, the hospital where Meghan Vaught, DVM, DACVECC, works, became a target of cyberbullying after an incident involving a surrendered German Shepard puppy went viral. Because of this, the clinic received thousands of calls threatening violence, not only to the clinic, but to the veterinary team, as well. 

During this episode of The Vet Blast Podcast, Meghan Vaught, DVM, DACVECC, explains how this incident started a movement to stop cyberbullying in veterinary medicine, how to get help if you are the target of cyberbullying, including 

Below is a partial transcript. Listen to the full podcast for more.

:  How can we help each other and feel that support on both sides, have that engagement, and try to minimize some of this hard negativity because that's not going to help us continue to practice the medicine that our families ultimately want us to be available for, right? We could have shut down in those days, but that's not what's going to be helpful for the pets that actually meet us here in this surrounding area. And so how can we do that together to be able to pull it all in, be the team that we all hope this to be every day, and be kind to one another.

Podcasts

Dr Meghan Vaught explains how to 'not bully the bully' after an incident at her clinic, plus why you should always choose kindness

Kindness can go a long way in veterinary medicine

Officials with the FDA have approved the first oral new animal drug to improve glycemic control in otherwise healthy cats with diabetes mellitus not previously treated with insulin. Bexagliflozin tablets (Bexacat; Increvet Inc) is also the first sodium-glucose cotransporter 2 (SGLT2) inhibitor new animal drug approved by the FDA in any animal species.

Cats with diabetes mellitus cannot properly produce or respond to the hormone insulin, which helps cells use glucose as a source of energy for normal function. Without treatment, cats with diabetes mellitus will have high levels of glucose in their blood and urine. The first symptoms of diabetes mellitus are usually increased thirst and urine output, weight loss, and increased appetite. Diabetes mellitus in cats often requires lifelong therapy.

Bexagliflozin oral tablets are administered to cats weighing 6.6 lbs or greater once daily, at approximately the same time each day, with or without food and regardless of blood glucose level. The drug product is available in 15mg flavored tablets in 30 and 90-count bottles.

Cats with diabetes mellitus have been traditionally treated with a combination of insulin therapy and diet. Insulin therapy requires owners to administer insulin injections, usually twice a day, roughly 12 hours apart at the same time each day. Bexagliflozin, the active ingredient in the new therapy, prevents the cat’s kidneys from reabsorbing glucose into the blood, causing excess glucose to be passed out in the urine and resulting in lowered blood glucose.

The data from two 6-month field studies and an extended use field study demonstrated that bexagliflozin tablets was more than 80% effective in improving glycemic control in cats with diabetes mellitus. However, potential patients must be selected carefully and screened to evaluate for kidney, liver, and pancreatic disease as well as ketoacidosis. This therapy should not be used in cats who have previously been treated with insulin, are receiving insulin treatment, or who have insulin-dependent diabetes mellitus, as serious adverse reactions can occur. It should also not be initiated in cats who are not eating well, dehydrated, or lethargic when diagnosed with diabetes mellitus.

Cats treated with bexagliflozin tablets may be at an increased risk of serious adverse reactions, including diabetic ketoacidosis or euglycemic diabetic ketoacidosis, which can be fatal. Cats with diabetic ketoacidosis or euglycemic ketoacidosis should be treated as emergencies, including discontinuation of bexagliflozin tablets and initiation of insulin therapy. All cats who receive bexagliflozin tablets should be examined and have blood tests at regular intervals following initiation of treatment. Cats should be carefully monitored for lack of appetite, lethargy, dehydration, and weight loss. Cat owners who note any of these signs should stop Bexacat treatment and immediately take the cat to a veterinarian, who should assess the cat for diabetic ketoacidosis or euglycemic diabetic ketoacidosis.

Although there are notable safety concerns with the use of bexagliflozin tablets, the FDA advised that they can be mitigated by carefully screening cats before starting the drug, continued diligent monitoring regardless of the duration of or response to treatment, and knowing how to promptly recognize and appropriately treat serious and life-threatening adverse reactions.

