Our host, Adam Christman, DVM, MBA, welcomed Matthew W. Brunke, DVM, DACVSMR (Canine), CCAT, Fellow IAVRPT, to this episode of 

, to close out our Pain Awareness Month. In this episode, the duo will share more on the multiple ways to manage patients in pain, including joint therapies and holistic evidence-based approaches, plus the true power clients have in their pets' daily care. 

Pain management in veterinary medicine: What’s new?

Below is a partial transcript, edited lightly for clarity. 

 OK, to the listeners: Guess what we did not talk about yet? I just want to take a step back. Look at all the things that we've talked about, and we [haven't] even [talked] about nutraceuticals and NSAIDs [nonsteroidal anti-inflammatory drugs] yet, which I think is so great, though, Matt, that we actually have all these other options that are out there. Because, before you go into it, I want to get your take on this. Is there [sometimes] a negative connotation when [clinicians] say we're going to put them on, say, an NSAID or drug? Would they want to go for something else first? I'm using air quotes, because you can't see me, [around] the word "drug."

Matthew W. Brunke, DVM, DACVSMR (Canine), CCAT, Fellow IAVRPT:

 No, it's a great point. They don't always want it. But when I think about arthritis management, my first-line defense is an NSAID—carprofen. And yeah, there was a negative connotation in the 90s and early 2000s, for those of you out there who remember when Rimadyl [carprofen] was the "R word"—and now I'm using air quotes. It was bad in the Labrador communities. It just killed dogs. That's not the case. We learned a lot about idiosyncratic reactions and how to screen patients appropriately. But you're right: If they only have 1 or 2 joints—or even 3 or 4 joint—that hurt, why are we challenging them systemically? 

So if we can do other things, [that's] great, but NSAIDs are still our first-line defense. [They] still have our best evidence, and they're usually going to help. The animal will feel better within 3 to 4 days. That's a big step to the pet parent, [who] is going, "Holy cow, my animal's in pain." We know, as clinicians, that [the] animal [has] probably been in pain for a month or more. So how do we help unwind that NSAIDs are a big help? Then maybe we do [a] transition to talk about nutraceuticals.

I want to say, before you go into that...[regarding] the negative connotation of the word "drug," I feel like we, as veterinary professionals, have a responsibility to educate [clients] on that, too, when we talk about safety and efficacy profiles of all these ones that are out there. And you pick your flavor—whatever one works well for you and your clinic, or what you see with their experience. But regardless of the fact that they're FDA approved, the safety and efficacy profiles are really good, and we do monitoring profiles, just to your point, so I think [it's] important that we mention that.

Podcasts

Discover effective pain management strategies for pets, including joint therapies and holistic approaches, in this insightful episode of The Vet Blast Podcast.

Modern multimodal pain management for patients

A new drug product for preventing and treating New World screwworm (NWS) larval infestations in cattle is conditionally approved by the FDA. Doramectin injection solution (Dectomax-CA1 Injectable; Zoetis) is also indicated for the prevention of NWS reinfestation for 21 days in cattle.

FDA Commissioner Marty Makary, MD, MPH, said the conditional approval is the first in the US for NWS. “We understand the urgency with which America’s farmers and ranchers are asking for tools to fight [NWS],” Makary said in a news release.

 “Today’s conditional approval shows our dedication to rapidly advancing important animal medicines when they are needed most. We continue to work tirelessly to complete review of other NWS products to protect multiple animal species in the US.”

NWS was recently confirmed less than 70 miles south of the US-Mexico border. This confirmation marks the northernmost detection of the parasite during the ongoing outbreak in Mexico and prompted an increase in concern for the US cattle and livestock industry.

“The New World screwworm continues its March northward.…Unlike typical maggots that feed on necrotic tissue, this screwworm larva loves living flesh. It will, in fact, disfigure and kill livestock, pets, wildlife, and yes, even you,” Christopher Lee, DVM, MPH, DACVPM, said in a 

Doramectin injection solution is indicated for use in beef cattle, female dairy cattle aged less than 20 months, pregnant beef cattle, newborn calves, and bulls.

 The drug is eligible for conditional approval because it aims to prevent and treat a serious or life-threatening disease in cattle and addresses an unmet animal health need. Eligibility was also determined because the drug requires complex or particularly difficult studies to demonstrate effectiveness.

“Under this conditional approval, the FDA has determined the drug is safe and has a reasonable expectation of effectiveness. We are making this treatment available to cattle producers immediately while the sponsor collects the data needed for a full approval,” Timothy Schell, PhD, acting director of the FDA’s Center for Veterinary Medicine, said in the release.

