Tibial plateau leveling osteotomy (TPLO) surgery is used to help dogs and cats regain mobility following a cranial cruciate ligament (CCL) tear. The CCL is the canine and feline equivalent of humans' anterior cruciate ligament (ACL) and connects the femur to the tibia. If the CCL tears, the tibia can slide forward relative to the femur, leading to instability in the stifle joint.

In dogs, most cruciate tears result from degeneration, obesity, poor physical condition, conformation, and breed.

 Canines commonly experience partial CCL tearing that, over time, progresses to a full tear.

 In cats, however, degenerative disease is rarely the culprit of CCL ruptures, although it can occur in overweight felines. Instead, CCL tears in cats are most frequently caused by trauma.

The top of the shinbone in dogs has a natural slope, making the bones in the leg more susceptible to sliding, according to a Texas A&M University College of Veterinary Medicine and Biomedical Sciences (VMBS) report.

 “Without the CCL holding the bones in place, that slope causes instability that leads to pain, inflammation, and the development of arthritis over time,” Katherine Barnes, DVM, MS, DACVS (Small Animal), clinical associate professor at VMBS, said in the report.

Although any feline or canine patient can tear their CCL, it is most common in large, active dogs. At least half of canine patients who experience a CCL tear in one knee will likely develop a similar issue in the other knee.

Breeds most at risk for a CCL tear include

For CCL tears, patients may undergo TPLO surgery. The procedure involves reshaping the knee by making a circular cut in the tibial plateau. The cut section is then rotated to reduce the slope of the tibial plateau until it reaches a more level orientation that brings the tibial plateau to approximately 90 degrees to the attachment of the quadriceps muscles, helping to prevent the abnormal forward sliding of the tibia that occurs with a CCL tear.

“Instead of replacing or repairing the damaged ligament, TPLO changes the anatomy of the knee to eliminate the need for the ligament entirely,” Barnes said in the Texas A&M report.

 “This is done by making a curved cut in the top of the tibia to flatten its weight-bearing surface. The bone is then secured with a specialized bone plate and screws.

“Clipping the fur and scrubbing the leg beforehand is a critical step, as it helps decrease the risk of postoperative infection,” Barnes continued.

 “Before surgery, x-rays are performed to confirm the diagnosis and rule out any other sources of pain, such as from a fracture, and blood work is done to ensure the patient is healthy for anesthesia. X-rays are also taken after surgery to ensure that the implants are well positioned before waking the patient up.”

According to VMBS, the entire process, from preparation to waking the patient, generally takes a few hours and has “excellent” outcomes.

 Still, carefully guiding clients through the recovery process is a crucial step for safe healing.

When the knee gives out: understanding TPLO surgery. News release. Texas A&M University Veterinary Medicine & Biomedical Sciences. May 29, 2025. Accessed June 2, 2025. 

https://vetmed.tamu.edu/news/pet-talk/understanding-tplo-surgery/

Canine cruciate ligament injury. Colorado State University James L. Voss Veterinary Teaching Hospital. Accessed June 2, 2025. 

https://vetmedbiosci.colostate.edu/vth/services/orthopedic-medicine/canine-cruciate-ligament-injury/

Cranial cruciate ligament injury disease (feline). Manchester Veterinary Specialists. Accessed June 2, 2025. 

https://www.mvsvets.co.uk/pet-owners/cranial-cruciate-ligament-disease-feline/#:~:text=What%20causes%20cruciate%20ligament%20disease,is%20often%20in%20overweight%20cats

Cranial cruciate ligament injury disease (CCL) in dogs. Schwarzman Animal Medical Center. March 21, 2024. Accessed June 2, 2025. 

https://www.amcny.org/pet_health_library/cranial-cruciate-ligament-disease-in-dogs/

Articles

Tibial plateau leveling osteotomy surgery involves changing the anatomy of the knee

Cranial cruciate ligament tears and TPLO surgery

Asking clients 1 or 2 questions about litterbox use during each exam can make a big difference, according to Tabitha Kucera, RVT, VTS (Behavior), CCBC, KPA-CTP, FFCP

Why having the litterbox conversation matters

Are you having regular conversations with caregivers about patients’ litterbox habits? In an interview with 

 on her lecture “Litterbox Lessons: Keeping Cats in the Litterbox,” presented at the Fetch dvm360 Conference in Nashville, Tennessee this past weekend, Tabitha Kucera, RVT, VTS (Behavior), CCBC, KPA-CTP, FFCP, stresses the importance of discussing appropriate litterbox setup with clients, especially when it comes to new kitten caregivers.

