Behavior issues are one of many significant concerns veterinary professionals and clients have regarding patients. Because of this, veterinary professionals are going to be faced with questions regarding behavioral issues regularly, and some may not be confident in answering behavioral questions, leading them to reach out to a behaviorist for help.

During her day 2 keynote address at Fetch Kansas City, Lisa Radosta, DVM, DACVB, shared multiple questions that she has received from general practitioners, ranging from shock collars to combining medication, to help general practitioners be better prepared to answer these questions if they come their way.

Question #1: I don’t ever recommend shock collar training for my patients. Am I wrong to take this stand?

In the presentation of this question, Radosta shared the ‘texts’ from a general practitioner who had a client tell her the patient had just finished a shock collar training course for her dog and did not consult the veterinarian about it. To Radosta, she said that the general practitioner is really asking if she should be recommending shock collars for her canine patients. Like any other potential treatment, the sciences need to be listened to and followed to solidify the standard of care.

“The consensus of [the] experts...is based on scientific literature that shock should not be used in training. It's not based on my opinion...it is science. So, if you ignore the science, welcome to the state board and someone testifying against you. That is the bottom line; follow the standard of care,” explained Radosta.

Radosta added that there is a lot of literature stating to avoid shock as a training tool for dogs due to adverse effects including increased fear, anxiety, injury, and aggression in dogs. These effects will then persist long after the trainings are completed and within different environments.

IRadosta tells those who ask her about shock collars not to recommend they use them and to follow the science. Instead of shock collars, positive reinforcement is a more effective and humane way to train pets. According to Radosta, veterinary teams should educate clients on the harmful effects of shock collars and that the American College of Veterinary Behavior recommends against using them.

Question #2: Can I safely combine trazodone with NSAIDs, without increasing the risk of gastrointestinal bleeding?

Radosta said that, in reality, the question the practitioners are actually asking is whether or not there is a higher risk of gastrointestinal (GI) bleeds when combining

Radosta explained that the combination of NSAIDs may increase the risk of gastric ulcerations and trazodone, a serotonin inhibitor/antagonist may alter platelet function. The patient has neurons sensitive to serotine in many areas of the body and the blood serotonin is mainly stored in platelet aggregation during clot formation. Because of this, Radosta explained that by inhibiting serotonin reuptake, which happens with any trazodone or serotine reuptake inhibitor, platelet serotonin levels can be reduced by up to 80%. This can potentially then impair clot formation, increasing the risk of a GI bleed.

Radosta mentioned to attendees a recent study that evaluated the effect of trazodone in dogs on hemostatic factors.

 The researchers evaluated buccal mucosal bleeding time, platelet count, platelet aggression, and platelet function testing. They found within the study that there were no significant changes in the buccal mucosal bleeding time, platelet count, or PFA-10 closure time. They did note however that there was a significant decrease in platelet aggression. It is not known at this time if this would cause clinical signs to worsen in a dog with GI ulceration, but the evidence does suggest that there is a risk, but it is small.

To answer this text, according to Radosta, general practitioners can combine them, but they must monitor the patient and warn the client of the risks.

Within her lecture, Radosta provided attendees with real-life scenarios as a way to provide insights educate attendees on practical solutions and provide answers to help those who need it. To close the lecture, Radosta told the crowd she hoped that her lecture gave me a sense of feeling empowered to go out and tackle the behavioral issues at their clinics, and not stop reaching out for help.

Radosta L. Tick Tidbits: Novel Insights & Protection Updates on These Tiny Troublemakers. Presented at: Fetch dvm360 Conference; August 23-25, 2024; Kansas City, MO.

Benjamin EJ, Nelson OL, Baumwart R, Haines J. Adverse effects of trazodone in dogs on primary hemostasis and electrocardiogram: A single-blinded placebo-controlled crossover study. 

. 2023;37(6):2131-2136. doi:10.1111/jvim.16841

Articles

Day 2 of Fetch Kansas City kicked off with common questions behaviorist Lisa Radosta receives, and how she answers them 

Behavioral answers for general practitioners questions

During her lecture, Tick Tidbits: Novel Insights & Protection Updates on These Tiny Troublemakers, Kathryn E. Reif, MSPH, PhD, Bailey-Goodwin Endowed Associate Professor in Parasitology Department of Pathobiology, gave an overview of these annoying arachnids, what they are, where they are, and how veterinary professionals can protect patients.

