and login or create a free CE account and claim your credit after listening to this episode.

In this podcast, Dr. Michelle Evason will discuss topics related to spectrum of care and feline care, and practical tips for communicating with pet owners about these topics.

Understand spectrum of care and how to communicate to pet owners

Learn about new research on feline Giardia and its emerging zoonotic aspects, and how to apply this to clinical management

Discuss current management of common feline infectious disease cases, e.g. ringworm, endoparasites, etc. and their implications for preventive care across the spectrum

Michelle Evason, BSc, DVM, DACVIM (SAIM), MRCVS, serves as Global Director, Veterinary Clinical Education for Antech (MARS). She has worked in general practice, academia, specialty clinical practice, and in the animal health industry. Michelle has published on numerous infectious diseases, antimicrobial stewardship, nutrition, spectrum of care, veterinary- and pet-owner education related topics. She enjoys ferrying her two-legged (and four-legged) children to various activities and fulfilling most ‘Canuck’ stereotypes.

Podcasts

Michelle Evason, Bsc, DVM, DACVIM (SAIM), MRCVS, sits down with Adam Christman, DVM, MBA, to talk about what spectrum of care means especially in the world of feline care. 


Podcast CE: Spectrum of care and feline care

Extracorporeal therapy (ECT) is a method of blood purification performed to remove a pathogenic substance, or 

, from the body. In this procedure, blood is removed from the patient and circulated through an extracorporeal circuit, which purifies the blood before it is returned to the patient.

Hemoperfusion (HP) is a type of extracorporeal blood purification therapy aimed at removing exogenous or endogenous toxins from the bloodstream. Other common types of ECT include renal replacement therapy (hemodialysis [HD], hemofiltration) and therapeutic plasma exchange.

 Advanced procedures are especially beneficial when traditional decontamination techniques fall short.

Toxicities: Traditional medical management

Acute toxin exposure is a common and potentially life-threatening emergency in dogs and cats. Traditional decontamination techniques include induction of emesis, gastric lavage, activated charcoal, cathartic or intravenous (IV) lipid emulsion (ILE) administration, IV fluid therapy, and antidote administration, if applicable.

 Few toxins have a specific antidote available, so therapy is predominantly aimed at decreasing gastrointestinal absorption of the toxin. If the protein is heavily lipophilic, then ILE administration may be considered to reduce clinical signs associated with intoxication and enhance the clearance of the toxin. IV fluid therapy is often employed for patients presenting with acute toxin ingestion, often at high rates, to encourage diuresis and more rapid clearance of the toxin. However, there is limited evidence to support the theory that IV fluid diuresis enhances toxin clearance, and for highly protein-bound toxins such as nonsteroidal anti-inflammatory drugs (NSAIDs), it has minimal positive effects.

Organ damage and life-threatening clinical signs may still develop despite traditional decontamination techniques because of the high ingested dose, rapid absorption of many toxins, and the inherent delay that precedes presentation for veterinary care.

 Extracorporeal toxin removal (ECTR) provides a vital bridge whereby the toxin can be removed from the blood after it has undergone partial or complete absorption through the gastrointestinal tract, but often before it has had time to cause significant organ damage.This can reduce the morbidity and mortality related to acute toxin exposure and shorten the time required in the hospital for acute decontamination and monitoring.

During HP, a machine continuously withdraws blood from a dual-lumen dialysis catheter and circulates it through an extracorporeal circuit containing a specialized filter known as an HP column. HP columns contain a large surface area of adsorbent media that can remove various pathogenic solutes. The HP column removes the pathogenic solute from the blood, and the purified blood is returned to the patient. HP columns must remove the pathogenic solute without extracting or affecting standard blood components.

HP can be performed alone or in series with HD (

). In-series HP/HD is performed in small animal patients using a machine designed for renal replacement therapy in humans. The circuit requires a dialyzer to be placed in series with the HP column. Stand-alone HP is mainly performed using a veterinary-specific machine that does not require a dialyzer in the circuit, such as AimaLojic ReVive.

. Schematic of an in-series HP/HD circuit (Images courtesy of ImmutriX Therapeutics, Inc

The most common HP columns in veterinary medicine include activated carbon (AimaLojic) and synthetic polymer (CytoSorbents) devices. Activated carbon HP devices contain synthetically derived activated carbon beads that are smooth and uniform (

). The carbon beads are activated by superheating them with carbon dioxide, creating many microscopic transport channels within the activated carbon beads, resulting in a massive surface area that is available to bind solute. In contrast, activated charcoal is a naturally derived product that is irregularly shaped with rough edges. Activated charcoal HP columns were previously used for ECTR; however, they have fallen out of favor because of concerns related to hemocompatibility, leaching, and column saturation.