Still, these conversations should not be limited to kitten caregivers. In the video, Kucera explains how just a few open-ended questions can help identify potential pain or underlying health issues in cats. She also talks about how veterinary teams can initiate these conversations with caregivers and highlights the value of educating clients on what a healthy feline environment looks like.

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

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

 I love proactivity and prevention and setting up caregivers and cats for success. So, a few [of these] things [are] asking and talking about litter boxes. Sometimes we don't really bring them up until there's been a concern. And we have to realize many caregivers may not even mention their cat is house soiling until it's been going on for a while and they're already over threshold. So, I think us just talking about it every appointment. Especially when they're kittens, in your kitten packs have—I call them the ‘Litterbox ABCs’—an appropriate litter box set up to start.

I'll be honest, in my 10,12, years of consulting, I have never seen appropriate litter box set up to start. And to be fair, I did not have one as a vet tech until I got a lot more into behavior, so be kind to yourselves. But most caregivers and cats aren't set up for success, so I think just talking about what appropriate litter box setup is and explaining that this is a need, not necessarily a want. Again, having some information in your kitten packs, or even better—having kitten kindergarten or kitten socialization classes.

And then also just a question or 2 you can ask during every exam. I think we always talk about open ended questions. So, what I like to ask is, “when was the last time your cat missed the litter box?” because they may say, “oh, never.” But also, the amount of times cats and dogs like, ‘when was last time your dog had an accident in the house?’ The amount of caregivers in general practice I've worked with who I've always gotten great histories [from], the practice I work with is awesome, the team is great, but these animals have been house soiling for years, and it was never identified. 

So that simple question; first off, you're starting the conversation, “When was the last time your cat missed the litter box?” And then [the client] might say “once or twice” and then you can get more context—“it was right outside of the litter box, both times it was defecation.” That's a big warning sign that most likely that cat has some underlying constipation and/or pain, I mean, definitely, right?

So, we can easily help by helping [clients provide a] low entrance, make sure those litter boxes are easily accessible to that cat. And then lastly, I think providing caregivers with the 5 pillars of a healthy feline environment, which we've all heard of—I love that it's getting more popular. So, providing multiple safe spaces, providing multiple and separated key environmental resources and telling clients what those are. So of course, food, water, litter boxes. Three boxes right next to each other is one box. 

So, kind of helping caregivers recognize scratchers, vertical spaces, providing opportunities for play and predatory behavior, providing positive, consistent and predictable human-cat, human-dog, cat-to-cat interactions. And then an environment that respects the importance of a cat's sense of smell. But by doing all those things, we're also helping to just manage stress and prevent other behavioral issues as well because those animals’ needs are being met.

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Asking clients 1 or 2 questions during every exam about litterbox use can make a big difference, according to Tabitha Kucera, RVT, VTS (Behavior), CCBC, KPA-CTP, FFCP.

Image Credit: © New Africa - stock.adobe.com

Chronic pruritus is one of the most frequent dermatologic complaints in general practice, and food allergies are responsible for roughly 15 to 35% of non‐seasonal cases.

 Accurately identifying food‐induced dermatitis requires a systematic approach, since most itchy dogs suffer from environmental allergens, parasites, or infections rather than dietary triggers. This was the topic in focus at a panel discussion at Fetch Nashville 2025 titled “Don’t dread the diet trial! Demystifying food allergies and their diagnosis,” featuring Joya Griffin, DVM, DACVD, Julia Miller DVM, DACVD and Natalie Marks, DVM, CVJ, CCFP, Elite FFCP-V. The trio came together to share practical insights on when and how general practitioners should implement diet trials.

