Andrea Pace, CVT, VTS (ECC), explains the importance of knowing employment laws, and things to keep in mind. 

Andrea Pace Veterinary Employment Laws

 ahead of her session, "Law for Veterinary Support Staff," at the Fetch dvm360 Conference in Atlantic City, New Jersey, Andrea Pace, CVT, VTS (ECC), training mentor for the emergency department at Mount Laurel Animal Hospital in New Jersey, explained why everyone should be aware of basic employment and contract law. 

Additionally, she discussed the role of Occupational Safety and Health Administration (OSHA) in veterinary clinics, misconceptions commonly held by veterinary professionals, and explained legal protections that are in play when raising workplace concerns.

 One thing that I bring up in my presentation is the fact that I was fired for talking about my salary once, and that is wholly illegal. A lot of people think, "Oh, you can't talk about salary. This is something that is a huge taboo." But, honestly, it's something that may be looked down upon, because we don't talk about money very much in the United States, but really it's the employers that are keeping us away from talking to each other about what our benefits are, what some people may have, that others may not, and being able to talk with our coworkers and other employees in other practices, we're able to realize, you know, we can better ourselves and make sure that we are receiving fair compensation compared to everyone else.

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Andrea Pace, CVT, VTS (ECC), explained why veterinary professionals should know basic employment laws, and discussed misconceptions, addressing concerns in an interview at the recent Fetch dvm360 Conference

Why technicians should know employment law 

Olive at CityVet (Images courtesy of Cordell Rech, DVM60) 

Olive, an approximately 1-year-old spayed female ferret presented with mild intermittent diarrhea, decreased weight, and lethargy, and her owner noted she had gone missing for several days prior to arrival. Initial treatment for her gastrointestinal (GI) symptoms was started, including subcutaneous lactated Ringer’s solution (30 mL/kg) and oral medications for GI upset. Broad-spectrum antibiotics consisted of enrofloxacin (10 mg/kg orally twice a day) and Clavamox Drops (12.5 mg/kg orally twice a day), gastroprotectants in the form of sucralfate (150 mg/kg orally 3 times a day), and a recovery diet to be offered due to lean body condition. She returned 2 days later for continued inappetence, diarrhea, and suspected fever. Olive was depressed but responsive, with an elevated temperature of 104.3 °F, tachycardia (>300 bpm), 7% to 10% dehydration, and a palpable abdominal mass in the right cranial abdominal quadrant.

After initial triage and physical examination, a complete blood count, chemistry panel, and radiographs were performed. Blood work showed mild leukocytosis (8.3 103/mL), elevated hematocrit (59%), low creatinine (0.1 mg/dL) and serum urea nitrogen (9 mg/dL), and elevated cholesterol (365 mg/dL). Full-body radiographs revealed abnormal contour to the right kidney as well as generalized dehydration but otherwise normal serosal detail and no evidence of a foreign body or obstruction.

Due to Olive’s lack of improvement on outpatient therapy, hospitalization was implemented to manage dehydration, reduce pyrexia, and treat for possible infectious etiologies. Olive had a 24-gauge intravenous (IV) catheter placed in a cephalic vein and was started on IV fluids at a rate of 150 mL/kg/day to restore hydration. Since Olive was already started on oral medications and there was no history of emesis, the oral medications previously prescribed were continued and meloxicam (0.3 mg/kg orally twice a day) was added as an anti-inflammatory. Olive was maintained on overnight fluids and hospitalization, during which her fever dropped to 103.1 °F and her attitude improved marginally to the point where she voluntarily consumed small amounts of a high-calorie recovery canned food.

During continued hospitalization, Olive’s improvement plateaued. Since Olive was not improving and there was a palpable mass effect, abdominal exploratory surgery was recommended to assess the cause of the mass and remove if indicated. The owners approved this plan, and 48 hours after hospitalization, Olive was taken to surgery. She was placed in standard dorsal recumbency and quarter-draped. The abdomen was opened in a standard midline approach, which revealed the right kidney to be diffusely covered in fluid-filled cysts with loss of normal architecture. No other abnormalities were seen, and the right kidney was removed without complication and hemostasis was managed by hemoclip placement across the renal artery, vein, and ureter. After sterile lavage of the abdomen, the body wall and skin were closed in 3 layers using a monofilament absorbable suture. The kidney was submitted for histopathology, and a sterile swab of several ruptured cysts was sent in for culture. Olive was discharged from the hospital 24 hours postoperatively, being more active, eating well, and with a normal temperature (101 °F).

