There are various topical therapies that can be recommended as treatment for conditions such as 

dermatitis, surface pyoderma, allergies, and autoimmune diseases. Although Natalie Marks, DVM, CVJ, CCFP, Elite FFCP-V, discussed some of these therapeutic options in lecture on topical solutions at the 2024 Fetch dvm360 conference in Atlantic City, New Jersey, she emphasized that there is even more to consider when treating dermatologic conditions than which therapy or shampoo is right for each patient.

According to Marks, one of the “major” components of topical treatments is bath time. “This can be a huge struggle, not just for us, but obviously for our pet parents and families,” she said.

Frequency of baths should be considered with prescription therapies for dermatological conditions, with the goal of preventing condition reoccurrence. Ideally, Marks said, bathing should happen 1 to 2 times a week and that maintenance is 2 to 4 times a month. The contact time for the pet should be 5 to 10 minutes.

“That’s a long time,” Marks said. “I know we've all been there 5 to 10 minutes with a reactive dog or an anxious dog in a bath.”

She noted that it is important for many veterinary professionals to “take a step back” in their practices with topical treatments and shampoos and refrain from simply instructing clients about how often to bathe their pet. “I think we've learned along the way that compliance is not great when we do that, and we also know more about dog's emotional health,” she said.

She continued by posing the question of how to change the mentality of a client and patient around bath time that would make it less emotionally stressful and a more effective treatment. “Well, one of the first things we need to think about is what we teach in Fear Free and also a lot of positive reinforcement training, which is the conditioned emotional response,” she said.

She encouraged the audience to consider how the patient responds when see a shampoo bottle, hear the water or feel the water, and whether they are relaxed, or appear to be triggered with an anxiety or fear. “Remember, any time of our patients, hear, see, taste, feel or smell something fearful to them, it imprints permanently in their amygdala, and it never goes away ever,” Marks said.

Negative experiences could imprint on a dog and shown through behavior, such as a fear of water if a patient was previously sprayed with a water bottle. “If we don't condition them to have a different emotional response, they will forever have that fear. And every time they get triggered, the amygdala tells them to have more intense response and a longer duration of response,” Marks said.

She recommended teaching clients how to condition their pets to respond positively around the bath. “So that might be they hold up a shampoo bottle and [the dog gets] a yummy treat just from seeing it in the garage or on a walk at the park. It might be taking it out of context. The shampoo bottle doesn't even need to be close to the dog, and they don't even need to see the shampoo or feel the water, but starting with something like that, and then changing that game. So then maybe next time they're outside and you run a hose, the dog [is there], and they get something yummy. So it's usually a yummy treat, but it can also be praise. It depends on the dog's motivation, but the big thing is we're trying to get them comfortable,” Marks continued.

Marks said she emphasized the importance of the bath behavioral response because veterinary professionals do not often enough ask clients if their dogs are fearful of the bath. “Because we just prescribe topicals and shampoos, especially in our allergic dogs, and just assume everybody's going to bathe. And that is not the case,” she said. “So it's important to have that conversation from the beginning of ‘how does your dog do?’”

A practitioner’s goal is to have their patients bathed routinely with prescribed treatment for the skin. “The majority of our dogs that are going to benefit from topical therapy are really struggling with the superficial layer of the skin, the stratum corneum,” she concluded.

Marks N. Scrub-a-dub-dub: sudsy topical solutions for pruritic patients. Presented at: Fetch dvm360 Conference; October 14-16, 2024. Atlantic City, NJ.

Articles

Combined with topical therapies, canine dermatological conditions can benefit from a relaxed, routine regimen

Ensuring a beneficial bath time

Natalie Marks, DVM, CVJ, CCFP, Elite FFCP-V, talks about 2 of the most common forms of incontinence

Neurogenic vs overflow incontinence

There are various reasons why incontinence can occur in the body. Two of the more common forms of incontinence are neurogenic and overflow. In an interview with

 on her lecture, “UrINe or UrOUT–Common Cases Involving Micturition Management,” Natalie Marks, DVM, CVJ, CCFP, Elite FFCP-V, differentiates between neurogenic incontinence and overflow incontinence. She explains that neurogenic incontinence is linked to abnormalities in the nervous system, whereas overflow incontinence tends to be caused by metabolic or endocrine diseases.

