Natalie Marks, DVM, CVJ, CCFP, Elite FFCP-V, explains the 4 stages of wound healing for feline and canine patients

Video interview with Natalie Marks, DVM, CVJ, CCFP, Elite FFCP-V

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Understanding the complexities of wound healing in dogs and cats is crucial for delivering the best veterinary care. In this Fetch Kansas City conference interview, Natalie Marks, DVM, CVJ, CCFP, Elite FFCP-V, provides listeners an insightful breakdown of each stage in the wound healing process for both canine and feline patients. Marks also provides some tips as to what veterinary professionals can look out for in the case of something abnormal happening with their patient based on their healing wounds.

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

:  The first is hemostasis, and as it sounds, we need that wound to be able to stop bleeding and so the formation of a clot with platelet aggregation and thrombin is very important. If we have wounds that do not display rapid wound clotting, then we start worrying about clotting disorders. So that's one of the sort of the key tip offs if we've got something abnormal going on. 

The second is more of an inflammatory phase, and that's where the body does what it does normally so well, which is to send in this fluid mixture of inflammatory cells and different cytokine and chemotactic factors, to draw in what's necessary to clean up debris, bacteria, sort of its natural flushing state, essentially and to start telling the body, 'hey, this is a wound, and we need to create some scaffolding so that new cells can start to come once that happens.' 

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Natalie Marks, DVM, CVJ, CCFP, Elite FFCP-V, explains the 4 stages of wound healing 

Canine and feline wound healing

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 gives you access to the best sessions, speakers, and over 30 CE credits. Learn when, where, and how it fits into your busy life. Whether you’re catching up between appointments, learning from the comfort of home, or squeezing in a quick session over coffee, Fetch On-Demand gives you the flexibility you need to earn CE credits on your terms.

During his Fetch dvm360 Conference session 

Is that a Zebra? Yup, it’s Addison’s Disease

, Christopher G. Byers, DVM, DACVECC, DACVIM (SAIM), CVJ, told a story about a 1-year-old, male intact, Chinese Crested dog named Rumble who was brought to a clinic presenting anorexia and adipsia.

 The patient had been experiencing symptoms for 4 days, although his diet hadn’t changed. His owners had not reported the ingestion of any foreign body or toxin, and he showed no signs of polyuria/polydipsia, and he had not left home.

A physical examination (PE) performed during an urgent care visit 2 days prior concluded stuporous mentation. A complete blood count (CBC)/serum biochemical profile (CHEM) was performed at the urgent care, and he was treated with IVF. After 2 days of continuing symptoms, Rumble was brought to the clinic, where the results of a second PE showed he was quiet, alert, and responsive (QAR), lethargic, had weak synchronous femoral pulses, lost muscle weight (sarcopenia), and had mild hypothermia.

CBC/CHEM, urinalysis (UA), and radiography results showed a normal lymphocyte count despite being sick, a normal K+ with slightly low Na+, as well as hypoglycemia, which set off red flags. An Adrenocorticotropic hormone (ACTH) stimulation test was performed and showed no cortisol present, with or without cosyntropin stimulation. Rumble was finally diagnosed with hypoadrenocorticism (Addison’s disease).

Byers explained that no matter what, when evaluating a sick dog, Addison’s disease should be considered. Dogs of any age or sex can get the disease, although it’s most common in female dogs that are young to middle-aged. Over-represented dog breeds include standard poodles, West Highland, White terriers, Great Danes, bearded collies, German shorthair pointers, and Nova Scotia Duck Tolling retrievers. There is also believed to be a genetic basis for the condition in Portuguese Water dogs and Wheaten terriers, though further research is required. Alterations to a dog’s normal routine can precipitate disease-related crisis.

Addison’s disease is caused by a problem in the adrenal cortex. Byers likened the adrenal gland to a peanut M&M, with the peanut representing the medulla and the chocolate exterior representing the cortex. The problem, Byers said, is in the chocolate. The adrenal cortex can be divided into 3 layers:

: The outermost layer; handles production and secretion of mineralocorticoid (aldosterone).

: The middle layer; responsible for production and secretion of glucocorticoid (cortisol).

: The innermost layer; responsible for production and secretion of androgen.

