Craig A Clifford, DVM, MS, DACVIM (Oncology), talks about mast cell tumors, sharing a bit about cytological grading, treatment options, common misconceptions, and more 

New insights on mast cell tumors

When Elizabeth Reed, BSVT, LVT, CCRA, was confronted with a life-or-death situation, she drew on her 16 years of experience as a vet tech and performed life-saving CPR on a man suffering a massive heart attack. Her quick action and veterinary training not only saved his life but highlighted the incredible, transferable skills vet techs bring to life outside the clinic.


So, I'm Elizabeth Reid. I'm a certified veterinary technician, and I’ve been a vet tech for over 16 years. I graduated from Cedar Valley Community College with my LVT degree and became certified and licensed in Texas, Colorado, and Oklahoma. I also completed my degree in veterinary technology at Petersburg College. Since 2012, I’ve been working on the industry side—first with Royal Canin for nine years, and now I’m a senior director at 2x, focusing on inventory and controlled substance management.

One Sunday afternoon, after church, my husband, 2 daughters (ages almost 4 and 6), and I stopped by Whole Foods for groceries. On our way home, we were driving on a 2-lane road when I noticed a Lexus SUV pulled off to the side. It seemed strange because the flashers weren’t on. As I looked closer, I saw a woman sitting on the center console. It looked off. I told my husband, “Go check it out. Give me a thumbs-up if I need to call 911.”

He went to the passenger window, talked to the woman for a bit, and then gave me the thumbs-up. I called 911, provided our location and details, and then I saw my husband walk around to the driver’s side and open the door. He waved me over.

When I got there, I saw a man slumped in the driver’s seat—eyes wide open, mouth agape, completely unresponsive. My husband said the 911 operator was telling them to perform CPR. Without hesitation, I pulled the man out of the car and laid him flat. My husband started unbuttoning his shirt, but I ripped it open to locate his sternum and immediately began compressions.

The first few compressions were intense—I felt his ribs break under my hands. His eyes were fixed and dilated, and his mouth stayed open. I kept going and told my husband, “He needs breaths.” After confirming with the wife that the man didn’t have any infectious diseases, my husband gave him a few breaths. The man’s body reacted, but it looked like agonal breathing, something I’ve seen during euthanasias in animals. I was worried it was too late.

A nurse who had stopped offered to help and encouraged me to keep going. It felt like an eternity. At one point, my husband shouted, “Where’s the ambulance?” Finally, EMTs arrived. They had my husband help with the equipment, and they shocked the man twice right there in the street. I spun his wife around so she wouldn’t see it.

The EMTs continued CPR for 45 minutes and shocked him 14 times. The man had suffered a massive heart attack with a full blockage. They placed an Impella catheter to address the blockage.

Over the next several days, I kept in touch with his wife, checking in as he progressed: off the ventilator, walking, starting cardiac rehab, and finally discharged from the hospital. Thirteen days later, we visited him at his home. He was fully recovered—walking, no oxygen deprivation, just 3 broken ribs.

I can only attribute his survival to a higher power. From my perspective as a vet tech, he was gone, but he came back. It was incredible to use the skills I’ve developed in veterinary medicine to save a human life.

I’ve done CPR on many animals in my career, but this was my first on a human. It made me realize the transferable skills we have as veterinary technicians. We often go through our days unnoticed, tirelessly working, but our training can save lives when it matters most.

This experience reminded me to slow down, notice others, and act when something feels off. Taking a moment can make all the difference—for families, for individuals, and for the world.

Videos

Elizabeth Reed, BSVT, LVT, CCRA, recounts the story of how her veterinary CPR skills helped save a stranger’s life during a roadside emergency.

How vet tech skills helped save a human life

 editorial team is counting down our Top 20 news stories and articles of the year, from January 1, 2024, to November 15, 2024. Rank was determined by measurable audience interest and engagement.

A spotlight is shining on 1 article each day through New Year’s Eve, when the No. 1 dvm360 story of the year will be shared. The following article is No. 10 on this list:

First RNA-particle vaccination for canine influenza receives USDA approval

Merck Animal Health announced that its latest product

 NOBIVAC NXT Canine Flu H3N2, has received approval from the US Department of Agriculture (USDA). According to an organizational release,

 NOBIVAC NXT Canine Flu H3N2 is a vaccination that leverages RNA-particle technology to allow a precise immune response to protect against a range of bacterial and viral pathogens.