 “The FDA will continue to expedite review of animal drugs to help the U.S. fight this devastating threat to our nation's livestock and the livelihoods of the farmers and ranchers who care for them."

Dectomax-CA1 contains the same active ingredient at the same dose as Zoetis’ Dectomax, which previously received full FDA approval for treatment and control of certain nematode and arthropod parasites in cattle and swine. The Dectomax approval included adequate target animal safety studies, manufacturing information, and human food safety information. This prior information submitted to the FDA negated the agency’s requirement for new information covering those aspects in support of the conditional approval for Dectomax-CA1.

The 35-day withdrawal period for cattle, as well as warnings to prevent drug residues in meat from treated cattle, are the same for Dectomax-CA1 as it is for Dectomax. However, a withdrawal period has not been established for this product in preruminating calves, and the FDA has advised against using the drug in calves that will be processed for veal.

“New World screwworm has the potential to bring unprecedented economic and animal health harm to livestock producers,” Mike Lormore, DVM, MS, MBA, director of cattle and pork technical services at Zoetis, said in a news release.

 “Our top priority is to support keeping animals healthy and provide timely, efficacious solutions to our customers and partners. With this conditional approval, Dectomax-CA1 Injectable can now be used as part of safe, effective control measures against [NWS].”

Doramectin injectable solution is available in 250-mL and 500-mL bottles with a new label for Dectomax-CA1, anticipated to arrive in early 2026.

 The label will contain both Dectomax and Dectomax-CA1 indications, although each drug has a unique application number, according to the FDA.

Zoetis is encouraging the implementation of strategic prevention and control measures by livestock producers working closely with herd veterinarians.

FDA conditionally approves first drug for prevention and treatment of New World screwworm infestations in cattle. News release. FDA. September 30, 2025. Accessed September 30, 2025. 

https://www.fda.gov/news-events/press-announcements/fda-conditionally-approves-first-drug-prevention-and-treatment-new-world-screwworm-infestations

Zoetis receives conditional approval for Dectomax-CA1 injectable for the prevention and treatment of New World screwworm myiasis in cattle. News release. Zoetis. September 30, 2025. Accessed September 30, 2025. 

https://investor.zoetis.com/news/news-details/2025/Zoetis-Receives-Conditional-Approval-for-Dectomax-CA1-Injectable-for-the-Prevention-and-Treatment-of-New-World-Screwworm-Myiasis-in-Cattle/default.aspx

Bautista-Alejandre A. New World screwworm detected less than 70 miles from the US-Mexico border. 

. September 22, 2025. Accessed September 30, 2025. 

https://www.dvm360.com/view/new-world-screwworm-detected-less-than-70-miles-from-the-us-mexico-border

Lee C. New World screwworm invasion update; a looming threat to US borders. 

. July 15, 2025. Accessed September 30, 2025. 

https://www.dvm360.com/view/new-world-screwworm-invasion-update-a-looming-threat-to-us-borders

Articles

Zoetis' Dectomax-CA1 is the first drug to receive conditional approval in the US for addressing this type of parasitic infestation.

FDA conditionally approves drug to prevent and treat screwworm in cattle

Some may think that veterinary medicine only teaches us about the ins and outs of our patients. However, it has taught me much more about client interaction and the bond with pets. With every patient comes at least 1 client, and with every client come financial obligations. In my time, I have learned to appreciate and thank my coworkers because we are all in this together.

A tale as old as time is that veterinary professionals enter the field because they love animals. With that comes a human who is worried about their beloved pet. This is a bond that needs to be understood and respected, and I have learned over time that I cannot judge clients solely based on appearances.

I have learned that we are not our best when we are stressed or scared, and in fact, we may be at our worst in those situations. Those are the times when we need to be more patient with clients, because rational thinking goes out the door.

We are in this together, and I have learned to acknowledge the hard times and offer support to my coworkers. A thank you goes a long way after a hard day. Nothing speaks more to me than a colleague cheering on another and offering educational support when they see someone struggling with something.

This field has taught me that it’s a combination of patients and clients. It’s just as much about the client as it is the patient because one cannot exist without the other. The same goes for my team. I would not be able to do my job without my assistants, technicians, kennel staff, custodians, and doctors.

Why it is pivotal to educate client service representatives

Let’s discuss educating your client service representatives (CSRs) and why it should be implemented in every hospital. CSRs are usually the first voices or faces clients see or hear, and that interaction can make or break the rest of the visit. A CSR must understand body language, client interaction, empathy, and more.