Clients whose cats receive bexagliflozin tablets should receive an information sheet informing them of the potential risks associated with the treatment, signs to watch for, and what to do if their cat becomes symptomatic. According to the FDA, there will also be educational outreach to veterinarians to familiarize them with the appropriate use of the product prior to prescribing its use.

FDA Approves First Oral Treatment for Cats with Diabetes Mellitus. FDA. December 8, 2022. Accessed December 8, 2022. 

https://www.fda.gov/animal-veterinary/cvm-updates/fda-approves-first-oral-treatment-cats-diabetes-mellitus

Articles

The bexagliflozin product (Bexacat; Increvet Inc) is also the first SGLT2 inhibitor new animal drug approved by the FDA in any animal species. 

First oral diabetes treatment for cats receives FDA approval

The Maryland Zoo asks the public every year to help it name one of the newly hatched African penguin chicks. This past fall, voters were tasked to pick between 3 Italian food-themed names: Mozzarella, Limoncello, or Ravioli, and with over 4,400 votes tallied, the Zoo announced Ravioli was the winner.

“We’ve already had four of these amazing chicks hatch at the Zoo this breeding season,” said Kirby Fowler, Maryland Zoo president and CEO, in an organizational release.

 “The naming competition is a fun way to draw attention to our program and the serious conservation issues facing African penguins, which are endangered in the wild.”

According to the release, the zoo begins the breeding season in mid-September and it goes until the end of February.

 This is to recreate the spring-to-summer breeding season the penguins would experience in the wild in South Africa and Namibia.

The zoo has the largest collection of African penguins in North America with over 1,000 chicks hatched there within the last 50 years. Although most stay in Baltimore, the zoo shared they are set to establish new colonies at zoos across the United States and beyond. Some of their penguins can be found in Canada, Spain, South Africa, the Netherlands, and more.

Ravioli and its siblings will stay out of public view until they are older. However, the public can visit the rest of the penguins at the zoo or check out the live Penguin Cam.

Maryland Zoo announces winner of penguin chick naming contest. News release. Maryland Zoo. December 6, 2022. Accessed December 8, 2022.

A public vote was held to name one of the zoo’s newly hatched African penguin chicks

Maryland Zoo announces penguin chick name contest winner 

Determining whether a patient has a neurological or behavioral condition‑and which veterinary specialist to seek out with certain cases—can be a challenge. Using a series of video case studies, an interactive session at the 2022 Fetch 

 Conference in San Diego, California, showed attendees how to use body language to better ascertain if a mind disorder or brain disfunction is affecting a patient.

Christopher Pachel, DVM, DACVB, CABC, with Animal Behavior Clinic in Portland, Oregon; and Fred Wininger, VMD, MS, DACVIM (Neurology), with Charlotte Animal Referral and ER in Charlotte, North Carolina, collaborated to present the session. The pair have been assisting each other with patients for a couple of years, they noted. “We share cases back and forth via email and video from this standpoint [that] we’re both working within the brain,” Pachel said. “It’s not always clear whose skill set really needs to be leveraged for those individual cases.”

With patients presenting issues such as structural abnormalities, functional changes, and cognitive impairment, there is potential for overlapping veterinary specialties. In these cases, Pachel noted common questions: Who do you call? Where do you refer? Which textbook do you open? Which medications to you try first? And, when collaborating, is this case yours or mine?

Pachel and Wininger provided examples of patients filmed exhibiting various types of body language that serve as clues to whether their condition might be neurological or behavioral. With each case, the audience was asked their opinion about which specialty should address the patient’s condition and weigh in with their own observations.

The first video relied on an examination of a dog, for which the audience overwhelmingly expressed that its body language suggested a neurology case. Clues included a short-stride gait, an extended neck, and not communicating anxiety or stress. “OK, so he seems like he’s behaviorally normal,” said Wininger.

Although Wininger and Pachel both noted subtle potential signs that could indicate a behavioral condition, such as certain small movements, the speakers ultimately agreed with the audience’s assessment with the first case they presented.

Another video prompted the speakers to addressed paroxysm—events that begin and end “out of nowhere”—such as seizures, narcolepsy, and vestibular syndromes. “[Paroxysm] is not going to include most behavioral disorders. It’s going to include neurology but maybe some other things too,” said Wininger.

