To kick off her lecture at Fetch Nashville, Taylor Root, VMD, asked attendees to picture a busy Friday afternoon in their clinics. The appointments are back-to-back, patients seem to be coming into the clinic without discussing the reason for their appointment, and then you get to an appointment for Binky and Miss Adams. From previous experience, you know that Miss Adams is going to want to chat about something, even though you may not want to chat for long. However, Miss Adams asks you for your thoughts on pet food, especially the one that she is now feeding Binky. You may not want to get involved, or you may not know the right answer, but this scenario can be relatable to every clinician.

“When you’re in practice, nutrition comes up a lot, and we kind of shut down when it does come up. I mean, there are certain people out there who love it and are really into it, but I think for most, especially general practitioners, it’s like, you know, we know we have to talk about it. We know it’s important, and we know that it’s going to come up in every conversation, but we just don’t want to have the talk that’s coming,” Root kicked off her lecture with.

Throughout the rest of her lecture, Root broke down pet food to attendees to help them be more confident when talking about the process of making pet food to help provide evaluations and recommendations to your clinic’s version of Miss Adams.

According to Root, companies producing pet food tend to follow multiple phases. The first is concept, which is brainstorming. This is where the company gets together to go over ideas and determine whether the second step is feasible. When moving on to whether it is feasible, the companies assess what they came up with in the development phase to determine whether their concept is possible to execute or would really work.

“So the concept phase is sort of like a blue sky approach.... The world is your oyster. If you could have anything, if we could make anything, what would it be? And that’s really what you want to have—that’s what their goal is during this phase: Don’t ask questions, don’t challenge things. Just say, ‘But what if? What if we did this? What if we did that?’ The questioning and the poking holes and things are coming later, but this is the time that...all the ideas can come together,” she explained.

When evaluating the concepts, it can be useful for these companies to also rely a little bit on the trends in human health and mimic what they are doing. Sometimes, the trends, like fatty acids, Root said, carry over into the animal space, and companies begin putting them into a lot more foods for joint support. The human food world also has bigger group sizes and things of that nature when it comes to testing products, so their research can sometimes be helpful when creating concepts for pet food.

After working through all the feasibility questions needed to determine whether the product could work, pet food companies need to determine whom the food is for. Is it for puppies? Geriatric dogs? Just adult dogs? This needs to be determined before looking into any ingredients, macronutrients, and micronutrients because, according to AAFCO, each group needs different things for whom they are targeting, so this needs to be defined before anything else. When patients then ask you the difference, this can help explain why their puppy food may not have all that is needed for their adult dog and vice versa. Once all of this is established, it may not guarantee the product will work.

“Sometimes, you think it’s going to work, and on paper it’s going to work, but when you put the formula together, it doesn’t actually do it. The ingredients and the manufacturing process don’t go together. You might run a batch along the way and have to reevaluate there. We also start to learn about: What does the food look like, feel like? What is the aroma? Does it run consistently every time we run it? How long does it take to run? How long does it take to cook? What temperatures are we looking at, all of that? And then we go into analytical testing, which includes nutrient analysis and shelf life testing,” Root explained to attendees.

When it comes to talking to pet parents about pet food, it may be the last thing you want to do, but it could be the most important thing they think to ask you during the appointment. Your understanding of how the pet food industry works and what they consider when creating products can help you better educate your clients and get your patients the right food for them.

Root T. You can't judge pet food by the cover. Presented at: Fetch Nashville. May 31, 2025. Nashville, TN.

Articles

Are you confident in talking about the pet food process with your clients? 

The pet food landscape 

We are living in a world that often feels divided, and finding safe and welcoming spaces matters more than ever. For many individuals in our LGBTQ+ community, our pets are a source of love, comfort, and stability. They give us a sense of peace in a world that doesn’t always embrace who we are. They don’t judge, they don’t question, and they don’t care about labels. They just love us.

That kind of unconditional acceptance is powerful, and it is something we should also experience when we step into a veterinary clinic or hospital. Whether we are there as pet parents or as part of the veterinary team, feeling accepted and respected should be the baseline.

For our LGBTQ+ clients, the experience at a veterinary clinic can be personal, as our pets are part of our chosen families. They have helped us through depression, anxiety, grief, and rejection. They have also grounded many of us with routine and have brought joy during difficult times. For most of us, pets are our “kids.” But when someone walks into a space that feels unwelcoming or judgmental, that support system can suddenly feel compromised.