Early in the conversation, Griffin described her typical approach to newly pruritic patients. She said she rarely brings up diet in a first‐time offender unless there is a clear nonseasonal pattern. She illustrated this point with a hypothetical example: “If it’s June and it’s a Labrador and it’s the first time they’ve ever had issues, I don’t talk about food…I treat that dog like an atopic [dermatitis] case, because atopy is more common.”

The panel agreed that environmental allergies, parasites, and infections are far more likely in a first‐time itchy dog than food. In many general practice settings, Marks noted that general practitioners often feel pressed for time and said, “We don’t need to do a diet trial on every itchy dog.” She encouraged ruling out infections and parasites first, managing pruritus, and monitoring the patient’s response before considering elimination diets.

A diet trial becomes reasonable when pruritus is persistent and nonseasonal or when standard atopy treatments fail over several months. Griffin explained that once you establish that itching persists into colder months, when environmental allergens should be less active, it makes sense to discuss diet.

Framing the diet trial as a diagnostic test

A recurring theme was how to position the elimination diet as a finite, diagnostic tool rather than a lifelong prescription. Griffin stressed that it’s important to communicate clearly with clients due to the challenge of compliance with the prescribed diet, stating it “takes a lot of work” to get the client on board. “If I’m going to do a diet trial, I want to do it once and do it well,” she said

She typically asks clients to commit to at least 6 weeks on a novel or hydrolyzed‐protein diet, with a plan to taper pruritus medications around week 4. In her words:

“Give me 6 weeks. If you can give me 6 weeks with this, I’m going to try to get your dog off of Apoquel right around week 4 or 5, and then we’ll see where we are…By week 8, you are going to get dramatic improvement in greater than 95% of your food allergic dogs.”

At the mid-point (week 4–5), Griffin will withdraw medications such as oclacitinib (Apoquel; Zoetis) or lokivetmab (Cytopoint; Zoetis)—provided she knows the patient’s Cytopoint injection schedule—so she can judge whether the diet alone maintains comfort. If itch returns immediately, she discontinues the trial; if the dog remains comfortable, she continues to week 8, she said.

The idea is that describing the trial this way helps owners see it as a limited study, not a permanent expense.

The panel next addressed diet selection, emphasizing the pitfalls of over‐the‐counter limited‐ingredient foods. Griffin debunked the grain‐free myth:

“Grains are great. They’re great for the heart…There is the occasional wheat or soy allergic dog, but they are really, truly the low end of the list.”

Griffin explained that “cross‐contamination” in commercial kibble is rampant. Even novel diets often contain trace amounts of common proteins. Marks cited a 2011 study showing that 10 of 12 over-the-counter “limited‐ingredient” foods labeled free of mammalian, fish, or dairy contaminants nonetheless tested positive for those proteins.

 This evidence led all 3 veterinarians to recommend prescription diets containing a verified novel protein (e.g. rabbit, alligator) or a hydrolyzed protein (commonly salmon).

Miller reminded attendees that in cats, beef, dairy, and fish top the allergy list. She agreed that choosing a diet involves a thorough review of every protein or treat the patient has consumed, including flavored medications and occasion‐specific snacks.

Throughout the discussion, several pitfalls emerged:

Hidden allergens in treats and supplements

Griffin warned that owners may inadvertently sabotage a trial by offering flavored pill pockets, rawhides, or table scraps. “Cheese for pills … flavored medications … they forget that.” She recommended alternatives like vegan cheese or specialized “pill wrap” products to ensure no animal protein is introduced.

In urban practices, Marks has seen dogs flare because doormen or neighbors slip them treats. She advised, “Ask exactly what goes in the mouth…even treats outside the home count.”

Griffin described how some owners simply reorder prescription food indefinitely, too often without re‐evaluation. She suggests restricting refills to a three‐month supply. “Your front desk staff will call you and say, ‘Myrtle needs her refill.’ And you'll look back [think], ‘Oh my god, I haven't talked to Myrtle in 3 months. Is that [hydrolyzed‐protein diet] even working?

Both Miller and Griffin stressed that a recheck—ideally at week 4 or 5—is non‐negotiable. Owners need guidance on tapering medications, troubleshooting appetite issues, and confirming compliance.