 Photomicrograph of synthetically derived activated carbon beads


 SEM illustrating smooth surface area and uniformity of activated carbon beads


. Activated carbon bead with surface stripped off, revealing 3000-nm pore size inner structure

Newer activated carbon HP columns have an improved safety profile and increased surface area, offering a far superior option to earlier activated charcoal HP columns. Activated carbon removes solute from the blood via adsorption. During adsorption, atoms, ions, or molecules adhere to the surface of an adsorbent through van der Waals forces, hydrogen bonding, ionic bonding, and covalent bonding. Toxins with a high affinity to bind to activated charcoal will bind to activated carbon.

 The following list includes toxins that can be removed with activated carbon HP

It is important to note that this list is not exhaustive, and novel toxins have the potential to be successfully removed with activated carbon HP (

). Knowledge of the toxin characteristics (molecular weight, protein binding, volume of distribution, half-life) is vital in guiding the decision to pursue ECTR.

 When presented with severe intoxication, the veterinary clinician should research the toxin characteristics to determine whether referral for ECTR should be recommended.

NSAIDs (eg, ibuprofen, carprofen, naproxen, meloxicam) are among the most common toxins accidentally ingested by dogs, according to American Society for the Prevention of Cruelty to Animals Poison Control. NSAIDs can cause gastrointestinal disturbances such as vomiting, diarrhea, and gastrointestinal ulceration; renal disease like acute kidney injury; and central nervous system toxicosis. There are veterinary data

 to support that activated carbon HP successfully removes NSAIDs from the bloodstream, greatly enhancing their clearance from the body and reducing the severity of toxicosis. A patient who has recently ingested a renal toxic dose of an NSAID should be offered a referral for ECTR if referral is feasible given the geographic location of the patient, patient characteristics, and pet owner wishes. Asymptomatic patients that undergo ECTR for massive NSAID ingestion are often able to be discharged after 24 to 36 hours, which may be financially comparable if not advantageous to intensive care hospitalization for 72 hours for traditional medical management or prolonged hospitalization due to treatment of acute kidney injury.

. Patient undergoes activated carbon hemoperfusion after massive meloxicam ingestion. The patient has a dual-lumen dialysis catheter in the right external jugular vein connected to the AimaLojic ReVive hemoperfusion machine.

When should hemoperfusion be considered for my patient?

If ECTR is promptly initiated, it may prevent, if not minimize, the extent of organ damage experienced secondary to the intoxication. Generally, only a single HP treatment is required for acute toxin removal. Initiating HP early following acute toxin exposure can decrease patient morbidity and mortality and shorten hospitalization time.

 If your patient meets specific indications, a referral for ECTR should be offered. Indications for ECTR are as follows

The toxin is likely to result in significant organ dysfunction/injury (eg, acute kidney injury, acute liver failure, respiratory failure) or death.

Extracorporeal clearance will exceed endogenous clearance.

A lifesaving antidote is unavailable or ineffective in preventing toxicosis (eg, ethylene glycol).

It is recommended that you call to consult with your nearest ECTR center before referral to ensure that your patient is a suitable candidate for ECTR and determine the modality of ECT that should be performed. If you are unsure whether a referral is indicated, contact your nearest ECTR center for consultation.

Understanding the risks and contraindications

ECT has been available for small animal patients since the 1970s, and there has been extensive advancement. Although there is minimal risk in a safely prescribed HP treatment, benefits and risks for the individual patient should be considered. Risks associated with HP include the following

Periprocedural: hypotension (due to extracorporeal circuit volume, which generally should not exceed 10% to 15% of patient blood volume), hypothermia, hemorrhage (excessive heparin effect), thrombosis (inadequate anticoagulation), allergic reactions (rare, secondary to dialyzer/filter), hypocalcemia (if using citrate anticoagulation), or transfusion reactions (if blood products are required for circuit priming).

Postprocedural: catheter thrombosis, infection, or hemorrhage (minimal as the catheter is only used for 1 treatment).

