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.

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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

Articles

A foundation for safe and effective dental care

Dentistry A to Z: H is for happy anesthesia

 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. 12 on this list:

First torsemide drug for dogs received conditional approval

The FDA has issued a conditional approval for the first torsemide drug for dogs (UpCard-CA1; Vetoquinol). This drug is intended to be used alongside concurrent medications including pimobendan, spironolactone, and angiotensin-converting enzyme (ACE) inhibitors. This therapy combination will help manage pulmonary edema, a buildup of fluid in the lungs seen in dogs with congestive heart failure caused by myxomatous mitral valve disease (MMVD).

MMVD is an abnormality in the heart valve or muscle that prevents the valve from closing properly and should be diagnosed by a veterinarian through thorough physical and cardiac evaluations.

 This abnormality affects the heart's ability to pump blood efficiently and can lead to an enlarged heart (cardiomegaly). If left untreated, MMVD can progress to congestive heart failure, causing fluid buildup in the chest and abdomen. MMVD is prevalent across various dog breeds, with a higher occurrence in smaller breeds such as Cavalier King Charles spaniels, Yorkshire terriers, and dachshunds. 

At the 2023 American College of Veterinary Internal Medicine (ACVIM) forum in Philadelphia, Pennsylvania, third year cardiology resident at Texas A&M University, Tess Sykes, DVM 

 on the link between cardiac complications including MMVD in Borzoi dogs. The data she presented suggests that this breed can still be prone to develop dilated cardiomyopathy (DCM), ventricular arrhythmias, and myxomatous mitral valve disease (MMVD).

The FDA allows drugs treating serious or life-threatening diseases in animals to be marketed after demonstrating safety and manufacturing standard before receiving full approval. The organization allows recognized the difficulty this disease poses for gathering effective studies as it would be time consuming and difficult to gather a large data pool.

 Therefore, the FDA has deemed UPCard-CA1 has met the necessary requirements for expanded conditional approval.

For more information on this story, including product vial size and dosage, continue reading the full article: 

https://www.dvm360.com/view/first-torsemide-drug-for-dogs-received-conditional-approval

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

2024 veterinary news in review: #12

Coming Soon: Inside the Clinic Canine Lymphoma Treatment—Never a One Size Fits All

This CE will discuss how Laverdia CA-1 (verdinexor tabs) fit into treatment of dogs with lymphoma. We will discuss the mechanism of action, dosing, adverse events and efficacy of this novel agent. Finally discussing why Laverdia CA-1 should be utilized in the primary care setting.

Understanding the data behind its conditional approval and how this impacts its current usage

 Seeing where this drug is valuable in the primary care setting

Luna the puppy from North Pole, Alaska, ingested a bag of Christmas candy and the head of a chocolate Santa Claus (Image courtesy of Pet Poison Helpline) 

Historically, puppies will eat anything they can find. This proved to be true to Jacob Harvison from North Pole, Alaska, after a quick errand would almost result in an emergency room trip for his puppy Luna.

"We had just finished dinner, and my grandma gave us a bunch of candy," Harvison explained, in an organizational release.

 "I had to run out for a few minutes, so I left the bag on my bed. While I was gone, my dog Luna was able to break out of her cage and get into the candy. There were wrappers everywhere. She ate an entire package of SpongeBob Giant Krabby Patties Holiday Sliders gummy candy."

Along with the gummy candies, Harvison reported that Luna also helped herself to the head of a chocolate Santa Clause, a bold move for living so close to the big man himself.

 However, jokes aside, Harvison realized some of the candies he suspected Luna to have ingested could be toxic, so he called his local veterinary clinic. The clinic recommended to call Pet Poison Helpline.

According to the release, the experts at Pet Poison Helpline consulted with Harvison to determine the items Luna consumed and the quantity.

 Because she ate Santa’s head, the team shared that chocolate contain methylxanthines, especially theobromine and caffeine, and when ingested can cause abnormal heart rhythm, diarrhea, elevated heart rate, hyperactivity, seizures, tremors, and potentially death.

 Chocolate products can also contain other toxic materials, including raisins, coffee beans, macadamia nuts, or xylitol

"The holiday season is the busiest time of year at Pet Poison Helpline," said Renee Schmid, DVM, DABT, DABVT, a senior veterinary toxicologist and director of Veterinary Medicine at Pet Poison Helpline.

 "We receive more calls involving chocolate than any other potential toxin, though it isn't usually in the shape of Santa Claus."

After speaking with Harvison, the team recommended he keep Luna at home, explained the symptoms to be on the lookout for, and cal back if any fure issues or concerns arise. Harvison explained that the call provided him peace of mind because he knows his pet would be okay, and it saved time and expenses of taking her to an emergency room.

"Thinking of a dog eating SpongeBob Giant Krabby Patties Holiday Sliders may be amusing, but it can still cause significant concerns. While the specific ingredients in these gummy treats were not a toxic concern, ingesting a large number of gummy candies can create a fluid shift into the gastrointestinal tract which can then lead to electrolyte abnormalities such as hypernatremia,” explained Schmid.

Pet Posion Helpline shared that among its calls regarding cholocate, 95% involve canine patients.

North Pole Nightmare Before Christmas. News release. Pet Poison Helpline. December 18, 2024. Accessed December 18, 2024. 

https://prnmedia.prnewswire.com/news-releases/north-pole-nightmare-before-christmas-302334201.html

Chocolate. Pet Poison Helpline. March 3, 2020. Accessed December 18, 2024. https://www.petpoisonhelpline.com/poison/chocolate/

Luna the puppy helped herself to some of her owners Christmas treats, including the head of a chocolate Santa Claus 

Alaskan puppy steals holiday treats

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

What are some controversies or misconceptions about mast cell tumors (MCTs)? In a preconference interview, Craig A Clifford, DVM, MS, DACVIM (Oncology), talked about his lecture “Controversies in Oncology: Mast Cell Tumors,” presented at the Fetch dvm360 conference in 

. In the interview, Clifford discussed various aspects of mast cell tumors, including grading, prognosis with multiple MCTs, subcutaneous MCTs, and the new treatment for MCT in dogs: Stelfonta.

Below is a partial transcript. It has been lightly edited for clarity.

Craig A Clifford, DVM, MS, DACVIM (Oncology): 

The goal of this lecture is to look at a variety of different things associated with mast cell tumors that are either considered controversial or things that we don't have a perfect answer for. Perfect example would be now we have the ability to do grading, which traditionally was only through taking a piece of the tumor tissue. We can actually do it through cytology. The parameters that are looked at can be seen under [histopathology] and can be seen cytologically. So for select cases where maybe it's a challenging tumor in a tough location, and the primary care doctor, you know, doesn't know ‘how aggressive should I be’? Well, if we do cytologic grading first and the cytologic grading suggest it's a low-grade tumor, well now the primary care doctor can look at it and be like, ‘I just need to do a marginal surgery.’ If, say, it's between the digits, ‘I don't have to take a digit. I can do a really close surgery, barely get it all out, but that's probably enough.’ While, conversely, if it turns out it's [a] more aggressive tumor, well, that's when we have to have very good margins. So just going in and trying to pull it out—not going to be enough, we probably need to take a digit. So that's one that they either may want to downsize first or potentially refer.