Findings on a retrospective evaluation of major complications and risk factors associated with ultrasound-guided percutaneous renal biopsies in dogs were shared by lecturer Jasmine Zaibek, MVB, the study’s coauthor, at the 2024 American College of Veterinary Internal Medicine (ACVIM) Forum in Minneapolis, Minnesota. The most recent previous study regarding this procedure was recorded in 2005, at which time hemorrhage and death were reported as major complications with a rate of 13%. Since then, there have been changes in the techniques for renal biopsies in dogs, but no reevaluations of its complications nor any current literature available with out-patient procedure status, according to Zaibek.

Approximately 1 in 10 dogs and 1 in 3 cats suffer from renal disease, making it an extremely common disease among canines and felines. In order to properly diagnose kidney disease, renal biopsies may be required.

The study presented at ACVIM was a multicenter retrospective observational study between the Schwarzman Animal Medical Center in New York, New York, and Friendship Animal Hospital in Washington, DC. It looked at 76 dogs aged 8 months to 13 years that were undergoing ultrasound-guided renal biopsy over the course of 5 years from 2017 to 2022. Of the 76 dogs, 35 were male and 41 were female. Biopsy samples were submitted to the renal pathology service with pre and post procedure monitoring. Exclusions consisted of incomplete medical records, which included patients that did not have appropriate post procedure monitoring.

For the medical record review, patient names; weight; age; pre procedure packed cell volume (PCV); post procedure PCV; pre procedure blood pressure; pre procedure creatinine; status of patient at discharge, 1 week post discharge, and 1 month post discharge, were included.

Furthermore, the researchers defined severe hemorrhage as a drop in PCV that was greater than 20%. “The reason that we did that was because we were…trying to mirror the 2005 study. And that's what they could use previously to define severe hemorrhage,” Zaibek, an internal medicine resident at the Schwarzman Animal Medical Center, explained during the ACVIM session.

Complications were reported in 11 of 76 dogs. Additionally, major complications included death and hemorrhage, with minor complications being excluded from the study. None of the deaths were attributed to the procedure.

“We didn't investigate minor complications like [researchers did in] the previous study. And that's really just because the prior microcomplications that they had listed were…gross and microscopic hematuria, hematoma, and…infection at the site of surgery, which…we will provide for performing surgery in these patients,” Zaibek said.

Severe hemorrhage occurred in 6 of 76 patients. Pearson Chi-squared testing revealed a positive association between elevated creatinine levels and severe hemorrhage (

 = .08). Dogs with a creatinine level of 5 mg/dL or more were more likely to experience hemorrhage (OR = 2.5). Furthermore, a positive correlation was observed between older age and severe hemorrhage (

 =0.01). There was no increased risk of complications shown for hypertension (

 = 0.8). Additionally, hospitalized patients had a higher likelihood of experiencing hemorrhage (OR = 1.7) compared to outpatients.

Regarding limitations to the study, Zaibek explained, “Unfortunately, [our limitations include] our population size. Ideally, we would have had more. We could have assessed more variables, and the study didn't account for variability between the person obtaining the renal biopsy, but a majority of the people that were obtaining the biopsies were board certified radiologists.”

Zaibek J. Retrospective evaluation of major complications associated with ultrasound guided percutaneous renal biopsy in dogs. Presented at: American College of Veterinary Internal Medicine Forum; Minneapolis, MN; June 5, 2024.

Vaden SL. Renal biopsy of dogs and cats. Clinical Techniques in Small Animal Practice. 2005;20(1):11-22. 

https://doi.org/10.1053/j.ctsap.2004.12.003

What you need to know about animal kidney disease. Naples Coastal Animal Hospital. Accessed June 6, 2024. 

https://naplescoastalvet.com/what-you-need-to-know-about-animal-kidney disease/#:~:text=Here's%20what%20you%20should%20know,effects%20on%20our%20furry%20friends

Articles

Jasmine Zaibek, MVB, presented the study’s findings at the 2024 American College of Veterinary Internal Medicine Forum

Study evaluates major complications associated with ultrasound-guided percutaneous renal biopsies in dogs

As we celebrated Asian American and Pacific Islander (AAPI) Heritage Month last month, I had the pleasure of talking with Hira Basit, DVM, one of the founders of the Association of Asian Veterinary Medical Professionals (AAVMP). Basit shares the inspiration behind the creation of this vital organization and the pivotal role it plays in promoting diversity and inclusion within the veterinary industry.