Natalie Marks, DVM, CVJ, CCFP, Elite FFCP-V: 

So incontinence in the body, there are many different buckets of why that happens, but 2 of the more common forms that we talk about are neurogenic and overflow. Neurogenic, if you think about the name, it sort of infers the cause there, right? It's that something abnormal has happened within the nervous system that is not allowing the bladders, lower urinary sphincter to stay close. And sometimes we think about that with lumbar disease, so intervertebral disc disease, if there's been trauma, if there's neoplasia, if there's been some type of emboli or some other degenerative condition that's caused trauma to the spine, which, of course, those nerves help control the bladder incontinence.

On the flip side, though, overflow incontinence is actually more often a metabolic or endocrine focused disease. In other words, the body is producing too much urine and just sort of like a sink where the drain is clogged, but water keeps coming in, eventually it overflows. So, we don't typically think about trauma in these cases. We're thinking again more about diseases that create more of a polyuric condition. So a PU/PD patient or one that is going to excessively produce urine, which overflows the actual kind of containment within the bladder itself.

Довидович Михаил/Adobe Stock

Adesola Odunayo, DVM, MS, DACVECC, a professor of emergency and critical care at the University of Florida’s College of Veterinary Medicine, kicked off the third and final day of the 2024 Fetch dvm360 Conference in Atlantic City, New Jersey, with her keynote session, “From Chaos to Calm: Mastering Emergency Medicine Excellence.”

 Over the course of the presentation, Odunayo provided a comprehensive overview of her 7 keys to dealing with emergency scenarios in a calm manner, with skill and confidence. Her key points are applicable to patients being managed in practice or stabilized for transfer to a referral hospital.

“Emergency cases and chaos go hand in hand,” Odunayo said as she began her lecture. “[Emergency room cases] are not very different from what you’re going to see in general practice. I cannot say that there aren’t days where I feel stressed out, they definitely happen, but… the goal today will be to make things a little bit less chaotic for you in your practice.”

The first point that Odunayo focused on was the significance of establishing vascular access early on in an emergency. “When emergency cases come in, I see vascular access as the lifeline of the patient,” Odunayo said. “We want to try to get an [intravenous] catheter in the patient as quickly as possible so that we can administer fluids, medication, pain medication, anti-seizure medication.”

Odunayo explained canines and felines that present in severe respiratory distress are the ones that need vascular access. The same is true for patients who have a history of seizures or tremors, and those that are critically ill. To get venous access in a patient, it is critical to minimize stress, especially for cats in respiratory distress, as Odunayo pointed out. She shared that she sometimes utilizes an oxygen cage and would consider intramuscular sedation, as well as analgesic drugs for patients in severe pain.

Peripheral access should be prioritized, when possible, with the only exception being pediatric patients. She recommended use of the cephalic and lateral saphenous veins, while consciously trying to avoid placing a central vessel reclusively. When cats present in shock, she said she prioritizes placing the catheter in a medial saphenous vein.

Fluids are the most utilized drugs in veterinary medicine. It’s crucial to have an intentional fluid prescription plan, because it can be easy to forget that fluids are drugs. Odunayo referenced the common “prescriptions” of 2x, 3x, or 4x maintenance, saying that these are not true prescriptions, but arbitrary volumes that hold no real significance. The drawback to this method of fluid treatments is the strong likelihood that the patient is receiving too much or too little fluids.

Instances where fluid therapy should be implemented are in cases of hypovolemia, poor perfusion, and shock, in conditions including:

Dehydration should be treated intentionally with a prescription fluid plan. For more information on fluid therapy, Odunayo references the 2024 AAHA Fluid Therapy Guidelines for Dogs and Cats.