In the video, a dog appeared to turn his head, rather than tilt it, and freeze, possibly losing consciousness. “He seems kind of unaware. I’m already thinking of brain problems, seizure problems, because of the head turn and then he’s not paying attention,” said Wininger.

“It’s called an absence seizure,” he added. “Although they are hard for us to characterize in dogs, this is as close to an absence seizure as you can get.”

Subsequent videos indicated potential behavioral conditions. “We often talk about the behavior that we're observing and the antecedents or the relationship between that view, whether it's physical environment, or the social environment,” said Pachel. “Can I draw a connection here, and how the animal is interacting with what's happening around it?”

According to Pachel, observers can look for shifts or changes in posture. In one video case, a dog demonstrated hesitation in approaching a human visitor. The animal is stretched with rear legs anchored, and their head and neck reached out, to possibly smell or taste what’s in front of them, before recoiling back. “This is a dog who has stranger danger,” said Pachel.

In a second video with the same dog, the animal demonstrates more fear-based behavior. “We now have a level of hyper vigilance alertness,” said Pachel.

The dog holds a tight body posture and looks behind him. Pachel said this movement isn’t necessarily a response to something behind the dog, but rather an anticipation that something might be there. “That’s more characteristic of situation or generalized anxiety, or we see exaggerated startle responses, the readiness to respond if, and when, something changes in the environment,” he added.

In this case, the dog’s body language changes in response to the environment, along with the lack of physical changes or gait abnormalities, favors a more emotional condition rather than a neurological disorder, according to Pachel.

Wininger said that a decision on which type of specialist the animal belongs, as far as needs, should take into consideration the client’s needs as well. “Going to see a behaviorist is going to be very long examination. It’s going to be very interactive examination and probably a lot less expensive than seeing a neurologist, who is going to have a shorter examination and say, ‘these are the diagnostics that we need to run’. I think it's going to be a very different experience for your clients and so that's a big variable too,” Wininger added.

The availability of veterinary professionals may also be a deciding factor in which specialist to seek out for help. On the behavior side, Pachel said, it’s not uncommon to have 3 to 4 months lead time before a patient is seen. “And that’s unacceptable,” he said. “If you’ve got an acute issue, they need help.”

Pachel C, Wininger F. Brain or Mind: Where Veterinary Behavior and Neurology Collide. Presented at: Fetch dvm360® Conference; December 2-4, 2022: San Diego, CA.

Veterinary collaboration can help determine whether a case is a neurological or behavioral condition

Working between the brain and the mind

Pain management is a hot topic in veterinary medicine, and the multimodal approach to treating chronic pain in pets involves both pharmacologic and nonpharmacologic solutions. Tamara Grubb, DVM, PhD, DACVAA, and president-elect of the International Veterinary Academy of Pain Management, examined nonpharmacologic treatment options in depth during her session at the 2022 Fetch dvm360® Conference in San Diego, California.

Here are 5 modalities Grubb discussed and how they can play a role in controlling and managing long-term pain:

Grubb said that weight loss and exercise go a long way toward decreasing decreasing pain. It can reduce wear on the joint and increase muscle strength to reduce instability and better support joints. She added that some studies have demonstrated that puppies who exercise more experience decreased pain, among other health benefits.

A word of advice when communicating with clients: Grubb said she prefers to use the term play instead of weight loss and exercise. She finds it more engaging to pet parents, leading to better compliance. Psychologically, she said, it helps them conceptualize more avenues for exercise, as play can encompass a variety of activities, whereas the term exercise might sound like it requires more intensive action (such as hiking or running). They key is to get that pet moving any way possible, Grubb said.

Even though the mechanism of action is not completely understood, Grubb said she performs acupuncture and recommends it to clients. One of the key benefits, she said, is that acupuncture affects nearly every part of the pain path:

“When we stick the needle in…we get a local inflammatory response; we get more blood flow in that area and red blood cells bringing in oxygen. We also get an alteration of the transmission of impulses, which is why a lot of our points are directly over nerves. We get release of endogenous opiods…”

Grubb explained, that while research on acupuncture in veterinary medicine is limited, she believes that the evidence is there for human medicine and worth employing in animals.