In patients with massive and life-threatening intoxications, generally, the most significant risk is the development of organ dysfunction, injury, or death if ECTR is not performed; thus, the benefits far outweigh the risks in most cases. Depending on how quickly the patient is referred for ECTR, there is a variable risk of toxicosis despite ECTR. The sooner the patient is referred for ECTR, the better.

Before proceeding with HP, traditional decontamination techniques (eg, induction of emesis, activated charcoal administration) and baseline diagnostics (eg, baseline renal values for NSAID ingestion cases) should be performed as appropriate for your patient. If referring a patient for ECTR, do not use the jugular veins for venipuncture, as these vessels are required for dialysis catheter placement.

Contact an ECTR center early if HP is a potential treatment for your patient. In the setting of intoxications, early referral is vital for a successful outcome, as there is a time-sensitive window in which HP can help with acute toxin removal. Once you have collected a toxin history (toxin ingested, maximum potential ingested dose, time of ingestion, potential for coingestion, patient comorbidities, etc), assessed your patient, and instituted traditional decontamination techniques where appropriate (eg, activated charcoal administration), it is recommended to promptly contact your nearest extracorporeal center to discuss referral for ECTR.

HP offers an innovative blood purification treatment that helps remove toxins from the bloodstream in animals, particularly following acute toxic exposures. This method reduces the risk of organ damage and the length of hospital stays for affected animals. ACCESS Specialty Animal Hospitals - Los Angeles, in Culver City, California, provides this innovative treatment, which has already successfully supported the recovery of several animals experiencing severe toxic ingestions.

Amanda Spillane, MS, BVSc (Hons), DACVECC, 

f Queensland, Australia, with a degree in veterinary medicine. After a small animal rotating internship in Queensland, she completed an emergency and critical care residency at the University of Illinois. In 2022, she achieved diplomate status with the American College of Veterinary Emergency and Critical Care. Spillane then completed a fellowship at The Ohio State University in extracorporeal therapies, where she developed a deep passion for nephrology. Currently, she is advancing her specialization as one of the inaugural residents of the American College of Veterinary Nephrology and Urology. In October 2023, Spillane joined ACCESS - Los Angeles, a Thrive Pet Healthcare partner, to lead the nephrology and extracorporeal therapies department.

Foster JD. Extracorporeal therapies in the emergency room and intensive care unit. 

. 2020;50(6):1215-1236. doi:10.1016/j.cvsm.2020.07.014

Groover J, Londoño LA, Tapia-Ruano K, Iacovetta C. Extracorporeal blood purification in acutely intoxicated veterinary patients: a multicenter retrospective study (2011-2018): 54 cases. 

. 2022;32(1):34-41. doi:10.1111/vec.13100

Barnes J, Cowgill LD, Diaz Auñon J. Activated carbon hemoperfusion and plasma adsorption. 

. 2021;2:131-142. doi:10.1016/j.yasa.2021.07.010

Her J, Gordon D, Spillane A, Finstad J, Langston C. Outcomes of nonsteroidal anti-inflammatory drug toxicosis treatment with carbon hemoperfusion in dogs. Presented at: International Veterinary Emergency and Critical Care Symposium; September 7-11, 2024; St Louis, MO.

Spillane A, Langston C. Extracorporeal Blood Purification. In: Cohn L, Côté E, eds. 

Cote’s Clinical Veterinary Advisor: Dogs and Cats. 

Articles

Using this advanced decontamination procedure can help improve outcomes 

Hemoperfusion for acute toxin ingestion

Photos courtesy of BluePearl Pet Hospital

The demand for donated blood continues to grow, and veterinary professionals are working to meet the needs of patients.

 National Blood Donor Month, which is annually recognized in January, is an opportunity for veterinary professionals to elevate awareness and educate clients about blood banks, the donation process, and how patients and pets can help.

BluePearl Pet Hospital, a division of Mars Veterinary Health, estimates that the amount of donations needed will increase in 2025 to meet the growing demand for specialty and emergency care. It aims to have 50% of its needed blood products sourced from its network of hospitals by the end of 2026.

Despite the need, pet blood donation is not well understood by the general public, nor are many owners aware that it’s an option. According to a study conducted in the UK, 70% of the 158 pet owners surveyed were not aware their animals could donate blood, but 89% of respondents indicated they would be willing to volunteer if their pet was an eligible donor.

"We rely on pet blood donations to be able to provide lifesaving and lifegiving care in our hospitals when pets need us most," Richard Stone, DVM, DACVIM (SAIM), chief medical officer at BluePearl, said in a news release.