Respiratory distress is a common presentation in both general practice and the emergency room. There are well established methods for managing these cases that can be very effective, including sedation, oxygen supplementation, thoracocentesis, bronchodilators, and diuretics. There will be cases in which patients do not respond to these methods of supportive care, in which case Odunayo advised turning to airway control, and intubating the patient. She admitted that there are cases where this is the first thing she does, when the patient presents in exceptionally poor shape. As a result of the control over the patient’s airway achieved through intubation, the emergency room tends to calm down, and diagnostics become easier to attain.

“I would say this is probably the most common indication to intubate a patient,” she said. “Just looking at that animal and saying, ‘you are going to die or stop breathing if I don’t do something.’”

She also pointed to use of the pulse oximeter. Although, she implied that the pulse oximeter can be somewhat unreliable, based on the consistency of the plethysmograph, she reiterated the importance of rapid intubation, with intravenous access, a fast-acting induction drug, and positive pressure ventilation. Dogs and cats who are intubated because of an upper-airway obstruction are the exceptions, not requiring positive pressure ventilation, she noted.

This point can be lifesaving for patients. Odunayo estimated that 80% of cats that present with respiratory distress have chests full of fluid, or pleural effusion. She shared that she is able to effectively treat the majority of cats once she can identify the pleural effusion. She advised attendees not to be afraid of using needles, especially into sensitive organs like the heart, and offered her own personal technique.

“I always palpate 2 ribs,” she said. “I personally like to go right in between 2 ribs… you want to be running perpendicular to the ribs. Once you get into the pleural space… it’s helpful to redirect the needle so that it’s now parallel to the ribs. [This way], once you’ve evacuated the chest and the lungs start to expand, you’re less likely to hit the lungs.”

Odunayo explains that there is never a good reason to withhold analgesia. She said that the reason she feels so strongly about analgesia in the ICU, is directly correlated to mortality, because pain releases a lot of catecholamines, which have a negative impact on healing. Opioid can be used, which provide excellent analgesia, have a minimal effect on the cardiovascular system, are reversible, and offer a simple method for multimodal analgesia. Although, opioid usage can result in ileus, urinary retention, respiratory depression, and vomiting. Additionally, she recommends the use of the Feline Grimace Scale, which is available in the form of a smartphone app.

Odunayo expressed that point of care ultrasounds have changed the landscape of emergency and critical care medicine. These ultrasounds are quick, efficient, and wildly available, saving clients time and money. There are numerous applications for point of care ultrasounds in practice, including pleural and pericardial effusion, pulmonary infiltrates, pneumothorax, pulmonary hypertension, and left atrial enlargement, among others.

The final point that Odunayo included in her presentation involves the importance of keeping an open mind and considering all possibilities. It’s crucial to avoid tunnel vision and to remain open to all differentials. Before arriving at any conclusions, it should be established whether or not the history and presenting complaint fit with the diagnostic findings. Additionally, clients should have the opportunity to decline diagnostic tests.

“You never want to make assumptions,” Odunayo said. “You always want to do the diagnostics and make sure you’re on the right track.”

Odunayo A. From Chaos to Calm: Mastering Emergency Medicine Excellence. Presented at: Fetch dvm360 Conference; October 14-16, 2024; Atlantic City, NJ.

2024 AAHA Fluid Therapy Guidelines for Dogs and Cats. American Animal Hospital Association. Accessed October 16, 2024. https://www.aaha.org/resources/2024-aaha-fluid-therapy-guidelines-for-dogs-and-cats/

Seven key points for handling emergency situations with skill and confidence were covered in the day 3 keynote at the Fetch dvm360 Conference in Atlantic City.

Calmly handling emergency patients

Michael Azzarello, MBA, CVT, LVT, president of New Jersey Veterinary Technicians and Assistants, talks about licensure for these professionals.

