As we continue to adjust to these unprecedented times, we will continue to keep you updated with the latest pandemic news and our coverage of the veterinary industry.

The US Food and Drug Administration announced on Monday, the conditional approval of Laverdia-CA1 (verdinexor tablets), 

The FDA announced earlier this week that Midwestern Pet Foods, Inc 

has significantly expanded its recall of Sportmix brand pet foods

 due to potentially elevated levels of aflatoxin.

 Standards & Policies for new PAVE for Veterinary Technicians

, a program designed to assess the education equivalence of global veterinary technician/nurse graduates. 

, Tom Seeko, cofounder of Florida Veterinary Advisors, talks with Dr. Christman about the 4 key elements to maximizing your veterinary practice.

Articles

Here's a look at this week's top news stories. 

News wrap-up: This week's veterinary headlines, plus an alarming pet food recall expansion

The US Food and Drug Administration announced yesterday, the conditional approval of KBroVet-CA1 (potassium bromide chewable tablets) to help manage seizures in dogs with idiopathic epilepsy.

 treatment to be granted under the reauthorized 

stabilizes neurons in the central nervous system to reduce the chances of having a seizure. KBroVet-CA1 is administered orally daily.

Previously potassium bromide had long been used to control canine seizure disorder, however, prior to the FDA’s new authority, no veterinary drug sponsor had applied for approval.

“We are pleased to see animal drug sponsors respond to the expanded conditional approval authority by bringing forward applications to treat serious, life-threatening diseases for which there are no approved therapies available,” said Steven M. Solomon, DVM, MPH, director of the FDA’s Center for Veterinary Medicine, in this 

Conditional approval, which is an option for drugs intended for minor use in major species, provides veterinarians with access to necessary treatments while the pharmaceutical company gathers additional efficacy data.

The expanded authority allows for the conditional approval of drugs intended to address “a serious or life-threatening disease or condition, or an unmet health need, but for which demonstrating effectiveness would require complex or particularly difficult studies,” according to the release.

According to the FDA website, the initial conditional approval is valid for 1 year with the potential for 4 annual renewals. During this period, the drug sponsor must demonstrate that it is actively working toward collecting the remaining effectiveness data to support full approval.

KBroVet-CA1’s reasonable expectation of efficacy was demonstrated in a retrospective study of the medical records of 51 client-owned dogs diagnosed with idiopathic epilepsy. All were treated solely with potassium bromide at the same dose for at least 60 days to control their seizures.

According to peer reviewed articles, the most common adverse reactions associated with potassium bromide administration were found in the neurologic (including behavioral changes), gastrointestinal (including inflammation of the pancreas), reproductive, endocrine, dermatologic ,and respiratory systems. Some dogs also experienced increased thirst and urination. Dogs with decreased kidney function appear to have a greater risk of bromide intoxication (overdose).

Signs of severe bromide intoxication can include depression, behavioral changes, ataxia, hind limb paresis, mydriasis, stupor, and coma.

The FDA advises owners who have dogs with idiopathic epilepsy to work closely with their veterinarians to monitor clinical signs to help control potential seizures that may result from bromide intoxication. The agency also recommends avoiding abrupt diet changes in dogs receiving potassium bromide, as it could either compromise seizure control or raise safety concerns.

KBroVet-CA1 is available by prescription only. To learn more about this new drug, go

KBroVet-CA1 reduces the likelihood of seizures by stabilizing neurons in the central nervous system.

FDA conditionally approves first oral treatment for canine idiopathic epilepsy, under its expanded authority

Being a veterinarian can seem like an impossible job most days. Who else juggles being a dentist, dermatologist, orthopedic specialist, cardiologist, surgeon, oncologist, radiologist, and mind reader to a patient that can’t talk?

Veterinarians tend to be honest, caring, selfless, hardworking, and creative problem solvers (think James Herriot), but many of us have sky-high debt and constantly face pushback from clients about the costs of specialized care. Pet owners want it all, but they do not want it to cost too much.

Although the coronavirus disease 2019 (COVID-19) pandemic has only added to these challenges, it presents a unique opportunity for us to improve our boundary setting and our people-pleasing natures, gain perspective on what we can and cannot control, and take care of ourselves so we can take care of others.

With people spending more time at home with their pets, the human-animal bond is stronger than ever, making the service we provide essential. The work we do benefits the mental health of our human clients just as much as it does the physical health of our patients.

If you or your team members are suffering from compassion fatigue during these unprecedented times, tap these 5 useful strategies to help everyone come out on top.