Histopathology and culture for the kidney returned, showing multifocal renal cysts, moderate chronic pyelonephritis with hydronephrosis, and pyogranulomatous peritonitis without evidence of bacteria or other infectious neoplastic agents. After 96 hours the renal culture returned with no growth, and although Olive had been on antibiotics for 24 hours prior to surgery, this was considered unlikely to cause a false negative culture given the number of cysts and amount of inflammation present. Due to the clinical history and diagnostic findings, it was concluded that Olive’s abnormal kidney was an incidental finding and not a primary factor in her illness.

Olive returned 1 week post nephrectomy due to worsening condition with 7% to 10% dehydration, returned pyrexia (104 °F), anorexia, and severe lethargy. At this visit, our differential list had been narrowed to include sepsis and disseminated idiopathic myofasciitis (DIM). Blood work was repeated, and Olive had several changes considered to be caused by the recent nephrectomy: low hematocrit (32%), low red blood cell count (6.3 x 106/mL), and low hemoglobin (9.6 g/dL). Clinically significant changes to her blood work that gave indication to the primary disease process being DIM were a severe leukocytosis (32.2 x 103/mL) characterized by a severe neutrophilia with toxic changes (18,998/mL), severe lymphocytosis (11,914/mL), moderate thrombocytosis (680 x103/mL), low total protein (4.8 g/dL), low albumin (1.8 g/dL), and mildly elevated chloride (114 mEq/L).

Due to the lack of response to treatment and the increasing suspicion of DIM, the decision was made to switch Olive’s antibiotics and begin immunosuppressive steroids in an effort to improve her clinical signs: enrofloxacin was stopped and replaced with doxycycline (10 mg/kg orally twice a day), famotidine (0.5 mg/kg orally twice a day), and prednisolone (0.5 mg/kg orally twice a day). Over the next several days, Olive showed no improvement despite the changes to her treatment plan and quality of life continued to decline. Due to this, her owners elected humane euthanasia.

After euthanasia, muscle biopsies were taken from the diaphragm, esophagus, and gastrocnemius muscles for histopathology. Histopathology showed severe suppurative esophagitis and myositis with pyogranulomas. DIM typically affects young ferrets under 18 months of age and is not contagious, and onset is typically fast; owners may report overnight changes to attitude and behavior as well as persistent but fluctuating fever. Initial blood work may show normal to mildly elevated white blood cell counts, as in Olive’s case, which can rapidly progress over 7 to 10 days up to 100,000 cells/mL of blood with toxic changes. Glucose is frequently elevated and albumin levels are usually decreased, while creatine kinase is not elevated. Biopsy of affected muscle typically reveals severe, widespread inflammation often with suppurative changes, with the esophagus being particularly affected.

Prognosis for this condition is poor, and the etiology is still unknown but suspected to be autoimmune. There have been some cases where systemic immunosuppression has caused remission using steroids and other immunosuppressants. Olive’s histopathology combined with her history is most indicative of DIM and was her postmortem diagnosis.

Articles

A case study of Olive, a 1-year-old female ferret, who was brought into the clinic presenting with GI symptoms 

Disseminated idiopathic myofasciitis in a ferret

Apollo. (Photo courtesy of Alley Cat Allies)

A kitten found in Cleveland, Ohio with a suspected traumatic foot injury is believed to be the victim of animal cruelty or neglect. Alley Cat Allies, an advocacy organization for cats, is offering a reward of up to $10,000 for any information that aids in the prosecution and conviction of anyone responsible for these acts of animal cruelty or neglect of the kitten, later named Apollo.

“Any knowledge offered by citizens about Apollo is critical to uncovering what caused his injury and seeking justice,” wrote the organization in a news release.

According to the organization, Apollo, an orange tabby kitten approximately 3 months old, was discovered in Cleveland with his right front paw missing and the tendons of his leg exposed due to the injury.

After Apollo was found, Alley Cat Allies alerted the Cleveland Animal Protective League (APL) of Apollo’s situation and arranged for him to receive urgent veterinary care. Alley Cat Allies covered his treatment costs, including veterinary forensics to investigate the injury's cause.

 Earlier this week, Apollo’s entire leg had to be surgically amputated due to the severity of his injury, according to an Alley Cat Allies Facebook post.