Addison’s disease is classified as either primary or secondary, depending on a number of factors. The terms primary and secondary are used sparingly in discussions of the disease, however, according to Byers.

Primary Addison’s is either referred to as typical—indicating classic electrolyte changes—or Eunatremic eukalemic Addison’s (EEA), if there are no electrolyte derangements. This classification of the disease is the result of immune-mediated destruction of more than 90% of the adrenal cortex and glucocorticoid and/or mineralocorticoid deficiency.

Formerly “atypical” Addison’s, secondary Addison’s is now more commonly referred to as EEA. It is the result of ACTH deficiency, specifically the lack of ACTH release from the pituitary gland, which then results in cortisol deficiency. The difference is especially notable because ACTH does not have a strong effect on the zona glomerulosa, which only limits glucocorticoids, sparing mineralocorticoid secretion and function.

Identifying mineralocorticoid deficiency is relatively easy. Indicators to look for include hyperkalemia and hyponatremia. Glucocorticoid deficiency indicators tend to be more subtle. Signs include the lack of a “stress leukogram,” hypoglycemia, hypoalbuminemia, and hypocholesterolemia.

“Never ignore low cholesterol,” Byers said in his presentation. “There are only 3 major differentials: liver disfunction, protein-losing enteropathy (PLE), and Addison’s disease. So, just by documenting hypocholesterolemia, your differential lists [got a lot smaller].”

Addison’s disease is often referred to as the Great Pretender, as there is no pathognomonic presentation for patients living with the disease. Patients could present acutely across various stages of hypovolemic shock, and other patients could have waxing and waning, vague gastrointestinal (GI) signs. These signs may include vomiting, diarrhea, anorexia/hyporexia, melena, among others. For patients in shock, signs may vary depending on the stage they are in (compensatory, early decompensatory, or late decompensatory).

First, a physical examination should be conducted. Similar to the clinical presentations, results will be variable. “For the waxing and waning GI sign patients: dehydration, they’re not going to feel well, they’re going to have lost weight—especially muscle mass,” Byers said. In contrast, there will be patients that are, “actively trying to die in front of you.” They may show symptoms like bradycardia, hypovolemic shock, weak pulses, hypothermia, melena, or collapse.

A thorough diagnostic investigation is encouraged to establish a database of potential clues for Addison’s. Initial screening tests may include CBC, CHEM, venous blood gas (VBG), UA, fecal ova/parasites, electrocardiography, thoracic radiography (CXR), and abdominal sonography (AUS). Byers also recommends the use of basal cortisol levels in screening tests for Addison’s due to its high negative predictive value.

“If you want to confirm Addison’s disease, you’ve got to do the ACTH stimulation test,” Byers said. “While the normal patient will experience an increase in their cortisol via stimulation with cosyntropin, the Addisonian patient will experience a flatline, just like we documented for Rumble.”

ACTH stimulation tests are considered the gold standard for diagnosing Addison’s. The test is conducted in 3 steps:

Administer synthetic ACTH (cosyntropin), 5 ug/kg IV

Collect a post-cosyntropin cortisol sample after 1 hour

Cortisol levels <2 ug/dl (<55 nmol/L) before and after ACTH stimulation are consistent with Addison’s disease.

There are 4 main points for the treatment of Addison’s disease: fluid therapy, correction of electrolyte abnormalities, all dogs need glucocorticoid replacement (typical/primary and EEA/secondary), and some dogs need mineralocorticoid replacement (typical/primary). In general, the interventions required for patients are largely dependent on their individual presentation. Stabilization is necessary for patients presented in shock—or Addisonian crisis. Available stabilization therapies include intravenous fluids, calcium gluconate, and regular insulin and dextrose supplementation to address a variety of individual issues.

Byers offered brief tips regarding the administration of fluid therapy:

If a patient is hypotensive (from hypovolemic shock), they require a fluid bolus or a fluid challenge for the restoration of intravascular volume.

If a patient is no longer in hypovolemic shock, their fluid therapy needs should be reassessed by calculating their hydration status and their daily physiologic requirements.

He does not recommend twice maintenance, calling it dangerous, as it may not address hypovolemia, or it may be too much. He also advises that “maintenance is a type of fluid, not a rate of fluid.”