Ticks are arachnids and are in the same taxonomic class as spiders and scorpions. As adults, they have 8 legs and nymphs, and their body and head are fused. They largely use their Haller’s organ, the tick's first pair of legs, to identify a host. According to Reif, most ticks that infest dogs in the United States are “hard ticks” which is a designation reflecting the scutum, sclerotized cover on the tick’s dorsum. To tell ticks apart, veterinary professionals can use certain simple characteristics of the mouthpart and scutum to differentiate the species that bite people and their pets.

Ticks will only feed typically 3 times in their lifespan, which is 2 to 3 years long, and once in each of their stages of life: larvae, nymphs, and adults. When it comes to ticks that bite patients and clients, they rely on the variety of wildlife species within their local area to maintain populations. Once a tick has found a host, it can live up to 2 weeks on its body while feeding, but most of their lives are spent off the host within their environment.

Once the tick identifies a host, it will then crawl to a favorable spot to begin attaching. The tick uses a combination of hypostome and chelicerae to attach and then reinforces its attachment by dispensing salivary proteins that effectively “glue” the tick to its chosen host. Reif explained that when some clients remove a tick, they see what they think is the host’s skin coming off with it. However, this is the residue of the proteins that glue the tick to the host, not the host's skin.

This process of attaching begins can take up to 24 hours, and once completed, the tick will then salivate a complex mixture of salivary proteins to prepare the feeding lesion, recruit blood to the lesion, and hide its presence from the immune system of the host. Leif said killing or incapacitating the tick during this time period is crucial.

“Once it's attached, it's going to secrete [basically] a pharmacy into the skin of the host, several different pharma-coactive proteins that do a lot of different functions…The first couple of proteins will help dissolve the tissue matrix underneath where [the tick is] embedded and recruit the flow of blood cell adhesion that it's creating. What does blood like to do? Clot, [but] don't worry about that,” explained Reif.

“The tick has 7-8 mount novel anti-coagulation proteins to prevent that blood from clotting. The more that tick is attached to that post, the longer that tick is attached to the host. The pathogens are replicating in their salivary glands, which are in their body. And so more and more and more of those pathogens have the potential to be dispensed as the tick continues. And the tick continues feeding and protecting,” she continued.

Reif went on to also let attendees know that risk factors between humans and animals are shared, meaning if a pet tests positive for a tick-borne pathogen, they have been in an area infected with ticks with their owner. It is exceedingly rare for direct transmission of tick-borne pathogens between patients and clients.

Because ticks can threaten the health of patients and clients, most want to know how to protect themselves and their pets. Veterinary professionals can off multiple strategies, especially tick control products. Reif explained if they live in an area with a high number of ticks, clients should check their body and their pet's body. On dogs, certain areas of the body tick such as ears, under the legs, under the collar, and around the tail to name a few. If an owner finds a tick, veterinary professionals can instruct them to use a pointed pair of tweezers to remove it by grasping it as close to the skin as they can get. Then, pull back with steady and even pressure and follow up with that with washing or disinfecting the bite site. Clients could also be instructed to safely save the tick for testing or evidence of a previous bite.

For tick control in patients, there are multiple safe and effective tick control products available to protect and reduce the patient's risk of developing a tick-borne disease. Collars, topicals, and systemically-acting isoxazoline-containing products are the 3 general categories. Topicals are typically applied to the skin of the pet and then distributed through dermal translocation to provide the pet protection. Collars work similarly with active ingredients moving onto the pet’s skin and then migrating all over the body.

Systemically-acting isoxazoline-containing products can depend on the product. They can either be administered to pets orally or topically applied. Reif told attendees to instruct clients to read the label carefully and work with their veterinary team. For tick control in clients, Reif recommended dressing in light-colored and no patterned clothing to help spot a tick quickly and using acaricide as well as skin repellents such as DEET.

Clients will also need to work with their veterinary professionals on deciding which control option is best for their pet and can make this decision based on lifestyle, owner preference, and risk factors of tick-borne diseases. Reif also mentioned that an important factor that should be taken into consideration is how the product works to quickly kill ticks. The faster the kick is killed, the less likely a tick-borne pathogen will be transmitted.

Ticks can cause health issues in both clients and patients. Giving patients a general overview of what exactly ticks is and how they move, plus discussing some common misconceptions, can help veterinary professionals keep their pet parents and patients tick-free.

Reif K. Tick Tidbits: Novel Insights & Protection Updates on These Tiny Troublemakers. Presented at: Fetch dvm360 Conference; August 23-25, 2024; Kansas City, MO.

It is not news that ticks pose a risk to the health of patients, clients, and staff, but how much do you know about them?