Client interactions are crucial. If the CSR is cheerful, knowledgeable, and interactive, the client will feel more at ease or confident in the rest of the care team’s skills. The CSR needs to know how to handle a difficult client and when to ask for help from a manager. They also need to be able to understand how a client could perceive their body language. Yes, crossing your arms a certain way does make a difference.

A CSR needs to be able to understand empathy and express it. They are usually the ones going over euthanasia paperwork, sometimes even consent forms for hospitalization. It is important that they can put themselves in the client’s shoes in these tough situations.

Besides client interactions, CSRs need to understand medical terminology, vaccinations, the importance of prevention, and the basics of some diseases. CSRs triage calls every day, so they must know which patients need to be seen immediately, what is considered an emergency, and, at the very least, what questions to ask.

Educating CSRs will help your hospital, patients, and clients, while also fulfilling your CSR responsibilities. You are already spending time training them; let’s also spend time educating them. A CSR or really any staff member who can grow in their hospital has a higher chance of staying.

A successful veterinary clinic can rely on the entire team and its ability to connect with clients. 

Building a better practice: A focus on CSR education and client relationships

This year, the US Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) has awarded more than $11 million to support prevention, control, and research for chronic wasting disease (CWD) in wild and farmed cervids such as deer and elk.

 Funding was allocated to states, research institutions, universities, and Tribal governments.

CWD is a contagious, fatal, and progressive neurological disease that affects deer, elk, moose, reindeer, and muntjac, and may also infect other cervids. The disease is caused by misfolded proteins, called prions, that kill brain cells. CWD has a “silent” incubation period, during which affected animals may not exhibit symptoms for months or years, but are still infectious. The final stages of infection are deadly.

As of April 11, 2025, CWD has been detected in free ranging cervids in 36 US states and in captive cervid facilities in 22 states. In Canada, the disease in free ranging cervids has been found in 4 provinces, with 3 provinces reporting infection in captive cervids.

“Because CWD is widespread and there are a limited number of effective tools, controlling and managing the disease is especially challenging,” wrote APHIS in a news release.

CWD continues to spread across North America

In 2025, the organization awarded a total of $5,290,775 for farmed cervid initiatives. Projects consisted of predictive genetics testing, herd plans, Herd Certification Program management, indemnity, live animal testing, and depopulation of infected and exposed animals.

For projects pertaining to wild cervids, the federal agency awarded $5,905,577. These initiatives included surveillance and management, research and development of ante-mortem diagnostics and management practices, and depopulation of infected herds and animal removal.

In a news release, APHIS said funding allocations for farmed cervid initiatives were mainly based on the state’s CWD status, number of herds participating in the CWD Herd Certification Program, and number of positive herds participating in genetic-based herd plans.

“These awards will enable State departments of agriculture, State animal health agencies, State wildlife or natural resources departments, Tribal governments and organizations, and research institutions and universities to expand CWD research, management, and response activities,” APHIS said.

APHIS awards over $11 million in 2025 to combat chronic wasting disease. US Department of Agriculture Animal and Plant Health Inspection Service. September 30, 2025. Accessed September 30, 2025.

Chronic wasting disease. US Department of Agriculture Animal and Plant Health Inspection Service. July 30, 2025. Accessed September 30, 2025. https://www.aphis.usda.gov/livestock-poultry-disease/cervid/chronic-wasting

Distribution of chronic wasting disease in North America. National Wildlife Health Center. April 11, 2025. Accessed September 30, 2025. https://www.usgs.gov/media/images/distribution-chronic-wasting-disease-north-america-0

General CWD FAQs. Texas Parks and Wildlife Department. Accessed September 30, 2025. https://tpwd.texas.gov/huntwild/wild/diseases/cwd/faqs.phtml#:~:text=What%20is%20Chronic%20Wasting%20Disease,posture%20and/or%20drooping%20ears.

Chronic wasting disease is a contagious, fatal, and progressive neurological disease that affects cervids like deer and elk.

USDA awards $11 million in funds for chronic wasting disease

Brachycephaly is a breed conformation that consists of short and wide skull proportions.

 The short and wide conformation of the skull results in compression of the nasal and laryngeal airways, which may lead to reduced or absent frontal sinuses, aberrant nasal turbinates, and a reduction in overall airway space caused by a lack of alteration in the local soft tissue structures. The tongue, tonsils, soft palate, and nasopharyngeal mucosa are proportionally larger than the space within which they are housed, reducing the area for airflow through the upper respiratory tract.

Despite these conformational changes, not all brachycephalic dogs will be affected by brachycephalic obstructive airway syndrome (BOAS). Breeds with more severe brachycephalic conformation, including French bulldogs, pugs, and other bulldog breeds, are at greatest risk.