That’s why inclusive care matters. It is not just about providing excellent medical treatment. It is about being seen, heard, and valued as a whole person. I believe that inclusivity isn’t just for clients, as it starts from the inside, with the veterinary team.

Creating a supportive, respectful environment for staff is just as important as creating one for our clients. LGBTQ+ team members deserve to work in places where we can show up as our full selves, without fear of judgment, bias, or exclusion. When all team members feel safe and accepted, we thrive, collaborate better, communicate more openly, and deliver more compassionate care.

I want to share some ways in which we can incorporate inclusivity into our daily routine. Start by clearly stating your commitment to inclusivity on your website, intake forms, and/ or employee handbook. Include protections based on gender identity, sexual orientation, race, disability, and more. You can also ask for and use pronouns in client intake forms and staff introductions. Train the team to respectfully correct mistakes and normalize asking pronouns when unsure.

It is important to recognize and respect nontraditional family structures. Make space for partners, roommates, or friends who are important in a pet’s care. Consider regularly training your team on cultural competency, LGBTQ+ terminology, and inclusive communication. Make it part of onboarding and ongoing education. It is also important to make sure everyone knows how to report discrimination and that they will be taken seriously.

I personally love recognizing Pride Month, and you can also consider recognizing Transgender Day of Visibility and other cultural celebrations. At my hospital in Texas, we even pay attention to small things like rainbow stickers in the lobby and inclusive signage, like all-gender bathrooms.

Consider supporting local LGBTQ+ events, sponsoring Pride activities, or partnering with advocacy groups. Also, be vocal about your clinic’s values! For example, anytime I interview a candidate for any open position, I always mention that we have an accepting culture and that any sort of discrimination, including homophobia and transphobia, will not be tolerated.

I believe that a strong veterinary team is built on mutual respect, and that means that we need to embrace our differences. We need to listen to each other’s stories and learn from one another.

It also means calling out discrimination when it happens and committing to growth, even when it is uncomfortable. This is not about just “tolerance,” this is about accepting each other for who we are.

At my clinic, we make inclusivity part of our daily culture. From front desk team members to technicians to doctors, everyone is expected to treat clients and coworkers with kindness, respect, and openness. We live our values in every interaction, and it truly makes a difference. I have seen clients open up and I have seen team members feel more confident and empowered because they know they are supported exactly as they are.

Inclusivity is not about politics or checking a box, and this is very important. It is about people and creating spaces where everyone feels safe, respected, and cared for. That’s the kind of environment where healing happens, relationships grow, and trust is built. We all deserve a team that supports and respects us. No one should have to hide who they are to do the job they love. To all my LGBTQ+ people, stay strong and always stand up for your rights!

At the end of the day, our pets are here for us in the purest way possible. Let’s honor that bond by building veterinary spaces that reflect the same love, acceptance, and trust they give us so freely.

, is known as “Dr Josh” and grew up in Puerto Rico. Sanabria earned a bachelor’s degree in veterinary technology at the University of Puerto Rico, Medical Sciences Campus in San Juan, and a doctorate degree from the University of Missouri College of Veterinary Medicine in Columbia. He is the owner of Isla Veterinary Boutique Hospital in Addison, Texas, where he provides medical consultations in Spanish and English.

Josh Sanabria, DVM, discusses cultivating environments where people feel safe, respected, and cared for, in this dvm360 commentary. 

Why inclusivity in veterinary settings matters—for clients, pets, and the medical team

Vet Watch Update: New tick species implicated in alpha-gal syndrome

Is the lone star tick the only vector for alpha-gal syndrome? New evidence says no, expanding the geographic risk for this serious meat allergy across the United States.

 update at dvm360. I’m Christopher Lee.

Alpha-gal syndrome—new studies have shown that this potentially deadly disease may be transmitted by more than 1 tick species.

To review, alpha-gal syndrome, or AGS, is a serious meat allergy in people against galactose-alpha-1,3-galactose, a large sugar molecule found in the tissues of nonprimate mammals. People with AGS can no longer eat most mammalian tissue—including beef, pork, lamb, and even rabbit—but they can still eat poultry, seafood, and less common protein sources such as alligator or escargot.

