The San Francisco SPCA (SF SPCA) shared the news it has been awarded a $200,000 grant from PetSmart Charities’ Accelerator program which is committed to improving veterinary care access in North America. The funding from the grant will go toward SF SPCA’s Community Veterinary Clinic located in the Excelsior District.

"We are honored to receive this generous funding from PetSmart Charities," said Jennifer Scarlett, DVM, SF SPCA chief executive officer, in an organizational release.

 "We launched the Community Veterinary Clinic in the Excelsior District because we knew that is where accessible veterinary services are needed most in our city. PetSmart Charities' invaluable support will play a critical role in providing access to care for all companion animals and their families."

According to the release, the funding SF SPCA received from PetSmart Charities helped it expand the services offered at the Community Veterinary Clinic with a particular focus on veterinarian recruitment, providing care in English, Spanish, and Cantonese/Mandarin, and expanding outreach within the communities in the most need of these veterinary services. The grant will also help the clinic double its operating hours to be open 4 days a week. With the expansion of hours, the clinic expects to serve over 7,500 animals in 2024.

Clinics like Community Veterinary Clinic are a crucial resource to California to help alleviate the state's access to care crisis, which is due to a shortage of veterinarians available. A statewide survey completed by 111 professionals investigated shelter organizations in the state and if they were experiencing a lack of access to veterinary care. Out of the organizations that have full-time employment positions, there were 60.3% unfilled veterinary positions and 53.7% unfilled RVT positions.

 The findings of the survey also investigated where the positions were unfilled because of the inability to recruit qualified candidates and budgetary constraints.

"Our veterinary system is in crisis," said Kate Atema, director of community grants and initiatives at PetSmart Charities. "Rising costs are putting standard veterinary care out of reach for as much as 50% of pet-owning families. We need innovative solutions that make veterinary care affordable for the families in every community who want the best for their four-legged companions but struggle to meet the cost of vet care. We're inspired by the incredible work the SF SPCA is doing to create solutions that will build strong families and a healthy community."

SAN FRANCISCO SPCA RECEIVES $200,000 GRANT FROM PETSMART CHARITIES TO IMPROVE ACCESS TO VETERINARY CARE. News release. SF SPCA. February 8, 2024. Accessed February 8, 2024. https://prnmedia.prnewswire.com/news-releases/san-francisco-spca-receives-200-000-grant-from-petsmart-charities-to-improve-access-to-veterinary-care-302056996.html

The Program for Pet Health Equity, University of Tennessee. Access to veterinary care in California animal shelters. Esri. Published November 18, 2022. Accessed February 8, 2024. https://storymaps.arcgis.com/stories/5ae46f84f8c3438d9c32126d54681936

Articles

The funding will be used to support its efforts to improve access to veterinary care  

San Francisco SPCA receives $200,000 grant 

With National Pet Dental Health Month occurring this month, Thrive Pet Healthcare, a veterinary healthcare network, is noticing a concerning trend in veterinary dentistry in which small dogs tend to develop dental problems more rapidly and at younger ages than bigger dogs.

 The veterinary network is hoping to bring more awareness to this predisposition by reminding pet owners to bring their pets in for dental exams.

"With French bulldogs reigning as America's top breed, and a rise in small dog ownership, it's crucial for owners of smaller dog breeds to understand their unique dental challenges," said Curt Coffman, DVM, FAVD, DAVDC, Thrive Pet Healthcare's specialty director of dentistry, in the release. "Their compact mouths, heads, and faces, along with other genetic features, predispose them to rapid tartar buildup, plaque, and gingivitis more than larger dogs."

According to Thrive, brachycephalic dog breeds can have crowded or misaligned teeth, leading to early onset periodontal disease. This is significant because periodontal disease is one of the most common diseases affecting dogs, with a reported prevalence of at least 80% in dogs over 3 years of age.

 It can present in a variety of conditions like gingivitis and periodontitis, which all impact the teeth and gums.

 To make matters worse, as they age, these brachycephalic breeds lose jawbone density, and therefore require extractions at a younger age compared to larger dogs.

 These flat-faced breeds include Boston terriers, boxers, bulldogs, pugs, Shih Tzus, and more.

"It's challenging to have 42 teeth in such a small mouth," Coffman stated. "When something gets stuck between their teeth, they can't floss to remove it like humans. Beginning a proactive oral hygiene regimen at home when your dog is young, and having your veterinarian perform regular dental cleanings is the best way to prevent periodontal disease and potential tooth loss later in life."