Apollo is recovering well and is currently receiving additional care at the Cleveland APL. An ongoing investigation into the cause of his injury is in progress. “Alley Cat Allies helped make the surgery possible, and we're glad to say Apollo is doing well in the aftermath,” wrote the organization in a Facebook post.

Even after his traumatic injury, Apollo has maintained a positive disposition. “Despite what he's been through, everyone who has come in contact with him says he's very sweet,” wrote Alley Cat Allies in the Facebook post.

Anyone with information is encouraged to reach out to the Cleveland APL humane investigations hotline at 216-377-1630.

 “We are determined to discover what caused the horrific injury and get to the bottom of the situation for Apollo's sake,” Alley Cat Allies stated.

Reports for animal abuse in cats, dogs, horses, and livestock are most frequently reported.

 Moreover, data on domestic violence and child abuse cases indicate that a significant number of animals facing abuse are targets of individuals who also abuse their children or spouses, according to the Humane Society of the United States.

Worldwide, approximately 1 animals are victims of abuse every minute, with around 10 million animals in the US dying from abuse or cruelty each year.

Alley Cat Allies offers $10,000 reward related to kitten with traumatic foot injury in Cleveland, Ohio. News release. Alley Cat Allies. October 22, 2024. Accessed October 24, 2024. 

https://www.alleycat.org/alley-cat-allies-offers-10000-reward-related-to-kitten-with-traumatic-foot-injury-in-cleveland-ohio/

Alley Cat Allies Facebook page. Alley Cat Allies is providing critical care for a kitten from Cleveland, Ohio. October 21, 2024. Accessed October 24, 2024. 

https://www.facebook.com/story.php?story_fbid=1043784551124920&id=100064801538068&_rdr

Animal cruelty facts and stats. The Humane Society of the United States. Accessed October 24, 2024. 

https://www.humanesociety.org/resources/animal-cruelty-facts-and-stats#:~:text=Correlation%20with%20domestic%20violence,physical%20abuse%20of%20their%20children

Sleight M, Nyerges S, McGinley K. Animal abuse facts and statistics 2024. 

. September 25, 2024. Accessed October 24, 2024. 

https://www.usatoday.com/money/blueprint/pet-insurance/animal-abuse-statistics/

A 3-month-old kitten was found in Cleveland, Ohio, with a missing right front paw and exposed tendons

Advocacy organization investigating a kitten’s case of animal cruelty

Animal Dermatology Group, Inc., (ADG), the largest veterinary dermatology organization in the US, has announced its acquisition of 4 dermatology specialty practices in key markets: Long Green Animal Dermatology in Baldwin, Maryland, Nashville Veterinary Dermatology in Nashville, Tennessee, Animal Dermatology & Allergy in Estero, Florida, and Dermatology & Allergy Clinic for Animals in Santa Barbara, California.

 ADG’s veterinary dermatology team now consists of more than 90 doctors across 17 US states, focused on delivering best-in-class veterinary dermatology care to patients across the US.

“ADG is now providing specialty care in 17 US states,” Steven Mrha, CEO, Animal Dermatology Group, said in a news release.

 “As we expand our services across multiple US markets, partnering with Long Green Animal Dermatology, Nashville Veterinary Dermatology, Animal Dermatology & Allergy, as well as Dermatology & Allergy Clinic for Animals, [allows] us to provide pet owners with the highest level of veterinary dermatology specialty care.”

Established in 2007, and led by Joseph A. Bernstein, DVM, DACVD, and Deirdre F. Vaughan, DVM, DACVD, Long Green Animal Dermatology is devoted to the diagnosis, treatment, and management of skin diseases in companion animals and horses. Located in the Long Green Valley, just north of Baltimore, Maryland, the practice provides specialized diagnostics and therapeutic techniques for challenging cases, ensuring the best patient outcomes.

“We are committed to providing pet owners and their pets with the highest level of care for skin, allergy, and ear disease,” Bernstein and Vaughan shared in a joint statement.

 “Becoming part of the ADG team of veterinary specialists aligns with our dedication to advancing dermatology specialty and supporting the expansion of our services.”

Founded by Sarah ONeill, VMD, DACVD, a board-certified veterinary dermatologist, specializing in acute and chronic skin and ear conditions, Nashville Veterinary Dermatology aims to establish successful and sustainable solutions for pets’ skin problems.