"On behalf of Merck Animal Health and our NOBIVAC brand, we are beyond proud to introduce our latest vaccine using ‘NXT-level’ technology. This is a groundbreaking advancement in our vaccine pipeline designed to meet the evolving needs of veterinarians and pet owners alike,” said Christine Royal, DVM, vice president, companion animal and equine business unit, Merck Animal Health.

 “With over 70 years of innovation and commitment to animal health, our new NOBIVAC NXT technology will continue to lead the way in providing breakthrough solutions for the prevention of disease in animals.”

NOBIVAC NXT Canine Flu H3N2 is currently the first and only canine influenza vaccination to be built on the company’s RNA-particle platform to protect pets against the most prevalent canine influenza spreading across the United States. The vaccination is a nonadjuvanted, low-volume 0.5 mL dose that utilizes the immune system’s natural ability to generate a response without compromising the safety or comfort of the pet.

 The vaccination is indicated for healthy dogs 8 weeks or older against canine influenza H3N2.

According to the American Veterinary Medicinal Association, canine influenza is a highly contagious respiratory disease caused by 2 type A influenza virus. Canine patients of any age, breed, sex, or health status are at risk and infections can occur anytime during the year.

For more on this story, view the full article here: 

https://www.dvm360.com/view/first-rna-particle-vaccination-for-canine-influenza-receives-usda-approval

Articles

dvm360 is counting down the Top 20 news stories and articles from 2024 with this series of spotlights

2024 veterinary news in review: #10

A spotlight is shining on 1 article each day through New Year’s Eve, when the No. 1 dvm360 story of the year will be shared. The following article is No. 11 on this list:

Retrievers have a mutation that make them hungrier, study discovers

Retrievers are known for eating anything and everything and are always excited to eat. This trait even gets them in trouble of ingesting harmful objects that cannot be digested and need veterinary intervention. However, a new study published in the 

 journal found that a genetic mutation may actually be the cause of this excessive hunger.

 Overall, the study found that 1 in 4 Labrador retrievers and 2 in 3 flat-coated retrievers (FCRs) have the genetic mutation. This excessive hunger could also contribute to the breeds’ rising obesity levels.

In Labrador retrievers, researchers identified a 14 bp deletion in pro-opiomelanocortin (POMC). The POMC mutation disrupts the production of β-MSH and β-Endorphin neuropeptides that are usually involved in switching off the feeling of hunger after eating a substantial meal.

 So, dogs with the POMC mutation feel hungry even after eating enough. This research is not suggesting that these dogs are not eating enough, it’s more so that these dogs just feel hungry when they no longer should.

A similar study conducted in 2016 evaluated this same phenomenon, further confirming this genetic mutation’s prevalence.

 Labrador retrievers tend to be more motivated by food and have a higher prevalence of obesity than other dog breeds. Eleanor Raffan, PhD, veterinary surgeon and geneticist at the University of Cambridge was an author on both studies. She said, “Whenever there’s something more common in one breed than another, we think genetics are involved.”

The most recent study did further experiments and found that dogs with this mutation feel hungrier between meals and burn less energy than those without.

 From there, researchers aimed to dive deeper into how this mutation can impact a dog’s overall health and quality of life.

https://www.dvm360.com/view/retrievers-have-a-mutation-that-makes-them-hungrier-study-discovers

2024 veterinary news in review: #11

Novel targeted therapies can provide rapid relief for canine allergic and atopic dermatitis. In this podcast, Andrew Rosenberg, DVM, DAVD, and Adam Christman, DVM, MBA, react to the availability of a once-daily oral JAK inhibitor, highlighting it as an advancement in managing difficult skin conditions in dogs.




 - Understand the various causes of canine allergic and atopic dermatitis.
 - Gain insight into using available treatment options to manage canine allergic and atopic dermatitis.
 - Learn how Zenrelia™ (ilunocitinib tablets) can be used to offer dogs relief from pruritus associated with allergic and atopic dermatitis.

Zenrelia is indicated for control of pruritus associated with allergic dermatitis and control of atopic dermatitis in dogs at least 12 months of age.

Read the entire package insert before using this drug, including the Boxed Warning.

WARNING: VACCINE-INDUCED DISEASE AND INADEQUATE IMMUNE RESPONSE TO VACCINES. 

Based on results of the vaccine response study, dogs receiving Zenrelia are at risk of fatal vaccine-induced disease from modified live virus vaccines and inadequate immune response to any vaccine. Discontinue Zenrelia for at least 28 days to 3 months prior to vaccination and withhold Zenrelia for at least 28 days after vaccination.

