The Innovator of the Month series, sponsored by Chewy Health, spotlights veterinary professionals who are driving positive change and inspiring their peers. By recognizing outstanding clinicians, technicians, and paraprofessionals, Chewy Health aims to highlight impactful initiatives and promote a brighter future for veterinary medicine.



Kwane Stewart, DVM, has practiced veterinary medicine in California for over 2 decades. During a 5-year tenure as a shelter veterinarian in an underfunded area of California, Dr. Stewart decided to embark on a new mission: providing free veterinary services to the pets of individuals experiencing homelessness. As Co-Founder and President of Project Street Vet, Dr. Stewart aims to expand the organization’s reach across major cities in the United States to provide free-of-charge check-ups, medication, and even food. With his personal motto of “no judgement, just help,” Dr. Stewart knows that there are myriad reasons why pet parents may not be in the position to afford health care for their pets. With access to care being an increasingly hot-button topic across the veterinary industry, Dr. Stewart is carving out a way to make obtaining that much-needed care easier.



Note: The following interview has been edited for brevity and clarity.

Can you introduce yourself and tell us about your work?

 I am Co-Founder and President of Project Street Vet, a 501c3 we established in 2020. Our mission is simple: we give free veterinary care to pets of people experiencing homelessness.

What was the pivotal moment or experience that inspired you to pursue Project Street Vet?

 There was a moment outside of a 7-Eleven where I randomly met this unhoused gentleman and his dog. His dog was suffering from a really bad skin condition. I treated the dog then saw the same man about a week and a half later, and the dog was transformed. I realized that, in those five minutes of care, I changed this dog's life and this man's life. That inspired me to do what I'm doing, and it’s been 13 or 14 years now.

What does success look like for you? How would that impact veterinary medicine, your practice, or community?

My dream is to be in the 15 largest cities. If we had a Project Street Vet team in those markets, we would account for about 75 percent of the homeless population in pets. It's an expansion that will probably take another two years. However, if I can reach that, we will have a serious footprint.

Can you share a specific example of how your innovation has positively impacted the veterinary community or success stories that demonstrate the effectiveness?

For many years it was just me, and now we've expanded to 8 cities and in those 8 cities I probably have 12 to 15 volunteer vets and maybe 30 to 35 veterinary techs. We have a little network and family of people doing the work. I think the biggest impact that I’ve noticed is a renewed belief in our purpose and what we're here to do. I spoke with someone who felt stuck in the mundane and had lost their desire and passion for the profession. I found that people who do this work for passion and not for pay are given a new lease on their career.

How has your work been received by the veterinary community and by pet owners or other stakeholders?

My work has been received with open arms and gratitude in ways that are hard to describe. It's very emotional and we have very personal interactions. It's not just the folks on the streets but the veterinarians and people who hear my story, or donate, or read the book. I'm building this beautiful network of people who are inspired to do more of this.

What are your plans for the future development of Project Street Vet?

It comes down to growth and expansion, we're on a tear. So, give me two years and check back with me.

What advice would you give other veterinarians or researchers who aspire to innovate in their field?

I think what drives vets, and I say this a lot, is the passion. You sometimes start to lose that in the race of building net wealth, or your practice, or staying afloat financially, or paying off your student loans. Then you start to lose that childhood part of you—the part that wanted to be a veterinarian. That seven-year-old boy in me dreamed of being a vet, and I sometimes realize I'm starting to stray from my very basic nature of helping animals.

In your opinion, what are the most pressing challenges facing the veterinary field today, and how can we work together to solve them?

A pressing challenge is access to care. I think if you ask any vet, that'll be in their top three challenges. There aren’t enough of us. The number of pet parents and pets in the country is outpacing the number of care providers. Unless we empower technicians or telemedicine as it becomes more popular, we're going to keep losing this battle and more and more pets aren't going to be seen to get the care they need.

Dr. Stewart closes out the 2024 Innovator of the Month series, which has brought forth some insightful conversations about advancing the veterinary field in more meaningful ways. Over the past five months, dvm360 has partnered with Chewy Health to celebrate these veterinary professionals who have combined compassion and innovation to make positive changes across access to care, affordability, practitioner burnout, and more. Creative new charities, products, and professional development programs are all included in this exciting series – Check out the other great innovators featured in 

Articles

Dr. Kwane Stewart’s mission is to provide free veterinary care to pets of individuals experiencing homelessness, which addresses critical access-to-care challenges in veterinary medicine.

