10. Combining the best of private practice with clinic spay/neuter care

Making the top 10, Lori Cobb, VMD opines on speed, safety, and surgery skills needed for this common procedure.

Articles

We have compiled a countdown of our top 15 content in 2023, here is number 10

Dr Laura Greene shares more on the mysterious canine respiratory disease 

Over the last few months, pet parents across the United States began to worry about the 

 that affected pets in multiple states and took the media by storm. Now that pet owners are preparing to travel to see loved ones, and their pets, what should pet owners be aware of with this mysterious disease? 

During an interview with dvm360, Laura Greene, DVM, DACVIM, senior professional services veterinarian and national internal medicine expert at Merck Animal Health, shared more background knowledge on her role at Merck Animal Health, plus the history of canine infectious respiratory disease complex in the United States. 

: Canine infectious respiratory disease complex always has a baseline level of activity in the United States and elsewhere. Whereas a complex of viral and bacterial, infectious disease for for dogs, it's easily transmitted and dogs are constantly coming in with one or another or multiple of those pathogens affecting them. And we typically expect it to have a clinical course of a coughing dog that is feeling well, but coughing, and that occurs for maybe seven to 10 days is often self resolving [and] will resolve regardless of treatment, which is why the current guidelines typically don't advocate for, say antimicrobial treatment in those cases.

Videos

Dr Laura Greene reviews what is known about canine infectious respiratory disease complex

Unmasking the mysterious canine respiratory disease 

Blue Ridge Beef is recalling certain raw pet food products because of 

All lot numbers and used by dates between N24 1124 to N24 1224 of the brand's 2 lb log of Kitten Grind (UPC 8 54298 00101 6); 2lb log of Kitten Mix (UPC 8 54298 00143 6) and their 2lb log of Puppy Mix (UPC 8 54298 00169 6) have been voluntarily recalled with knowledge of the FDA.

Blue Ridge Beef was notified by the North Carolina Department of Agriculture and Consumer Services on December 15, 2023, that one lot of each of the sampled raw meat products tested positive for 

. Out of an abundance of caution, the company is recalling all lots with the used by dates between N24 1124 to N24 1224, according to the FDA. The lot numbers and used by dates are located on the silver tabs at the end of the tubes.

Distributed between November 14, 2023, and December 20, 2023, the recalled products were packaged in clear plastic and sold primarily in retail stores located in Connecticut, Massachusetts, Maryland, North Carolina, New York, Pennsylvania, and Virginia. To date, no illnesses have been reported.

Pets eating the contaminated products can be infected by 

 Infected animals may be lethargic and have diarrhea or bloody diarrhea, fever, and vomiting. Some pets will have only decreased appetite, fever, and abdominal pain. Infected but otherwise healthy pets can be carriers and infect other animals or humans. Pet owners should contact their veterinarian if their animal has consumed a recalled product and is showing symptoms of possible infection.

There is also risk to humans who handle the recalled pet foods, especially if they have not thoroughly washed their hands after having contact with the products or any exposed surfaces. Healthy individuals infected with 

 should monitor themselves for nausea, vomiting, diarrhea or bloody diarrhea, abdominal cramping and fever. Rarely, 

 can result in more serious ailments, including arterial infections, endocarditis, arthritis, muscle pain, eye irritation, and urinary tract symptoms. Consumers exhibiting these signs after having contact with this product should contact their health care providers.

Consumers who have purchased these products are urged to contact Blue Ridge Beef at blueridgebeefnc@yahoo.com for a full refund and destroy the food in a way that children, pets, and wildlife cannot access it. The recalled products should not be sold, donated or fed to pets or other animals.

Those handling the recalled products should wash and sanitize their hands or any utensils that come in contact with recalled food. Pet food bowls, cups, and storage containers should also be washed and sanitized, according to the FDA.

Consumers with questions may contact Steven Lea at (704) 880-4500 Monday through Friday 8:00 am–5:00 pm EST.