 Serving middle Tennessee since 2010, ONeill has since been joined by 2 additional board-certified dermatologists, Mandy Akerman, DVM, DACVD, and Lindsay McKay, DVM, DACVD.

“Our medical team is highly trained to find successful and sustainable solutions to enhance the quality of life for our patients suffering from dermatological diseases,” ONeill said.

 “The ADG partnership is exciting, as it supports our growth and our mutual focus on providing unsurpassed veterinary dermatology care for our patients.”

Animal Dermatology & Allergy was started in 2000 by Glen Burkett, BVSc, a board-certified veterinary dermatologist, to serve veterinarians, their clients, and the pets of southwest Florida. Since joined in practice by his wife, Leigh Burkett, DVM, the clinic believes in a collaborative approach, working with pet owners and referring veterinarians to achieve the best outcomes.

 The clinic utilizes cutting-edge technology and innovative techniques to support pets suffering from allergies, dermatitis, ear infections, and other skin-related issues. “Our service takes pride in applying the latest diagnostic and treatment options for pets with skin, ear, and allergy problems,” Burkett shared.

“Joining ADG allows us to stay up to date with the latest advancements in veterinary dermatology, utilizing cutting-edge technology and innovative techniques to achieve optimal results,” the Burketts said of the partnership.

The Dermatology & Allergy Clinic for Animals

Board-certified veterinary dermatologist, Jean Greek, DVM, founded the Dermatology & Allergy Clinic for Animals in 2011. Serving Santa Barbara, Ventura, and the surrounding areas of California, Greek has more than 30 years of experience providing clients with individual attention and addressing their pet’s specific medical needs.

 Since relocating to Santa Barbara in 2000, Greek has remained the only board-certified veterinary dermatologist on the central coast.

“[I’ve] always had a great appreciation for ADG, and it’s exciting to be a part of such a collaborative group of veterinary specialists,” Greek said.

Animal Dermatology Group Expands to Over 90 Doctors with Four New Acquisitions Across Key US Markets. News release. Animal Dermatology Group. October 24, 2024. Accessed October 24, 2024. 

https://prnmedia.prnewswire.com/news-releases/animal-dermatology-group-expands-to-over-90-doctors-with-four-new-acquisitions-across-key-us-markets-302285227.html

Welcome to Long Green Animal Dermatology. Long Green Animal Dermatology. Accessed October 24, 2024. 

We Are Nashville Veterinary Dermatology. Nashville Veterinary Dermatology. Accessed October 24, 2024. 

About Us. Animal Dermatology & Allergy. Accessed October 24, 2024. 

About Us. Dermatology & Allergy Clinic for Animals. Accessed October 24, 2024. 

The group's most recent acquisitions extend their coverage into Maryland, Tennessee, Florida, and California

Animal Dermatology Group continues strategic expansion into 4 key US markets

Валентина Свиридо/stock.adobe.com

For years, a treatment for feline infectious peritonitis (FIP) has been talked about as a hypothetical, a what-if, but now it is a reality. US veterinarians can treat this fatal disease with GS-441524, along with current antivirals such as remdesivir, Paxlovid, and others.

FIP is a historically fatal-without-treatment disease that stems from a feline coronavirus, an RNA virus. Although the majority of affected cats are diagnosed before they are 2 years old, it is important for clinicians to be aware that cats of any age and breed can get it. FIP can present in multiple ways, and current suggested treatment protocols have high rates of survival in treating the following:

Effusive (wet) FIP: protein-rich effusions in the abdomen and chest cavity 

Non-effusive (dry) FIP: pyogranulomatous mass lesions on any organ, such as intestines, kidneys, eyes, etc

Neurological FIP: brain or spinal cord deficits seen through seizures, walking abnormally, trembling, etc

Ocular FIP: cloudy or bloody eyes, different pupil sizes, and/or cats showing pain by holding their eyes closed

Life-saving treatment is now available in the US

Sally Coggins, BVSc, MANZCVS, PhD candidate at the University of Sydney, in Australia, recommends GS-441524, an antiviral tablet now available in the US through Stokes Pharmacy, to treat FIP. The FDA allows compounding GS-441524 from a bulk active pharmaceutical ingredient under the FDA Center for Veterinary Medicine’s Guidance for Industry #256’s enforcement discretion. While GS-441524 is under review for approval as office stock, it can be ordered and kept as office stock in most states. 