What is unusual about AGS is that it is transmitted through the bite of a tick, 

, the lone star tick. This tick has an enzyme in its salivary glands, alpha-D-galactosidase, that cleaves alpha-gal from mammalian tissue. How alpha-gal then ends up in the tick’s saliva when biting a person is not fully understood, but we do know that partially fed ticks carry high levels of alpha-gal in their saliva.

 tick feeds on a dog, mouse, or deer, and its meal is interrupted—perhaps it gets brushed off. Now it’s searching for a new host. It finds a human, climbs up, and begins to bite. With high levels of alpha-gal in its saliva, that molecule gets injected subcutaneously into the person, triggering a strong immune response and an IgE-mediated reaction. If sensitization occurs, that individual will have AGS for life. Within hours of eating pork or beef, they can experience facial swelling, hives, and even life-threatening anaphylaxis.

, ticks famous for transmitting Lyme disease, may also trigger AGS. This finding expands the geographic risk. 

 is found throughout the eastern half of the United States. The lone star tick’s range overlaps much of this area but does not extend as far north. 

 inhabits the Pacific coast (California, Oregon, and Washington).

So what do we do with this information? We keep prescribing year-round tick prevention to all  our patients.

 here at dvm360, where what you know today protects everybody tomorrow.

Videos

Recent research suggests that Ixodes scapularis and Ixodes pacificus may also trigger alpha-gal syndrome, broadening the geographic risk for this potentially life-threatening meat allergy.

Vet Watch update: New tick species is implicated in alpha-gal syndrome

Reframing litterbox issues as "house soiling" rather than "inappropriate elimination" helps caregivers better understand their cat's needs and seek appropriate care, according to Tabitha Kucera, RVT, VTS (Behavior), CCBC, KPA-CTP, FFC.

Rethinking feline house soiling: What you should know

Tabitha Kucera, RVT, VTS (Behavior), CCBC, KPA-CTP, FFCP, details 3 key takeaways from her session “Litterbox Lessons: Keeping Cats in the Litterbox,” which she presented at the Fetch dvm360 Conference in Nashville, Tennessee.

First, she stresses the importance of offering caregivers empathy and support, helping them move away from blame-based narratives surrounding cats, like "spiteful" or "inappropriate" behavior, and instead viewing the issue as "house soiling"—a sign that the patient may be struggling.

Second, a full medical and behavioral workup is key. This includes not only a urinalysis and physical exam but also consideration of pain and other emotional or behavioral factors.

Stress management is also crucial, according to Kucera. Creating safe spaces, reducing household stressors, and addressing multi-cat tension can significantly improve outcomes for both the patient and client.

Below is the interview transcript, which has been lightly edited for improved clarity:

Tabitha Kucera, RVT, VTS (Behavior), CCBC, KPA-CTP, FFCP: 

We should do our best to provide caregivers with hope and support and validate their feelings. And I understand that that's not addressing the medical issue just yet, but as a VTS and behaviorist who commonly deals with caregivers who have been unfortunately struggling with this for really long periods of time, the emotional burden can be really challenging and unfortunately, there is quite a few labels to describe cats, like “spiteful,” or even we call it “inappropriate elimination”—that's already problematic. There's nothing inappropriate about it. The animal is trying to essentially communicate, “I'm struggling with severe stress and/or medical and/or behavioral issues” versus what I call it, “house soiling.”

But when caregivers hear things like “my cat's spiteful,” “inappropriate elimination”—labels aren't really helpful to describe the behavior or its cause, so we can't help, but also it causes caregivers to create—even though they love their cats—to create narratives around like “my cat should know better, they're jealous,” like all of these kind of dangerous narratives where they may not reach out to someone like me or even to your veterinary clinic to get an appropriate medical workup. 

So, I think a big thing would be to provide caregivers with hope and support. Understand, “oh, this is so frustrating.” Like, address that, but then also share with them, “I understand how frustrating this can be. I know sometimes it feels like your cats are spiteful, but that's a human thing. I love humans, but that's a human thing.” And then kind of touch on, similar to when your child—I use a lot of analogies— is throwing up because they're not feeling well, your cat is expressing they're not feeling well. So just that will make such a big difference.