For the treatment of hyperkalemia, Byers recommends the use of calcium gluconate only to buy more time for fluid therapy. Dextrose, insulin, sodium bicarbonate, and terbutaline may also be for hyperkalemia. Glucocorticoid supplementation is key for all Addisonian patients. Initially, supraphysiologic supplementation with dexamethasone (0.05 to 0.07 mg/kg IV q24 hr) is recommended. Once the patient is cardiovascularly stable, and willing to eat and drink, they should be transitioned to prednisone at supraphysiologic doses (0.3 to 0.45 mg/kg PO q24 hr) lifelong. Doses should be adjusted based on clinical signs and any side effects.

Mineralocorticoid replacement is required for patients with primary Addison’s. Patients can be prescribed oral deoxycorticosterone pivalate (2.2 mg/kg) or fludrocortisone (0.01 mg/kg PO q12 hr) administered via injection every 25-30 days.

Regardless of electrolytes, Addison’s disease needs to be on the list of differentials anytime a sick dog is presented. Practitioners need to keep an eye out for red flags that may signal the presence of Addison’s, which could start by identifying an at-risk breed the second they walk through the clinic door. The ACTH stimulation test is the gold standard for Addison testing. If it’s recognized and treated, dogs who survive the initial crisis period have “an excellent prognosis, if managed properly,” said Byers.

Byers C. Is That a Zebra? Yup, It’s Addison’s Disease. Presented at: Fetch dvm360 Conference; August 23-25; Kansas City, MO.

Addison’s disease, and why it should be added to every differential list, was discussed in a session at the 2024 Fetch dvm360 Conference in Kansas City

Could it be Addison's disease?

Detweiler and Weinstein explain why veterinary professionals think logbooks are tedious, and how to get the whole team involved in helping make the progress easier

Video interview with Kelley Detweiler and Dr Peter Weinstein 

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at the Fetch Kansas City conference in Kansas City, Missouri, Kelley Detweiller, and Peter Weinstein, DVM, MBA, explain why veterinary professionals most likely feel like keeping up with their logbooks is tedious, and how DEA registrants within clinics can make the process easier for themselves and their clinic. 

: The problem is, if you think it's tedious and you don't do it, you're at high risk of exposure, which could be a fine, or it could be a loss of license. So the way to get around tediousity, and I don't know if that's a word, but I'm using it anyhow, is to learn how to use your staff and delegate appropriately and legally, and have them do as much as they can within the guidelines of the DEA and Kelley is also big on advocating for staff delegation is what can staff do to help decrease the tedious

: What you want to do is you have to put in the time and the work to memorialize standard operating procedures processes, and then you have to train your personnel on them, because it's not possible to be everywhere at once. These DEA registrants who are practitioners, they cannot do everything but their license and their livelihoods depend on the ability to have the right records in place. So teach, train, and empower your team to work for you, but you [have] got to put in the work.

Tackling the tedious logbook

Veterinary organizations and schools play a key role in shaping the future of animal care and welfare. These organizations may be guided by leaders who drive initiatives and policies. Effective leadership in this field can improve the quality of pet care while supporting the professional growth of employees and student learners. Moreover, a good industry leader can create a culture of innovation and ensure their institution stays aligned with the latest developments in animal health and veterinary education.

Several veterinary organizations and schools have announced new promotions and appointments recently. Below are some of those individuals advancing in their careers.

Jarrod Kersey, vice president of food safety and quality assurance, Alphia

Alphia named Jarrod Kersey, MS, MPA, PhD, as its vice president of food safety and quality assurance.

 As vice president of food safety, Kersey will focus on safety and quality standards for Alphia’s products, playing a key role in ensuring overall product safety, quality, and compliance with regulations, according to the company.

 Kersey assumed his new role on September 4, 2024.

“It is an honor to join the Alphia team and to continue my career working with a pet food manufacturer that values food safety, and quality,” said Kersey in a news release.

“Providing safe and healthy food for pets and protecting the family that loves them is my number one priority. I am thrilled to start this next chapter with Alphia.”

Kersey brings more than 20 years of experience in the pet food industry. In his new position, he will also oversee supplier management and safeguard the brand's reputation by ensuring that products align with customer standards.