Investing in your well-being has never been more crucial. Try to find an activity that refreshes you. I have found a 2- to 5-minute meditation first thing in the morning very helpful (the Calm app is great). If meditation does not appeal, I have also found leisure reading (not the internet, and not about COVID-19) calming. Online exercise classes or even a morning walk or jog can be incredibly mind-clearing. Whatever you choose, make sure it is something you can maintain. Create a routine and follow it daily. Remember, you have to put the oxygen mask on yourself before you can help others. Self-care is not selfish; it is necessary.

Compassion fatigue may look different during the pandemic. For example, your team may be manifesting it in new ways such as making mistakes, being more withdrawn, or having problems focusing and staying on task. Pay attention to all signs of isolation, anxiety, and stress. 

As leaders, veterinarians should regularly check on their teams and maintain open communication. A simple “Hey, are you having a rough day?” goes a long way.

COVID-19 significantly affects our clients as well. Many are experiencing financial strain, hindering their ability to pay for veterinary care. Some clients are delaying elective items and other less urgent services. Acknowledging that clients are coping with their own anxiety and stress helps us not to absorb all the responsibility for things beyond our control.

. Telehealth has become an increasingly popular platform during the pandemic. Not only did it allow us to continue providing quality care to patients, but it has increased client loyalty. I like to think of telemedicine as a client gratitude builder during COVID-19 and suspect the trend will continue far beyond the pandemic. It is also important to note that placing value on our services and receiving income for client-driven telemedicine consults is beneficial to our profession. Telemedicine helps us set appropriate boundaries with clients and to stop giving away our time and expertise for free.

Additionally, clients love participating in their pets’ appointments and are so appreciative when they are able to watch the examination.

 We have fully transitioned to inpatient drop-off and curbside protocols, and it appears we will not be doing otherwise anytime soon. Many veterinarians are discussing ways to maintain curbside protocols beyond the pandemic.

Although curbside care has inconveniences, such as a lot of walking between the office and parking lot, it can also streamline workflow and reduce stress. Using telemedicine to connect with clients during curbside appointments has been exceedingly helpful. Utilizing a videoconference app (my practice uses TeleVet) to take a history, ask questions, and perform an examination in front of the client is far more efficient and less time-consuming than going back and forth on the phone throughout the curbside appointment. It has also helped our new clients to feel connected to the appointment, even though they are parked outside.

 I have developed the following internal mantra during COVID-19: I can do anything for a short time. That needs repeating. I can do anything for a short time. This mantra reminds me that the pandemic will eventually pass, and when it does, I believe our teams and practices will be stronger and more committed than ever.

Amy C. Garrou, DVM, isMedical Director at Washington Heights Veterinary Clinic in Houston, TX. Her areas of interest include internal medicine, endocrinology, soft tissue surgery, cardiology, and telemedicine. She is a member of the American Veterinary Medical Association, the Texas Veterinary Medical Association, the Harris County Veterinary Medical Association, the Veterinary Information Network, and the International Association of Veterinary Pain Management. She serves on the board of the Houston Zoo, YPO (formerly Young Presidents’ Organization), Gulf States Chapter, and the Harris County Veterinary Medical Association.

One veterinarian offers advice on coping with pandemic pressures while strengthening well-being among team members.

5 strategies to help avoid compassion fatigue during COVID-19

During the past decade I’ve treated thousands of pruritic dogs and cats, some with very extreme presentations, and lengthy diagnostic and therapeutic histories. Regardless of how mundane or shocking the presentation, I rely on a steadfast diagnostic foundation to ensure that no diagnoses are missed. My passion is not dogma; rather, it’s the art of communication and tailoring therapy to meet the needs of patients and clients. With these principles firmly in place, I confidently enjoy even the most challenging of cases, placing focus on the client and the patient.

The first thing to keep in mind is that pruritus control, when strategically executed, does not interfere with the diagnosis. Rather, it enhances client adherence and confidence.

Look for lesions associated with folliculitis, such as patches of alopecia, papules, pustules, crusts, comedones, or collarettes. If any of these are present, perform multiple deep skin scrapes for Demodex (D canis and injai in dogs, and D cati, albeit rare, in cats). Obtain multiple cytologic preparations to assess for staphylococcal infection. In cats, crusted papules may arise due solely to hypersensitivity, or they may represent staphylococcal infection, so remember to look.