The founding of the AAVMP was driven by a profound need to address the underrepresentation of AAPI individuals in veterinary medicine.

"I was inspired to create an organization where AAPI individuals could have a platform to showcase all the awesome things they have achieved in our profession. I also wanted my AAPI colleagues to find solidarity through an organization that reflects our society’s diversity," reflected Basit

This mission is not just about representation; it's about providing support through advocacy, scholarships, and mentorship opportunities, ensuring that AAPI professionals can thrive in a field where they have historically been underrepresented.

Establishing a national non-profit organization while still in veterinary school posed significant challenges. Basit credits the success of AAVMP to the collaborative efforts of the initial team, including Stephanie Kuo, Effie Makrygiannis, Kelly Hicks, and Chloe Pham.

"Our organization’s history exemplifies that enacting change takes collaboration and innovation," Basit stated. This teamwork laid a strong foundation that continues to support the organization's growth and impact.

The AAVMP stands as a beacon of diversity and inclusion within the veterinary community. Basit envisioned the association as a collective of AAPI professionals dedicated to core values such as representation, mentorship, advocacy, and fellowship. "We wanted our organization to be a resource for AAPI individuals and allies to the AAPI community," Basit explained.

Kaori Sakamoto, current president of AAVMP (left) and Christa Lam (right) digital communications director.

By highlighting the diverse backgrounds within the AAPI veterinary community, AAVMP aims to educate others on how recognizing an individual’s background can support career growth and opportunities.

Unique contributions of AAPI veterinary professionals

AAPI veterinary professionals bring invaluable experiences and perspectives to the field. Basit points out that these professionals often possess a deep understanding of various cultural beliefs, enabling them to provide more empathetic and culturally sensitive care.

"AAPI professionals provide valuable input in a predominantly Caucasian field when it comes to collaborating on strategies towards access to care, cultural competency, and general equity and inclusivity," she said.

However, she also notes the importance of personal choice in advocacy, acknowledging that the responsibility to educate and advocate can be both rewarding and exhausting.

The AAVMP is dedicated to the professional development of Asian veterinarians through a variety of initiatives. These include a mentorship database, scholarship opportunities, educational content, student outreach, and platforms for showcasing members’ stories. "Our core values together enable us to advance the profession further while inspiring, empowering, and supporting AAPI veterinary professionals," emphasized Basit.

Recognizing and celebrating AAPI heritage 

Representation is crucial in fostering a diverse and inclusive profession. Basit highlights that according to a 2020 AVMA survey, only 5.5% of veterinary students in the US identify as AAPI, and a 2022 NAVTA demographics report showed over 94% of veterinary technicians are of non-AAPI backgrounds.

 "With how small of a percentage AAPI individuals make up, it is easy for those who are AAPI in this field to feel alone," she shares. Celebrating AAPI Heritage Month is essential for highlighting the contributions of AAPI professionals and educating the broader community on important issues from an AAPI perspective.

Looking ahead, Basit sees a bright future for AAVMP. Although she is no longer an active board member, she expresses confidence in the current leadership's efforts to evolve the organization, including the current President, Kaori Sakamoto, and members of the board of directors and executive committee.

"I know our current executive board and board of directors are hard at work trying to imagine the next steps for the organization," she said, anticipating a more structured membership process and further outreach in the years to come. As for aspiring Asian veterinarians, Basit offers heartfelt advice.

"The biggest thing I wish more people told me was that I am meant to do this." Acknowledging the challenges of not seeing oneself represented in the field, she encourages young AAPI veterinarians to persevere. "If they really love veterinary medicine, stick with it. You are not alone and there will always be support for you."

"The AAPI community has been through a lot, but together we are stronger. Although we are not a monolith, we have similar experiences as we advanced in this career; we echo sentiments of imposter syndrome, lack of representation, and cultural barriers," Basit concluded. She emphasizes the value and uniqueness that AAPI professionals bring to the field, encouraging everyone to recognize and celebrate these contributions.

In conclusion, the AAVMP continues to make significant strides in promoting diversity and inclusion within veterinary medicine. Through the dedication of its founders and members, it stands as a testament to the power of representation, support, and community. As we reflect on AAPI Heritage Month, lets continue to celebrate the achievements and contributions of AAPI veterinary professionals, knowing that their presence enriches the field for everyone.