Introducing dvm360 and Chewy Health’s December Innovator of the Month: Kwane Stewart, DVM, Co-Founder and President of Project Street Vet

Recent innovations and technology opportunities give veterinary teams a wealth of resources to streamline operations and improve efficiency, freeing up time to focus on what we do best: care for patients and assist clients. The important question is, are we taking full advantage of these opportunities? Results from a recent survey of veterinary practice owners by the American Veterinary Medical Association (AVMA) provide some important insights.

Many practices are using practice information management software (PIMS), electronic medical records software, and online pharmacies. Adoption has been slower for digital inventory management systems, online appointment scheduling, and telehealth.

Technology adoption rates also vary by practice type. For example, PIMS integrated communications software and online appointment scheduling are more common in companion animal practice than in mixed animal or equine practice.

To delve deeper into these findings, the AVMA asked practice owners whether they felt they were keeping up or falling behind when it came to using technology in their practice. Overall, 69% of owners said they were keeping up, 20% said they were falling behind, and the remainder said they didn’t know.

What reasons were given for falling behind? The most common reason was time constraints, followed by financial constraints and lack of interest.

Although these reasons need to be acknowledged, they don’t need to hold us back. Many digital tools are available to simplify or automate routine tasks and seamlessly incorporate technology into everyday practice. These tools provide solutions to specific problems that teams may be experiencing and opportunities to deliver what clients are demanding. Most of these tools, if not all, save more time in the long run than they take to incorporate. And as artificial intelligence continues to be integrated into technology solutions, the potential is immense for significant efficiency gains through responsible use of these capabilities. 

The good news is you don’t have to fully implement all available technologies right now to see results. In fact, a thoughtful, incremental approach can not only help overcome any hesitancy or resistance within your team but also prime your path toward sustained rewards.

Here are some tips to get started. If technology isn’t your thing, consider recruiting a technology enthusiast from your team to lead the charge.

Identify which types of digital tools or services your practice currently lacks. You can use the ones mentioned previously from the practice owners survey as a reference.

Talk with your team about pain points and frictions they are encountering in their daily roles and how these might be overcome.

Pick 1 tool that you think will address a problem or opportunity you’ve identified and would be easiest or least costly to implement. You’ll earn bonus points if the tool promises a quick win with potentially high impact, such as a ready-to-use online pharmacy or appointment scheduling platform or videoconferencing software for telemedicine visits.

Ask the vendor to highlight what the tool can do, the steps involved in implementation, and any ongoing support to help with training, technical issues, and updates.

Find out about the cost as well as the potential savings in both money and time you might expect with implementation. Several digital tools can substantially improve revenue streams or cut costs and time, with just a minor financial commitment. For tools that facilitate client communications, patient follow-up, or product sales, these benefits can be realized even if only a portion of clients take advantage.

Start with a small pilot project to discover how you and your team like the tool and its impacts on a specific area of your practice. Often, you can try things out for minimal expense, and within a week or two, you will know more about the technology than you could garner from a vendor’s pitch. If you like what you see, you can gradually expand the tool’s application to minimize disruption.

Another great way to overcome hesitancy is to learn about the experiences of other practices in implementing your chosen tool as well as any advice they have to offer, so you don’t need to start from scratch.

Check out the new AVMA Axon Tech Talk webinar series (avma.org/Axon), which focuses on technology and how it can be used to improve practices, processes, and productivity. Be sure to catch the episode “Online Ordering and Home Delivery.”

Find tips and real-life case studies on putting telemedicine services into practice

Practices that have already embraced digital technologies have growth opportunities as well. Quite often, the tools we’re already using have features we have yet to discover or use. Leveraging those features can offer a low-budget, high-impact boost.

For example, PIMS can be great for automating or facilitating a myriad of routine, often repetitive tasks. Are you taking advantage of all features, or do some go unused?

Although you could find out about a technology’s full capabilities by reading about the available features in the marketing or instructional materials, a quicker path might be to contact the vendor directly—for example, the PIMS company’s technology support team. Ask them to highlight what your practice could be doing with the tool.