Clinical studies in Australia and the UK have shown a greater than 80% survival rate when treating FIP with Bova GS-441524. Specifically, results from a study at the University of Sydney showed a 96% survival rate if a cat lives through the first 48 hours of treatment and an 86% survival rate to 6 months after treatment.

 Bova GS-441524 has been used in multiple clinical research studies around the globe.

The availability of this life-changing drug is groundbreaking news in the US. Previously, with veterinarians unable to prescribe or advise on the use of GS-441524, the use of unregulated black market FIP drugs grew among pet owners. Although there has been some success using black market drugs,

 this practice lacks veterinary oversight and quality control, which leads to a great variation in potency and no clear instructions for use.

These problems are solved with the Bova formulation of GS-441524.

The dosage of GS-441524 depends on the type of FIP, the cat’s weight (Table 1), and clinical responses. A minimum of 84 days of total treatment is recommended in all cases.

Researchers and FIP experts recommend the following:

The daily dosage of oral GS-441524 can be given once daily or divided twice daily; some cats may benefit from twice-daily treatment to optimize serum levels of GS-441524.

Once-daily treatment is acceptable for cats that are challenging to medicate and/ or obtain a positive response.

Higher dosages may overcome issues with poor absorption in some cats; the drug may better cross the blood-brain barrier and the blood-eye barrier.

The dosage should be adjusted according to clinical responses.

The introduction of Bova GS-441524 tablets led to most treatment regimens starting with tablets from the first day, resulting in a better-tolerated treatment compared with previous options.

“From a welfare perspective, being able to move these cats over to oral therapy is so important, and to be able to just bypass injectables altogether in cats that have a competent swallow reflex has been a real advantage,” said Coggins.

Bova GS-441524 should be given on an empty stomach. Coggins recommends food be withheld for at least 1 to 2 hours before each dose, but the fasting must be tailored to the age of the cat. While further study is needed on the effect of food on absorption, a tablespoon of wet food or a creamy treat can be used to wash it down. A full meal must be given at least 30 minutes later.

While starting this treatment, practitioners should support owners who will need to administer the tablet at home. Coaching owners to administer at-home treatment and perform weight and symptom monitoring is important since the treatment lasts 84 days. Empowering owners to use positive reinforcements, like creamy treats, with their cats ensures the GS-441524 treatment’s success.

While previous research suggested injectable remdesivir be used first in FIP cases and then be transitioned to oral medication, current studies with the Bova formulation show that FIP cats can be treated successfully when starting with Bova GS-441524 tablets. In the US, remdesivir treatment for cats can only be used off-label with Veklury, a medication used to treat humans with COVID-19. It is acceptable to use off-label on cats, with the main barrier being that it is difficult to obtain because it is generally used to treat humans in hospitals.

When treating with Bova GS-441524, it is especially important to monitor the cat’s clinical response during the first 6 weeks of treatment. A weekly physical exam or a home weight check, if the owner has a digital baby scale, is recommended. Cats typically gain weight rapidly, and the dose needs to be recalculated regularly to ensure they are being maintained at the desired dose rate. Always round up to the nearest one-fourth tablet so cats are growing into the dose, not out of it. Although monthly blood tests are considered appropriate, a focus on clinical response during the first half of treatment is very important. If clinical signs resolve rapidly, the cat is eating and playful again, and their fever has resolved, serum biochemistry and hematology can be assessed at 6 to 8 weeks and again at 10 to 12 weeks before determining whether to stop treatment. In studies, mild persistent hyperglobulinemia and abdominal lymphadenomegaly are sometimes reported, but this does not indicate a relapse.

For successful treatment with Bova GS-441524, follow these guidelines:

Do not allow cats to get less than a daily 15mg/kg dose at any point.

Do not adjust the dosage down with weight drops; the dose should only go up with weight gains.

Do not stop treatment before the 12 weeks, even if the cat is responding well and quickly. There is currently not enough data supporting shorter treatments.

Do not continue any type of corticosteroids beyond the first 1 to 2 weeks.

If there is a need to troubleshoot any suboptimal responses to these treatments, take the following steps:

Ask, “Was the diagnosis definitively FIP?”

If the answer is yes, increase the dosage by 5 to 10 mg/kg daily and try the strategy of dividing the dose every 12 hours.