A challenge for veterinary technicians

Michael Azzarello, MBA, CVT, LVT, president of New Jersey Veterinary Technicians and Assistants, and other members of the organization met with 

 editors at the 2024 Fetch Coastal conference in Atlantic City, New Jersey. The work and team role of veterinary technicians were discussed as well as challenges faced by these professionals.

dvm360 announces new Fetch veterinary conference location in Maryland

, Azzarello spoke about licensure, the biggest challenge he sees for veterinary technicians. The following is a transcript of the video:

I think the biggest challenge in veterinary medicine is utilization and licensure, and just the overall growth of veterinary medicine. We're short staffed. Techs are burnt out. Utilization is vague, and when we look at the word, every state has their own variation of what techs are allowed to do. And I think that we need to have more uniformity. The ability to go ahead and get us on one pathway will make it much easier throughout the rest of the country, specifically in New Jersey, where we have no licensure, a certification, but we're eventually trying to get there.

For more articles and interviews from Fetch Coastal, visit our 

Videos

The team in the break room is involved in a discussion: What is the correct way to handle a client’s question? What is the proper protocol for follow-up tests for a patient with a long-term illness? Is it necessary to get 2 approvals for a particular medical service? In most cases, the problem is not that the team is clueless; instead, the team has witnessed 2 or more versions of the “correct way,” and everyone wants to get on the same page. The team needs a standard operating procedure (SOP).

An SOP is a detailed, written set of instructions or guidelines that outlines the steps to complete a particular organizational task or process. SOPs are designed to ensure consistency, efficiency, safety, and compliance with regulations or standards. They are commonly used in various industries, including health care, manufacturing, finance, and hospitality, to document best practices and ensure that tasks are performed correctly, regardless of who executes them. SOPs typically include step-by-step instructions, safety precautions, quality control measures, roles and responsibilities, and references to relevant regulations or policies.

Writing SOPs for a practice can seem cumbersome. However, following specific steps and using a standard template can make the process effortless and ensure a document that helps the team maintain consistency, efficiency, and clarity in operations. The following is a comprehensive guide for writing and implementing an SOP.

: Clarify the purpose of the SOPs. Are they for clinical procedures or administrative tasks?

: Determine which processes or tasks will be covered by the SOPs. Identify the departments or individuals involved.

 List all the processes that need SOPs. This may include patient intake, billing procedures, scheduling appointments, and handling medical records. 

: Talk to the team members who perform these tasks to understand current practices, challenges, and potential improvements.

: Include the title, date written, or the revision date (and revision number if applicable).

: Provide a clear outline of the document’s contents for easy navigation—and use the same template for every SOP to ensure consistency.

: List the job titles of those who should be able to perform the task (eg, veterinarians only, technician/nurse and customer service representatives [CSRs], or all personnel).

: Define any abbreviations used in the SOP, considering a new hire who may not be familiar with industry abbreviations.

: Specify any safety protocols or precautions. Be sure to specify any material safety data sheets to follow.

: Provide detailed instructions for each task using clear language and action verbs. 

: Diagrams, flowcharts, or screenshots can enhance understanding. 

: Clearly outline who is responsible for each step or task.

: Include checks or validations to ensure accuracy. 

: Provide citations for relevant regulations, guidelines, or policies. In other words, what are you basing your SOP on?

: Have the practice owner(s), medical director, and manager(s) review the SOPs for accuracy and completeness.

: Incorporate feedback from the team and make necessary revisions.

: Determine how and when the SOPs will be implemented.

: Conduct sessions to ensure the team understands and can follow the SOPs effectively.

: Keep records of training sessions and ensure all team members acknowledge receipt of the SOPs.

: Schedule periodic reviews to ensure SOPs remain relevant and up to date.

: Clearly label document versions and revisions.

: Establish a system for the team to provide feedback or suggest improvements.