Blue Ridge Beef issues voluntary recall of Blue Ridge Beef Kitten Grind, Blue Ridge Kitten Mix, and Blue Ridge Beef Puppy Mix Due to Salmonella and Listeria Monocytogenes contamination. FDA. December 21, 2023. Accessed December 21, 2023. 

https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/blue-ridge-beef-issues-voluntary-recall-blue-ridge-beef-kitten-grind-blue-ridge-kitten-mix-and-blue#recall-photos

Certain Blue Ridge Beef products may be contaminated with Salmonella and Listeria monocytogenes

Voluntary recall issued for raw kitten and puppy food

Whoever said “If you love what you do, you’ll never work a day in your life” clearly was not a veterinarian. More appropriately, the expression should go something along the lines of “if you love what you do, you’ll be willing to work more hours than you thought were possible, to achieve your dreams.” This expression is twice as true for those of us who want to pursue additional training through internships and residencies. It was once the case that if you wanted to specialize, your path to get there would be to finish your 4 years of veterinary school and then do a rotating internship for a year.

Armed with your extra year of specialty exposure, you could jump into the residency of your choosing. While this fortunate situation exists for some, the large majority take a more circuitous path, often pursuing (sometimes multiple) specialty internships prior to finally being accepted into a residency. Here’s all you need to know about the path to a residency.

Most internships and residencies can be found on the Veterinary Internship and Residency Match Program (VIRMP) website. This is where institutions list available positions and applicants can apply for those positions. This is like the “common app” when you applied to undergraduate programs, where the same documents can be sent to multiple institutions, so you don’t have to submit the same information for multiple programs. There are a few institutions that may ask for supplemental applications, but this information will be indicated in their position description on the VIRMP. Applicants may apply for as many internships and residencies within a given specialty as they wish, and they can even apply for both at the same time.

Pricing of the applications is a tiered system based on how many institutions you apply to whether it’s $95 for 0-10, $260 for 11-20, or $365 for over 21 applications.

 Application deadlines are pre-determined and listed on the VIRMP website, usually in January of the upcoming year. Then, interviews are extended by the institutions to certain individuals, and take place over the next one and a half months.

Rankings are due by mid-February. This is where applicants will rank the institutions they have applied to in order of their preference, and institutions will in turn rank their applicants. Applicants do not have to rank all institutions they have applied for and institutions do not have to rank each applicant who applied to their program. A computer algorithm then matches applicants to their ranked institutions, with preference given to the applicant. By early March, the Match results are finalized and every applicant and institution are told where and with whom they have matched. For some, this means landing the program of their dreams. However, for many it means matching into an internship instead of a residency or not matching to a program at all.

The VIRMP has a wide array of programs available in both small and large animal, exotics, and non-clinical practice with rotating internships, specialty internships, and residencies. A rotating internship is typically the first internship a veterinarian can apply for and entails rotating through most specialties within a given multispecialty hospital. A rotating intern will spend a predetermined amount of time on a specific service and rotate (hence the name) to different services throughout the year. This allows you to get in depth experience in a wide variety of clinical disciplines to make you a more well versed, experienced veterinarian.

Following completion of a rotating internship, you can then apply to specialty internships and residencies, as these programs typically have a prerequisite of previous completion of a rotating internship. In the case of specialty internships, you will spend an entire year within a specific specialty. Typically, applicants enroll in the same specialty internship they hope to pursue a residency in, such as surgery or internal medicine, or they may enroll in a research internship. The additional year of experience hopefully strengthens your residency application for the following year and gives you more in-depth experience within your chosen specialty.

Specialty internships are not required, and some applicants are fortunately strong enough to get accepted into a residency program directly from a rotating internship. It’s important to know that you can apply for both specialty internships and residencies at the same time. The VIRMP will default to matching you into a residency over a specialty internship.

Not all programs elect to have their open positions on the VIRMP. Often, programs will reach out directly to institutions with internships to let them know positions will be available for the following year. Additionally, each veterinary specialty college will have a list of residency-accredited institutions. This list can be cross-referenced with the programs available on VIRMP and you can quickly find out which programs are qualified to have a residency/internship. Not all qualified programs will have open positions available every year, and many programs may skip years between resident/internship classes for various reasons.

A friendly email inquiry never hurts though! Programs that are listed outside of the Match often have an earlier timeline than the VIRMP match programs. Applicants will typically apply for both types of programs and find out their acceptance to the “outside of Match” programs ahead of the VIRMP results. If accepted to one of these programs, you will typically be required to commit before the Match date, and likely be required to withdraw from the Match to avoid double acceptance.