 "I encourage all pet owners to learn more about our blood banking program and sign up to help other pets in need."

According to BluePearl Pet Hospital, a single pet blood donation has the potential to save the lives of up to 3 other animals. The company operates a voluntary, community-based blood banking program in 15 locations throughout the US. It recently issued a call to action for US pet owners to help alleviate the shortage of veterinary blood by signing up their canines and felines up to become blood donors.

Pet blood donation is most common with dogs and cats. These donations are used for transfusion to patients, as needed, in cases that can include surgery, traumatic injury, anemia, and exposure to certain toxins.

 Rabbits, ferrets and other exotic species are less common but can also benefit from blood donation and transfusion, according to experts Meghan Respess, DVM, DACVECC, director of blood banking at BluePearl Pet Hospital; and Karen Roach, RVT, VTS (ECC), a team trainer at Mount Laurel Animal Hospital (MLAH) in New Jersey.

At MLAH—a large, independent practice—the internal blood bank relies on donations from volunteer canine patients and staff-owned felines. “We usually have a fair amount of dog blood on hand. Cat blood is a little bit harder to get, and we do order it from blood banks, which can take a while to get. We do sometimes have to buy it from another hospital,” Roach said in a 

The MLAH team regularly banks whole blood, packed red blood cells, and fresh frozen plasma. “We have the facilities here to also spin down the blood and separate it. The packed cells can be refrigerated for a little over a month, and then the plasma is frozen, and that's good for up to 5 years,” Roach said.

Eligibility for blood donation can vary by blood bank. BluePearl requires blood donors to be aged between 1 and 8 years, while patients at MLAH are eligible between 2 and 8 years. A patient’s overall health, weight, blood type, vaccination history, and temperament are other factors for which eligibility is determined.

 Roach and Respess both emphasized that the donors must have a willing temperament and the ability to remain calm throughout the process of collecting blood. 

When a patient donates blood with BluePearl, the inventory is tracked with a bar coded system, according to Respess. Not only does the system help staff keep track of expiration dates as well as a patient’s medical record, but it also allows for continued engagement with pet owners. “No matter if it's used in Tampa, for example, where they gave the donation, or in Seattle, when that is scanned and dispensed to a patient, an owner gets a notification to say that the contribution of [their] pet went to save a critical patient,” Respess said in a 

Hospitals can also offer rewards to further incentivize pet owners to consider blood donation. For example, BluePearl offers a free physical exam before each donation as well as annual lab work,

 and MLAH provides first-time donors with a bandana and an Amazon gift card.

Veterinary professionals interested in learning more about blood donation and banking can attend a demonstration hosted by BluePearl at the North American Veterinary Community’s Veterinary Meeting and Expo (VMX) hosted by the North American Veterinary Community in Orlando, Florida, January 25-29, 2025. Open to VMX attendees, the event aims to highlight the ease of the process and will feature a live canine donor giving blood.

“It's only through outlets like this and demonstrations like that, that we continue to bring the awareness [to blood donation],” Respess added.

This National Blood Donor Month your pet could be a hero. News release. BluePearl Management LLC. January 7, 2024. Accessed January 21, 2024. 

https://www.prnewswire.com/news-releases/this-national-blood-donor-month-your-pet-could-be-a-hero-302343193.html?tc=eml_cleartime

Wilder A, Humm K. Pet owners’ awareness of animal blood banks and their motivations towards animal blood donation. 

. 2019;185(16):509. doi:10.1136/vr.105139.

Mount Laurel Animal Blood Bank. Mount Laurel Animal Hospital. Accessed January 23, 2025. 

Roach K, Crossley KC. Collecting patient blood donations. 

. January 17, 2025. Accessed January 23, 2025. 

https://www.dvm360.com/view/collecting-patient-blood-donations

National Blood Donor Month is recognized annually in January

Pet blood donation is needed to save patient lives

Animal food ingredient submissions for the “Official Publication”—a yearly publication of the most widely recognized and comprehensive list of approved feed ingredients globally by the Association of American Feed Control Officials (AAFCO)—will be evaluated by the Kansas State University (KSU) Olathe Innovation Campus (K-State Olathe) as part of an approved proposal from K-State Olathe. In a recent news release, AAFCO announced that its membership voted ‘yes’ to a K-State Olathe proposal to provide a scientific review for a new animal food ingredient submission pathway.