Annual Data Report: 2019-2020. Association of American Veterinary Medical Colleges. 2020. Accessed May 2024. Available online at: 

https://www.aavmc.org/wp-content/uploads/2020/10/2020-aavmc-annual-data-report.pdf

NAVTA 2022 Demographics Survey Results: Pay and education have increased; Burnout and debt are still issues. National Association of Veterinary Technicians in America. February 13, 2023. Available online at: https://drive.google.com/file/d/11pmYzIouybfL55YsduRbaZ1TtMD1i2DB/view?usp=drivesdk 

A conversation with Association of Asian Veterinary Medical Professionals’ cofounder Hira Basit 

Reflecting on AAPI heritage month

Andi Davison discusses what positive psychology coaching is and how it can work in the clinic

Interview with Andi Davison

When it comes to the veterinary clinic, not every team is going to get along all the time. There will be times where team members argue, stop getting along, or bring personal issues into the workplace. Because conflict, with coworkers or within yourself, can be unavoidable. But, how can it be managed? 

 and the 2024 American College of Veterinary Internal Medicine Forum in Minneapolis, Minnesota, Andi Davison, BA, BS, LVT, CAPP, APPC, explained what positive psychology means, what it is like to work with a coach, and how understanding the science behind it can help bridge the gap between personality conflicts to create a learning opportunity. 

The following is a partial transcript of the video:

And so when you implement positive psychology coaching, that really brings in the science of human flourishing. [It] focuses on the strengths and options and opportunities that you already have, and really helps you focus and guide yourself to get from where you are to where you want to be.

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 if you haven't already done so. Our editorial team has been attending all kinds of lectures at the American College of Veterinary Internal Medicine (ACVIM) Forum in Minneapolis, Minnesota this week; stay up-to-date on all our 

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 led by the University of Arizona College of Veterinary Medicine, Tucson sought to discover if a partnership with a trained service dog was associated with decreased post-traumatic stress disorder (PTSD) symptom severity, lower anxiety, lower depression, and greater psychosocial functioning.

A veterinary journal recently announced it has retracted a published study, after its authors publicly announced a discovery of new data that would change the outcome of their findings. At the ACVIM Forum, Brad Hanna, DVM, MSc, PhD, used multiple clinical trial examples to demonstrate 

 to attendees at the 2024 ACVIM Forum on the effects of probiotics for idiopathic epilepsy therapy.

Valerie Wiles, DVM, DACVIM and Thrive Pet Healthcare explain when treating patients with chemotherapy in your practice or referring to an oncologist, you may get questions from your clients regarding 

 was posted this week! Take a look at the 3 veterinary centers newly opened or coming soon. 

Wrap up: Our ongoing 2024 ACVIM Forum coverage, and other news

Diuretics play a critical role in the management of congestive heart failure (CHF) in both veterinary and human patients. Among loop diuretics, furosemide has been the most prescribed drug in this class in both human and veterinary medicine since it became available in 1966. Loop diuretics act via inhibition of the Na+/K+/2Cl cotransporter at the thick, ascending loop of Henle to promote the excretion of sodium, chloride, and water. This diuresis leads to a reduction in intravascular volume and thus a decrease in venous and capillary pressures, leading to resolution or at least mitigation of the clinical signs of CHF. Furosemide’s potency and rapid onset (when given intravenously) make it a mainstay in the acute treatment of the CHF crisis in dogs. Furosemide is also the most commonly used diuretic in the chronic management of canine CHF, including CHF secondary to myxomatous mitral valve disease (MMVD) and dilated cardiomyopathy. In this chronic usage, furosemide plays a critical but supporting role alongside other medications, most commonly including angiotensin-converting enzyme (ACE) inhibitors, pimobendan, and spironolactone (and less commonly, thiazide diuretics, other vasodilators, digoxin, and other agents).

As with all diuretics, there are limitations and potential side effects associated with the use of furosemide. The most common adverse effects can include polyuria/polydipsia, urinary incontinence, decreased cardiac output (because of decreased preload), azotemia, and/or hypokalemia and hypomagnesemia (due to increased urinary loss). Furosemide is also a potent activator of the renin-angiotensin-aldosterone system, which promotes near- and long-term negative impacts, including increased aldosterone secretion, vasoconstriction, promotion of arrhythmia, and myocardial fibrosis. These effects not only are deleterious for dogs with chronic heart disease, but they also likely contribute to the gradual onset of furosemide resistance in some patients.