Because of the treatment of periodontal disease, Thrive wants to encourage owners to come into the clinic and have their pet’s dental wellness checked out. As an incentive, more than 150 primary care hospitals within Thrive Pet Healthcare's network are offering a $50 discount on dental cleanings through April 14, 2024.

 This promotion is exclusively for dental cleaning procedures and does not include costs for exams, tooth extractions, and oral surgeries. Thrive Plus members can save more with an additional 10% off dental cleanings and 10% off services like diagnostics and bloodwork.

Overall, it is necessary to educate clients on the importance of dental wellness and the need for routine professional assessment of periodontal health,

 so use this month of National Pet Dental Health to raise awareness for your clients.

Little dogs have smaller teeth, but bigger teeth problems. News release. Thrive Pet Healthcare. February 7, 2024. Accessed February 8, 2024. 

https://prnmedia.prnewswire.com/news-releases/little-dogs-have-smaller-teeth-but-bigger-teeth-problems-302056466.html

Enlund KB, Brunius C, Hanson J, et al. Dog Owners' Perspectives on Canine Dental Health-A Questionnaire Study in Sweden. Front Vet Sci. 2020;7:298. doi:10.3389/fvets.2020.00298

Small Animal Dental, Oral, and Maxillofacial Disease: A Color Handbook

Raising awareness for owners of smaller dog breeds to implement proactive dental care in regular check-ups

Small teeth, but big dental challenges

 (USP) Chapter <795>, for compounding of nonsterile pharmaceuticals, and Chapter <797>, for compounding sterile preparations, are in effect. The revised USP guidelines limit the ability of 503A compounding pharmacies to extend beyond-use dates (BUDs). This regulatory change is one of many by both the USP and the FDA to improve the testing and manufacturing standards for veterinary medicines. It can be challenging to keep up—what is the real impact on your veterinary practice?

Traditionally, veterinary hospitals and clinics utilized neighborhood or national 503A compounding pharmacies to fill prescriptions for compounded medications with a BUD label. The new regulations will further shrink the window for usability. Alternately, 503B veterinary medicines are manufactured according to carefully controlled manufacturing and testing standards, and typically offer a longer, proven expiration date, usually up to 365 days.

Many of the most-prescribed medications have been impacted. For 503A compounding pharmacies without testing in place to verify BUDs, these use-by dates may decrease from 180 days to 1 to 4 days, making them impractical to prescribe. Some of the common 503A prescriptions and their available 503B medication alternatives include

Flurbiprofen 0.03% ophthalmic ointment, 1-day, controlled room temperature under new USP guidelines. Alternate option: flurbiprofen 0.04% ophthalmic solution, 365 days from date manufactured.

Cidofovir 1% ophthalmic solution, 4 days refrigerated under new USP guidelines. Alternate option: cidofovir 0.5% ophthalmic solution, 365 days from date manufactured. 

Tacrolimus AQ 0.05% ophthalmic suspension, 4 days refrigerated under new USP guidelines. Alternate option: tacrolimus AQ 0.03% or 0.1% ophthalmic suspension, 365 days from date manufactured.

Testing processes have traditionally varied widely in compounding pharmacies, and many pharmacies have expanded testing in anticipation of these regulations. These new pressures may cause backlogs at external testing facilities, presenting a logistics challenge in getting these to your patients within the usability window.

The BUD is important to ensure the product’s safety, quality, and efficacy, and plays an important role in safeguarding patient well-being. Products that exceed their shelf life can cause a variety of problems that impact patient health, including degradation or increased concentration of the active ingredient, contamination during distribution or storage, changes in the drug’s bioavailability that alter the rate and amount absorbed by the patient, and the development of toxic by-products over time.

These changes can cause some disruption and confusion. Here’s what you need to know to safeguard both your patients and practice:

Familiarize yourself with standard formulations and dosages available. The higher testing standards of 503B medicines can mean that a standard strength is closer to your desired dosage than a custom compound.

Design for flexibility. Help pet owners get what their pets need by recommending acceptable alternatives if a medication or drug is unavailable or impractical.

Anticipate questions. This will impact your clients’ prescription refill schedules, and many will likely need to adjust from a quarterly refill to a monthly refill. Make sure your front office is prepared to answer questions and modify prescriptions to ensure clients have access to the medications their pets need. 

Understand that pharmacies must follow the regulations but are ready to support you with guidance on available right-fit medications to fit your patients’ needs.

Advise your clients to stay on top of refills and pay attention to the BUDs: Clients should stop using drugs past the BUD and plan for replenishment. Their pharmacy can help them figure it out.