Consider a dermatophyte culture with or without polymerase chain reaction (for a rapid result), particularly if no Demodex or cocci are found. Should your cytologies, deep skin scrapes, and dermatophyte culture provide no diagnosis, then perform multiple skin biopsies, because your patient may have a less common diagnosis such as pemphigus foliaceus, sebaceous adenitis, or cutaneous lymphoma.

Also examine your patients for nonspecific inflammatory lesions, including patchy erythema, lichenification, and seborrhea. Consider impression smear or acetate cytology to assess for bacterial and/or Malassezia surface overgrowth. Perform deep skin scrapes for Demodex as well as superficial skin scrapes to assess for Cheyletiella, Sarcoptes (dogs), and D gatoi (cats). and D gatoi (cats). 

Superficial scrapes do not yield reliable results for 2 pruritogenic mites: Sarcoptes scabiei in dogs and D gatoi in cats. Of note, D gatoi may mimic the classic “fur mowing” presentation of feline hypersensitivity. Diagnosis is frequently made via response to therapy. The isoxazolines work well against both mites.

Ensure that strict flea control is in place for all dogs and cats in the home. I particularly like the isoxazoline products (eg, Simparica; Zoetis) for parasite prevention.

Treat secondary Staphylococcus and Malassezia for a minimum of 2 weeks and recheck the patient during therapy. Infections enhance dermatitis severity and confound interpretation of ectoparasite control and elimination diet trials. Once infections are resolved, if you are pursuing a diet trial or have diagnosed the patient with atopic dermatitis (environmental allergy), consider preventive maintenance topical therapy at least twice weekly in key areas of recurrent secondary infection (eg, miconazole and chlorhexidine wipes on the interdigital spaces).

Food allergy is diagnosed via an 8-week elimination diet trial, and atopic dermatitis is a diagnosis of exclusion. Allergy testing for the diagnosis of atopic dermatitis, whether intradermal or serologic, is not reliable because false positives do occur. I use these tests solely to identify allergens for inclusion in immunotherapy. If you have performed your baseline diagnostics and are still unsure about the diagnosis, consider referral to a dermatologist.

Rapid and reliable canine itch relief options include oclacitinib (Apoquel; Zoetis), lokivetmab (Cytopoint; Zoetis), and systemic corticosteroids (eg, oral prednisolone). Oclacitinib and lokivetmab are well tolerated and efficacious, and do not require a washout period or discontinuation for allergy testing. Treatment is chosen based on patient factors and client preference. For patients aged less than 1 year, I prescribe lokivetmab. It is prudent to rule out demodicosis prior to prescribing oclacitinib or corticosteroids.

Rapid and reliable chronic atopic dermatitis options for dogs include lokivetmab, oclacitinib, modified cyclosporine (Atopica; Elanco), and allergenspecific immunotherapy. Immunotherapy can take up to a year to provide noticeable benefit, so I invariably initiate immunotherapy with concurrent antipruritic therapy. If corticosteroids must be used, try to reduce the dose to the lowest every-other-day dose possible to reduce adverse effects, such as calcinosis cutis.

Rapid and reliable itch relief options for cats include systemic corticosteroids (eg, oral prednisolone, dexamethasone) and oclacitinib. Of note, although oclacitinib is not approved in cats, recent studies support its efficacy

 in feline hypersensitivity, as well as its safety

supports a more frequent and higher dosing schedule in cats compared with dogs. Doses documented include 0.4 to 2 mg/kg every 12 to 24 hours.

 The 2-mg/kg dose has been associated with gastrointestinal upset.

 I typically start at 0.5 to 1.0 mg/kg twice daily for 1 to 2 weeks followed by daily therapy. It has been well tolerated in my patients. Long-term tablet therapy may prove difficult for clients and their cats.

Treatment options for chronic atopic dermatitis in cats include cyclosporine, allergen-specific cyclosporine, and allergen specific immunotherapy. With regard to the safety of oclacitinib in cats, information is limited to 3 studies, all spanning a period of 28 days.

 Therefore, it is prudent to consider baseline complete blood cell count, chemistry, and urinalysis findings and repeat these tests every 3 to 6 months initially, and in otherwise healthy patients perhaps consider at least annual monitoring. As with dogs, if long-term corticosteroids are used in cats, use the lowest every-other-day dose required to provide acceptable relief.

Moderately to severely affected dogs will require maintenance administration of 1 of these therapies for good control. The addition of weekly bathing with a moisturizing shampoo, daily fatty acid therapy, and topical antimicrobials and barrier restoring (eg, phytosphingosine) optimizes control. Even with consistent treatment, breakthrough itch will occur periodically occur and may prompt temporary or longer term changes in therapy.