Kirsty Husby, DVM, MS, DACVS (LA), senior technical services veterinarian, PetVivo Holdings, Inc

Kirsty Husby, DVM, MS, DACVS (LA). (Photo courtesy of PetVivo Holdings, Inc)

Kirsty Husby, DVM, MS, DACVS (LA), recently stepped into the role of senior technical services veterinarian for PetVivo Holdings, Inc. Husby joins PetVivo with more than 10 years of experience in animal health. Her background includes clinical practice and research as a board-certified equine surgeon, small animal veterinarian, clinical instructor, and medical director/managing veterinarian at animal clinics and educational institutions like Columbia Equine Clinic, Cascade Animal Clinic, Banfield Pet Hospital, and the Oregon State University Department of Clinical Sciences.

“I’m excited to join the PetVivo team at this pivotal point in its growth and development, and assist in demonstrating the powerful therapeutic benefits of Spryng [with OsteoCushio Technology],” said Husby in a news release.

 “As an expert technical resource for veterinarians, my mission will be to improve the quality of life and restore the athletic ability of horses, dogs and other animals living with osteoarthritis and other lameness issues with effective use of Spryng.”

Andrew M Hoffman, DVM, DVSc, DACVIM, University of Pennsylvania School of Veterinary Medicine dean

Andrew M Hoffman, DVM, DVSc, DACVIM. (Photo courtesy of University of Pennsylvania School of Veterinary Medicine and 

Andrew M Hoffman, DVM, DVSc, DACVIM, will be continuing his term as the Gilbert S Kahn dean of the University of Pennsylvania School of Veterinary Medicine (Penn Vet). His service will continue until June 30, 2030 and is subject to approval by the Board of Trustees, per a news release.

“Hoffman is an empathetic, visionary, and effective leader who will steer the school to continued success,” J Larry Jameson, interim president of the university, said in the release.

 “His first term has been marked by substantial enhancements to the educational, clinical, and research strengths of the Penn Vet community.”

In March 2024, the university’s Consultative Review Committee began evaluating Hoffman’s first-term accomplishments and the challenges facing Penn Vet. They praised his successful reaccreditation efforts; advancements in diversity, equity, and inclusion initiatives; and establishment of interdisciplinary research programs. The Committee also noted his commitment to curriculum redesign, strong funding records, and innovative dual-degree programs.

Kayla Henderson, DVM, president elect, Colorado Veterinary Medical Association

Kayla Henderson, DVM. (Photo courtesy of the Colorado Veterinary Medical Association). 

Earlier this month, officers of the Colorado Veterinary Medical Association (CVMA) took part in an installation ceremony led by Michael Lent, DVM, district IX director of the American Veterinary Medical Association’s (AVMA) board of directors. During the meeting, 2024-2025 CVMA officers assumed new roles.

Among those elected was Kayla Henderson, DVM, named president-elect for the board. Henderson currently serves as the secretary/treasurer for the CVMA and holds various positions on local and state boards. Her interests include equine medicine, reproduction, lameness, herd health care, and general small animal practice, as well as teaching and mentorship.

Henderson graduated from Colorado State University in 2008 with a bachelor’s degree in equine science and business administration and earned her DVM in 2012. After volunteering at Alpine Vet Hospital as a teenager, she joined the hospital as an associate veterinarian in 2012 and became an owner and partner in 2019, according to the CVMA. Henderson is passionate about all aspects of rural mixed animal practice and advocates for the profession and lifestyle at state and national levels.

Rod Christmas, DVM, MS, DACT, chairman, National Association for Biomedical Research board of directors

The National Association for Biomedical Research (NABR) recently announced the appointment of Rod Christmas, DVM, MS, DACT, as chairman of its board of directors. Currently, Christmas is the chief veterinary officer and institutional official at Boehringer Ingelheim, where he oversees NABR’s global animal welfare program. Christmas has more than 2 decades of experience in laboratory animal health, working as a private mixed animal practitioner, a professional services veterinarian, and a professor of veterinary medicine, according to an organizational release.

"I am truly honored to accept the position of chairman for NABR's board of directors. As the only national nonprofit organization solely dedicated to sound public policy for the essential use of laboratory animals in biomedical research, NABR plays a key role in ensuring the voice of the biomedical research community is well represented in the halls of congress, state, and local legislatures. I look forward to contributing to NABR's essential work on behalf of the research community as chairman of the board,” expressed Christmas in the release.

