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BEAT VETERINARY eMAGAZINE ISSUE 27 DECEMBER 2025
COMMON DIFFERENTIALS AND MANAGEMENT OF FELINE SEIZURES
highlights inside MIND MASSAGE
TECH TIPS
FAILURE TO LEAD: WHAT HAPPENS WHEN LEADERS DON'T GET ALONG?
MOVING FORWARD WITH PROP 129 : AN UPDATE A YEAR LATER
REBREATHING CARBON DIOXIDE (CO 2 ) IN VETERINARY MEDICINE: IDENTIFYING CAUSES
Learn about all these compelling topics and more inside!
QUARTERLY BEAT / DECEMBER 2025
COMMON DIFFERENTIALS AND MANAGEMENT OF FELINE SEIZURES 04
ONCOLOGY DIAGNOSTICS FOR THE PRIMARY CARE VETERINARIAN ... 08
MOVING FORWARD WITH PROP 129 : AN UPDATE A YEAR LATER 12
FAILURE TO LEAD: WHAT HAPPENS WHEN LEADERS DON'T GET ALONG? 16
REBREATHING CARBON DIOXIDE (CO 2 ) IN VETERINARY MEDICINE: IDENTIFYING CAUSES 20
MIND MASSAGE 24
TECH TIPS 28
UPCOMING WEBINARS 29
ISSUE 27 – DECEMBER 2025 TABLE OF CONTENTS
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COMMON DIFFERENTIALS
OF FELINE SEIZURES
AND MANAGEMENT
Missy Carpentier, DVM, DACVIM (Neurology) Minnesota Veterinary Neurology, Columbus, MN Cats commonly present to both general practice and referral centers due to seizures. For a long time, it was thought that if a cat has a history of seizures, then they must have something sinister occurring in their brain. Luckily, we now know that this is not often the case. Though we rarely see true idiopathic or genetic epilepsy in cats due to the decreased presence of purebred cats in practice, it is important for veterinarians to know that up to 22-54% of cats presenting with seizures are secondary to epilepsy of unknown cause (EUC), and in most cases we are successfully able to manage their seizures. The clinical picture of epileptic cases varies considerably, but the ultimate goal for every patient is the same - good seizure control with a good quality of life. This discussion will summarize my general approach to the feline epileptic patient, reviewing the initial evaluation, differential diagnosis, diagnostics, and treatment. SIGNALMENT It is important to know that a complete work up should be recommended for any cat that has seizures, regardless of age. It is, however, important to pay attention to the age and breed of the cat to help you start to think about possible differentials for the seizures. Remember, until you officially neurolocalize your patient based on the neurologic examination, you cannot finalize your list of differentials! Some top differentials that you should consider for a cat less than 1 year of age with seizures would include metabolic disease (a portosystemic shunt), degenerative, developmental, toxin, or inflammatory brain disease. For an older cat (greater than 10 years of age) that is presenting for seizures, neoplasia or a cerebrovascular accident need to be high on your differential list, but these are not the only differentials! For purebred cats, you need to have developmental or degenerative high on your list. HISTORY The history that the owners provide is invaluable. One of the first obstacles that you face with a seizure patient is whether or not that patient is truly experiencing seizures. There is a wide variety of seizures, and unfortunately, many of them are not the classic tonic-clonic seizure that makes identification easy, and this is particularly true for cats. Cats can
Struggling with how to approach feline seizure management? In this VETgirl article, Dr. Missy Carpentier, DACVIM (Neurology), walks you through a step-by-step process for evaluation and treatment of feline seizures. From diagnostic workup to therapeutic options, read on for practical strategies to better diagnose and manage seizures in your feline patients.
present with any type of seizure, however, two of the most common types of seizures in cats include focal and orofacial, and these can sometimes be difficult to identify. That is why it is extremely important that the owners describe the seizure to you in detail, to identify the type of seizure they possibly are having, and to recognize any signs that may not be related to a seizure. I commonly see patients presenting with a complaint of seizures, but after gathering further information from the owners, they are diagnosed with neck pain, vestibular disease, syncope, etc. It is also important to recognize that an owner may give you a perfect description—or, even better, have a video of the episode in question—and you still are left uncertain if it truly is seizure activity or not. In these cases, often times it is best to use the clinical signs that are present before or after the suspect seizure to help you identify if the episode in question was a possible seizure.
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DIFFERENTIALS I cannot stress the importance of coming up with a list of differentials for your seizure patients, because this will help guide your diagnostic recommendations. The International League Against Epilepsy publishes new etiologic classifications for epilepsy every couple of years and often the veterinary field will make modifications on our classification based on these changes. I don't worry so much about the classification, just use what works best for you to come up with a good list of differentials. For example, if you are used to using the DAMNIT-V scheme, below is a list of some differentials that you may want to consider for a feline patient with seizures. This is by no means an exhaustive list of causes of seizures.
Some key features that are commonly seen with seizure activity include:
Apprehensive behavior, pacing, agitation, seeking out the owners, hiding, etc.
Pre-ictal
Tonic-clonic: loss of consciousness, autonomic dysfunction, less than 2 minutes (can be longer but most seizures are 2 minutes or less), facial twitching Focal: Uni-lateral facial twitching, contracture of a forelimb, consciousness normally maintained Cats: Orofacial
Ictal
Confused/disoriented, blind, restless, hungry, thirsty, aggression, etc.