The new process replaces AAFCO’s previous “Ingredient Definition Request” procedure, which identified the safety, utility, and identity of ingredients used in animal food with scientific and technical help from the FDA. According to AAFCO, the former process ended with the expiration of a Memorandum of Understanding (MOU) between AAFCO and the FDA last year.

Speaking of the new pathway, Austin Therrell, executive director of AAFCO said in a news release, "We understand the animal feed industry has much to consider when introducing a new proposed ingredient. We're committed to a collaborative process that is safe, scientific and streamlined to meet the industry's demand for new ingredients while upholding AAFCO's unwavering standards for animal and human health."

“AAFCO's partnership with K-State Olathe begins a new era of innovation and proficiency for the animal feed industry," he continued.

 "This new pathway will offer a regulatory review process that is straightforward and comprehensive to bring ingredients to market safely and more efficiently than our previous process with FDA.”

The new ingredient approval pathway will be directed by Haley Larson, PhD, assistant professor at KSU, and will include a scientific review panel of experts from US universities and independent consultants, providing a broad representation of all animal species, according to AAFCO.

 The panel will assess ingredient submissions from the industry and make recommendations to AAFCO members for final approval. Once approved, ingredients will be added to AAFCO's “Official Publication.” According to AAFCO, the document is recognized by state and international regulators as well as the animal food industry.

AAFCO plays a key role in developing uniform standards and regulations that are adopted by most US states to ensure the safety and quality of animal food products. The organization also develops model laws and regulations that serve as the foundation for animal feed programs across the country.

Members of AAFCO include government officials from US states, federal agencies, and other countries. These officials are responsible for executing laws and regulations related to the production, labeling, distribution, use, and sale of animal food and its ingredients, including pet food and livestock feed, according to the FDA.

We're honored to partner with AAFCO and apply our scientific and technical expertise to ensuring the safety and quality of animal food ingredients," Ben Wolfe, dean and CEO of K-State Olathe, said in a release.

 "We look forward to working closely with AAFCO to implement this transformative approach and foster a regulatory environment that benefits producers, consumers and the broader community."

K-State Olathe specializes in professional education, research, and outreach in food safety, animal health, and bioscience. According to the university, K-State Olathe’s campus functions as a center for applied research, professional education, and industry collaboration.

According to AAFCO, the new pathway will support the FDA’s Generally Recognized as Safe (GRAS) Notice program, which lets people and companies notify the agency if a substance is safe to use as intended. The pathway is also intended to “provide the feed industry with another option to bring new and innovative products to the market,” per AAFCO.

 Additionally, procedures have been outlined to prevent ingredients from being submitted through multiple avenues.

AAFCO membership votes yes on new regulatory pathway for animal food ingredients. News release. Association of American Feed Control Officials. January 22, 2025. Accessed January 22, 2025.

FDA Enforcement Policy for AAFCO-Defined Animal Feed Ingredients. US Food and Drug Administration. Accessed January 22, 2025. 

https://www.fda.gov/media/180441/download#:~:text=in%20its%20Official%20Publication%20(OP),-AAFCO%20is%20an&text=AAFCO%20provides%20a%20mechanism%20for,and%20sale%20of%20animal%20food

K-State Olathe. Kansas State University. Accessed January 23, 2025. 

https://www.k-state.edu/engagement/economic-impact/olathe.html

AAFCO is partnering with Kansas State University for the new regulatory review process

New animal food ingredient review process is approved by AAFCO

Dr. Shadi Ireifej talks with Vanessa Vidal about PRN Pharmacal's contributions to veterinary medicine, focusing on their innovative products like Proin® ER for urinary incontinence, VPL® sutures for improved surgical outcomes, and Reconcile® for managing canine separation anxiety. Vidal details the company's approach to addressing common challenges in veterinary practice with effective, accessible, and specialized solutions.

A Closer Look at VPL Sutures for Modern Surgical Care

 Hello, everybody. I’m Dr. Shadi Ireifej, a board-certified veterinary surgeon based in Las Vegas, NV. Today, I’m joined by Vanessa Vidal from PRN Pharmacal. We’ll be discussing how PRN has positively impacted the field of veterinary surgery. Vanessa, could you start by telling us more about PRN Pharmacal and your role with the company?