In addition, there are some pharmacokinetic limitations inherent to furosemide that can limit its impact. Bioavailability in dogs following oral administration has been reported as only 77%. It is worth noting that in extensive human studies, furosemide bioavailability when given orally has been shown to be highly variable (10%-90%), both among patients and even within an individual. Moreover, the half-life of furosemide after oral dosing in the dog is just 1 to 2 hours and the duration of increased natriuresis is only 5 to 6 hours. As a result, oral administration needs to be at least twice a day in most CHF cases, with advanced or long-standing CHF often requiring furosemide every 8 or even every 6 hours. This frequency can be limiting for clients who work or need a full night’s sleep, and in many cases, this can lead to a decision to euthanize.

Thankfully, for canine patients with CHF secondary to MMVD, research over many decades has yielded high-quality evidence outlining the clear survival benefits and improved quality of life associated with some cardiac medications. These include ACE inhibitors, pimobendan, and spironolactone, which have all been shown to have benefit when used with a loop diuretic in this setting. Recently, there has also been growing interest in investigating the use of alternative loop diuretics for canine CHF such as torsemide in lieu of furosemide to see if there could be any advantages.

Torsemide is a loop diuretic first approved by the US Food and Drug Administration in 1993. It acts via inhibition of the Na+/K+/2Cl cotransporter at the thick, ascending loop of Henle, but it has a chemical structure different from furosemide’s. Torsemide has received interest and greater usage in human medicine over the years as a result of its higher bioavailability and longer duration of action compared with furosemide, as well as its anti-aldosterone effects. Some studies in chronic human heart failure patients have demonstrated reductions in hospitalizations associated with heart failure as well as decreased cardiac mortality when using torsemide compared with furosemide.

Early veterinary research showed that torsemide also had different pharmacokinetic and pharmacodynamic properties compared to furosemide.

 In dogs, torsemide was shown to have a longer half-life and a longer duration of action (12 hours) compared with the 5- to 6-hour natriuresis provided by furosemide. Moreover, orally administered torsemide was shown to be more bioavailable (80%-100%) than furosemide in dogs. Veterinary research has suggested that torsemide is approximately 10 to 20 times as powerful as furosemide. Some canine studies have suggested that the potency ratio between them varies on a “sliding scale” in dogs, such that at lower dose of furosemide, torsemide may be closer to 10 times as powerful. That ratio may rise to torsemide being closer to 20 times as powerful when substituted for high doses of furosemide. As a result, one of the challenges when beginning to use torsemide is determining the proper dose to use in an individual. Below I will address how we consider this in our practice.

Diuretics are the only cardiac medication I use for which I tell the client that I expect them to see at least 1 adverse effect (polyuria/polydipsia). The spectrum of potentially more serious adverse effects seen with torsemide in the dog is very similar to those listed above with furosemide. Loop diuretics provide powerful and often lifesaving impacts and their adverse effects can be equally powerful. We therefore need to be vigilant with monitoring and work to find the lowest effective dose for keeping a dog out of CHF. As with any loop diuretic, renal function and electrolytes need to be monitored very carefully both before and after adding or changing the dose of torsemide.

There have thus far been 2 large-scale prospective veterinary studies investigating the safety and efficacy of using torsemide vs furosemide in naturally occurring canine CHF.

Published in 2017, the TEST study was a randomized, single-blinded, controlled trial in which the authors hypothesized that torsemide given once a day would be noninferior to furosemide given twice a day.

 They evaluated 366 dogs with CHF secondary to MMVD. All were receiving standard therapy that included furosemide at enrollment. About half the dogs then started torsemide every 24 hours in lieu of their furosemide and continued their other CHF medications. The other half of the dogs simply continued their furosemide every 12 hours as well as their other CHF therapy. When torsemide was substituted for furosemide, the daily dose of torsemide given was generally between 5% and 10% of the daily furosemide dose. This was done on a sliding-scale basis in which the higher the dose of furosemide in an individual dog, the more powerful torsemide was projected to be on a mg/kg/day basis. As a result, torsemide was dosed with the assumption that it was about 10 to 20 times as powerful.