Post-ictal
DEGENERATIVE
Lysosomal storage diseases
Complete details of the seizures that I obtain from owners include the following information:
DEVELOPMENTAL
Hydrocephalus, lissencephaly, cortical dysplasia
ANOMALOUS
Epilepsy of unknown cause
• When seizure activity started • Total seizures • Seizure frequency • Description of seizure activity, time of day, associated with any exercise, etc. • Length of seizure • Pre-ictal phase
• Post-ictal phase • Toxin exposure • Behavior in between seizures • History of trauma • Anti-epileptic drugs (AEDs) currently being administered and any recent blood levels • Improvement of seizure activity with AEDs
Hepatic disease, renal disease, electrolyte abnormalities, hypoglycemia, hypoxia, mitochondrial encephalopathy
METABOLIC
NEOPLASTIC
Primary or secondary
NUTRITIONAL
Thiamine deficiency
Infectious (FIP, Cryptococcus, toxoplasmosis, etc.) vs non-infectious (meningoencephalitis of unknown etiology) feline limbic encephalitis-hippocampal necrosis complex
INFLAMMATORY
PHYSICAL AND NEUROLOGIC EVALUATION A complete physical and neurologic evaluation should be performed on every patient. If there are abnormal physical examination findings, then diagnostics based on those findings should be pursued. In regards to the neurologic evaluation, a cat is always going to be a cat and makes things a little tricky. Do the best you can, but it is highly unlikely that you will be performing a complete neurologic evaluation AND THAT’S OKAY! Special attention should be paid to any other signs of forebrain dysfunction (e.g., circling, head pressing, cortical blindness, conscious proprioception deficits). Many animals will have an abnormal neurologic evaluation in the post-ictal period. Normally if you have abnormal neurologic examination findings, it makes epilepsy of unknown cause less likely, but a lot of cats will have mentation changes, visual deficits, ataxia or paresis for hours or sometimes days after seizure activity. So don't necessarily give the cat a bad prognosis if they have neurologic deficits immediately after a seizure, but if the deficits remain after 1-2 days, or worsen, then other causes besides epilepsy of unknown cause need to be considered. One abnormal neurologic examination finding that wouldn’t be due to the post ictal state would be spinal hyperesthesia – if spinal hyperesthesia is present inflammatory disease of the nervous system should be high on your differential list. After you have completed your full evaluation, you will then neurolocalize your patient. If a patient is presenting for seizures, you know that the forebrain is involved. The importance of the neurologic evaluation is to be sure that other parts of the nervous system aren’t involved, in which case your neurolocalization would change from forebrain to multifocal. Based on where you neurolocalize your patient will then allow you to form an appropriate list of differentials.
TOXIC
Pesticides, lead, ethylene glycol, mycotoxins
TRAUMATIC
Traumatic brain injury, skull fractures
Cerebral vascular accidents (ischemic vs. hemorrhagic)
VASCULAR
DIAGNOSTICS Recommended diagnostics for the epileptic patient will largely depend on your differentials, but at a minimum these patients should be receiving complete blood cell counts, full chemistry profiles, urinalysis, and a liver function test (either bile acids or ammonia). From there, further testing that you may include would be thoracic and abdominal radiographs, abdominal ultrasound, brain MRI +/- cerebrospinal fluid analysis. It is important to stress that in our feline patients, a complete neurologic work-up, including a brain MRI and CSF evaluation, is recommended if indicated and safe to do so.
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CONTROLLING THE EPILEPTIC PATIENT In 2015, the ACVIM published a Consensus on seizure management in dogs and I follow those same guidelines for when to start an AED in cats. The consensus states that an AED should be started if:
frustrations early on, it will increase our overall ability to help these patients in the long-term. I often get asked what is considered good seizure control and the answer is that it is very case dependent. If I see a patient that has been having seizures once a week and I can get their frequency down to 1 seizure every 1-2 months, I am happy. On the flip side, if I have a patient that is only having seizures every 2-3 months but their seizures last up to 5 minutes and they are dangerously aggressive to the owner in the post-ictal state, then I will not be satisfied and I will strive for better seizure control. I find that it is good information to let the owners know that as long as we get good seizure control, which 44% of cats with EUC will have good control with phenobarbital, then the overall life-expectancy of their beloved pet shouldn’t be altered. AED OPTIONS When you start a patient on anti-seizure or anti-epileptic medications, we have three goals:
• Identifiable structural lesion present or prior history of brain disease or TBI • Acute repetitive seizures or status epilepticus (SE) (ictal >5 minutes or >3 or more generalized seizures within a 24-hours period) • >2 or more seizure events within a 6-month period • Prolonged, severe or unusual postictal periods
If an underlying disease for the patient is found – i.e., inflammatory brain disease – then treating the underlying disease in conjunction with AED’s is needed. If epilepsy of unknown cause is diagnosed, it is important for the owners to understand that there is no cure. We do our best to control the frequency, duration, and severity of seizures with AEDs. Treatment is normally started with one anticonvulsant medication and other medications are added if needed. I try and “max out” the current AED that a patient is receiving prior to adding in a 2nd AED as long as the patient is handling the medication well. When I am considering if I have “maxed out” a drug, I am considering the patients drug blood level, blood work, side effects, owners’ ability to handle the side effects, and cost. For example, though levetiracetam is a great medication to choose for cats, most owners have a very difficult time giving a medication three times a day. A frustrated owner of an epileptic patient is not something that we want, though out of fear and uncertainty it often does come with the territory. That being said, if we can provide as much information and minimize their concerns and
1. Seizure control 2. Side effects 3. Owner satisfaction
Below is a chart of the most commonly used feline AED’s, the recommended starting dose of these AED’s, drug blood level monitoring, and side effects. Once I have chosen the AED for the patient, I normally start at the listed dose and make further dosage adjustments based on the drug blood levels and side effects. Remember, every seizure case is different, and you should expect that you are going to need to adjust your treatment plan many times until you find what works for them.