So, what happens if you don’t match? Unfortunately, this is a question many of us have had to answer. After match results are released, a simultaneous list of institutions and applicants who have not matched becomes available to those within the VIRMP system. Unmatched applicants and institutions can contact each other to see if they would make a good fit. Some institutions may elect not to fill out their availability and some applicants may elect to pursue other opportunities outside of the VIRMP match, so there is no commitment to selection at that point. After a few weeks, this list goes public and those outside of the match can contact the available institutions with open positions if they are interested.

In my opinion, if you have a passion for a certain specialty of veterinary medicine, you should do everything in your power to explore that passion to the best of your ability. Unfortunately, passion alone often isn’t enough to beat the bleak odds of matching and make the extra years of training, and the massive pay cut during internship/residency training worth it.

The journey towards specializing is a competitive one, so I would urge you to look inward and be honest with yourself. Do you think you’ll get there and is the end of the road worth the tough journey for you if you make it? How many years of specialty training in the form of internships are you willing to do for the opportunity to match into a residency? These questions are not meant to be discouraging but are meant to be humbling and put matters into perspective. This journey isn’t ideal for many people, so it’s worth having honest discussions with mentors, family, and friends to decide if the road to a residency is right for you.

Even if you don’t go into a residency, but start your journey towards specializing, your years in rotating and specialty internships will not be wasted. They will allow you to work in a high-level specialty hospital while training under some of the brightest minds in the profession. You will undoubtedly grow and learn during your time in these positions and will become a more well-rounded, experienced clinician.

There’s also nothing that says you must specialize! Many people choose to do a rotating internship as a way of exploring different specialties or just to gain more experience before going into practice with less need for supervision. For many people, additional specialty training isn’t right for them, and that’s okay too! You can still become a fantastic veterinarian without pursuing additional training from internships and residencies.

VIRMP info. Veterinary Internship and Residency Match Program. Accessed December 21, 2023. https://www.virmp.org/Home/VIRMPInfo?page=13

The Match can be an overwhelming, intimidating process but a veterinary surgery resident has advice and information for those considering applying to internships and/or residencies

Navigating the veterinary internship and residency maze

Trends in veterinary diagnostics

And Dr. Penn, there's so many trends that are happening right now in the industry. So, what are some current trends that you're seeing in our industry? And how are these trends different versus, let's say, 2010?

Yeah. So, I think that we what we're seeing now is we're seeing, which is a good problem, right? Lots of families are adopting pets, and we see a lot more of that happening. But with that comes increased caseload and as we went through the pandemic, we had a lot of those families who were sitting home who maybe didn't notice those things from their pets before they were watching them kind of every single day. And now they're more in tune with doing that and watching and really seeing what's happening with their pet. So, the caseload went up. And we know that as we think about caseload, we think about all of the efficiency concerns that we talk about. And you know, if we have all of these cases coming in, and we're trying to be as efficient, as thorough, because our pet owners...that pet is a member of their family, and they want a really thorough workup that can be communicated across to them. Back in 2010, When we think about what was available, there was not as much available. So, as we've had this increased caseload, really the need in veterinary medicine, in my mind, that was really there was to provide a way for practitioners or veterinary professionals to really have a way to help with workflow efficiency, to help with consistency, and to provide that value to be able to educate and communicate with those with those pet owners, which I think is just vital. And I think that has changed between now to where it was in 2010.

And Dr. Hann, curious to get your opinion, because as an internist, you must have seen such a rapid change in the way in which we communicate to your point about technology as general practitioners. So what has it been like for you?

Well, it's very interesting, just the trends we've seen of kind of the standard of care and the expectations of pet owners and what they want for their pets. And so, having technology and access to specialists in hand with that, just really bringing up the level of standard of care and what we can offer to them. So having easier access to a quicker diagnosis, and it's having our pet owners trust and understand what's going on, and then being able to access specialist sometimes beyond just the diagnosis, to really build up the opportunities and kind of the different aspects of care so that we can really maximize and pinpoint the exact needs of that particular case, rather than it just staying kind of more of a general workup and maybe not even really getting to that diagnosis in order to kind of really give the best care possible.