 Dogs should be up to date on vaccinations prior to starting Zenrelia. Do not use in dogs less than 12 months old or dogs with a serious infection. Monitor dogs for infections because Zenrelia may increase susceptibility to opportunistic infections. Neoplastic conditions (benign and malignant) were observed during clinical studies. Consider the risks and benefits of treatment in dogs with a history of recurrence of these conditions. The most common adverse reactions were vomiting, diarrhea and lethargy. Zenrelia has not been evaluated in breeding, pregnant, or lactating dogs and concurrent use with glucocorticoids, cyclosporine, or other systemic immunosuppressive agents has not been tested. For full prescribing information see 

Zenrelia, Elanco, and the diagonal bar logo are trademarks of Elanco or its affiliates. PM-US-24-1648 (2).

Podcasts

Andrew Rosenberg, DVM, DAVD, and Adam Christman, DVM, MBA, talk about shortcomings of treatments approved for canine allergic and atopic dermatitis and react to the availability of a novel JAK inhibitor.

Podcast CE: Using Novel Targeted Treatment for Canine Allergic and Atopic Dermatitis

Rapid Readout with Terrence Ferguson, DVM

Reviving the deam: What all aspiring practice owners should know

Sponsored by PetSmart Veterinary Services

“I think most veterinarians want to own their own private practice,” said Terrence Ferguson, DVM, Co-Owner, Critter Fixers Veterinary Hospital. At the 2024 Long Beach Fetch dvm360® conference, Ferguson talked about the obstacles he and his partner, Vernard Hodges, DVM, endured on the long path toward running their own veterinary practice. Through his experiences and lessons learned, Ferguson offers valuable insights and key considerations for aspiring practice owners, no matter where they are on their journey.

The role of mentorship in achieving practice ownership

Mentorship is a cornerstone of Ferguson’s journey in veterinary medicine, from his early days to his current success as a practice owner. Reflecting on his experiences, Ferguson notes that having mentors is not just helpful—it’s essential. “Without [Dr Ernest Corker], I wouldn’t be here,” said Ferguson. “There are a lot of struggles you go through that nobody is going to understand…unless they’re somebody who has done it before.”

Mentors provide guidance that transcends technical knowledge, and steer mentees away from costly mistakes and offer insights gained from their own successes and failures. For Ferguson, this support extended into real-world scenarios, such as performing anesthesia on an unfamiliar animal like a camel. Even after nearly three decades in the field, he continues to rely on mentors, showing the lifelong value of these relationships. Importantly, Ferguson notes that mentors don’t always have to be older or more experienced. Younger professionals with specialized expertise can also serve as valuable guides.

Building and retaining a strong team is pivotal to success in veterinary practice ownership. From the early days of his career when Ferguson and Hodges handled all tasks, up to now, when the practice operates with 8 doctors, Ferguson focused on creating a supportive and growth-oriented environment. A huge part of fostering this type of environment is ensuring empathy is the center of team decision-making. “When I see things from the veterinarian point of view, I also see things from the technician point of view,” said Ferguson. “We want employees who want to be there, not just have to be there.” By ensuring all voices in the practice are not only heard but valued, the entire team feels supported in their roles and are thus more likely to develop their professional career at that practice.

“We’ve had a lot of employees who have been [at Critter Fixers] for a long time,” said Ferguson. One employee joined the practice as a kennel technician right out of high school, and later became a receptionist, assistant technician, and is now an office manager and personal assistant.

Retention, he notes, is not just about fair pay but also creating a balanced work environment. Lessons learned from the duo’s early years—working long hours and rarely taking breaks—have inspired policies that prioritize staff mental health and a healthy work-life balance.

Ferguson, Terrence. Reviving the Dream: Considerations for Practice Ownership. Presented at: Fetch dvm360® Conference; Long Beach, California. December 6-8, 2024.

Becoming a practice owner requires building connections across the industry, including both mentors and a solid team of employees.

Reviving the dream: What all aspiring practice owners should know

As a veterinary dentist with nearly 5 decades of experience, I’ve amassed more than 53,000 dental and oral cavity images in storage on my laptop. At my wife’s encouragement this past November, I ventured beyond my comfort range to focus on a 5-day landscape nature photography trip in Utah’s Badlands. The experience broadened my photographic skills and provided unexpected insights into veterinary anesthesia practices.