Alphia names new vice president of food safety & quality assurance to leadership team. News release. Alphia. September 4, 2024. Accessed September 20, 2024. 

https://www.businesswire.com/news/home/20240904246952/en/Alphia-Names-New-Vice-President-of-Food-Safety-Quality-Assurance-to-Leadership-Team

PetVivo meets growing demand for Spryng with appointment of veterinary surgeon, Kirsty Husby, as senior technical services veterinarian. News release. PetVivo Holdings, Inc. September 9, 2024. Accessed September 20, 2024. 

https://www.globenewswire.com/news-release/2024/09/09/2942973/0/en/PetVivo-Meets-Growing-Demand-for-Spryng-with-Appointment-of-Veterinary-Surgeon-Kirsty-Husby-as-Senior-Technical-Services-Veterinarian.html

Andrew M. Hoffman reappointed dean of Penn Vet. News release. 

. September 12, 2024. Accessed September 20, 2024. 

https://penntoday.upenn.edu/news/andrew-m-hoffman-reappointed-dean-penn-vet

2024-2025 CVMA officers assume new roles. Colorado Veterinary Medical Association. News release. September 7, 2024. Accessed September 20, 2024. 

https://www.colovma.org/cvma-news/2024-2025-cvma-officers-assume-new-roles/

NABR announces new board chair. News release. National Association for Biomedical Research. September 16, 2024. Accessed September 20, 2024. 

https://prnmedia.prnewswire.com/news-releases/nabr-announces-new-board-chair-302249204.html

Check out the latest news in the veterinary industry with these 5 recent position promotions

Paws and profits: Latest veterinary appointments in business and academia

Let’s face it: An election year brings stress, anxiety, uncertainty, and sometimes division among our clients, teams, and families. One cannot miss multiple political stories in the news cycle. The symbiotic relationships we have with our pets and even our patients become even more critical during tumultuous periods such as volatile election years. As we get closer to Election Day, the societal stress level appears to go higher and higher. But one thing is certain: Regardless of which side of the aisle one is on, our pets and our patients need us.

Pets are emotional anchors even for those in the White House. For this reason, I thought it would be fun to take a look back on some of the pets that have graced and waddled through the halls of the White House.

Perhaps the biggest animal lover president was the Father of Our Country, George Washington. Throughout his presidency, he owned foxhounds, coonhounds, an Andalusian donkey (a gift courtesy of King Charles III of Spain),

 a parrot, several horses and stallions, and a greyhound named General Cornwallis.

President John Tyler (1841-1845) owned a horse named The General, a pair of wolfhounds that he imported for his wife Julia, and a canary. When The General died, Tyler had a grave dug on his estate, Sherwood. Over the grave, he had a headstone placed with the following inscription: “Here lies the body of my good horse ‘The General.’ For twenty years he bore me around the circuit of my practice, and in all that time he never made a blunder. Would that his master could say the same! John Tyler.”

President Abraham Lincoln (1861-1865) owned a pig! He also was very attached to his family’s beloved dog, Fido, who stayed home in Springfield, Illinois. Lincoln also owned other dogs, white rabbits, several ponies, and 2 cats, named Tabby and Dixie.

In 1944, Franklin D. Roosevelt was running for his fourth term when rumors surfaced that his Scottish terrier, Fala, had accidentally been left behind during their visit to the Aleutian Islands. After allegedly sending back a Navy ship to rescue his dog, Roosevelt was ridiculed and accused of spending thousands of taxpayers’ dollars to retrieve his beloved pet. At a speech following this incident Roosevelt said, “You can criticize me, my wife, and my family, but you can’t criticize my little dog. He’s Scotch, and all these allegations about spending all this money have just made his little soul furious.”

 What was later called the Fala speech reportedly helped secure re-election for Roosevelt.

Former First Lady Laura Bush celebrated “all creatures great and small,” highlighting the importance of pets to family life at the White House with her 2002 holiday decorations theme. Bush noted that “animals and birds of every description have entertained, befriended, comforted, and worked for presidents and their families,” according to the White House Historical Association. With the assistance of the executive residence staff, the National Park Service, and a team of volunteers, the display truly honored “the endearing role of all dogs, cats, birds, horses, sheep, and even alligators and raccoons in White House history.”