3. Targeted pulsed electromagnetic field therapy (tPEMF)

Grubb also discussed the healing and pain-relief benefits of tPEMF via the Assisi Loop (Zomedica). The FDA-cleared wearable device can be use in-clinic or at home to decrease inflammation, reduce pain, and promote soft-tissue and bone healing. The ring-shaped device produces an electromagnetic signal to stimulate the body’s own production of nitric oxide. Grubb explained that nitric oxide produces anti-inflammatory, analgesic, and biotherapeutic effects (excitedly, as the topic has been the subject of her PhD thesis). This nonpharmacologic therapy can be used in conjunction with other modalities and continued at home easily.

“The best thing about the loop is that the owners can continue to do treatment at home,” said Grubb. “I don't know about you guys, but one of the most frustrating things, whether it’s acute pain or chronic pain, is what do we do to discharge the patient and continue treatment?

Grubb T. Nonpharmacologic treatment for chronic pain. Presented at: Fetch dvm360® Conference; San Diego, California. December 2-4, 2022.

Videos

Dr Tamara Grubb, president-elect of the IVAPM, explains nonpharmacologic options for the multimodal approach to chronic and acute pain

3 nonpharmacologic treatment options for pain management

Veterinary professionals involved in end-of-life care handle the toughest, most emotional aspect of pet ownership. During her presentation at the Fetch dvm360® Conference in San Diego, California, Mary Gardner, DVM, co-founder and chief information officer of Lap of Love Veterinary Hospice & In-home Euthanasia in Jupiter, Florida, shared simple advice for these fellow veterinary staff to follow: LOVE rules.

Throughout her lecture, LOVE was evident. Gardner displayed slides with pictures of pets truly loved and cared for at their most critical stage, and social media and in-person comments from veterinary professionals who also handle this difficult task.

Gardner had a road map slide detailing the pathway of the euthanasia experience, and how everything done is from a respectful, caring perspective. She gave advice for every stage, from handling the pet owner’s initial phone call to the office, proper etiquette to prepare for a pet and owner’s arrival, having the appropriate environment in the designated room and to ensure the bill payment receipt never be itemized or list charges. Allowing the owner and the pet ample time to say goodbye, verbal priming to speak compassionately to a pet owner, and so much more were solid tips for conference members to employ back in their offices.

Gardner, who for a decade was a business analyst and software designer, is a “second-career veterinarian.” She got interested in this type of work soon after Snow White, a Simoya mix dog she had since she was a teenager, died at age 13. Snow White was being watched while Gardner was away on a work trip. The dog got in a fight with the pet sitter’s Rottweiler and suffered from 72 bite wounds and a broken jaw. Gardner tried everything to save Snow White, but the latter succumbed to an infection.

“The loss of her just changed my life,” Gardner said. “I went through some grief, and I thought what an amazing and horrible experience I had at that vet clinic. I decided I wanted to go back to school and become a veterinarian. So, her passing is why I became a vet. I graduated when I was 35. I did a year of general practice, but I knew it wasn’t the impact I wanted to make.”

When she reconnected with a veterinary school alumna who did end-of-life pet care and asked Gardner to create software to help her manage drug logs, appointments and more, a light bulb went on.

“I became a veterinarian because of the death of my dog. If I can make it better, then I can come full circle, and I get to build software.”

She co-created Lap of Love Veterinary Hospice and In-Home Euthanasia, a business venture in which she uses her software and that has grown to 127 locations in 35 states, 200 veterinarians, and 150 call center agents. Gardner has also written 2 books about geriatric dogs and cats.

Speaking to veterinary professionals at conferences about the end-of-life process empowers Gardner to inform others on how impactful the topic is. “I love my rooms because they are into what I am doing, and they want to do [end-of-life care] better, too.”

Gardner M. Creating a good end-of-life experience.Presented at: Fetch dvm360® Conference; San Diego, California. December 2-4, 2022.

Dr Mary Gardner's tips on ensuring a compassionate end-of-life experience for pets and her inspiration for pursuing this commendable field 

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