Consider adding Paxlovid, which is legal for off-label use via prescription in the US, or switching to an alternate antiviral such as EIDD-1931 or molnupiravir

Mefloquine can also be used with GS-441524, but it has been found to be a much weaker antiviral for treating FIP and is considered a last resort

Lastly, throughout this treatment, be sure to provide supportive care. Cats with FIP may be in pain from pleural and peritoneal inflammation, distension from masses, uveitis, and neurological lesions. Consider an analgesic that is appropriate for that patient. Furthermore, they could need fluid therapy, nutrition support, antiemetics, specific ocular/neurological medications, or more. However, be aware that no specific supplements have been studied to be used alongside the antivirals mentioned. Most cats that respond well do not require supportive measures beyond the first week of therapy.

There are many variants in treating FIP. But with the introduction of regulated GS-441524, veterinarians can now provide ethical, critical support to their patients, improving the chance of survival for thousands of cats in the US.

Coggins SJ, Norris JM, Malik R, et al. Outcomes of treatment of cats with feline infectious peritonitis using parenterally administered remdesivir, with or without transition to orally administered GS-441524. 

. 2023;37(5):1772-1783. doi:10.1111/jvim.16803

Taylor SS, Coggins S, Barker EN, et al. Retrospective study and outcome of 307 cats with feline infectious peritonitis treated with legally sourced veterinary compounded preparations of remdesivir and GS-441524 (2020–2022). 

. 2023;25(9):1098612X231194460. doi:10.1177/1098612X231194460

Green J, Syme H, Tayler S. Thirty-two cats with effusive or non-effusive feline infectious peritonitis treated with a combination of remdesivir and GS-441524. 

. 2023;37(5):1784-1793. doi:10.1111/jvim.16804

Jones S, Novicoff W, Nadeau J, Evans S. Unlicensed GS-441524- like antiviral therapy can be effective for at-home treatment of feline infectious peritonitis.

Kent AM, Guan S, Jacque N, Novicoff W, Evans SJM. Unlicensed antiviral products used for the at-home treatment of feline infectious peritonitis contain GS-441524 at significantly different amounts than advertised. 

. 2024;262(4):489-497. doi:10.2460/ javma.23.08.0466

 is the pharmacist-in-charge and coowner of Stokes Pharmacy. McVey holds a pharmacy degree from Temple University School of Pharmacy in Philadelphia, Pennsylvania, and has over 35 years of experience. McVey is also a licensed consultant pharmacist, offering expert advice on medication therapy management, regulatory compliance, and patient care optimization.

Veterinarians in the US can now treat feline infectious peritonitis with the breakthrough antiviral GS-441524

Step up your practice: Start treating FIP today

During his session, “Navigating the cOAst: Current Consensus Managing Canine Osteoarthritis,” presented during the Fetch dvm360 Conference in Atlantic City, New Jersey, Mark E. Epstein, DVM, DABVP (C/F), CVPP, senior partner and medical director, TotalBond Veterinary Hospitals, offered insights into the current state of canine osteoarthritis (OA) treatment strategies.

 Traditionally, OA management is complex, and there is little guidance on which tools should be utilized. In his lecture, Epstein covered the validated Canine Osteoarthritis Staging Tool (COAST), which provides a new point of reference for OA management.

“When it comes to [OA]… you’ve got all of these tools in the toolbox, but what [should] you use and when? How long, how often, and for which patient?” Epstein introduced his session.

 “So, [now] we have the benefit of having some industry guidelines that point us in the direction of how to triage our treatments for different kinds of patients. That’s really going to be the focus today.”

According to Epstein, old studies indicated that OA was present in 20% of all dogs. More recent studies indicate that OA prevalence is actually significantly higher, with OA affecting 68% of dogs between 5-12-years-old and 40% of dogs between 8 months and 4-years-old.

 According to Epstein, more than 50% of OA cases are diagnosed in dogs between 8-13-years-old.

With that said, the high prevalence of OA in young dogs encourages early diagnosis and intervention. Epstein emphasized the importance of this early intervention, especially in at-risk patients, long before they are even subtly symptomatic. Undiagnosed and unmanaged OA, or any chronic pain, can lead to diminished mobility, cognition, and mental acuity. Epstein also points to the connection between undiagnosed chronic pain and clinical depression in humans, implying that the same might be the case for dogs.