The transition from handheld dental macrophotography to landscape photography using a tripod and long lenses required adjustments in technique and approach. (

) This adaptability is necessary in veterinary medicine, where embracing new technologies and equipment is crucial for optimal patient care.

Photos courtesy of Jan Bellows, DVM, DAVDC, DABVP (Canine, Feline), FAVD

The author uses a telephoto camera on a tripod.

The tripod analogy: Strength in photography and anesthesia

Using a tripod in nature photography can be likened to the foundational principles of successful veterinary anesthesia. Just as a tripod provides stability and support for capturing clear, sharp images, the 3 critical synergistic components of anesthesia—patient evaluation, tailored anesthesia protocols, and vital sign monitoring—form a stable base for safe and effective anesthetic procedures. Client communication is equally important in achieving happy anesthesia results. We need to take the time to explain the necessity of anesthesia for proper dental care, potential risks and benefits, expected recovery time, and postoperative care instructions. This open dialogue helps alleviate owner anxiety and sets realistic expectations for the procedure and recovery process.

Similar to assessing the landscape before setting up a shot, thorough preanesthetic evaluation is crucial for identifying potential risks and tailoring the anesthetic approach. The American Veterinary Medical Association and American Animal Hospital Association mandate that all dental procedures be performed under general anesthesia. This makes sense, but how can you transform the anxiety caused by general anesthesia in dentistry into a blissful experience for you and your patients? Start with the physical examination and testing to determine the American Society of Anesthesiologists (ASA) scoring. In addition to the physical examination and history, the ASA score helps you decide what additional testing is indicated before anesthesia. (

The author conducts a physical examination on a conscious patient.

The patient assessment may include comprehensive blood work (complete blood cell count, chemistry panel, and electrolytes), urinalysis, chest radiographs for older patients or those with suspected cardiopulmonary issues, and N-terminal pro b-type natriuretic peptide (NT-proBNP). This detailed evaluation helps identify any underlying health concerns affecting anesthesia safety.

One example is our dog KC, a 4-year-old Polish lowland sheepdog, which we had since a puppy and had no clinical signs of kidney disease. It was time for his first professional comprehensive oral prevention, assessment, and treatment visit. His blood tests revealed end-stage kidney disease. The procedure was canceled and he passed 6 months later.

A study evaluated more than 2000 dogs who underwent anesthesia. A death rate of just over 1% (26 patients) was recorded. A direct correlation was found between the patients’ ASA score and the death rate

A total of 0.3% of fatalities involved ASA 1 and 2 scores.

A total of 1.7% of fatalities involved ASA 3 scores.

A total of 13% of fatalities involved ASA 4 or 5 scores.

Approximately one-fourth of the deaths happened during surgery, whereas the others occurred in the postoperative period. This is a good reminder that patients should be monitored closely after extubation.

American Society of Anesthesiologists classifications

: Minimal risk in an average healthy patient with no underlying disease

: Slight to mild risk of systemic disease, especially in neonates, older patients, and those with obesity

: Moderate risk and apparent systemic disease involving anemia, moderate dehydration, fever, low-grade heart murmur, or cardiac disease

: High risk with severe, systemic, life-threatening disease involving severe dehydration, shock, uremia, toxemia, high fever, uncompensated heart disease, uncompensated diabetes, pulmonary disease, and emaciation

: Extreme risk of moribund state, with patient facing likely death with or without surgery, involving advanced cases of heart, kidney, liver, or endocrine disease; profound shock; severe trauma; pulmonary embolus; and terminal malignancy

Resembling adjustments of camera International Organization for Standardization sensitivity, f-stop, and speed settings adjustments for specific lenses and lighting conditions, anesthesia protocols must be customized to each patient’s unique physiological needs and anticipated procedure duration.

This is a good starting point, which may need modification for dental procedures:

For premedication, a combination of an opioid (eg, hydromorphone 0.05-0.1 mg/kg intramuscular [IM] or fentanyl 3 μg/kg) and a benzodiazepine (eg, midazolam 0.2-0.3 mg/kg IM) can provide excellent sedation and analgesia.

Preoxygenation is performed using a maskvto deliver medical oxygen for 5 minutes.

Propofol (4-6 mg/kg intravenous [IV]) orvalfaxalone (2-3 mg/kg IV) is excellent for smooth induction. These agents allow for rapid, controlled induction with minimal cardiovascular effects.

Inhalation anesthesia with isoflurane or sevoflurane is typically used for maintenance. It is recommended that the concentration should be 2% to 3% and that the number should be adjusted based on patient response and monitoring parameters.

