitation), taught attendees at DIVM what products, and how they work, are available for intraarticular injections such as steroids, platelet-rich plasma, radiosynoviorthosis, and more.

Here is a sneak peek of this week’s headlines

This week on dvm360.com: Our DIVM conference coverage, plus more veterinary news

Phibro Animal Health Corporation and Rejuvenate Bio, Inc. have partnered for the development and commercialization of canine mitral valve disease (MVD) gene therapy.

"We have confidence that our collaboration with Rejuvenate Bio will meet our goal to bring about an effective gene therapy that will revolutionize the way veterinarians treat MVD, adding healthy, happy years to the life of a dog who suffers from this disease,” stated Thomas Zerzan, president of the companion animal division at Phibro Animal Health, in a company release.

MVD is the most common congenital heart disease in dogs, accounting for over 70% of all canine heart disease and it is a leading cause of death for cavalier King Charles spaniels.

 The American Cavalier King Charles Spaniel Club gifted support to Rejuvenate Bio for this research.

According to the release, existing therapies have been proven to slow the course of MVD, but there is no therapy that stops the disease or reverses the damage. Thus, Phibro and Rejuvenate Bio's breakthrough gene therapy aims to address the latter.

“We are excited to work with Phibro to make the treatment of MVD a reality. We expect to file for a conditional approval as early as 2023. We view this as a first step to tackling numerous age-related diseases that affect the animals we love,” Daniel Oliver, CEO of Rejuvenate Bio, expressed.

Based on research and findings, the gene therapy for MVD was revealed in the laboratory at Harvard Medical School and the Wyss Institute by genetics scientist and startup founder, George Church.

Phibro Animal Health Corporation and Rejuvenate Bio announce agreement to develop gene therapy for mitral valve disease in canines. News release. Phibro Animal Health Corporation. June 22, 2022. Accessed June 27, 2022. https://www.businesswire.com/news/home/20220622005079/en

Parker, HG, Kilroy-Glynn, P. Myxomatous mitral valve disease in dogs: does size matter? 

(1):19–29. https://doi.org/10.1016/j.jvc.2012.01.006

Mitral valve disease and the cavalier King Charles spaniel. Cavalier health. Accessed June 27, 2022. https://cavalierhealth.org/mitral_valve_disease.htm

They strive to create a novel gene therapy that stops MVD before it causes heart failure and reverses some or all heart damage

Phibro Animal Health Corporation and Rejuvenate Bio to develop canine mitral valve disease gene therapy

Henry celebrates with his owners and oncology team (Image courtesy of Texas A&M SATH) 

Last month, Texas A&M Small Animal Teaching Hospital (SATH) announced that Henry, a 7-year-old rescue Mastiff finished his final round of chemotherapy and was the first patient at the hospital to celebrate the end of his chemotherapy by ringing the hospital “BTHO Cancer” bell.

“The completion of therapy is always the most emotional day for our owners,” said

Jaclyn Christensen, a veterinary technician in the SATH’s Oncology Service, in an organizational release,

 “The bell signifies that they’ve done it, they’ve hit this milestone and started a new chapter. Most owners feel pretty defeated by the cancer diagnosis, so this is an opportunity for us to turn their mindset around.”

Installed in April 2022, the bell celebrates and signify a milestone in a pet's fight against cancer when they complete radiation treatment or chemotherapy. The inspiration behind the bell came from human medical institutions with similar bells and was built by SATH technician Julio Peraza.

In Henry’s case, his owners, Robin and Derrick Newkirk noticed his lymph nodes felt swollen, so they brought him to SATH in October 2021. After some blood work and tests, the Newkirks learned Henry was suffering from multicentric lymphoma.

 With the shock of the diagnoses came another possible heartbreak to the Newkirks, Henry was most likely in stage 5, and SATH gave henry 4-6 weeks to live if he did not receive treatment.

Henry started treatment on November 1, 2021, and they continued to drive him to SATH once a week for 6 months. However, Henry fell into a small percentage of dogs that suffer side effects of treatment including gastrointestinal problems and infections. Despite the side effects, Henry’s lymphoma was gone in December after treatments and has not returned since then.

For the Newkirks, not only did the bell mark his official end of treatment, it celebrated all the hospital employees who worked with and grew to love the Mastiff.

“They love him so much there, truly love him. They have tears in their eyes when they talk about him,” Robin said in the release.

 “I know that when he goes there, Ashley’s (Wiley) going to sit with him on the floor and clean his ears at least every other week. And my husband says that the way Liz (Wood) puts her face up to his and nuzzles his forehead is just like what I do, even though she’s never seen me do it."

Texas A&M Veterinary Hospital celebrates patient successes with new cancer bell. News release. Texas A&M Small Animal Teaching Hospital. May 25, 2022. Accessed June 24, 2022. https://vetmed.tamu.edu/news/press-releases/henry-cancer-bell/

After finishing his final round of chemotherapy, the 210-pound rescue and his family celebrated by ringing the “BTHO Cancer” bell.

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