Antihistamines provide lackluster results, so I do not recommend them for acute pruritus. Chronic administration of antihistamines as an adjunct immunotherapy and/or fatty acid regimen may help reduce pruritus and have a steroids paring effect. Studies regarding pharmacokinetics and efficacy of antihistamines are relatively few. The most evidence based in the dog are hydroxyzine and chlorpheniramine.

Ortalda C, Noli C, Colombo S, Borio S. Oclacitinib in feline nonflea-, nonfood-induced hypersensitivity dermatitis: results of a small prospective pilot study of client-owned cats. Vet Dermatol. 2015;26(4)

Noli C, Matricoti I, Schievano C. A double-blinded, randomized, methylprednisolone-controlled study on the efficacy of oclacitinib in the management of pruritus in cats with nonflea nonfood-induced hypersensitivity dermatitis. Vet Dermatol. 2019;30(2):110-e30. doi:10.1111/ vde.12720

Lopes NL, Campos DR, Machado MA, et al. A blinded, randomized, placebo-controlled trial of the safety of oclacitinib in cats. BMC Vet Res. 2019;15(1):137. doi:10.1186/ s12917-019-1893-x

Ferrer L, Carrasco I, Cristòfol C, Puigdemont A. A pharmacokinetic study of oclacitinib maleate in six cats. Vet Dermatol. 2020;31(2):134- 137. doi:10.1111/vde.12819

Eichenseer M, Johansen C, Mueller RS. Efficacy of dimetinden and hydroxyzine/chlorpheniramine in atopic dogs: a randomised, controlled, double-blinded trial. Vet Rec. 2013;173(17):423. doi:10.1136/ vr.101907

Tips for providing optimal diagnostics and treatment for your veterinary patients with skin concerns.

Think like a dermatologist: untangling itch

To fully maximize your veterinary practice, the first step is: knowing why you’re in business and understanding the value of your practice, according to cofounder of Florida Veterinary Advisors, Tom Seeko.

In his talk with Adam Christman, DVM, MBA, Seeko breaks down 4 key strategies to maximize your practice and build your net worth, and they are as follows:

One of the biggest threats to practice owners, says Seeko, is that most don’t know the value of their business. “It’s surprising how many times the [practice owners] we bump into have never had a real evaluation.”

 Cashflow is vital to your business, so make sure you’re not spending money on unnecessary things, have clean records, and know how much you are saving, Seeko tells Christman. 

Understand how you’re spending money on employees. 

Be familiar with all employee salaries and make sure you have adequate staff. 

A lot of practices don’t have enough staff to support the overall inflow of business that they’re getting,” says Seeko.

Many practice owners wait until they’re ready to leave a practice before creating their exit strategy. But according to Seeko, everyone should have an exit plan right when they get into business.

Listen below to learn more about these 4 strategies and how to implement them at your clinic.

Podcasts

On this episode of The Vet Blast Podcast, Dr. Christman is joined by financial advisor Tom Seeko, who discusses potential threats to your clinic, how to manage cash flow, and other ways to amplify your clinic.

Episode 37: 4 key elements to help maximize your veterinary practice

The American Association of Veterinary State Boards (AAVSB) announced recently the completion of the Standards & Policies for the much-anticipated PAVE (Program for the Assessment of Veterinary Education Equivalence) for Veterinary Technicians. The core mission of the new PAVE is to assess the educational equivalences of veterinary technician and nurse graduates on an international scale on behalf of participating AAVSB Member Boards, according to an 

PAVE evaluates the education equivalence of graduates of non-accredited veterinary programs outside the United States and Canada on behalf of participating AAVSB member boards.

 in the early 2000's, it was a game changer for both our Member Boards and licensure applicants,” says AAVSB president Roger Redman, DVM, in the release. “In the past few years, our membership has made it clear the demand to expand PAVE into the veterinary technician/nurse profession is immense.”

The PAVE for Veterinary Technicians certificate will be recognized by jurisdictions that accept it as substantiating the educational requirements as one criterion toward credentialing eligibility. The certificate is 

a credential to practice as a veterinary technician. To be credentialed to practice, candidates who receive the certificate must also meet additional statutory criteria, including successful completion of the Veterinary Technician National Examination (VTNE).

Since requirements vary from jurisdiction to jurisdiction, the AAVSB urges candidates to directly contact the specific veterinary board(s) in which they desire credentialing.

For more information about the new PAVE program, go 

PAVE for Veterinary Technicians is a new program formed to assess the education equivalence of international veterinary technician/nurse graduates.