MOST COMMON SIDE EFFECTS IN CATS
DRUG
DOSE (PO)
MONITORING
2 Weeks after starting and after dose change, then q6m 10–20 µ g/dl
Behavioral (hyperexcitability), lethargy, ataxia, facial itching, ALT elevation
PHENOBARBITAL
1–2mg/kg q12–24hrs
REGULAR: 20–60mg/kg x 8hrs XR: 30mg/kg x 12hrs
Not well established, proposed 5–45 µ g/ml
LEVETIRACETAM
Sedation
Under investigation, but currently use human ranges of 2–5mg/L
PREGABALIN
1–4mg/kg q12hrs
ATAXIA (Start low)
Sulfonamide based, sedation, inappetence
10–40 µ g/ml
ZONISAMIDE
5–10mg/kg q12–24hrs
TOPIRAMATE
5–10mg/kg q12hrs
Lethargy, inappetence
REFERENCES
1. Pakozdy A, Halasz P, Klang A. Epilepsy in cats: Theory and practice. J Vet Intern Med. 2014;28:255-263. 2. Podell M, Volk HA, Berendt M, et al. 2015 ACVIM small animal consensus statement on seizure management in dogs. J Vet Intern Med. 2016;30:477-490. 3. Wahle AM, Bruhschwein A, Matiasek K et al. Clinical characterization of epilepsy of unknown cause in cats. J Vet Intern Med. 2014;28:182-188.
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ONCOLOGY DIAGNOSTICS FOR THE PRIMARY CARE VETERINARIAN:
FOR REFERRAL
HOW TO PREPARE YOUR PATIENT
Curious how you can best support your cancer patients before referral? In this Drs. Christine Mullin, DACVIM (Oncology) and Craig Clifford, DACVIM (Oncology), share practical ways primary care veterinarians can take a proactive role in oncology diagnostics. From staging and immunophenotyping lymphoma to incorporating innovative, noninvasive screening tools, learn how everyday diagnostics can streamline care, reduce costs, and enhance collaboration with your local oncologist. 4. Abdominal: Not required for all tumors, but can be informative for lymphoma patients that are clinically ill (particularly with gastrointestinal signs), dogs with abnormal serum chemistry screens (i.e., liver enzymopathy, azotemia), and dogs with notoriously metastatic tumors on the caudal half of the body (i.e., anal gland tumors, large swollen mast cell tumor on a hind limb, etc.). Ideally this test is performed by a board-certified radiologist or internal medicine specialist with ultrasound experience, or by a veterinarian or technician with thorough training in ultrasonography that can send the images for evaluation by a radiologist.
Christine Mullin, VMD, DACVIM (Oncology) Craig A. Clifford, DVM, MS, DACVIM (Oncology) BluePearl Malvern, Malvern, PA
INTRODUCTION The average cost for a routine veterinary visit in the United States can range from $70 to $174 for dogs and $53 to $124 for cats. 1 The financial burden can increase exponentially for a sick visit, particularly when a cancer is discovered or suspected. A considerable portion of the expense incurred by an owner of a veterinary cancer patient lies in the diagnostic workup, much of which is traditionally performed at referral institutions. In order to free up client financial resources and potentially increase client access to specialty oncology care, the primary care veterinarian could play a more significant role in the diagnostic workup of these patients. Below, we outline some of the diagnostic tools available in everyday practice that can help streamline oncology care for our veterinary patients, all while promoting a more active and ongoing role of the primary care vet in that patient’s cancer journey. GENERAL CANCER PATIENT WORKUP Upon diagnosis or suspicion of a cancer, a few basic tests could be performed in primary care practice to not only expedite the staging process but also provide general insight into that pet’s overall health. Whether evaluating a patient confirmed or suspected to have a systemic cancer, like lymphoma, or one that has been diagnosed with a solid tumor that will ultimately require surgery, such as a mast cell tumor, soft tissue/bone sarcoma, or an oral tumor, the following tests are typically recommended as part of the workup when indicated.
1. Basic lab work: Complete blood count (CBC), serum chemistry, urinalysis (when indicated). 2. Pulmonary metastasis screening: Three-view thoracic radiographs with review and official report provided by board certified radiologist or AI radiology service. 3. Regional lymph node sampling: For oral tumors and solid tumors on a limb, fine needle aspirate cytology should be performed and submitted to a reference lab to screen for metastasis. This result can significantly impact treatment approach and prognosis.