What is so remarkable is how veterinary professionals were needed all the way back to the first presidential days. As human medicine advanced during the past few centuries, so did veterinary medicine. In the 1700s and 1800s, we discovered treatments for cholera, typhoid fever, and tuberculosis. We could then apply those treatments to farm animals to protect them from these same deadly diseases.

In 1863, the American Veterinary Medical Association was established to promote the field. Its purpose was to oversee the advancement of veterinary medicine and its practitioners. The FDA added a veterinary medical branch— now the Center for Veterinary Medicine (CVM)—in 1965 to oversee veterinary pharmaceuticals. The work of the CVM is still essential as it oversees regulations relating to food, medicine, and other products for animals.

The practice of veterinary medicine has been essential for centuries and veterinarians will continue to elevate and uphold our veterinary oath for future residents of the White House. While some pets provided simple companionship, others gained fame. Our profession’s rich past of care for pets in the White House is a true testament to our adaptability and resilience.

We must continue to provide great care to all our patients, for they need us to be their doctor, their advocate, and their voice. Our patients teach us the beauty of unconditional love and the importance of choosing kindness and compassion. Here’s to continuing to provide wonderful care for the future animals in the White House and those in your clients’ homes. We are stronger and more powerful together, as veterinary professionals and as the United States of America!

Barrett MB. Presidential menageries: George Washington, hound dogs, and super mules. Our White House. The National Children’s Book and Literacy Alliance. Accessed August 15, 2024. https://ourwhitehouse.org/presidential-menageries/

. Sterling Publishing Company Inc; 2007. White House pets (1789-1850). Presidential Pet Museum. Accessed August 13, 2024. https://www.presidentialpetmuseum.com/whitehousepets-4/

1944-09-23 FDR Teamsters Union address – Fala. Internet Archive. Accessed August 5, 2024. https://archive.org/details/wwii-radio-archive-torrent/1944/1944-09-23+FDR+Teamsters+Union+Address+-+Fala.mp3

NCC staff. Fala, the dog who helped win a presidential election. Yahoo News. September 23, 2017. Accessed August 13, 2024. https://www.yahoo.com/news/fala-dog-helped-win-presidential-election-180000212.html

White House pets. The White House Historical Association. Accessed August 12, 2024. https://www.whitehousehistory.org/white-house-pets

Retrospective: a brief history of veterinary medicine. Oakland Veterinary Referral Services. September 27, 2019. Accessed August 13, 2024. https://www.ovrs.com/ blog/history-of-veterinary-medicine/

dvm360's chief veterinary officer, Adam Christman, DVM, MBA, uses this year's election as an excuse to reflect on some American (veterinary) history

The amazing POTUS — pets of the United States!

Gianluca Bini, DVM, MRCVS, DACVAA, describes what to do if a heart murmur is detected during a physical exam

Video interview with Gianluca Bini, DVM, MRCVS, DACVAA

During his lecture, 'Don’t Skip a Beat: Anesthesia for Cardiac Patients Made Easy,' at our most recent conference Fetch Kansas City, Gianluca Bini, DVM, MRCVS, DACVAA, discussed with attendees how to manage cardiac patients that were under anesthesia, and what veterinary professionals should do if they hear a heart murmur.

In this post conference interview with Bini, he explains the steps that veterinary professionals should take if they hear a heart murmur during their patients' physical exam, and what teams can do if certain equipment is not available to them when dealing with a patient like this. 

So of course, you're going to look at the whole picture between you know what to get on your physical exam. And of course, like, you know, breed, age, species and that can give you a sort of a hand of what could be. Of course, the gold standard is always to perform an echo. And so refer to a cardiologist or somebody that could [perform] an echo. In reality, of course, some clients can afford that. Some clients can't afford that. And so, you know, although this is the ideal, we don't always have the luxury of having an echo available for us. 

Even just starting with what breeds and age and species, of course, that gives you a pretty good hand of what [it] could be. Of course, it will not tell you that it's a better thing sometimes. But you know, that gives you a pretty good idea.

Videos

So you heard a heart murmur during a physical exam, now what?