Consider 503B manufactured medicines whenever appropriate, as they offer a far-longer shelf life, ranging from months to years. The expiration date is determined after robust stability testing required by the FDA’s current good manufacturing practice regulations. This longer shelf life and comprehensive stability testing offer your clients easy availability with more convenient refill schedules, and offer veterinary practices the following:

• Improved inventory management and reduced waste

• Stock available for office use, improving patient care

• Accurate dosing and reduced risk of contaminated drugs and toxic byproducts

The latest USP changes may seem sudden to your clients but have been in the works for years. Pharmacies are prepared to help you and your clients understand the changes and recommend alternatives. It’s a challenging time, and as these regulations roll out state by state, your practice can improve patient safety by working with a reputable pharmacy partner to assess your inventory needs and make adjustments to ensure clients have access to right-fit medications held to a higher standard.

New United States Pharmacopeia (USP) Guidelines. Epicur Pharma. Accessed January 16, 2024. https://epicurpharma.com/ usp-guidelines

, is a pharmacist and director of manufacturing operations for Epicur Pharma. King is a pharmacist and operations leader for Epicur Pharma. She oversees manufacturing and distribution operations in accordance with current good manufacturing practices, which are integral to 503B drug manufacturing. She holds a doctor of pharmacy degree from the former University of the Sciences in Philadelphia, Pennsylvania.

, is director of pharmacy compounding for Stokes Pharmacy and a multistate licensed pharmacist with 14 years of experience in compounding. As director of pharmacy compounding, he is focused on continuous process improvement while streamlining the compounding process. Filewicz holds a doctor of pharmacy degree from Fairleigh Dickinson University School of Pharmacy and Health Sciences and previously served as Stokes Pharmacy’s production manager.

These standards of practice can now be enforced by the FDA, local state boards of pharmacy, and accreditation organizations

Beyond-use dates: Ready or not, USP guidelines will impact your practice

French bulldogs—now the most popular canine breed in America

—are known to have numerous disease predispositions, including respiratory and gastrointestinal diseases. There is growing recognition of the close relationship between diseases of these 2 body systems. In fact, some dogs with primary gastrointestinal disease may present with respiratory signs only. During a session at the 2024 Veterinary Meeting and Expo in Orlando, Florida, Aida I. Vientós-Plotts, DVM, PhD, DACVIM (SAIM), of the University of Missouri, College of Veterinary Medicine in Columbia discussed these conditions in French bulldogs and what general practitioners need to know about their diagnosis and management.

Many of the respiratory abnormalities seen in French bulldogs are related to their brachycephalic anatomy, which creates obstructions to airflow at the level of the nares, nasopharynx, and oropharynx. This can lead to laryngeal collapse, which should be suspected in any brachycephalic dog presenting with both stertor and stridor. Collapse occurs in 3 progressive stages and can be diagnosed during an upper airway examination

Stage 1 has everted laryngeal saccules. This is the only stage that can be corrected surgically.

Stage 2 has irreversible changes to the cartilage of the larynx caused by aryepiglottic collapse.

Stage 3 includes collapse of the corniculate processes. It creates a complete obstruction and requires a permanent tracheostomy for treatment. Patients with this stage of collapse have a guarded prognosis.

In addition to screening for signs of laryngeal collapse, Vientós-Plotts recommended asking clients specific questions about the patient’s sleeping habits to evaluate for obstructive sleep apnea. Signs include episodes of apnea during sleep (more than 5) and any 1 of 4 behaviors observed by the owners: waking up gasping or choking, having low levels of activity or falling asleep while sitting or standing, breathing interruptions (apneic episodes), and sleeping in a position that is specific to improve breathing. “These are important to ask about,” said Vientós-Plotts. Patients with obstructive sleep apnea can develop secondary pulmonary hypertension, so an echocardiogram is recommended.

Brachycephalic dogs are more likely to have abnormal esophageal motility than other dogs, which can lead to several abnormalities, including sliding hiatal hernias and gastroesophageal reflux disease (GERD). French bulldogs are predisposed to sliding hiatal hernias.

 Many of these patients will present with respiratory signs despite this being a gastrointestinal (GI) disease. In one study, 44% of patients with hiatal hernias presented with only GI clinical signs, 35% had signs of both GI and respiratory disease and 25% presented with only respiratory signs.

 Compared to nonbrachycephalic dogs, brachycephalic patients with hiatal hernias tend to present younger and are more likely to present in respiratory distress.