Fentanyl constant-rate infusion (3-10 μg/kg/h) should be used for specific cases where minimum alveolar concentration reduction is desired and there is a need to alter analgesia throughout the procedure.

Incorporating local anesthesia techniques can significantly enhance pain management and reduce the required depth of general anesthesia.

Consider the following nerve blocks for dental procedures. Long-acting local anesthetics such as bupivacaine 0.5% (0.1-0.5 mL per site) can provide extended operative and postoperative pain relief for 6 to 8 hours.

Infraorbital nerve block for same-sided maxillary incisors, canines, and premolars

Maxillary nerve block for same-sided maxillary teeth

Mandibular nerve block for same-sided mandibular teeth

Mental nerve block for samesided mandibular incisors, canines, and premolars 

Incorporating a ventilator into the anesthesia protocol offers benefits and can significantly ease the management of patients under general anesthesia, particularly in its ability to provide precise ventilation control. These devices allow for accurate delivery of tidal volumes and respiratory rates, ensuring optimal gas exchange and oxygenation. Precise control is especially beneficial for patients with compromised respiratory function. Ventilators with ascending bellows technology provide immediate visual feedback on proper ventilation and allow for quick detection of leaks or disconnections on a breath-by-breath basis. This enhanced patient safety feature enables prompt identification and resolution of potential issues, significantly reducing risks associated with mechanical ventilation. The use of ventilators in anesthesia practice also leads to a reduced workload for anesthesia providers. Automatic ventilation frees the anesthesiologist to focus on other aspects of patient care, medication administration, and monitoring. Ventilators offer various ventilation modes, including pressure-controlled, volume-controlled, and support modes for spontaneously breathing patients. This flexibility allows for tailored ventilation strategies based on individual patient needs and dental requirements.

A veterinary team monitors vital signs during a procedure in which anesthesia is used.

Continuous monitoring during anesthesia is akin to constantly checking composition and exposure in photography, allowing for real-time adjustments to ensure optimal outcomes. Effective monitoring is crucial for patient safety during dental procedures. A portable multiparameter monitor is ideal, providing essential physiological readings, including electrocardiogram, pulse oximetry, capnography, blood pressure, and patient temperature. These monitors typically feature a touch screen interface and compact design, making them well suited for dental procedures across various clinical settings. The comprehensive data provided allow us to respond quickly to changes in patient status.

Customizable alarms allow us to set patient-specific limits, ensuring prompt alerts to potential issues. Trend analysis enables the review of physiological data over time, helping identify subtle patient status changes that might go unnoticed. Some models offer network connectivity, facilitating remote monitoring and consultation with specialists when needed. Capnography offers end-tidal, inspired, and real-time CO2 waveforms and crucial information about the patient’s ventilation status. Temperature monitoring is facilitated by calibrated modules with flexible probes for easy rectal or esophageal placement. Pulse oximetry technology delivers accurate readings of saturation of peripheral oxygen even in challenging conditions such as low perfusion or patient movement. These features collectively enhance the monitor’s ability to provide reliable, real-time data, supporting safe and effective patient care during dental procedures.

Happy anesthesia is achievable in virtually all situations. We are fortunate to have excellent advice from our vendors, boarded anesthesiologists, and veterinary technician specialists certified in anesthesia (VTS-anesthesia) available for the asking.

A dental procedure with anesthesia is performed on a canine patient.

The results achieved through tripod based landscape photography demonstrate the importance of a stable foundation, much like the outcomes of well-managed anesthesia. In both scenarios, preparation, proper equipment use, and vigilance lead to superior results, be it in capturing stunning landscapes or ensuring patient safety through anesthesia during dental procedures. (

The journey toward happy anesthesia is ongoing, requiring dedication, continuous learning, and a commitment to excellence. By combining our clinical expertise with advanced monitoring technologies, we can elevate the standard of care in veterinary dental anesthesia, ensuring safer procedures, more comfortable patients, and more satisfied clients. This foray into landscape photography expanded my photographic skills and reinforced the principles of excellence in veterinary anesthesia. The parallels between these seemingly disparate fields underscore the universal importance of preparation, adaptability, and attention to detail in achieving optimal outcomes, whether in capturing images or providing veterinary care.

1. Gil L, Redondo JI. Canine anaesthetic death in Spain: a multicentre prospective cohort study of 2012 cases. 

. 2013;40(6):e57-e67. doi:10.1111/vaa.12059

A foundation for safe and effective dental care