Afterward, ask your team about their thoughts on the unused features and how those features might affect their work. (Discover how one practice did this, followed through, and reaped the rewards in the Tech Talk webinar “Boosting Productivity.”

In today’s busy practices, technology is a necessity, not a luxury. Among the many benefits are superior patient care, happier clients, smoother operations, and less stress on the team, not to mention financial gains. Indeed, research has shown that optimizing efficiency in companion animal practice can allow veterinary teams to accomplish more and reach more patients with their current contingent of staff.4 For more ideas on how technology can be used to achieve these goals, be sure to check out the Just One Thing series on the AVMA@Work blog (avma.org/Blog), featuring practical tips for veterinary practices that can be achieved in 15 minutes or less.

Doherty C, McKay C, Ouedraogo FB. 2024 AVMA Report on the Economic State of the Veterinary Profession. American Veterinary Medical Association. 2024. Accessed September 11, 2024. https://ebusiness.avma.org/ProductCatalog/product.aspx?ID=2157

Doherty C, Hayworth R. AVMA Tech Talk: online ordering and home delivery. American Veterinary Medical Association. Accessed October 18, 2024. https://axon.avma.org/local/catalog/view/product.php?productid=285

Doherty C, Boudreau L. AVMA Tech Talk: boosting productivity. American Veterinary Medical Association. Accessed October 18, 2024. https://axon.avma.org/local/catalog/view/product.php?productid=319

Ouedraogo FB, Weinstein P, Lefebvre SL. Increased efficiency could lessen the need for more staff in companion animal practice. 

. 2023;261(9):1357-1362. doi:10.2460/javma.23.03.0163

A practice can benefit in many ways by embracing and utilizing modern tools and resources

Take advantage of technology

, our host Adam Christman, DVM, MBA, welcomes Pam Hale, DVM, MBA, JM; George Melillo, VMD; and Keith True, DVM, MBA, to discuss a new group making its way to veterinary medicine: the New Order of Veterinary Leaders (NOVL) . The trio explains to Christman what the goals and aspirations of NOVL are and how they are using their years and successes as veterinarians and business professionals to provide support and encouragement to veterinarians through coaching and business training. 

 So barriers to ownership, obviously, what started probably 20 or 30 years ago, which sort of led to this growth in veterinary groups, is a lot of young DVMs coming out of school not wanting to get a loan to pay for a practice, considering the school loan debt that many of them have, and also the feeling of the need to learn more medicine before they enter into practice. Ownership, which we all do, coming out of school. Traditionally, what is it? Fifty-60, years ago, you might come out of school on a Friday and open up your own practice on a Monday or you would go in and work with Doc Joe for 5 or 6 years and start buying into the practice, but as we've grown into veterinary groups, we also need veterinarians that are in those important roles that help to give us agency. I know I've done some of my best work, even as a clinician, as a leader, as a regional medical director, when I've answered to another veterinarian, because we know that they can help us and they understand exactly what we go through each day. 

Don't get me wrong. I do believe we need our paraprofessionals around us—and paraprofessionals being those non DVMs—not just at our hospital level, but even at the corporate home office level. I think we need those [professionals] around us. But I do believe that veterinarians also should bring that most important part of what our profession needs, and that's the veterinary medical leadership and the business leadership, which I know, Dr True and Dr Melillo can talk to.

Podcasts

NOVL founders discuss its creation, and how it will empower veterinarians to pursue leadership and practice ownership opportunities. 

Introducing the New Order Of Veterinary Leaders

 editorial team is counting down our Top 20 news stories and articles of the year, from January 1, 2024, to November 15, 2024. Rank was determined by measurable audience interest and engagement.

A spotlight is shining on 1 article each day through New Year’s Eve, when the No. 1 

 story of the year will be shared. The following article is No. 14 on this list:

Spaying and neutering dogs: Myth vs reality

“Every lame animal that comes to your practice is not treated the exact same way; every animal hit by a car is not treated the same. I am going to try and convince you that spaying and neutering are no different in that respect: you should be taking each case and evaluating it separately. There is simply no cookie cutter answer to spaying and neutering dogs.” So began Bruce W Christensen, DVM, MS, DACT, founder of the Kokopelli Assisted Reproductive Services in Sacramento, California, in his session, “To spay or not to spay? And how? And when?” at the 2024 American Veterinary Medical Association (AVMA) Convention in Austin, Texas.