BOAS is a spectrum of disease characterized by multilevel, partial, or complete obstruction of the upper airway secondary to brachycephalic anatomic conformation and progressive secondary changes to the local anatomy.

The primary anatomic components of BOAS include the following

The secondary anatomic components of BOAS include the following

Everted laryngeal saccules (stage 1 laryngeal collapse)

BOAS primarily affects the respiratory system, with secondary consequences to the gastrointestinal system.

 A less commonly considered consequence of BOAS is sleep-related disorders, particularly obstructive sleep apnea, which can impact overall quality of life.

Clinical signs of BOAS include stertorous breathing, snoring, stress, heat and exercise intolerance, regurgitation, sleep disturbances, and, in extreme circumstances, respiratory distress, collapse, and cyanosis.

 These clinical signs result from the overall reduction in airway diameter because of the brachycephalic conformation. Stenotic nares and aberrant nasal turbinates reduce the size of the nasal passages, making movement of air through the nasal cavity challenging, which often results in open-mouth breathing.

 Movement of air through the nasal passages is important for thermoregulation, making these animals prone to hyperthermia.

 The elongated and hyperplastic soft palate extends across the rima glottidis, resulting in a reduction in upper airway diameter, thus increasing the negative pressure required for air to pass. The increased negative airway pressures can result in eversion of the laryngeal saccules and tonsils locally but also result in increased negative pressure within the thoracic cavity, leading to gastroesophageal reflux and, in severe circumstances, hiatal hernias.

 The hypoplastic tracheal component of this disease may exacerbate the respiratory signs but likely plays a lesser role in the airway obstruction.

Many dogs exhibit mild signs such as stertor or snoring early in life, which many owners may consider normal for the breed. It is important to begin discussing BOAS early in these animals’ lives, so that owners can better understand the consequences of the disease and monitor for progression of clinical signs. Early intervention when clinical signs are mild is ideal, as the longer the upper airway tissues are exposed to increased upper airway pressures, the more affected they become (ie, further hyperplasia, redundancy, and eversion of local soft tissues), leading to more severe clinical signs.

Diagnostic evaluation for BOAS can vary greatly based on the severity of clinical signs, the disease’s chronicity, and the surgeon’s preferences. Stenotic nares are easily identified on routine physical examination; however, further investigation of the nasal passages for aberrant nasal turbinates requires advanced imaging such as a CT scan or rhinoscopy.

 Evaluation of the palate, laryngeal saccules, tonsils, and other nasopharyngeal tissues can be achieved with a sedated oral and laryngeal examination. This can be performed with or without endoscopic equipment. However, greater assessment of soft palate thickness and overall airway diameter can be achieved via CT scan.

 Thoracic imaging (3-view thoracic radiographs or CT) can rule out aspiration pneumonia because of gastroesophageal reflux/regurgitation and can be used to assess for evidence of a hiatal hernia. Hiatal hernias can be dynamic in nature and therefore may not always be identified on static imaging.

Surgical interventions are typically aimed at the respiratory components of the disease, with the goal of reducing the negative pressures within the upper airway, thus improving air flow.1,3 By reducing the upper airway pressures, the negative intrathoracic pressures may also be improved, resulting in the improvement or resolution of gastrointestinal-related clinical signs. However, if gastrointestinal signs persist, medical management with antacids and promotility agents may be required, or direct surgical intervention for treatment of a hiatal hernia may be warranted.

Surgical interventions may include any combination of the following procedures

Partial staphylectomy for elongated and hyperplastic soft palate

Laryngeal sacculectomy for everted laryngeal saccules

Laser ablation turbinectomy for aberrant nasal turbinates

Tonsillectomy for enlarged and everted tonsils

The individual dog’s anatomic abnormalities will determine the combination of procedures. Surgeon preference and experience will dictate the specific surgical techniques used to address each component of the disease.

Preoperatively, a brachycephalic risk score may be determined to understand the relative risk for a negative outcome following BOAS surgical interventions.

This score can help set appropriate expectations for owners and inform the veterinary team of the individual risk for each dog undergoing surgical treatment for BOAS. In addition to the specific risk associated with airway surgery, brachycephalic dogs are at increased risk of complications associated with anesthesia.

 Preanesthetic interventions are recommended and often include medications used to reduce the risk of vomiting and regurgitation, as aspiration pneumonia is the most common complication following brachycephalic anesthesia.

In addition to aspiration pneumonia, the risk for postoperative upper airway obstruction following BOAS surgery is significant. There are many ways to reduce the risk of upper airway obstruction, such as administration of injectable steroids, topical application of mannitol in the oropharynx, and a slow and controlled anesthesia recovery. However, being prepared for an emergency temporary tracheostomy is always recommended.