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DIAGNOSING AND IMMUNOPHENOTYPING CANINE LYMPHOMA
Lymphoma is one of the most common cancers diagnosed in pet dogs, with the most frequent presenting clinical sign being “lumps” in the neck (ultimately determined to be peripheral lymphadenopathy on exam). Most primary care veterinarians are proficient at performing fine needle aspiration to confirm the diagnosis via cytology, either by shipping samples to a reference lab or digital cytology, which is available through multiple platforms. We encourage our primary care vets to also take the next step, which is to collect samples for immunophenotyping, i.e., B-cell vs. T-cell testing. The immunophenotype of lymphoma has a significant impact on prognosis (i.e., B-cell is better, T-cell is tougher) and in most progressive oncology practices, it will help the oncologist tailor the chemotherapy protocol. When the immunophenotyping information is available at the time of initial oncology consultation, it allows the specialist and pet owners to have a more informed and directed conversation about treatment options and expected prognosis. There are several options for immunophenotyping available, all of which can be performed by the primary care veterinarian via fine needle aspirate. 1. Flow cytometry: This is almost always the test of choice for immunophenotyping because it can both confirm the diagnosis as well as provide prognostic information via subtyping, which allows for the differentiation of unique forms of lymphoma such as indolent T-zone lymphoma. Flow cytometry requires the cells to remain alive for analysis, so most labs either recommend placing the aspirate in a saline/serum solution in a non-additive tube or using a lab-provided tube pre-filled with cell media. Often this may necessitate having the owner bring the dog back to the clinic to perform this test, which can be done during the waiting period for referral. Typically, 2-3 aspirates will provide enough cells for analysis. A turbid solution usually indicates adequate cellularity for flow cytometry testing. Samples must be sent on cold packs (not ice) via overnight shipping to ensure cell survival. 2 2. Immunocytochemistry (ICC): ICC can be performed on cytology slides at some reference labs and does not require overnight shipping of cells in a fluid medium (as with flow cytometric analysis) or an incisional biopsy (as with IHC). The sample required for ICC submission is simply 4 adequately cellular, unstained or stained, air-dried glass slides prepared the same way as those for standard cytologic evaluation. While cell size and thus an impression of lymphoma grade/aggressiveness can be discerned through cytology with ICC, the determination is somewhat subjective and not as reliable as with flow cytometry. 3 3. PCR for antigen receptor rearrangement (PARR): PARR testing can be performed on both cytology and histopathology samples at most reference labs and universities. While choosing PARR saves the pet owner from having to bring the dog back for additional aspiration (as with flow cytometry), PARR will only provide a binary B-cell or T-cell designation and cannot differentiate the grade or subtype, so indolent forms may be missed. As such, PARR is most indicated when seeking to confirm lymphoma rather than to determine immunophenotype.
CADET® BRAF MUTATION DETECTION ASSAY FOR CANINE TRANSITIONAL CELL CARCINOMA/ UROTHELIAL CARCINOMA (TCC/UC) Transitional cell carcinoma (TCC), also known as urothelial carcinoma (UC), is the most common bladder cancer in dogs. Traditionally, diagnosis has required imaging, cytology, and often biopsy—each with limitations in sensitivity or risk of invasiveness. Recent research has identified a specific mutation in the BRAF gene that occurs in about 85% of canine TCC/UC cases. This mutation, known as BRAF V595E (analogous to the human V600E mutation), was independently discovered by two research groups using different sequencing approaches— one comparing DNA from tumors versus normal tissues, and another analyzing RNA from affected tissue. The consistent discovery across both methods confirmed its strong association with TCC/UC. Importantly, this BRAF mutation is not found in non-cancerous bladder tissues or in most other canine tumors, making it a reliable diagnostic biomarker. The CADET® BRAF test (developed by Sentinel Biomedical; available through Antech Diagnostics) 4 detects the presence of tumor cells carrying this mutation in free-catch urine samples. The assay is highly sensitive— able to identify as few as 10 cancer-bearing cells—and is not affected by blood or bacteria in the sample, unlike some older urine-based tests (e.g., VBTA). A second-generation assay has since been introduced to detect an additional 10% of cases that lack the original BRAF mutation, increasing overall detection sensitivity. The CADET® BRAF test can detect TCC weeks to months before clinical signs such as hematuria, dysuria, or stranguria become apparent. Therefore, it is a valuable non-invasive diagnostic and screening tool for at-risk breeds (e.g., Scottish terriers, Shetland sheepdogs, West Highland white terriers) or dogs showing chronic lower urinary tract signs. Clinical uses for this test include:
• Screening: Annual testing in high-risk breeds • Diagnosis: Helps confirm TCC/UC in dogs with persistent urinary signs • Monitoring: Tracks treatment response or tumor recurrence through repeat urine testing