 And then the second thing, I think understanding the full context. So, it's important to obtain more information just like we would with any medical condition. So of course, we want to explore medical possibilities, which, yes, starting with the cystocentesis and a good exam is great, but let's say this cat is repeatedly having these cystitis workups or urinary issues, we should definitely be recommending radiographs and further diagnostics. But also kind of think outside of the urinalysis.

I had a cat once house soiling due to fleas. The discomfort that the fleas caused that animal—understandably—increased their stress and caused that house soiling.

I see pain contribute to more than 60% of my cases, whether it's osteoarthritis pain, GI pain, so of course, bladder pain. So again, we really want to explore those medical possibilities but also consider behavioral and emotional factors.

 And then the third, I think it's really important to manage and reduce stressors. We all know that a cat's stress organ is their bladder, so identifying and avoiding triggers is a big thing. For example, if [clients are] like, “when friends come over, my cat hides for 5 hours and doesn't return to baseline by coming out and being themselves in 8 hours.” Hey, we're going to set up a safe space for that kitty before people come over with enrichment and make sure it's somewhere they choose to be, not just putting them in a room that causes stress, and we're going to prevent them from interacting with that stranger at all. 

Or if you notice—in many cases this is something I see—there is some multi-cat tension. There are some simple things we can do.

Sometimes that might be creating safe spaces and separating cats, depending on the severity of the tension. But increasing resources, meeting their needs. If outdoor cats are a trigger, sometimes I just have my clients as immediate management—“hey, tape up some sheets to your windows.” And also there's really great like window decals that allow the sun to come in, but things are a little fuzzy outside.

So, do your best to manage and reduce stress. Those would be my 3 takeaways.

Internalized, harmful narratives about feline behavior can prevent caregivers from seeking appropriate care, according to Tabitha Kucera, RVT, VTS (Behavior), CCBC, KPA-CTP, FFC.

Image Credit: © ryanking999 - stock.adobe.com

At the 2025 Fetch dvm360 Conference in Nashville, Tennessee, on May 31, 2025, William Rausch, DVM, DACVIM (Cardiology), presented “Torsemide: When, How and Why I Use It in Canine Heart Failure.” Rausch highlighted that loop diuretics remain the cornerstone of congestive heart failure (CHF) therapy but noted evolving evidence suggesting torsemide may outperform the long-standing “workhorse” furosemide in certain clinical scenarios.

Rausch explained that torsemide’s pharmacokinetic profile may offer advantages over furosemide. In dogs, torsemide has a half-life of approximately 12 hours compared with 5 to 6 hours for furosemide, allowing for sustained diuresis with fewer daily doses. He stated, “Torsemide just might be that next step, which is...a super exciting thing…. Lasix has always been such an assumption, and it’s been a workhorse, and it’s been wonderful. But I think there may be more benefit to be had with torsemide.” He further emphasized that torsemide is “about 10 to 20 times as powerful” on a milligram-to-milligram basis and noted, “I’ve never treated a dog with more than twice-a-day torsemide, ever. And many of my patients are on [once-daily].”¹

To substantiate these claims, Rausch reviewed the TEST study, a prospective, randomized, blinded, positive-control clinical trial conducted in Europe. Enrolling 366 dogs with stable CHF secondary to degenerative mitral valve disease, the trial compared twice-daily furosemide to once-daily torsemide while maintaining all other cardiac medications (eg, ACE inhibitors, pimobendan, spironolactone) unchanged. Investigators defined clinical success using a composite scoring system that included thoracic radiographs, physical examination findings, and owner-reported signs (cough, appetite, activity). A second end point was the risk of death, euthanasia due to CHF progression, or the need to escalate diuretic dosing. At 3 months, 60% of torsemide-treated dogs vs 55% of furosemide-treated dogs “remained stable,” demonstrating noninferiority of torsemide.

More strikingly, Rausch highlighted, “over the course of those 3 months, about 22% [of dogs on furosemide] died or had severe worsening heart failure. In the torsemide group, 11%. So, a 50% reduction in your risk of dying or having worsening heart failure.” Despite torsemide’s greater potency, mortality due to renal failure was similar between groups (2% furosemide vs 4% torsemide; not statistically significant).