At the end of 8 weeks, Griffin expects a clear reduction in pruritus, measured via a Pruritus Visual Analog Scale (PVAS) recorded at baseline and week 8. “If there’s been no change or only a teeny change by week 8…that diet has not made a difference,” she said. Successful diets not only allow withdrawal from medications but also provide a basis for a formal rechallenge: re‐introducing the original diet or suspect protein to confirm a true food allergy. If a dog’s itching returns immediately upon rechallenge, the diagnosis is confirmed, the panel said

Griffin acknowledged that some patients have mixed atopic and food allergies. In such cases, even after confirming a food trigger, clinicians must address environmental allergens while maintaining dietary restriction for the offending protein.

Diet trials don't have to be scary or arduous. By following a structured approach that starts with ruling out more common causes first, framing elimination diets as limited diagnostic tests, choosing verified prescription diets, and scheduling timely rechecks, general practitioners can efficiently identify those few patients who truly require lifelong dietary restriction.

Carlotti DN. Cutaneous adverse food reactions in dogs and cats. 

Olivry T, Mueller RS. Critically appraised topic on adverse food reactions of companion animals (3): prevalence of cutaneous adverse food reactions in dogs and cats. 

Griffin J, Marks N, Miller J. Don’t dread the diet trial! Demystifying food allergies and their diagnosis. Presented at: Fetch dvm360 conference; Nashville, TN. May 30, 2025.

Raditic DM, Remillard RL, Tater KC. ELISA testing for common food antigens in four dry dog foods used in dietary elimination trials. 

. 2011;95(1):90–97. doi:10.1111/j.1439-0396.2010.01016.x.

Not every itchy dog needs a diet trial, but when they do, these tips can make all the difference

Diet trials 101

Kristen Ward, RN-BSN, RVT, VTS (Anesthesia/Analgesia), shares insights on the use of capnography with anesthesia in pets.

Using capnography with anesthesia

What should veterinary professionals know about capnography? In a lecture at the 2025 Fetch dvm360 Conference in Nashville, Tennessee, Kristen Ward, RN-BSN, RVT, VTS (Anesthesia/Analgesia), a member of the Safe Pet Anesthesia team as well as a nurse in human medicine, shared insights on the use of capnography with anesthesia in pets. In a 

 interview, Ward explained why she is passionate about the use of capnography and what her lecture covered.

The following is a transcript of the video:

Kristen Ward, RN-BSN, RVT, VTS (Anesthesia/Analgesia)

: I'm so glad you asked about capnography, because that is definitely my ‘desert island’ choice of equipment, if I was ever left there.

For me, I want attendees to take away that capnograph is not just a number. It is a continuous, real time insight to ventilation, perfusion and metabolism. We're going to learn how to interpret capnograms, look at and detect problems like hypoventilation, obstruction, things like that.

I want people to know that capnography is an early warning system. This is something that if you learn it and you can see it and use it in your practice, then you're going to be able to anesthetize patients safely and understand where things are changing in a very second to second moment. So that's kind of why it's my desert island piece of equipment.

Kristen Ward, RN-BSN, RVT, VTS (Anesthesia/Analgesia), explains why she is passionate about the use of capnography and what her lecture at the 2025 Fetch dvm360 Conference in Nashville covers.

At Fetch Nashville 2025, day 2 kicked off with a keynote address from Temple Grandin, PhD, and Marty Becker, DVM. The pair walked through the history of Grandin’s innovations in livestock handling, explaining how those lessons could be applied to improve small animal veterinary practice. As the founder of Fear Free, Becker framed her advice in terms of practical ways veterinary professionals can positively affect the emotional well-being of companion animals.

“I want the world to know that animals have emotions and feel pain,” Grandin said, with an emphasis throughout the talk about how animals perceive the world around them in a way that humans tend not to intuitively understand. Because of that disconnect, Becker and Grandin pointed out a number of improvements most practices can make to ensure a positive experience for patients.

Animals encode fear in sensory terms such as sight, sound, and texture, Grandin said. Becker shared that he has observed many practices have holding cages in full view of the treatment area. In these cases, he said, the animals are emotionally impacted by observing what happens to other patients, especially if they are handled roughly. He recalled a particular instance, saying of the animal onlookers watching a patient be restrained: “Every pet was in a defensive position. All their feet pulled in…their tail tucked, and their ears back.”