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NU.Q® VET CANCER TEST Nucleosomes are small fragments of chromosomes that are released into the blood during cell death. It has been shown that high cellular turnover in diseases such as cancer can increase the level of nucleosomes in the bloodstream. The Nu.Q® Vet Cancer Test (developed by Volition; available through Antech Diagnostics and IDEXX) uses specific antibodies to quantify circulating nucleosomes (specifically H3.1 nucleosomes) in canine plasma to aid in cancer detection. In a multicenter study of 528 dogs with confirmed malignancies versus 134 healthy controls, the assay demonstrated 97% overall specificity, with higher sensitivity for hematopoietic malignancies such as lymphoma (~77%), hemangiosarcoma (~82%), and histiocytic sarcoma (~62%). Sensitivity across all cancer types was approximately 49.8%, and for some localized solid tumors (e.g., mast cell tumors, osteosarcoma, soft tissue sarcoma) detection rates were low. This test was designed to serve as a screening tool to be used as part of routine wellness checks. Significantly, nucleosome levels correlated with disease burden and response to therapy in hematopoietic cancers, suggesting there may also be some utility for monitoring remission and relapse. However, the test does not identify tumor location or type and should not be used as a replacement for imaging, cytology, or biopsy. Inflammation and other non-neoplastic causes can occasionally elevate nucleosome levels, though the high specificity of this test minimizes the chance of false positives in healthy dogs. Clinically, Nu.Q is best suited as an adjunctive screening and monitoring tool in older or high-risk dogs, or in conjunction with other diagnostics, rather than as a stand-alone test. 5
ABBREVIATIONS
CBC: cell blood count ICC: immunocytochemistry IHC: immunohistochemistry TCC: transitional cell carcinoma (also called urothelial cell carcinoma) UC: urothelial carcinoma (also called transitional cell carcinoma) PARR: PCR for antigen receptor rearrangement PCR: polymerase chain reaction
RESOURCES
• https://www.imprimedicine.com/flow-cytometry • Mochizuki H, Shapiro SG, Breen M. Detection of BRAF mutation in canine cancers using PCR-based assay. PLos One 2015;10(6):e0129534. • Decker B, Parker HG, Dhawan D, et al. Homologous mutation to human BRAF V600E is common in naturally occurring canine bladder cancer—evidence for a relevant model system and a novel diagnostic test. Mol Cancer Res. 2015;13(6):993–1002. • Mochizuki H, Kennedy K, Shapiro SG, et al. BRAF mutations in canine cancers and their value as diagnostic and prognostic biomarkers. Vet Pathol. 2017;54(6):846-853. • Knapp DW, Dhawan D, Ostrander EA. New insights into canine bladder cancer and opportunities for comparative oncology. Nat Rev Urol. 2020;17(1):50-62. • Wilson-Robles H, Pennell M, Rissetto K, et al. Evaluation of nucleosome concentrations in canine plasma for the detection of cancer. BMC Vet Res. 2022;18(1):323. • De Remigio H, Ivey J, Wood J, et al. Plasma nucleosome concentrations for monitoring dogs with hematopoietic malignancies. Front Vet Sci. 2023;10:1184352. • Volition Veterinary. Nu.Q® Vet Cancer Test: Detecting Cancer Early to Give Dogs and Their Owners a Brighter Tomorrow. White paper. Volition Veterinary; 2025. Accessed October 13, 2025.
REFERENCES 1. https://www.carecredit.com/vetmed/costs/ 2. https://vetmedbiosci.colostate.edu/chl/sample- collection-and-submission-instructions/ 3. https://easternvetpath.com/our- services/#immunocytochemistry 4. https://www.antechdiagnostics.com/test/cadet-braf/ 5. https://volition.com/nuq-vet-cancer-test-early- detection-dogs/
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MOVING FORWARD WITH
AN UPDATE A YEAR LATER
PROP 129 :
Curious where Colorado’s groundbreaking Proposition 129 stands a year after shaking up the veterinary landscape? In this VETgirl article, Amy Johnson, BS, LVT, RLATG, CVJ, breaks down what’s changed, what’s still in flux, and what it all means for the veterinary team. Read on to see how this bold experiment in mid-level veterinary care is unfolding — and how practices can prepare for this major shift in the veterinary workforce.
Amy Johnson, BS, LVT, RLATG, CVJ Senior CE Manager, VETgirl
INTRODUCTION & RECAP When Colorado voters approved Proposition 129 in November 2024, the veterinary profession awakened to a paradigm shift. Prop 129 authorized the creation of a new Veterinary Professional Associate (VPA) role — a mid-level provider licensed by the state, holding a master’s degree (or equivalent), and functioning under the supervision of a licensed veterinarian. 1 The rationale: Colorado and many states increasingly face veterinary workforce shortages, especially in rural and agricultural areas. Proponents argued that VPAs will expand capacity, allow task delegation, and improve access to care. 2 Critics — professional organizations including CVMA, AVMA, and AAVSB — warned about risks in scope, training ambiguity, quality of care, and regulatory oversight. 3 The proposition passed by a modest margin (~53 % to 47 %) on November 5, 2024. 4 But governance, rulemaking, implementation, and real-world adjustments lie ahead. In this updated blog, I revisit the promises, challenges, and new developments as of late 2025 through the lens of practicing veterinarians and veterinary technicians. WHAT PROP 129 ACTUALLY ENABLES: THE STATUTORY FRAMEWORK (UPDATE AS OF 2025) HB 25-1285: REGULATORY BACKBONE Following voter approval, Colorado’s legislature passed HB 25-1285, which provides the statutory authority for the Colorado State Board of Veterinary Medicine to establish rules and regulations for the VPA role. 5 This law clarifies: • Effective date / practice start: VPAs may begin practicing under supervision as of January 1, 2026. 5 • Registration & oversight: The Colorado State Board of Veterinary Medicine is empowered to issue, renew, deny, suspend, or revoke VPA registrations, and to put rules into place defining scope, supervision standards, education equivalencies, and discipline protocols. 5 • Scope / allowed tasks: VPAs may perform tasks “within their qualifications,” under supervision of a licensed veterinarian.