 He said that higher rates of polyuria/polydipsia and mild, nonserious increases in blood urea nitrogen or creatinine were seen with torsemide, but that in over 90% of cases, no dose adjustment was required.

Rausch then summarized a US-based, noninferiority trial beginning at first CHF diagnosis rather than stable disease. Dogs presenting in CHF were randomized to receive either once-daily torsemide or twice-daily furosemide, along with other indicated cardiac therapies. At 3 months, torsemide again demonstrated noninferiority in maintaining clinical stability; 23% of furosemide-treated dogs experienced death or CHF-related decompensation vs 13.7% of torsemide-treated dogs, replicating the approximately 50% risk reduction observed in TEST. Both trials reported higher rates of polyuria/polydipsia and transient, nonserious renal parameter elevations with torsemide.

From a clinical standpoint, Rausch advocated converting furosemide to torsemide using a sliding-scale potency ratio, approximately 1:10 at lower furosemide doses and up to 1:15 to 1:20 at higher doses. He recommended obtaining baseline renal panels, rechecking bloodwork at 48 to 72 hours, and scheduling follow-up exams and labs at 1 month, mirroring trial surveillance frequency.

Owner compliance and practical considerations

On owner compliance, Rausch stated, “There was better compliance in the torsemide group than the furosemide group. And these are people in a clinical trial…you’d think they’d be 100% compliant, right? It’s just like real life.”

 He also stressed selecting clients who would reliably return for monitoring: “I choose my clients pretty carefully who I’m doing this on. I wouldn’t just do this for any client…I want you to come back in a week for blood work with our technicians—they’re going to do that.”

Rausch communicated to the attendees that torsemide offers at least equivalent efficacy to furosemide in canine CHF, with the added benefits of halved morbidity and mortality over 3 months and improved owner compliance due to once-daily dosing. Rausch suggested that these findings support earlier adoption of torsemide, particularly for patients struggling with high-frequency dosing or recurrent decompensations. Further long-term studies may clarify whether torsemide’s short-term advantages translate into prolonged survival and enhanced quality of life.

Rausch W. Torsemide – when, how and why I use it in canine CHF. Presented at: Fetch Nashville. May 31, 2025. Nashville, Tennessee.

Chetboul V, Pouchelon JL, Menard J, et al. Short-term efficacy and safety of torasemide and furosemide in 366 dogs with degenerative mitral valve disease: the TEST study. 

. 2017;31(6):1629-1642. doi:10.1111/jvim.14841

Besche B, Blondel T, Guillot E, Garelli-Paar C, Oyama MA. Efficacy of oral torasemide in dogs with degenerative mitral valve disease and new onset congestive heart failure: the CARPODIEM study. 

. 2020;34(5):1746-1758. doi:10.1111/jvim.15864

William Rausch, DVM, DACVIM (Cardiology), explains that torsemide offers at least equivalent efficacy to furosemide in canine CHF while significantly reducing short-term mortality/worsening events by approximately 50%.

Torsemide for canine CHF: Emerging evidence and clinical benefits

Approximately 20% of all spayed female dogs and up to 30% of large-breed dogs will develop urinary incontinence.

 Although any dog can develop incontinence, the condition most commonly affects large-breed female dogs who are middle-aged or older.

Typically, incontinence presents as an intermittent or continuous dribbling of urine alongside episodes of normal urination, according to Mark J. Acierno, DVM, MBA, DACVIM (SAIM), professor at Midwestern University College of Veterinary Medicine and associate dean for the school’s Clinical Affairs in Glendale, Arizona. At the Fetch dvm360 Conference in Nashville, Tennessee, Acierno led a lecture on the topic.

Incontinence can be caused by bladder spasms, ectopic ureters, an inability of the bladder to dilate, damage to the nerves that control micturition, and urethral sphincter incompetence (USMI)—also called spay-related incontinence. Still, 85% of canine incontinence cases are caused by either ectopic ureters or urethral incompetence.

To diagnose incontinence in a dog, it is important to obtain a thorough history. According to Acierno, the discussion should also include questions about timing. “Knowing the timing is really, really important because a middle-aged female dog who's spayed, who's wetting its bed at night, is a very, very different situation than the puppy that is dribbling urine constantly, right?” said Acierno during his talk at Fetch.

 “So, the history is really, really important.”