The overall prognosis for dogs following BOAS surgery remains unclear because of the multilevel nature of the airway obstruction with this disease.

 Overall, dogs who recover from BOAS surgery should show improvement in respiratory and gastrointestinal clinical signs. If clinical signs persist, further investigations and interventions may be warranted. It is important to note that not all components of BOAS may be addressed with surgical interventions; thus, a return to normal airway function (nonbrachycephalic breeds) is unrealistic.

Ekenstedt KJ, Crosse KR, Risselada M. Canine brachycephaly: anatomy, pathology, genetics and welfare. 

. 2020;176:109-115. doi:10.1016/j.jcpa.2020.02.008

Tomlinson F, O’Neill E, Liu NC, Sargan DR, Ladlow JF. BOAS in the Boston terrier: a healthier screw-tailed breed? 

. 2024;19(12):e0315411. doi:10.1371/journal.pone.0315411

Krainer D, Dupré G. Brachycephalic obstructive airway syndrome. 

. 2022;52(3):749-780. doi:10.1016/j.cvsm.2022.01.013

Hynes JM, Menard JV, Lopez DJ. Quality of life improvement in 3 dogs with sleep-disordered breathing managed by permanent (crico)tracheostomy. 

. 2024;86(2):1-9. doi:10.2460/ajvr.24.09.0270

Stordalen MB, Bray S, Stringer F, Stonebrook C, Guilherme S, Bray JP. Awake 160-slice computed tomography for upper airway evaluation in 17 dogs. 

. 2024;11(8):342. doi:10.3390/vetsci11080342

Tarricone J, Hayes GM, Singh A, Davis G. Development and validation of a brachycephalic risk (BRisk) score to predict the risk of complications in dogs presenting for surgical treatment of brachycephalic obstructive airway syndrome. 

. 2019;48(7):1253-1261. doi:10.1111/vsu.13291

Gruenheid M, Aarnes TK, McLoughlin MA, et al. Risk of anesthesia-related complications in brachycephalic dogs. 

. 2018;253(3):301-306. doi:10.2460/javma.253.3.301

Hill M, Lepiz ML, Ida KK, Rutter C, Mankin KT, Dickerson V. Implementation of a standard perioperative protocol reduces postoperative respiratory distress events in dogs undergoing surgical correction of brachycephalic obstructive airway syndrome. 

. 2025;263(5):590-598. doi:10.2460/javma.24.09.0598

Surgery can help improve respiratory and gastrointestinal clinical signs of the disease.

Managing brachycephalic obstructive airway syndrome

Did you know that besides our Vet Blast Podcast, dvm360 has recently launched 2 new podcast options for our listeners? 

, hosted by Christopher Lee, MPH, DACVPM, which features board-certified specialists and industry-change-makers to talk more on the world of veterinary preventative medicine, and The Resilient Vet, hosted by Aaron Shaw, OTR/L, CHT, CSCS, and Jennifer Edwards, DVM, ACC, CPC, ELI-MP. 

 aims to help veterinary professionals build both physical and emotional resilience to help them thrive in veterinary medicine. You do not want to miss out on these new video podcasts, so tune into dvm360.com to see the latest from each.

Since you are on the website already, be on the lookout for these headlines coming out this week:

 that was led by the University of Maryland demonstrated promising results for cats infected with highly pathogenic avian influenza (H5N1) that receive early care and treatment. The research highlights both the importance of rapid recognition of H5N1 and potential role of antiviral therapy to protect animal health.

Ruby, a Labrador retriever from Phoenix, Arizona, recently was featured in Pet Poison Helpline’s Toxin Tails after she ingested almost an entire container of her owner's medicated cream for psoriasis, including the tube, and was rushed to the emergency room to treat her ingesting too much ruxolitnib.

, Matthew W. Brunke, DVM, DACVSMR (Canine), CCAT, Fellow IAVRPT makes a guest appearance on our show to share more about pain management with our host Adam Christman, DVM, MBA.

The US Department of Energy’s National Nuclear Security Administration and Texas A&M University announced a partnership to combat New World Screwworm after it has been found by the USDA less than 70 miles from the US border.

Our newest addition of Clinic Center will be available this week! This latest installment will include the first and only 24/7 Specialty and Emergency Veterinary Facility in San Luis Obispo, California, the opening of South Florida’s referral only advanced imaging center for pets, and more.

Merck Animal Health recently announced the results of a new study on PROTAZIL, a pelleted treatment for equine protozoal myeloencephalitis—a neurological disease in horses.

Check out this week’s upcoming headlines on dvm360.com.