Christensen broke down the reasons for canine sterilization into 3 main categories: To prevent the contribution to the stray pet population; to halt undesirable behaviors; and to decrease the chance of contracting disease.

For the first case, overpopulation, although Christensen acknowledges the problem exists, he said, “keep in mind, there is also a variety of places people get their dogs from (ie, animal shelters, friend, breeder, etc.). “That should be considered when you are looking at the spaying or neutering,” Christensen said.

If, for example, the dog comes from a reputable breeder, that’s different than if the dog is coming from a shelter, which usually requires the dog is spayed or neutered before leaving the shelter. When coming from a breeder, said Christensen, almost always there is a discussion about spaying or neutering this animal. For breeders who, for example, sell a puppy that they consider great for future breeding, they might want to retain some coownership or breeding rights, with sterilization happening later in life for that dog. For other breeders, it might be in the contract that the adoptive family will spay or neuter this puppy at a certain point.

“You, as the veterinarian, should be aware that these conversations are happening, and if you are not on board with these decisions, then you should ask yourself why,” Christensen said.

For information on this story, including about the prevention of undesirable behaviors and decreasing the chance of contracting disease, continue reading the full article: 

https://www.dvm360.com/view/spaying-and-neutering-dogs-myth-v-reality

dvm360 is counting down the Top 20 news stories and articles from 2024 with this series of spotlights

2024 veterinary news in review: #14

The FDA recently released a document offering guidance on how to minimize the risk of highly pathogenic avian influenza (HPAI) H5N1 in felines and highlighting recent investigations on HPAI infection in cats. According to the FDA report, felines—both domestic and wild species like tigers, mountain lions, and lynx— are especially vulnerable to HPAI H5N1, so precautions should be taken to prevent their exposure to the virus.

Clinical signs of HPAI infection are better understood in cats than in dogs, according to the American Veterinary Medical Association (AVMA).

 Still, both canines and felines exhibiting any of the following symptoms should receive prompt veterinary treatment

Neurologic signs, like tremors, seizures, incoordination, or blindness

To help prevent the risk of a HPAI infection in cats and dogs, the AVMA recommends maintaining cats indoors; keeping pets that go outdoors away from wild birds, poultry, and cattle, including these animals’ environments; ensuring pets do not consume dead birds or other animals; and steering clear of feeding pets raw meat or poultry and unpasteurized milk.

According to the FDA document, several investigations have shown that HPAI can spread to cats through food, with the most common route of transmission being raw or undercooked meats and unpasteurized milk. “Cats should not be fed any products from affected farms that have not been thoroughly cooked or pasteurized to kill the virus. Cats should also be kept from hunting and consuming wild birds,” wrote the FDA.

A study published by the Centers for Disease Control and Prevention (CDC) in July 2024 on HPAI A(H5N1) infection in domestic dairy cattle and felines in the US detailed that domestic cats fed raw colostrum and milk from infected cattle developed a fatal system influenza infection. These cats also exhibited neurologic signs before death. Affected cattle, meanwhile, showed signs of nonspecific illness, reduced feed intake and rumination, and a sudden decline in milk production.

In Seoul, South Korea, investigators reported multiple cases of HPAI in 2023 from July of the same year at 2 cat shelters where the felines were fed raw food that was “improperly sterilized” and made from domestic duck meat.

According to the study, the postmortem examination of the cats showed “systemic pathologic lesions.” Additionally, the virus was found in different tissues.

The United States Department of Agriculture runs a testing program to detect HPAI in wild mammals, including both feral and domestic felines, according to the FDA.

 These most recent HPAI detections can be found on the usda.gov website. 

FDA outlines ways to reduce risk of HPAI in cats. United States Food & Drug Administration. December 13, 2024. Accessed December 17, 2024. 

https://www.fda.gov/animal-veterinary/cvm-updates/fda-outlines-ways-reduce-risk-hpai-cats?utm_medium=email&utm_source=govdelivery

Avian influenza in pets and backyard flocks. American Veterinary Medical Association. Accessed December 17, 2024. 

https://www.avma.org/resources-tools/animal-health-and-welfare/animal-health/avian-influenza/avian-influenza-companion-animals

Burrough ER, Magstadt DR, Petersen B, et al. Highly Pathogenic Avian Influenza A(H5N1) Clade 2.3.4.4b Virus Infection in Domestic Dairy Cattle and Cats, United States, 2024. 