Countering this is as easy as installing a curtain in treatment to obscure the view, rather than remodeling the clinic. As Grandin bluntly put it, “Just put a curtain up there.”

Another important visual tactic is to differentiate exam rooms, if at all possible. If every consult room looks identical, an anxious animal may refuse to enter a room where it previously had a negative experience. Grandin recommended creating unique visual cues—paint, decor, or layout—that allow you to rotate pets into a different room. “If this animal had a bad experience in one [room], you don’t put it back in here,” Grandin said.

Fear of falling is a primal concern for all animals. On exam tables and clinic floors, slippery surfaces exacerbate anxiety. Becker said, “[An] animal’s No. 1 fear from birth is a fear of falling. What have we done all our life? Lift them off their feet and put them on an elevated, slippery table.”

To address this, clinics can use nonslip runners. Grandin described the effect of speckled, glossy flooring, which pets perceive as ice: “They think this is ice to them. It looks shiny and slippery.”

Marty Becker, DVM, addresses the audience during the day 2 Fetch Nashville keynote.

One of the most effective ways to transform a pet’s response is to pair a neutral or previously threatening stimulus with positive reinforcement, the two said. Two prime examples from the session:

: Needles and syringes often elicit fear because animals have a painful experience with them. “Give everybody…a syringe to take home, and…stick a piece of cheese, piece of baloney, put peanut butter on it. They want to think that they have positive associations with that syringe,” Grandin explained. By offering high-value treats on a capped syringe at home, pets learn that the syringe predicts reward, not pain.

: The noises of clippers, vacuums, and other treatment-area sounds can trigger anxiety. Grandin suggested recording these sounds and providing the audio to pet owners. At home, owners can play the recording while offering treats, establishing a positive association before the next clinic visit.

4. Seek leadership buy-in and allocate training time

Implementing Fear Free methods involves a learning curve. Grandin said, “While you’re learning, it’s probably going to be slower.… No pain, no gain.” Grandin and Becker said practice owners and head veterinarians must champion Fear Free protocols. Without leadership commitment, isolated efforts by technicians or associates often stall. Grandin also noted that, initially, exams may take an extra 20 to 30 seconds per patient. After consistent practice, typically 2 to 3 weeks, staff become proficient, and procedures resume normal speed. Grandin said, “You’ve got 2 to 3 weeks where it’s going to be slower, and then once you learn it, you love it.”

As Grandin and Marty Becker explained, relatively simple modifications can drastically reduce fear responses in the clinic. With leadership support, a brief adjustment period, and an earnest commitment, veterinarians can ensure every animal enters the clinic confident that Fear Free will guide its care.




Becker M, Grandin T. The top 5 seismic things happening in animal care you need to know about and take action on. Presented at: Fetch dvm360 conference; May 31, 2025; Nashville, TN. 

Renowned animal behaviorist Temple Grandin, PhD, joined “America's Veterinarian” Marty Becker, DVM, onstage to share how a Fear Free approach can help give animals “a life worth living”

Four actionable Fear Free tips from Temple Grandin, PhD, and Marty Becker, DVM

At Fetch Nashville, Tabitha Kucera, CCBC, RVT, KPA-CTP, VTS, delivered a presentation titled, “Not Just a Vet Tech: Business Opportunities for Veterinary Technicians.” Kucera’s talk focused on the diverse career paths for veterinary technicians beyond traditional clinical roles and how they use their unique veterinary expertise to create business opportunities and increase earning potential. This talk took place in Davidson Ballroom 104C in the Music City Convention Center, in Nashville, Tennessee from 1:15 to 2:15 PM on Friday, May 30.

Kucera’s presentation started by talking about the importance of veterinary technicians in the field.

“Technicians act as a voice for positive change,” Kucera said during her presentation. “But you’re also supporting others and you’re advocating for patients in and out of your care.”