The statute mandates that supervision levels and delegated procedures must ensure high quality and safety, though detailed definitions will emerge through rulemaking. 5 • Accountability & “competency”: The law underscores ensuring that VPAs be competent, appropriately supervised, and clearly accountable. 6 • Transition / grandfathering: The law and board rules are anticipated to define how existing personnel (e.g. experienced vet techs with advanced training) may transition into the VPA role (if permitted). As of now, no formal university programs yet exist. 6 Thus, as of now (fall 2025), VPAs are still theoretical — they are not yet practicing, and their detailed scope and supervision regimes are under active development by Colorado’s regulatory bodies.
CSU’S MASTER’S PROGRAM & TIMELINE Even before Prop 129 passed, Colorado State University (CSU) has been planning a Master’s in Veterinary Clinical Care program aimed to train future VPAs. 7 As of late 2025, CSU is reportedly proceeding with curriculum development, stakeholder consultation, and accreditation planning (though the first cohort will likely start close to the 2026 launch date). 7 Thus, in practical terms, veterinarians and practices have roughly one year to prepare for the initial wave of VPAs.
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QUARTERLY BEAT / DECEMBER 2025
KEY QUESTIONS & CONCERNS: WHAT WE’VE LEARNED (2024–2025) SCOPE CLARITY IS CRITICAL (AND STILL UNCLEAR) One of the biggest debates with Prop 129 is how broadly VPAs will be permitted to act—especially in surgical, diagnostic, and therapeutic domains. Prop 129’s ballot language and statute use terms like “routine surgeries” and “tasks within their qualifications”, 7 but critics argue that such language leaves too much ambiguity. After a year, stakeholders (including veterinary associations and state regulators) are actively working to clarify: • Which spay/neuter or soft tissue surgeries VPAs may perform, and under what supervision (direct, indirect, or remote oversight). • Whether VPAs may prescribe or dispense controlled or non- controlled drugs, and under whose responsibility/license. • How emergency interventions (e.g. stabilization, urgent surgery) may be allocated or restricted. • How diagnostics & imaging interpretation responsibilities will be divided. Professional organizations continue to emphasize that any delegated authority must ensure that a licensed veterinarian retains ultimate responsibility and oversight.3 In their “Midlevel Practitioner Proposal Secures Enough Votes in Colorado” commentary, AVMA also flagged concern that insufficiently rigorous training (e.g., partly online) might underprepare VPAs for surgical or medical complications. 8 It’s also important to emphasize that defining a clear scope of practice for a VPA inherently requires clarifying the roles of credentialed veterinary technicians and veterinary assistants. We’re introducing a new position into a system that already faces role confusion. Without clearly outlining the responsibilities of all existing professionals, regulating this new role will be challenging. Because rulemaking is ongoing, it is essential that practices engage in the regulatory process (public comment, board hearings) if they want a voice in shaping safe, workable frameworks. WORKFORCE & ECONOMICS: EXPECTATIONS VS. REALITIES HYPOTHESIS AT PASSAGE: VPAs will improve access to care, reduce costs, and reduce veterinarian burnout by delegating lower-acuity tasks. EMERGING REFLECTIONS (2025): • Pipeline timing: Because the first VPAs likely won’t be practicing until 2026, the immediate workforce relief will not be seen in 2025. Veterinary practices cannot (yet) rely on VPAs to bridge the gap. • Transition of roles: Some veterinary technicians or experienced professionals may aim to transition toward VPA pathways. The details of equivalency / grandfathering rules remain uncertain, which causes planning challenges for existing team members. The question remains: will this role cause a more extensive veterinary technician shortage? • Economic models: It remains to be seen whether services by VPAs will indeed have lower billing rates (and how insurers or clients will
respond). Practices will need to re-evaluate how to integrate VPAs into their staffing cost models. • Geographic distribution: Strategic deployment will matter — rural or underserved areas may see the first benefit. However, unless VPAs are incentivized to locate in shortage zones, their distribution might mirror existing patterns (clusters around higher- demand or urban areas). • Liability & insurance: Insurance underwriters, malpractice risk, and oversight risk must be closely scrutinized. Veterinarians must mitigate risk by clear contracts, scope definitions, supervision protocols, and continuing oversight. PROFESSIONAL TENSIONS & COLLABORATION After passage, there has been robust debate and tension: • Some veterinary associations remain cautious or opposed, voicing concerns that VPAs might lead to diminished standards or potential for complications if scope is overreached. 9 • Supporters (e.g., ASPCA, “All Pets Deserve Vet Care”) view the measure as a win for pet owners and workforce expansion. 10 • The actual rulemaking process has become a key battleground: stakeholder engagement (veterinary councils, veterinary technician associations, boards of veterinary medicine) is underway as of 2025. Practices, veterinary technician associations, and state boards are submitting comments and proposals for supervision levels and delegated responsibilities. • Some concerns persist over educational quality: how robust will the master’s curricula be? How will clinical hours, surgical exposure, and emergency training compare to human PAs or nurse practitioner models? GUIDANCE FOR VETERINARY PRACTICES IN COLORADO (AND BEYOND) If you are a veterinarian or practice manager in Colorado (or another state watching this evolution as other states are getting ready for this position), here are strategic considerations in the coming months: ENGAGE EARLY IN RULEMAKING • Monitor the Colorado State Board of Veterinary Medicine’s website for draft rules, public comment periods, and hearings. • Submit comments, voice concerns, or support over proposed supervision levels, allowed procedures, continuing education requirements, and liability protections. • Encourage your whole team, especially the veterinary technicians, to review proposals and weigh in.