Examine the changing expectations of pet owners and the pivotal role of technology in providing individualized patient care 

Trends in veterinary diagnostics and the standard of care 

The FDA has released updated information to help animal drug investigators and sponsors navigate the pathway to approval for animal drugs intended for minor uses and minor species (MUMS). The final guidance—

Special Considerations, Incentives, and Programs to Support the Approval of New Animal Drugs for Minor Uses and for Minor Species

—was released as a draft guidance in July 2020 for public comment.

The comment period was extended to 180 days to hear from all interested parties. The agency received many comments on the proposed Aquaculture Species Grouping section of the draft guidance; the agency intends to address aquaculture species grouping in greater detail in the future. Additional revisions were made in response to public comments and to improve clarity.

The FDA’s mission is to protect and promote the health of both humans and animals, including those animals that are considered 

. These are animals that may not be quite so common to many people including sheep, goats, and ferrets, as well as fish, zoo animals, wildlife and insects such as honeybees. Minor species are animals other than those typically thought of as livestock, such as cattle, pigs, chickens, and turkeys, or companion animals like dogs, cats, and horses.

The FDA also has a responsibility to facilitate approval of treatments for conditions that are relatively rare in the major species. These treatments are referred to as minor uses. Some examples of minor uses in major species include various cancers in dogs or regional occurrences of diseases, such as outbreaks of blackhead in turkey flocks in the Southern US.

Because MUMS drugs are used in relatively small markets, there is less economic incentive for a drug company to invest in the research and development necessary to bring a product to market through the traditional new animal drug approval process. Congress has tried to address the disparity of products available to treat these animals by passing legislation—the Minor Use and Minor Species Animal Health Act of 2004

that allows for alternative legal pathways to the marketplace for MUMS drugs, including conditional approval, and provides incentives such as exclusive marketing rights and grant eligibility to help investigators and companies overcome financial roadblocks.

In certain cases, a minor species drug is intended for use in species that are too rare or too varied to be the subject of adequate and well-controlled studies in support of a drug approval. The Index of Legally-Marketed Unapproved New Animal Drugs for Minor Species (the Index) provides an alternative FDA review process to affirm the safety and effectiveness of unapproved new animal drugs for use in nonfood-producing minor species. There 16 entries listed on the Index include use in animals such as elephants, raptors, ferrets and ornamental finfish.

Sponsors of MUMS drugs may pursue conditional approval of their products, which allows the marketing of a therapeutic when all requirements for its approval have been met except the “substantial evidence” standard for effectiveness. Instead, conditional approval requires these drugs to meet a “reasonable expectation of effectiveness” standard and to be marketed for up to 5 years (through annual renewals) while the drug’s sponsor continues to collect the effectiveness data needed to support a full approval. Conditional approval allows MUMS drugs to reach the market sooner, while the drug sponsor is required to demonstrate progress toward meeting the full effectiveness within 5 years. 

The MUMS Designation program provides incentives similar to those available for orphan medical products for use in people. Sponsors who are granted MUMS designation status are eligible to apply for grants to defray the costs of safety and effectiveness studies in support of the drug approval. They are also given 7 years of exclusive marketing rights beginning on the day of approval or conditional approval.

Many of those seeking approval for MUMS drugs are new to the new animal drug approval process. The final guidance released today describes the new animal drug approval process for MUMS drugs and explains the various scenarios that might arise along the way. This guidance also explains how to navigate the various components of the MUMS program so that sponsors can use them to their benefit when pursuing drug approval. For sponsors of products intended for use in aquaculture, the guidance describes special considerations that apply.

FDA Issues Final Guidance to Assist Sponsors of Animal Drugs for Minor Uses and Minor Species (MUMS). News release. FDA. December 21, 2023. Accessed December 21, 2023. 

https://www.fda.gov/animal-veterinary/cvm-updates/fda-issues-final-guidance-assist-sponsors-animal-drugs-minor-uses-and-minor-species-mums?utm_medium=email&utm_source=govdelivery

The document describes the new animal drug approval process for minor uses and minor species and explains various scenarios that might arise