Tabitha Kucera, CCBC, RVT, KPA-CTP, VTS, focused her talk on how veterinary technicians can find greater fulfillment in their jobs, which often requires seeking out new opportunities for continuous learning. Photo Credit: Will Wetzel

Despite veterinary technicians excelling in advocating for their patients, they are not always advocating for themselves, and that has led to one of the biggest challenges veterinary technicians are currently facing in the field. Despite several veterinarian technicians having strong support systems, many feel stuck in their current roles. As a result, Kucera highlights that many veterinarian technicians develop a sense of “learned helplessness,” which is a state of mind where technicians feel that burnout exists everywhere, so there’s not a pathway out from their current role.

“Many of us work in environments that are not conducive to learning,” Kucera said during her talk. “And that can often lead to burnout.”

What Kucera stressed during her talk was that there 

pathways for veterinary technicians to expand and grow their career opportunities and find better working conditions and environments conducive to their personal fulfillment.

According to Kucera, it all starts with a “KEY.”

Kucera’s presentation provided a comprehensive roadmap to veterinary technicians looking to change jobs and grow their careers, and it starts with the “KEY” acronym, which stands for “keep educating yourself.”

“One key to staying engaged and satisfied [in your career] is to continue to grow,” Kucera said. “Veterinary technicians have endless opportunities, more than they realize.”

Kucera recommended that veterinary technicians start with honing their skills and building their resumes. The good news, Kucera noted in her talk, is that these learning opportunities are much more accessible now than in the past. Besides a greater diversity of veterinary journals and magazines, online learning opportunities and veterinary podcasts have grown exponentially.

Apart from the access to educational materials, there is also on-the-ground learning that veterinary technicians can access. Kucera suggested veterinary technicians can build on their skills and foster connections through volunteer opportunities, as well as assisting at conferences and technical schools.

Kucera also stressed the importance of finding a good mentor when it comes to exploring new career paths for veterinary technicians.

“The first thing you need to ask is what do you want in a mentor,” Kucera said in her talk. “Know what you’re looking for. The mentor could be outside of veterinary medicine. Having a mentor helps prevent burnout and isolation, and it also helps hold you accountable in exploring new directions, such as specialities, leadership opportunities, speaking gigs, or ideas not previously considered.”

Kucera also offered a few tips when selecting a mentor, including seeking out one who aligns with your values and goals and who share your passion for where you want to go.

Part of advancing your career as a veterinary technician means demonstrating your capabilities. Kucera stressed that to land their role or job that you want, it is important to proactively apply newly acquired skills to expand your role and responsibilities, including volunteering for supervisory tasks and completing certification programs.

“There so many [certification programs] out there that you can do,” Kucera said.

Another important aspect to finding a more fulfilling role as a veterinary technician is to network. Besides advancing your career, Kucera discussed how networking offers another secondary and tertiary benefits, including improving your social well-being, exchanging new ideas, inspiring creative thinking, and meeting people at all professional levels.

“Part of networking is putting yourself out there, but it’s hard. So start small,” Kucera said.

And that also includes the online space, which has become essential for networking. Tools such as social media can be helpful in connecting veterinary technicians to good people in their space who can help, but it does require moderation.

“Social media requires healthy boundaries,” Kucera said.

And finally, Kucera concluded her talk by suggesting ways veterinarian technicians can expand their business opportunities. Some suggestions include setting up new training services or consulting businesses, writing, podcasting, or speaking engagements, teaching CE content, and creating tools for veterinary teams or caregivers.

Veterinary technicians: The importance of finding their “voice”

Ultimately, Kucera explained that for veterinary technicians to find more fulfilling jobs and opportunities, it requires honest self-reflection about what they want and what they can do to get there. The main issue currently, according to Kucera, is that many veterinary technicians need to speak up not only for themselves but for each other as well.

“A lot of vet techs are not advocating for themselves,” Kucera said. “It’s a big problem in our field. We need to be that voice for each other.”

“The biggest takeaway [from my presentation] is that you’re not stuck,” Kucera said. “The grass is greener on the other side.”

Kucera T. Not Just a vet tech: business opportunities for veterinary technicians. Presented at: Fetch dvm360 conference; Nashville, TN; May 30, 2025.

Tabitha Kucera, CCBC, RVT, KPA-CTP, VTS, discusses the numerous career pathways and opportunities for veterinary technicians.