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VETGIRL BEAT EMAGAZINE | VETGIRLONTHERUN.COM
QUARTERLY BEAT / DECEMBER 2025
PREPARE ORGANIZATIONAL FRAMEWORKS IF YOU THINK YOU WILL INCORPORATE THIS ROLE INTO YOUR PRACTICE MODEL • Define how a future VPA role would integrate into your staffing model: what tasks will be delegated, under what supervision, with what oversight. • Design protocols for supervision, referral, handoff, escalation, and quality assurance (QA). • Engage with your malpractice insurance carrier: discuss how coverage will respond to VPA-performed tasks, required oversight, and any changes in liability premium. TEAM DEVELOPMENT & TRANSITION PLANNING • Identify high-performing experienced vet techs or technicians with leadership ambition — they may be candidates to transition toward VPA pathways. • Explore how continuing education, mentorship, and cross-training might bridge parts of the knowledge gap. • Communicate transparently with your team about potential role changes, expectations, and career paths. CLINICAL RISK MITIGATION • For any delegated case or procedure, ensure that escalation triggers are clearly defined (when a supervising veterinarian must intervene, or a case must be referred). • Maintain rigorous QA and case review systems, particularly in surgical or diagnostic tasks newly delegated. • Meticulously document supervision, oversight, and outcomes (this will help support confidence, safety, and regulatory compliance). PUBLIC & CLIENT COMMUNICATION • Be proactive in educating clients: explain what a VPA is, how it differs from a veterinarian or veterinary technician, who supervises, and how quality is ensured. • Emphasize how integration of VPAs might help reduce wait times, expand access, and allow veterinarians to focus on more complex care. MONITOR OUTCOMES AND METRICS Once VPAs begin practicing, track key outcomes: • Complication and adverse event rates for procedures done by VPAs vs. veterinarians. • Referral, reintervention, or revision rates. • Client satisfaction, cost per case, and revenue impact. • Team member turnover and job satisfaction — does the VPA role relieve burnout or introduce friction? Sharing data transparently (within legal/regulatory bounds) with colleagues, associations, and state boards can help calibrate safe scope over time.
WHAT TO WATCH OVER THE NEXT 12–24 MONTHS As we head toward the 2026 rollout (and beyond), here are major inflection points to track:
1. Release of draft rules for public comment — expect any unclear or overreaching language about supervision, scope, or oversight to come to light during this stage. This will be your chance to share feedback before the rules become final. 2. First class of VPA students / graduates — their training programs, clinical performance, and job placement will set the precedent for how this role is viewed. 3. Initial licensure and real-world practice — early cases will test whether the framework holds up in practice. 4. Outcome reporting & audits — the first sets of QA data will inform whether the VPA scope needs adjustment, tightening, or expansion. 5. Interstate interest / imitation — if Colorado’s model succeeds (or fails), other states will mimic, reject, or adapt similar approaches to the mid- level veterinary provider role. 6. Legal or regulatory challenges — petitions or litigation may arise if disputes over VPA scope or patient safety emerge. 7. Insurance / payer adaptation — how commercial pet insurance, indemnity plans, or government
programs reimburse for VPA-delivered medical and surgical care may shape this role’s sustainability.
FINAL THOUGHTS FOR VETGIRL READERS Colorado’s Prop 129 could become a watershed moment in veterinary workforce restructuring — but the real test lies in implementation. The promise is compelling: new career pathways, improved access, lowered stress for veterinarians, and more capacity for primary and preventive care. But success will hinge on how carefully we define scope, supervision, training, and accountability. For practicing veterinarians and veterinary technicians, this is a moment to stay informed, engage actively, and prepare strategically. The development of the VPA role is not merely a legislative experiment — it will ripple into workflows, liability, mentoring models, team dynamics, and clinical safety. If you’re based in Colorado (or really anywhere), keep watching the State Board’s rule proposals, participate in public comment, think ahead about how a VPA might integrate into your team, and commit now to rigorous QA. The coming years will reveal whether Prop 129 becomes a model for transformative, safe expansion of veterinary care — or a cautionary tale.