Over the course of 3 months and multiple scheduled visits, the dogs that had been switched to torsemide were found to be at least as likely to remain clinically and radiographically stable or as improved as the dogs receiving furosemide (ie, torsemide was noninferior to furosemide). The investigators also looked at the percentage of dogs in each group that during the 3-month study period either experienced a cardiac death, had worsening of their heart failure class, or whose owners elected euthanasia due to their heart disease. They found that the dogs receiving furosemide were about twice as likely (22%) to experience one of those three serious or fatal cardiac complications as those receiving torsemide (11%).

The frequency of adverse events was also studied closely in each group. Dogs receiving torsemide were significantly more likely to have owners report urinary incontinence (20%) compared with the furosemide group (4%; 

 < .001). Additionally, renal adverse events, which ranged from mild increases in renal parameters compared with baseline (even if still within the normal ranges) to acute renal failure were significantly more common in the dogs receiving torsemide (18%) compared with the furosemide group (4%; 

 < .001). However, there was not a significant difference in the frequency of death due to renal events between the torsemide group (4%) and the furosemide group (2%) (

The second large, multicenter prospective investigation was the CARPODIEM study published in 20207. This was also a noninferiority study comparing torsemide to furosemide in dogs with CHF caused by MMVD. Unlike the TEST study, however, the CARPODIEM investigation looked at dogs that had just developed CHF and were thus starting a loop diuretic for the first time. These 319 dogs were then randomly assigned to receive either furosemide or torsemide in a double-blinded manner, plus other standard CHF therapy. Torsemide was prescribed every 24 hours and furosemide every 12 hours in nearly all dogs. The ratio of torsemide to furosemide used for the initial dose (in mg/kg/day) varied as in the TEST study, with torsemide assumed to be even more relatively powerful than furosemide as the dose increased.

They hypothesized, and then showed, that torsemide was noninferior to furosemide in controlling pulmonary edema, dyspnea, and cough over the first 14 days of treatment.They continued to follow these dogs over 12 weeks, with the cardiac investigators free to adjust the diuretic dose as they wished within certain limits. They found that dogs receiving torsemide had a significant reduction in the risk of developing cardiac death (spontaneous or euthanasia) or removal from the study due to worsening heart failure. The most common adverse events seen in each group involved the renal system, especially blood urea nitrogen or creatinine values above the normal range. While this was the most common adverse event in each group, it was more frequently seen in the dogs receiving torsemide. Over 93% of these instances of renal insufficiency were not serious enough to warrant a change in treatment.

Choosing the dose of a diuretic to use in a particular case is often a challenge regardless of which diuretic you are using. There is no simple recipe and we often begin by carefully considering questions particular to the case, such as the following:

What is the patient’s age? Renal function? Blood pressure?

If this is the first time the patient has developed CHF, we are certainly treating them with more than just a diuretic. What other medications are we using and at what doses? How severe was their CHF presentation? For instance, was it very mild and focal early edema, or severe and diffuse? Related to that question, how intensive was the therapy required to stabilize them when they presented with CHF?

If we are switching a patient to torsemide from furosemide, what is the current furosemide dose? Are they clinically stable on that furosemide dose at the time of the switch? Or had they developed recurrent CHF while on that furosemide dose? If they are already on furosemide, they are certainly on other cardiac medications. What are those medications and are they on optimal doses? If I am changing the other CHF medications at the same time, by how much?

In the private practice referral hospital setting where my colleagues and I work, the majority of dogs we are treating for congestive heart failure are still receiving furosemide as their loop diuretic. However, we do find ourselves using torsemide more often each year, both as an attempted rescue agent when we are seeing a poor response despite furosemide dose escalation and also sometimes as the initial loop diuretic when dogs first reach CHF.

In the cases in which I am using it as a first-line agent at the onset of CHF, I am choosing my cases with intention and carefully managing my dosing and follow-up plan. For example, part of my approach is that I am using torsemide only with clients who I know from their past behavior are absolutely committed to following through on all recommended lab value appointments and requested communications. I also am generally using torsemide preferentially with clients whose observational skills I trust to notice subtle negative changes in appetite or energy such that we might catch dogs developing adverse events before they become severe.All of these considerations are critical, of course, when starting furosemide as well, but the greater potency of torsemide and the necessary ratio estimation involved in converting from the familiar furosemide dose simply make me more particular in choosing my cases while I continue to gain a better feel for the drug.