Absolutely. PRN Pharmacal has been serving the veterinary industry since 1978. Our flagship product is Proin®, a medication for urinary incontinence. Many veterinarians know Proin®, but we also offer a wide variety of products beyond that. For example, we’ve introduced an extended-release version of Proin®, which is relatively new. Additionally, we provide surgical sutures, which are exceptional, and the Reconcile® line for behavioral health. PRN stands for Pro Re Nata, which means “as needed” in Latin, and we pride ourselves on being available to meet the needs of veterinarians whenever necessary.

That’s fantastic. Proin® is widely recognized and utilized by many of us. I’m curious to learn more about how PRN contributes to the surgical field specifically.

 Of course. Our catalog includes a range of high-quality sutures for various surgical applications—long-term, mid-term, and short-term use. We offer both absorbable and non-absorbable sutures. Our goal is to provide top-tier products that are also cost-effective. One of the features we’re particularly proud of is the performance of our VPL® sutures. They’re designed to minimize drag, which reduces inflammation and supports faster healing. Additionally, our needles are durable with just the right amount of flex, ensuring they won’t bend or break during procedures.

As surgeons, we’re all too familiar with the challenges of suture drag and needle flexibility. It’s great to hear that PRN has addressed these issues. Now, let’s talk about Proin®. What updates can you share about this medication?

We’re thrilled to introduce Proin® ER, an extended-release, chewable flavored tablet. This innovation allows for once-daily dosing instead of the traditional twice-daily regimen. Beyond the convenience, the extended-release formula provides steady medication levels in the bloodstream over a 24-hour period, which can improve efficacy and compliance. To top it off, Proin® ER is more affordable than the original formula.

That’s a game-changer for pet owners and veterinarians alike! What other products are you excited to showcase?

Another standout product is Duralactin®, a supplement derived from dried milk protein (Microlactin®) that helps manage chronic inflammation. It begins working within four days and reaches full efficacy in about 30 days. Veterinarians use the canine version for joint health and the feline version for conditions like stomatitis, which has limited treatment options. We’re also excited about Reconcile®, the only FDA-approved medication for canine separation anxiety. Behaviorists often recommend it for dogs not responding well to generic fluoxetine, as Reconcile®’s formulation works differently in the body.

With the holidays approaching, many pet owners face challenges like travel, fireworks, and large gatherings. Reconcile® sounds like a helpful solution.

Definitely. Reconcile® can calm pets and make them more receptive to behavior modification training. It’s an excellent option for managing long-term stress and anxiety.

Thank you for sharing these insights. Where can veterinarians and pet owners learn more about PRN Pharmacal and its products?

You can visit our website at www.PRNPharmacal.com for detailed information about all our products.


Videos

On this week's episode of The Vet Blast Podcast presented by dvm360, our host Adam Christman, DVM, MBA, and guests Megan Bauer, DVM, Fear Free Certified Elite, and Jessica Osborne, CVPM, Fear Free Certified Elite, discuss how the Fear Free concepts can be implemented into practices to make them a more calming and welcoming place for pets. 

Throughout the episode, the trio will address the importance of caring for both mental and physical wellbeing of patients, how practices can implement small changes to get big results, plus the positive impact of Fear Free practices on a clinic's relationship with its clients and patients. 

To those that may not know about it, what can you explain a little bit about what...fear free actually means? What's that mean?

Basically, looking after the mental well-being of your patients, and that was probably the hardest, well was the hardest discussion with clients. We can't trim your dog's nails today, but you did it last month. Yes, but you may not want to know what that looked like last month. And now this month, we're starting on our journey of Fear Free, and we're not going to hold them down. We're not going to use 3 assistants to do it. We need to give him some pre-visit medications and have him come back.

Yeah, like Jessica said, it's not thinking of physical and mental health as 2 separate things. Its all 1 being, you know, the more you learn about stress, the more you learn how it affects every system of the body and what we do for "just a second." "Oh, we're just going to hold him down 4 minutes and trim his nails" will last a minimum of 3 days in the body, potentially much, much longer, if you get into actual trauma. But it is not 2 separate things. Like, "well, that's just his mental health"... Nope, that's really important as well, just, it's just one animal, it's all together. 

Yeah, I love that you share. Yeah, "really quick, really quick" is what I hear too, like "it'll be really quick," you know, just to trim the nails or just to pop the vaccine or whatever. 

Learn more about Fear Free and the impact it has on veterinary clinics in this week's episode of The Vet Blast Podcast presented by dvm360