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VETGIRL BEAT EMAGAZINE | VETGIRLONTHERUN.COM
QUARTERLY BEAT / DECEMBER 2025
REFERENCES
1. Colorado General Assembly. “Proposition 129: Establishing Veterinary Professional Associates.” 2023–2024 Colorado Legislative Blue Book , 2024, https://leg.colorado.gov/sites/default/files/images/2023-2024_145vbb.pdf. Accessed 21 Oct. 2025. 2. Simpson, Kevin. “Proposition 129: Should Colorado Establish a Veterinary Professional Associate Position?” The Colorado Sun , 4 Oct. 2024, https:// coloradosun.com/2024/10/04/proposition-129-explained-colorado-ballot. Accessed 21 Oct. 2025. 3. American Veterinary Medical Association (AVMA). “Colorado’s Proposed VPA.” AVMA Advocacy: Workforce — What’s Best, Safe & Quality Animal Care , 2024, https://www.avma.org/advocacy/workforce-what-best-safe-quality-animal-care/colorados-proposed-vpa. Accessed 21 Oct. 2025. 4. Colorado Secretary of State. “Results: Proposition 129 (2024 General Election).” Colorado Election Results , 3 Dec. 2024, https://results.enr. clarityelections.com/CO/122598/web.345435/#/summary?category=C_10. Accessed 21 Oct. 2025. 5. Colorado General Assembly. H.B. 25-1285: Veterinary Workforce Requirements . 75th Gen. Asm., First Regular Session, 2025, Colorado General Assembly, 2025. Accessed 21 Oct. 2025. 6. Colorado Veterinary Medical Association (CVMA). “HB 25-1285 Regulation of Veterinary Professional Associates Signed by Governor.” CVMA Advocacy Update , 5 June 2025, https://colovma.org/advocacy-update-hb25-1285-signed-by-governor/. Accessed 21 Oct. 2025. 7. Colorado Public Radio. “Proposition 129: Establish Position of Veterinary Professional Associates, Explained.” Colorado Public Radio News , 1 Oct. 2024, https://www.cpr.org/2024/10/01/vg-2024-colorado-proposition-129-explainer/. Accessed 21 Oct. 2025. 8. American Veterinary Medical Association (AVMA). “Mid-Level Practitioner Proposal Secures Enough Votes in Colorado.” AVMA News , 2024, https:// www.avma.org/news/midlevel-practitioner-proposal-secures-enough-votes-colorado. Accessed 21 Oct. 2025. 9. Colorado Veterinary Medical Association (CVMA). “Proposition 129.” CVMA Advocacy , 2024, https://colovma.org/advocacy/proposition-129/. Accessed 21 Oct. 2025. 10. ASPCA. “Victory for People, Pets, and Vets: Colorado Passes Prop 129.” ASPCA News , 2024. https://www.aspca.org/news/victory-people-pets-and- vets-colorado-passes-prop-129. Accessed 21 Oct. 2025.
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VETGIRL BEAT EMAGAZINE | VETGIRLONTHERUN.COM
QUARTERLY BEAT / DECEMBER 2025
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FAILURE TO LEAD: WHAT HAPPENS WHEN LEADERS DON'T GET ALONG?
Wendy Hauser, DVM Peak Veterinary Consulting
What happens when leaders don’t see eye to eye? In this VETgirl Webinar, “Failure to Lead: What Happens When Leaders Don’t Get Along?” Dr. Wendy Hauser, DVM, examines how mistrust, poor communication, and role confusion can fracture teams, and offers practical strategies to rebuild trust, strengthen communication, and align leadership in veterinary practice. In case you missed the webinar, watch it again HERE or read the cliff notes below!
You are on a trip 8,000 miles away from home, in a van with 12 people you don’t know and two guides. The guides, or leaders, are responsible for the well-being of this newly formed ‘team’, with the team members depending on them for transportation, lodging, food, safety and guidance during the physical and risky outdoor activities. This was the situation my family found itself in while experiencing New Zealand. These leaders were at odds from day one. Their inability to communicate, share responsibility and create a psychologically safe environment was absent. The conflict between them was intensely uncomfortable to witness and deeply disturbing. I hadn’t been in a situation like this in decades, unlike many unlucky veterinary teams. Observing the leaders’ interactions, it was clear that there were several factors that contributed to their inability to work together and lead effectively. Let’s investigate how these dynamics show up in veterinary practices:
PERSONALITY PREFERENCE DIFFERENCES We have inborn psychological preferences that govern how we
communicate and interact with others. These preferences are neither good nor bad; they are traits that individualize us. Understanding and recognizing your own preferences, and those of others, is a critical leadership skill. Mismatches occur when leaders fail to adapt their personality preferences to align with others. A LACK OF TRUST It is almost impossible to form and build a successful collaboration without trust. If leaders doubt each other’s competence, integrity or intentions, the ability to co-lead deteriorates. This is worsened when there are unresolved past conflicts or perceived betrayals. When a leader’s actions cause stress and anxiety in the workplace, are inauthentic or when leaders fail to show that they care about each other and their followers, trust is broken. INEFFECTIVE COMMUNICATION When leaders don’t trust each other, communication suffers. A lack of psychological safety prevents leaders from discussing decisions transparently and authentically. They fail to share information with each other out of fear of losing influence. Due to a lack of collaboration and effective communication, mixed messages are sent to the team which leads to confusion, uncertainty, and frustration.
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VETGIRL BEAT EMAGAZINE | VETGIRLONTHERUN.COM
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