Any time I am starting torsemide anew or using it to replace furosemide, we request an email or phone update from the owner within 48 to 72 hours with respect to patient appetite, energy, and respiratory status. We add this anticipated update to our clinic schedule and if we do not receive the update on time, someone from our staff will get in touch to retrieve it. We also recheck renal values/electrolytes and blood pressure generally within 5 to 7 days of starting torsemide or making a significant change in daily dose.

Consider a dog that has developed CHF for the first time secondary to MMVD that has been stabilized in the emergency department and is switching to oral medications to go home. I am generally dosing torsemide in such a patient at approximately 10% of the total daily dose I would be using of furosemide. In other words, for an 8-kg dog that (based on their particular individual clinical situation) I might historically choose to start on 25 mg of oral furosemide per 24 hours (perhaps as 12.5 mg every 12 hours), I might try torsemide instead at 2.5 mg every 24 hours. Such a dog in our clinic would of course also be on other medications, generally, pimobendan, spironolactone, and an ACE inhibitor.

When starting torsemide after the initial onset of CHF, I am tending to use it either once a day or at most divided every 12 hours. I have yet to have an occasion where I used torsemide more frequently than twice daily, and we frequently find ourselves using furosemide every 8 hours in the latter stages of canine CHF. The longer duration of action is a powerful advantage of torsemide, both for the sake of owner convenience and also because there is no shortage of data showing that medication compliance decreases as the frequency of dosing increases.

In a dog that is presenting with recurrent CHF despite a high furosemide dose (eg, > ~7 mg/kg/day) and appropriate use of other CHF therapies (and anti-arrhythmic medications if appropriate), I would take a different approach when estimating the torsemide dose. First, the dog would need to be stabilized and possibly hospitalized as appropriate. Once they were stable and switched to oral medications to go home is when I would consider a switch to torsemide. Rather than a 10x ratio, based on the particulars of the case, I might choose a torsemide dose that was 1/15th or 1/20th the dose of furosemide that I might otherwise choose to increase this dog to.

Most veterinarians have spent the entirety of their careers using only furosemide when reaching for a loop diuretic. Such a depth of experience has given us a comfort with how we use furosemide and its inherent risks and benefits. The goal of this article is to provide some background on torsemide and why it might confer additive benefit in some canine CHF patients, as I believe you will be hearing more about it in the coming years.

CHF in dogs is most often a terminal condition, and any new treatment strategy that can confer incremental benefit will improve countless lives. The initial large investigations of torsemide use in canine heart failure have been promising and suggest efficacy that is at least on par with furosemide, with even more favorable outcomes seen in some cases. The fact that torsemide has a duration of action twice as long as furosemide is a clear benefit that gives you and your clients more convenient dosing options and better compliance. It is also clear that powerful medication can have powerful adverse effects and we need to be vigilant with our monitoring. If you find yourself considering using torsemide for chronic treatment in one of your canine CHF patients, I would choose your first such cases carefully.I would strongly recommend starting with cases that have previously been evaluated by a cardiologist and then talking with that clinician for guidance and dosage insight particular to that dog. The 2 large prospective veterinary clinical trials I mentioned are each detailed, illustrative, and well-written papers that are available free online. They are listed below, along with other primary source material, and I would recommend reading these papers closely if you are considering trying torsemide.

Keene BW, Atkins CE, Bonagura JD, et al. ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs. 

. 2019;33(3):1127-1140. doi:10.1111/jvim.15488

Cosin J, Diez J; TORIC Investigators. Torasemide in chronic heart failure: results of the TORIC study. 

. 2002;4(4):507-513. doi:10.1016/s1388-9842(02)00122-8

Shah P, Patel H, Mithawala P, Doshi R. Torsemide versus furosemide in heart failure patients: a meta-analysis of randomized controlled trials. 

. 2018;57:e38-e340. doi:10.1016/j.ejim.2018.08.015

Uechi M, Matsuoka M, Kuwajima E, et al. The effects of the loop diuretics furosemide and torasemide on diuresis in dogs and cats. 