“Think of the number of patients we are missing with GI disease if we only focus on respiratory signs,” said Vientós-Plotts. She recommended screening all brachycephalic dogs and any patients presenting with aspiration pneumonia for a sliding hiatal hernia. She shared that although “fluoroscopy is superior [diagnostically], you can still do plain radiographs and find some of these patients.” She recommended using a wooden spoon to place pressure on the abdomen during the lateral radiograph to increase the chances of identifying the hernia in the absence of fluoroscopy.

Vientós-Plotts shared that clients may mention their pet regurgitates or vomits frequently, thinking it is normal. “Typical is not normal,” she stated, encouraging veterinarians to investigate this information. Brachycephalic patients presenting with cough should be suspected of having gastroesophageal reflux disease (GERD). Additional clinical signs can include lip licking, repetitive swallowing, regurgitation, nasal discharge, neck extension, and head bobbing. Patients that are predisposed to GERD include those that are obese, fed high fat diets, and have delayed gastric emptying or hiatal hernias.

Reflux can exacerbate upper airway abnormalities and respiratory disease by causing inflammation and swelling of the tonsils, pharynx, larynx, and nasal passages. This can increase the risk of upper airway obstruction. Definitive diagnosis requires video fluoroscopic swallow studies (VFSS), but treatment trials can be instituted in general practice when there is a clinical suspicion. Treatments should be instituted in a stepwise fashion (one at a time) so that response to therapy can be closely monitored.

Treatment of GERD includes a combination of prokinetics and low-fat diets to promote gastric emptying. Additionally, Vientós-Plotts recommended slowing the rate of eating for these patients by feeding smaller, more frequent meals or using puzzle toys or slow feeders. This reduces the amount of aerophagia during eating, which can exacerbate reflux and herniation. Weight management should also be an essential part of therapy as obesity predisposes to GERD. Proton pump inhibitors are only recommended when esophagitis is suspected or diagnosed, and only for 10 to 14 days maximum.

Practical approach to the French bulldog patient

Vientós-Plotts recommended that general practitioners educate French bulldog (and any brachycephalic dog) owners about the close relationship between respiratory and GI disease in these dogs. She stressed that veterinary professionals must educate clients that what may be 

for these patients, such as abnormal respiratory noise, interrupted sleep, or frequent vomiting, is not 

. This will allow clients to be more observant of potential problems, which can reduce morbidity and mortality.

Veterinarians should ask specific questions about sleeping and eating habits, which can increase the suspicion for certain aerodigestive disorders in French Bulldogs. Referral for VFSS should be considered for a full workup in these patients. This is particularly important prior to brachycephalic obstructive airway surgery (BOAS). Patients whose respiratory and gastrointestinal diseases are simultaneously managed have better outcomes. There are few institutions in the US that are able to adequately perform VFSS. In 2022, The University of Missouri established the BREATHE (

alth) Clinic. The main goal of the BREATHE Clinic is to provide a comprehensive evaluation of dogs and cats with aerodigestive (respiratory and swallowing) disorders to allow individualized management.French Bulldogs and all brachycephalic breeds embody aerodigestive disorders and have greatly benefit from such a specialized service.

Kate Boatright, VMD, a 2013 graduate of the University of Pennsylvania, is a practicing veterinarian and freelance speaker and author in western Pennsylvania. She is passionate about mentorship, spectrum of care, and addressing common sources of stress for veterinary teams and recent graduates. Outside of clinical practice, Dr. Boatright is actively involved in organized veterinary medicine.

Pasols A. 20 most popular dogs breeds (2024). 

. January 9, 2024. Accessed February 7, 2024. https://www.forbes.com/advisor/pet-insurance/pet-care/popular-dog-breeds/

Vientós-Plotts AI. Frenchies rule! Now what? An internist’s guide to troubleshooting the most popular breed in the US. Presented at Veterinary Meeting and Expo: Orlando, FL. January 13, 2024.

Reeve EJ, Sutton D, Friend EJ, and Warren-Smith CMR. Documenting the prevalence of hiatal hernia and oesophageal abnormalities in brachycephalic dogs using fluoroscopy. 

https://onlinelibrary.wiley.com/doi/10.1111/jsap.12734

Pollard RE, Marks SL, Cheney DM, and Bonadio CM. Diagnostic outcome of contrast videofluoroscopic swallowing studies in 216 dysphagic dogs. 

 2017;58(4):373-380. doi:10.1111/vru.12493

To support the health of their patients, veterinarians should take a careful history and educate clients on common gastrointestinal and respiratory conditions seen in the breed.

Aerodigestive disorders in French bulldogs

Are you looking to utilize your technicians more by creating technician appointments at your clinic, but are not sure where to start, what to charge, or which patients will be best for these kinds of appointments? It can be an awkward transition, especially if clients have done this in the past for no fee. So, how do you successfully implement this in a way that makes everyone happy while also not burning out your technicians?