“We need to be thinking about catching, observing and recognizing, assessing, and treating degenerative joint disease, osteoarthritis, way earlier in their lives than [previously] thought,” Epstein said.

 “Imagine if we’re not catching [OA] until they’re the age of 13, but they’ve [had it since they were] just 2 or 3 years old. That’s on us.”

The Canine Osteoarthritis Staging Tool (COAST) looks to improve and standardize the approach to both the diagnosis, and monitoring, of canine OA by categorizing patients into stages of OA. The tool was developed by 9 international specialists, and it was officially validated in 2019. COAST was diagnosed with practices in mind and intended to be proactive with a multi-disciplinary team approach. Epstein explained that COAST is optimal for detecting OA early on in at-risk canines.

“[COAST involves] the whole team, it’s not just you in your physical exam,” Epstein explained.

 “Everybody knows that this is a Labrador, everybody can see that it’s overweight, some people will be able to see that it’s lame… so, you’re looking for all of the risk factors… you’re also [looking for OA] in these dogs that have risk factors, symptomatic or not.”

The multi-disciplinary care team should consider each patient who walks through the clinic door as potentially having OA. These dogs can be split into 2 groups: At-risk dogs, and dogs with clinical OA. Epstein advises that veterinary team members consider the following high-risk factors/predispositions to canine OA in at-risk patients

If a patient presents no risk factors, no clinical signs, and no abnormalities in the physical exam, they would be considered a COAST stage 0. A dog who presents no clinical signs of OA and has a normal physical exam, but has just a single risk factor, would be a COAST sage 1.

 “That’s a big population of dogs,” Epstein said. “That’s the younger ones… the ones that are 8 months to 4 years old without symptoms, that [veterinarians] aren’t seeing, and that [owners] aren’t seeing.”

 Clinically normal, with no OA risk factors

 Clinically normal, but OA risk factors are present; Example: A young, overweight Golden Retriever.

 Mild OA; Example: A 5-year-old Labrador-mix with a history of intermittent lameness.

 Moderate OA; Example: An 8-year-old large breed dog with hip dysplasia.

 Severe OA; Example: A 12-year-old dog with severe hip dysplasia and stifle OA.

The same group that established the COAST guidelines for early OA diagnosis recently released guidelines for OA treatment as well, which Epstein recommends. For dogs that are COAST stage 0, no action is required. For COAST stage 1 dogs, it’s essential to begin a dialogue with the owners about healthy habits for their puppy. Topics like weight optimization, what food they should be feeding their dog, and proper exercise habits should be discussed.

Stage 2 dogs should be started on non-steroidal anti-inflammatory drug (NSAID) therapy, in which NSAIDs should be administered daily for 1-3 months, after which point veterinarians can consider tapering doses or the frequency of administration. Although they did not receive unanimous consensus, veterinarians can also consider starting stage 2 dogs on polysulfated glycosaminoglycan, or other nutritional supplements.

Stage 3 dogs should be started on anti-nerve growth factor (NGF) monoclonal antibodies (mAbs). These can be considered in stage 2 dogs if there is a neurogenic component, although the group behind COAST was split on whether it was safe to use alongside NSAIDs long-term. Despite not receiving unanimous consensus, amantadine, gabapentin, joint injections, modalities, and cannabinoids can also be considered at this point. All of these should be continued in stage 4 dogs, as well.

Epstein referenced studies supporting the efficacy of long-term NSAID usage. He explained that, with decreased pain, patients were able to exercise more, strengthening their soft tissues and bones, and encouraging weight loss. Similarly, long-term NSAID usage contributed to decreased peripheral and central sensitization. The use of NSAIDs is unanimously recommended by experts as soon as OA is diagnosed.

Epstein M. Navigating the cOAst: Current Consensus Managing Canine Osteoarthritis. Presented at: Fetch dvm360 Conference; October 14-16, 2024; Atlantic City, New Jersey.

Canine Osteoarthritis (OA) Treatment Algorithm. Elanco. Accessed October 23, 2024. [PDF]

Cachon T, Frykman O, Innes JF, Lascelles BDX, et al. COAST Development Group’s international consensus guidelines for the treatment of canine osteoarthritis. 

https://doi.org/10.3389/fvets.2023.1137888

The current state of canine osteoarthritis management, and early diagnosis with COAST, were covered during a lecture at the Fetch dvm360 Conference in Atlantic City