. 2003;65(10):1057-1061. doi:10.1292/jvms.65.1057

Paulin A, Schneider M, Dron F, Woehrlé F. A pharmacokinetic/ pharmacodynamic model capturing the time course of torasemide-induced diuresis in the dog. 

. 2016;39(6):547-559. doi:10.1111/jvp.12316

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

Torsemide: when, how, and why  I use it in canine CHF

Any career switch can be daunting at first, but has the potential to be even more rewarding. Kate Vickery, VMD, MS, DACVIM (Oncology), explained how she made the professional transition into veterinary academia after working in private practice for more than 10 years. Addressing virtual attendees during her session at the 2024 American College of Veterinary Internal Medicine Forum in Minneapolis, Minnesota, Vickery said, “To give you a little background of my own professional journey, I discovered my love for clinical teaching during my residency at Colorado State University (CSU). During this phase in my career, I found that teaching students strengthened my knowledge base and encouraged me to stay current. I was also very honored to play a role in the students’ educational journey.”

“I enjoyed these aspects so much, that, as my residency was coming to an end, I prioritized looking for jobs in which I could continue to provide clinical instruction. I looked at both private practice jobs that had a teaching component, for example teaching externs or rotating interns, as well as academic positions,” she continued. Vickery ultimately went into private practice from 2008 to 2020, but then accepted a position with the Colorado State University in Fort Collins as an associate clinical professor in 2020.

According to Vickery, factors to consider when contemplating a career transition include the following 3 questions to ask yourself:

Vickery stated it is best to start with the 

. Why do you want to leave your current position? This answer could come from a number of reasons. It could be your current workplace culture, lack of professional growth, or “maybe you’re just evolving in your career, and you’re interested in pivoting and changing the primary focus,” Vickery explained.

, also evaluate your own strengths and possible challenges that may come with a career shift. Vickery explained that she even sought out a career coach for further guidance, however speaking with friends, family, and other colleagues can also help with this decision-making process.

Vickery also recommended trying to experience the new job before officially leaving your current position, to ensure it is the right path forward. This could be in the form of shadowing or exploratory interviews. These opportunities can offer you a way to ask questions to people in the same position you are considering. “This helps in an assessment of the pros and cons of what a transition could look like. With experience, you can also determine if your own values align with the values and priorities of the new institution,” Vickery said.

Asking yourself what you want to do, specifically, can help narrow down the choices you have with this transition. If education and teaching is the career path you want to explore, what role would you be interested in? Do you want to be a professor? Academic consultant? Institutional researcher? Do your goals extend further to becoming a dean of an accredited veterinary college or university? These questions can support the overall journey and lead you on a focused path.

When are you planning to make this change? With this question, it’s important to remember to set realistic expectations and keep in mind that successful transitions take time. A major career change can take longer than a smaller adjustment in your career priorities.

Once you are in this new career path, make sure you also give yourself a proper amount of time to settle in and understand the new position’s expectations and responsibilities.

A personal experience of transitioning to veterinary education

Vickery shared her personal journey as a faculty member at CSU and explained that 30 weeks out of the year is spent overseeing clinics, 20 weeks per year is dedicated to research and teaching, and 2 weeks is left for vacation time.

Vickery’s responsibilities regarding overseeing clinics involves having 1-on-1 clinical teachings with residents, interns, and DVM students as they manage cases. She also conducts group instruction during rounds and offers mentorship opportunities. The “off-clinic” time includes veterinary continuing education lectures, public lectures to clubs and organizations, committee and volunteer work, and clinical research and grant writing.

Addressing the difference Vickery has experienced with being in private practice versus academia, she said, “People have asked [me] questions like, ‘which is better, which is worse? Which is harder, which is easier?’ The answers to those questions are not simple. Both careers are equally challenging and equally rewarding. It is super difficult to compare the 2 and I often tell people it’s like comparing apples and oranges.”

Her main advice would be to make sure this career path is right for 

 goals. She left attendees with a reminder that, “Success doesn’t mean perfection and mistakes are the best way to learn and grow. I am so honored to be able to contribute to the clinical education and mentorship of the next generation of veterinarians and veterinary specialists.”

Vickery K. Career transitions: Private practice to academia. Presented at: American College of Veterinary Internal Medicine Forum; Minneapolis, MN; June 5–8, 2024.

An associate professor at Colorado State University shares her journey from private practice to academia, giving advice for those interested in this professional switch