: Store SOPs in an easily accessible location or digitize them and make PDF versions readily available on all computer stations throughout the hospital or accessible via an employee portal.

: Limit access to revise any SOP to authorized personnel only. 

: Maintain a clear version history to track changes.

: Encourage staff to provide feedback and suggestions for improving SOPs.

: Regularly assess adherence to SOPs and identify areas for enhancement.

: Compare your SOPs with industry best practices and adjust accordingly. Consider resources, including American Animal Hospital Association guidelines, articles, textbooks, other veterinary publications, discussion board topics hosted by professional associations, feedback from conference attendees, and more.

SOPs are helpful in many areas of the hospital. From stating treatment or testing protocols to handling client queries to clarifying team responsibilities, SOPs can provide the necessary clarification to a seasoned team member or guide a new hire. Regular reviews help rid a process of bureaucratic creep (ie, how many hoops one needs to jump through to finish a task) and update a process due to new technology or medical advancements.

SOP for requesting new pharmaceuticals and/ or medical equipment

: Explore new pharmaceuticals and/ or medical equipment for improved patient care while preventing excess inventory with “old” pharmaceuticals or repeat pharmaceuticals similar to the latest addition. 

 (who should be able to perform task): This task is the responsibility of veterinarians and managers. The SOP should include definitions or abbreviation, health or safety warnings, and equipment and supplies to be used. 

Submit information regarding new pharmaceuticals or equipment to the inventory coordinator.

The inventory coordinator will obtain pricing and any additional information. 

Information will be given to the chief medical officer for discussion with all the veterinarians.

Discussions are to include the following:

Use of the new pharmaceutical or equipment

The chief medical officer will inform the inventory coordinator regarding ordering and what to phase out 

: These policies are set by the hospital’s owner, manager, etc. 

: Establish steps to be taken when hospital policies are not followed. For example, what happens when an employee orders new pharmaceuticals or medical equipment without the proper approvals?

: Ensure thorough communication of information with the team and clients. Prevent errors in patient care. Reduce wasted time searching for information or calling the person who has left for the day. 

: SOPs for all team members, including veterinarian, lead technician, and lead CSR, should be established. These could include health or safety warnings, and notes about equipment and supplies.

Identify who is required to attend the transfer meeting.

Discuss in a quiet area that lacks patient and client traffic flow.

The area must have computer access to review medical charts.

Core issues to transfer include, but are not limited, to the following:

Urgent tasks for the incoming team, identifying who is undertaking the task

Changes in hospitalized patient conditions

Client contact needed, identifying who is undertaking the task

Consider quality control and records management, consequences, and industry standards as well as references and applicable regulations.

By following the steps for writing, updating, and implementing an SOP, you can create comprehensive and effective SOPs that contribute to the smooth operation of the veterinary hospital. Remember that SOPs should be living documents, subject to periodic review and refinement, to ensure they remain relevant and valuable.

How to write a standard operating procedure (SOP)

Waffles, one of the orphaned manatees, being transferred (Image courtesy of SeaWorld Orlando) 

Five manatees were transported over 1,000 miles to their temporary homes in Florida which is a crucial conservation achievement that has been in the works for more than 2 years as 4 zoological and marine institution successfully rescue the 5 animals. To ensure their safe travels, they were placed into custom-built contains and driven to the Cincinnati International Airport at the DHL Express Global hub.

 the manatees will be heading to Florida to complete their rehabilitation before returned to the waters where they were first rescued. For the manatees rehabilitation, The Columbus Zoo and Aquarium, Cincinnati Zoo & Botanical Garden, ZooTampa at Lowry Park, and SeaWorld Orlando joined forces to rehabilitate these 5 orphans for years. 

"For nearly 5 decades, we have been privileged to contribute to the conservation of manatees, a species that is essential to the health of our aquatic ecosystems. Our work, with the remarkable partners of the Manatee Rescue & Rehabilitation Partnership, has allowed us to play a key role in the rescue, rehabilitation, and return of these incredible animals that hold a special place in Florida's natural heritage,” explained Joseph Gaspard, PhD, vice president of zoological operations at SeaWorld Orlando and vice chair of the Manatee Rescue & Rehabilitation Partnership (MRP).