“Is it only at night? And is it happening 

 the bed? Because if it's happening next to bed, then the dog woke up, [went] next to the bed, peed on the floor, and went back to sleep, right?” Acierno continued, emphasizing questions that should be considered when discussing the patient’s history. He explained that the scenario would indicate something different if the patient were urinating directly 

 the bed. Considering the timing of events surrounding urination can help clinicians differentiate incontinence from other conditions such as nocturia, pollakiuria, or polyuria.

Part of the diagnostic process when evaluating a canine patient for incontinence includes obtaining a detailed examination of the genitalia. Veterinarians should look for anatomic abnormalities. According to Acierno, patients with incontinence will have wet or stained fur. Scalding and dermatitis will also be present.

“If we don’t [see these], the [patient] is probably not incontinent. It's probably something else,” said Acierno.

He also recommends asking clients to prevent their dog from urinating before the appointment and wait until during the appointment, as observing how the patient urinates can offer valuable information. Things to look for include whether the strain is normal and whether the patient postures correctly after urinating.

After observing the patient urinate and measuring the output, a complete and thorough diagnostic workup should be conducted. This should include a complete blood count, serum chemistry, and urine analysis with aerobic culture.

 Conducting a blood count, Acierno explained, will help in ruling out systemic illnesses while urine analysis can help determine if cystitis is causing the incontinence. Additional triggers of incontinence include urinary tract infections, which can themselves result from ectopic ureters and anatomic abnormalities.

When it comes to imaging, although radiographs can be helpful, ultrasounds are preferred—this method has a higher sensitivity rate in detecting uroliths, tumors, and, in certain cases, visualizing ureters. According to Acierno, radiographs miss approximately 27% of uroliths. Meanwhile, ultrasounds will yield only approximately 6% false negatives.

When looking at an ultrasound, Acierno shared he also looks to see if the bladder is mostly empty. “If it doesn't, then we have a different set of problems, right?” he said.

Although this step is commonly missed, conducting a neurological examination is a crucial part of the incontinence exam, according to Acierno. Spinal cord disorders above the fifth lumbar vertebra, ie, upper motor neuron lesions, can cause the bladder to empty involuntarily and reflexively, accompanied by increased resistance of the external urethral sphincter. Patients with these disorders may exhibit paresis, paralysis, hyperreflexia, decreased proprioception, and decreased pain perception.

For lower motor neuron lesions, or lesions of the sacral spinal cord, there is inhibition of bladder sensation from traveling up the spinal cord. Moreover, sacral lesions can affect the pudendal nerve, leading to loss of external sphincter resistance.

 Dogs with these lesions typically dribble urine and present with an easily expressed and overdistended bladder. Voiding will also be rare in these patients as they have lost bladder sensation.

As part of the neurological exam, patients may be taken for a walk. “You can get a dog, take it for a walk, and watch it walk, and do we see gait abnormalities?” said Acierno. “Another thing I'll do [is] look at the top of the nail, and if they're scuffed, it means they’re dragging [their] feet, which could be indicative of [lumbosacral] LS disease, right?"

According to Acierno, gently squeezing the distal portion of the penis or edge of the vulva and watching for a reflex contraction of the anus can also be used to assess afferent and efferent function of the pudendal nerve.

As incontinence presents ongoing challenges for veterinary professionals and caregivers, performing a thorough incontinence exam on patients is crucial for accurate diagnosis. To begin, the thorough history of the patient must be discussed with the client, with special focus on the timing of events surrounding urination. Veterinarians should also perform a physical examination and watch for any anatomic abnormalities or clear signs of incontinence, followed by laboratory work and, in some cases, imaging. Lastly, the neurological examination plays a crucial part in the exam and must not be overlooked.

Weir M, Hunter T, Ward E. Urinary incontinence (urethral incontinence) in dogs. VCA Animal Hospitals. Accessed June 5, 2025. 

https://vcahospitals.com/know-your-pet/urethral-incontinence-in-dogs

Acierno M. How do we turn off this spigot? Managing canine incontinence. Presented at: Fetch dvm360 Conference; May 31, 2025; Nashville, TN. 

Mark J. Acierno, DVM, MBA, DACVIM (SAIM), professor at Midwestern University College of Veterinary Medicine, offers a detailed run-through of the incontinence exam