. 2024;30(7):1335-1343. doi:10.3201/eid3007.240508.

Kang Y, Heo G, An S, et al. Highly Pathogenic Avian Influenza A(H5N1) Virus Infection in Cats, South Korea, 2023. Emerging Infectious Diseases. 2024;30(12):2510-2520. doi:10.3201/eid3012.240154.

The document offers tips for minimizing the risk of the highly pathogenic avian influenza in felines and highlights the virus' growing threat to these animals

FDA releases guidance to prevent bird flu risk in cats

Equine rehabilitation is a large, focused field of specialized equine medicine. Its main indications are to reduce pain, facilitate tissue healing, and restore muscle strength, endurance, and proprioception to return the patient to its prior level of activity while also trying to prevent further injury.

 Several modalities are available to the equine practitioner, and they can be divided into manual therapies, physical therapies, therapeutics, and biological.

Once an accurate and complete diagnosis is reached, a rehabilitation protocol can be put in place taking into consideration the phase of the tissue healing (acute, subacute, chronic) and the primary functional rehabilitation issues (pain, incoordination, muscle weakness).

 An adequate protocol should outline specific goals and a rehabilitation timeline after discussion with the owner/rider/trainer to ensure compliance.

Once a rehabilitation program has been chosen, regular reevaluation and adjustment of the modalities used may be necessary based on the clinical response obtained.

 A brief overview of 3 modalities the author uses commonly in equine rehabilitation and that could be incorporated into various rehabilitation programs follows.

. Equipment needed to perform mesotherapy: a blue linear adaptor connected to 5 intradermal needles and a small extension for ease of injection.

Mesotherapy consists of intradermal injection of small amounts of highly diluted drugs. By injecting small volumes of drugs, it reduces the risk of adverse effects and increases the drug duration activity. This procedure can be performed in a hospital or on the road, is relatively easy and economical to perform, and has the advantage of being synergetic with other therapies. Mesotherapy is often indicated in cases of back pain (kissing spine, lumbar pain, sacroiliac pathology) and cervical pain or stiffness. As with any other modalities, owner consent should be obtained prior to treatment, and risks of complications should be discussed including local reaction, infection, and hair growing back white at the injection sites. Mesotherapy necessitates the use of a linear injector, a small extension set, and intradermal needles with a depth of no greater than 4 mm (

). Drugs commonly used for mesotherapy include mepivacaine local anaesthetic, corticosteroids, Traumeel homeopathic injectable solution (Heel Veterinary Medicines), vitamin E complex, and sarapin. With the use of corticosteroids, withdrawal time should be taken into careful consideration as the drug may stay longer within the dermis. The linear applicator is inserted perpendicular to the skin in lines parallel to the midline for the back, about 1 cm apart. Medication is injected until a small lump is seen on the skin (

). Horses are usually given 24 hours of rest during which they should neither be washed nor rugged, and they can then progressively resume regular exercise.

 Mesotherapy is applied to a horse’s thoracolumbar region. Note the raised injection site in lines parallel to the midline and about 1 cm apart on each side of the back.

Kinesiotape consists of an elastic tape made of 100% cotton elastic fibers that can stretch along its longitudinal axis up to 130% to 140% of its resting length. Once applied it can stay on up to 5 days, 24 hours per day. Kinesiotape affects all layers of tissue and organs. Applied to the skin surface, it results in a lifting effect with the creation of space between superficial layers. It also directly acts on the fascia through an unwinding effect and redirection of movement. Finally, it optimizes muscle function and helps provide decongestion and fluid redirection by acting on the lymphatic system. The main indications for using kinesiotape are tendon and ligament injuries, muscle imbalances, postural adjustments, lymphatic and circulatory conditions such as lymphangitis (

), pathologic movement patterns, fascial adhesions, and acute and chronic pain.

 Kinesiotape is applied in a lymphatic drainage pattern to treat lymphangitis over the hock region. Most of the lymphatic drainage occurs on the medial aspect of the limb; therefore, that is where the tape should be applied predominantly.