“At our critical care facility at SeaWorld Orlando, we are equipped to care for up to 60 manatees simultaneously, providing a level of support that is rare in the United States. This facility, along with our ability to collaborate with other zoological institutions, allows us to transfer rehabilitating manatees when stable. By doing so, we ensure that valuable space is always available, maximizing our collective ability to safeguard the future of these remarkable creatures."

The 2 orphaned male manatees were brought to SeaWorld Orland from the Columbus Zoo after being rescued as calves from Charlotte County, Florida in January 2023. They were first observed in the same area alone but were presenting with declining body conditions. At the time of the rescue, both manatees were also still being bottle fed. Now, the orphaned manatees Nighthawk and Mr Dobak, currently weigh 678 and 497 lbs and are healthy and independent manatees.

 The plan for Nighthawk and Mr Dobak is to continue receiving care at SeaWorld Orlando until they are released in either winter or early spring 2025. 

Nighthawk (Image courtesy of Grahm S. Jones, Columbus Zoo and Aquarium)

The female manatees, Nolia, Amethyst, and Waffles left the Cincinatti Zoo & Botanical Garden and are heading to Zoo Tampa’s David A. Straz, Jr. Manatee Critical Care Center. The 3 manatees were rescued January and February 2023 and were brought to ZooTampa for treatment where they received around-the-clock care intensive care for 10 months. The trio was then moved to the Cincinnati Zoo’s Manatee Springs in October 2023 to continue their rehabilitation journey.

"As manatees continue to face hardships and critical care facilities operate close to capacity, these transfers are extremely important to make room for critically injured, ill and orphaned manatees," said Tiffany Burns, ZooTampa's senior director of animal programs and president of the Manatee Rescue and Rehabilitation Partnership.

"We are grateful to our partners in Ohio for providing secondary rehabilitation. It's an incredible team effort and we are excited about the manatees' return to Florida waters early next year."

The manatees were transported by DHL Express in custom-built, state of the art containers and were accompanied by a Columbus Zoo Animal Care curator to monitor their condition for the duration of the flight.

 Each container was secured on palettes that were attached to the floor of the plane for stability. Each manatee was rested on an 8-inch thick bed of foam and were covered in wool and space blankets to maintain healthy body temperature. They were monitored also by specialists using laser thermometers and were misted with water under their blankets throughout the flight to keep their bodies moist.

The manatees were rescued by the Florida Fish and Wildlife Conversation Commission and the MRP. The Columbus and Cincinnati zoos are 2 of only 3 facilitates outside of Florida to provide care for manatees as well as serve as a second-stage rehabilitation facilities. The Columbus and Cincinnati zoo provide temporary homes, veterinary care, and food for manatees until they are cleared to return to the Florida waters. 

"Manatee transfers are a testament of the dedication of the many organizations that make up the MRP and their unwavering commitment to save this amazing Florida species," Burns concluded.

 "It requires extensive coordination and collaboration across stateliness. It truly takes a village to protect this threatened species. I am proud of the dedication of all those involved to ensure these animals return to their native waters."

All 5 manatees were also transferred prior to Hurricane Milton and arrived safely to their final destinations. 

1. Five Manatees Successfully Rehabilitated at Two Ohio Zoos Flown Back to Florida Facilities to Prepare for Return to Home Waters. News release. SeaWorld Orlando. October 15, 2024. Accessed October 16, 2024. 

https://prnmedia.prnewswire.com/news-releases/five-manatees-successfully-rehabilitated-at-two-ohio-zoos-flown-back-to-florida-facilities-to-prepare-for-return-to-home-waters-302276522.html

Five orphaned manatees were rehabilitated by 4 zoological and marine institutions for the last 2 years