, host Adam Christman, DVM, MBA, is joined by the "Queen of Scripts" Wendy Myers, CVJ, president of Communication Solutions for Veterinarians, to answer the questions you have.

: What I want you to do is come up with a term of what you're going to call the fee that you're going to charge to clients, and then I'll go through in detail how to how to do it. So I like to reserve the term 'exam' for a service provided by a doctor of veterinary medicine. Okay, so exam only is performed by veterinarians. I then use the term 'health assessment,' which, interestingly, is the exact term that is used in human nursing. So if you vote for a nurse visit, and in New Jersey, you're charged that $96- $142 on your bill, it's going to say 'health assessment,' it's not going to say nurse exam, it's going to say health assessment. So, have a distinct term. In my mind, exam equals veterinarian health assessment equals technician or assistant. Okay, so that's what's key. When the technician or assistant does a health assessment, there is actually 3 activities that that are done. 

No 1, they get the patient's vital signs. So temperature, pulse, respiration, weight. No 2, they asked history questions—and how you ask makes a huge difference. Let me give you an example: I see when I do on-site coaching and training of teams where I'm shadowing appointments. I see sometimes doctors and technicians and assistants ask the wrong way. For example, is your dog on heartworm preventives? Client says yes. Well, we didn't ask the question the right way. Is your dog on heartworm preventives is a horrible history question. Because what if they gave the last dose in October and it's now February? You know, we have months of 0 protection for that patient. Instead, I asked that same question in a smart way. Which heartworm preventive are you giving and when did you get the last dose? And I want to know the brand name and the exact date that it was given and that's how I monitor and check compliance. You need to have templated history questions. I know some of our listeners have been technicians for 30 years and they know it ...but you still need templated questions because it ensures that our technicians and assistants ask consistently and ask the right way.

Podcasts

Learn how to make this year the year of the technician from this week's guest Wendy Myers, CVJ

How to charge for technician appointments

BluePearl Pet Hospital has announced the launch of its public charity, BluePearl Cares, a nonprofit organization created to make emergency and specialty veterinary care accessible for all. A practice network with more than 110 hospitals in 30 states, BluePearl is part of the Mars Veterinary Health family of businesses, and a provider of specialty and emergency veterinary care, according to a news release.

Arabella Smith, president and chair of the BluePearl Cares board of directors and vice president of corporate affairs for BluePearl, noted that BluePearl has a history of serving vulnerable pets and enabling access to critical veterinary care both in and out of the company’s hospitals. “Bringing to life a charity designed to support families and pets in crisis— providing access to life-saving care for those that need it—is a legacy we can all be proud of,” she said, in the release.

BluePearl Cares aims to increase access to care in communities, hospitals and shelters through a combination of grant programs and direct delivery of veterinary services and support. Charity initiatives include the following:

: Engaging BluePearl Associates in volunteer opportunities through BluePearl Cares Care Corps, a travel support program deploying emergency and specialty veterinarians and technicians to provide critical care in under-resourced communities and crisis situations.

: Supporting pets in need belonging to financially qualifying families with the cost of emergency or specialty care funded through the BluePearl Cares HOPE Funds grant program.

: Expanding care for owned and shelter pets across animal welfare organizations and nonprofit partners through medical equipment grants.

“The gap in access to emergency and specialty veterinary care is real and it’s continually growing—knowing we have an opportunity to help bridge that gap for the most vulnerable pets is why we exist,” said Kim Van Syoc, executive director of BluePearl Cares, in the release. “In just a few short weeks, we’ve already received an incredible response from BluePearl Associates, clients and local communities wanting to be involved in increasing access to lifesaving care through donations of time and money—a true movement of 

To celebrate the charity’s launch, BluePearl Cares released a series of Valentine’s Day e-cards for pets as part of a ‘Share the Care’ campaign. These e-cards are available on BluePearl Cares’ Instagram page. BluePearl will donate $14 to BluePearl Cares throughout February of this year for each card that is shared with #BluePearlCares. The donated funds will support BluePearl Cares grant programs, supporting access to emergency and critical care for pets.

BluePearl launches charitable arm, expanding access to emergency and specialty veterinary care. News release. February 7, 2024. Accessed February 7, 2024. 

https://bluepearlvet.com/press-releases-announcements/bluepearl-launches-charitable-arm/

BluePearl also released a series of Valentine’s Day e-cards for pets as part of the new nonprofit arm's ‘Share the Care’ campaign.