Laser, or light amplification by simulation of emitted radiation, is commonly used in equine practice. Class III and IV lasers are most commonly used in equine rehabilitation. They have a range of less than 500 mW, and their wavelengths vary from 540 nm to 1060 nm. Laser stimulates cell growth and metabolism, improves cell regeneration, increases fibroblastic activity, and modulates inflammation by acting on prostaglandin E2, tumor necrosis factor-α, interleukin-1β, plasminogen activator, and cyclooxygenase-1 and -2. Laser increases serotonin, which is an excitatory neurotransmitter peripherally, and it also works in the dorsal horn to modulate pain response, providing a general feeling of well-being. It also increases the release of β-endorphin, which results in increased production of endogenous opioids. Finally, it increases acetylcholine, which is an inhibitory neurotransmitter, resulting in the decreased discharge frequency of excitatory neurons and increases the frequency of inhibitory neurons; this results in a significant increase of the pain threshold required for the transmission of sensory nerve input. The main indications for laser use in equine practice are performance maintenance, prevention of injury recurrence, tendon and ligament injury, chronic joint disease, synovitis, osteoarthritis (

), back pain or injury, wound healing, and pain relief.

. Application of a class IV laser to a horse’s tarsal region to relieve pain caused by chronic osteoarthritis.

There are several modalities available for the practitioner to integrate into the rehabilitation of the equine patient. Each modality should be chosen carefully and the function of their mode of action and the pathology diagnosed. Given that the scientific evidence is limited in this area of veterinary medicine, frequent assessment and reevaluation of patients is recommended to make adjustments when needed and obtain the best outcome from each rehabilitation protocol.

McGowan CM, Cottriall S. Introduction to equine physical therapy and rehabilitation. 

. 2016;32(1):1-12. doi:10.1016/j.cveq.2015.12.006

Bergh A, Lund I, Boström A, Hyytiäinen H, Asplund K. A systematic review of complementary and alternative veterinary medicine: “miscellaneous therapies.” Animals (Basel). 2021;11(12):3356. doi:10.3390/ani11123356

Kaneps AJ. Practical rehabilitation and physical therapy for the general equine practitioner. 

. 2016;32(1):167-180. doi:10.1016/j.cveq.2015.12.001

Haussler KK, King MR, Peck K, Adair HS. The development of safe and effective rehabilitation protocols for horses. 

. 2021;33(3):143-151. doi:10.1111/eve.13253

Alves JC, Santos A, Lafuente P. Evaluation of different substance combinations in a multiple-session mesotherapy protocol for the management of osteoarthritis in dogs: a retrospective study. 

. 2024;262(8):1-7. doi:10.2460/javma.23.10.0588

Alves J, Jorge P, Santos A. Comparison of two mesotherapy protocols in the management of back pain in police working dogs: a retrospective study. 

. 2021;43:100519. doi:10.1016/j.tcam.2021.100519

Alves JC, Santos A, Jorge P, Lafuente P. Multiple session mesotherapy for management of coxofemoral osteoarthritis pain in 10 working dogs: a case series. 

Alves JC, Santos A, Jorge P, Lafuente P. A multiple-session mesotherapy protocol for the management of hip osteoarthritis in police working dogs. 

. 2022;84(1):ajvr.22.08.0132. doi:10.2460/ajvr.22.08.0132

Molle S. Kinesio taping fundamentals for the equine athlete. 

 2016;32(1):103-113. doi:10.1016/j.cveq.2015.12.007

Ericson C, Stenfeldt P, Hardeman A, Jacobson I. The effect of kinesiotape on flexion-extension of the thoracolumbar back in horses at trot. 

. 2020;10(2):301. doi:10.3390/ani10020301

1Luna SPL, Schoen A, Trindade PHE, Rocha PBD. Penetration profiles of a class IV therapeutic laser and a photobiomodulation therapy device in equine skin. 

. 2020;85:102846. doi:10.1016/j.jevs.2019.102846

Millis DL, Bergh A. A systematic literature review of complementary and alternative veterinary medicine: laser therapy. 

. 2023;13(4):667. doi:10.3390/ani13040667

Haussler KK, Manchon PT, Donnell JR, Frisbie DD. Effects of low-level laser therapy and chiropractic care on back pain in quarter horses. 

. 2020;86:102891. doi:10.1016/j.jevs.2019.102891

An overview of 3 types of therapy includes mesotherapy, Kinesiotape, and laser