Educating clients on ticks

Dr Michael Q. Bailey describes the power of veterinary professionals 

Interview with Dr Michael Q. Bailey

There is a multitude of medical advancements that have happened thanks to veterinary professionals. For example, Hap Paul, DVM, in the 1990s helped create Robodoc for the human medicine industry. However, many people, including veterinary professionals, might not understand their true potential. So, how do veterinary professionals help themselves and the world understand?

During an interview on-site at the 2024 Fetch dvm360 conference in Kansas City, Missouri, Michael Q. Bailey, DVM, DACVR, AAAS/AVMA, 2024-2025 president elect of the American Veterinary Medical Association, explains how the veterinary profession has so much potential that those in it might not even realize. Once veterinary professionals, and the world, understand their importance and what they can do, it will help begin to shape the future of the profession, he noted. 

Michael Q. Bailey, DVM, DACVR, AAAS/AVMA: 

I think that there are a lot of individuals out there, including veterinarians, but just in general, who do not realize the diversity of veterinarians. And when I say diversity, I mean that culturally, ethnically, as well as intellectually. You put us into an environment, you set us with a problem, and veterinarians can figure out how to solve that problem, but veterinarians are also good team workers.... There's nothing we can't do, unless we're not given the chance to try.

Michael Q. Bailey, DVM, DACVR, AAAS/AVMA, highlights the intellectual and teamwork capabilities of veterinarians

Harness the potential of veterinary professionals

A senior dog recovers from a medical procedure. 

Research has found that rehabilitation is useful for improving the lives of veterinary patients with various orthopedic and neurologic conditions.

 To aid in rehabilitation therapy, proper equipment is needed, and advancing technology and innovation for veterinary use has been robust in 2024. To learn more about some of the ways rehabilitation therapy is moving forward, read the following articles:

New mobility products for the veterinary market

: Walkin’ Pets launched the “Vet Exclusive Line” of new products earlier this year, at the 2024 Veterinary Meeting & Expo in Orlando, Florida. These products included an adjustable splint for lower leg support, training socks to enhance proprioception, a wrist hugger that supports the carpal joint while allowing freedom of movement; and a hock hugger for support of the tarsal joint and prevents hyperextension.

: Domer Technology released 2 new cold laser devices that are used in humans and animals. These laser devices can help manage pain from treat joint, ligament, or tendon injuries; post-surgical or trauma wounds; nerve injury; inflammation; muscle sprains or strains; bone arthritis, fracture, or dysplasia; and more.

: Erchonia recently introduced the first green and violet laser (GVL) for the veterinary market. This GVL is designed to improve outcomes with non-healing wounds, chronic infections, pain and inflammation, postoperative healing, bone healing, anxiety, neurological trauma, and more.

Millis DL, Ciuperca IA. Evidence for canine rehabilitation and physical therapy. 

. 2015;45(1):1-27. doi:10.1016/j.cvsm.2014.09.001

Articles spotlighting 2024 technological advancements for improving outcomes for veterinary patients in need of rehabilitation therapy

3 must-reads on rehabilitation innovation

FidoCure, the flagship brand of the One Health Company, has been granted a patent for a novel targeted therapy and biomarker for canine cancer by the US Patent and Trademark Office (USPTO). The patent covers a new approach to treatment, using mutation profiling to better manage bladder cancer in dogs.

The now-patented approach, driven by artificial intelligence (AI), considers real-world evidence from veterinary clinical data and uses it to determine the ideal methodology for therapeutic treatment. Early data reports suggest the new approach may be more efficacious compared to conventional treatment methods.

“This patent acknowledges the uniqueness of our approach, which has consistently demonstrated that it can transform outcomes for pet dogs with cancer while improving the quality of life for the patients,” Christina Lopes, cofounder and CEO of the One Health Company and FidoCure, said in a news release.1 "Receiving a patent is an important milestone in our mission to increase access to lifesaving treatments for pet dogs with cancer.”

Each year, 6 million dogs in the US are affected by cancer, and many of them by bladder cancer.

 Transitional cell carcinoma (TCC) is the tumor that affects the bladder, and Atlantic Veterinary Internal Medicine and Oncology (AVIMO) approximates that TCC is diagnosed in 80,000 dogs each year.

 Biologically speaking, canine cancer is relatively similar to human cancer, but, according to FidoCure, treatment and care for canine cancer is about 20 years behind humans.

“Bladder cancer [treatment] in dogs is an unmet need,” Gerald Post, DVM, MEM, CACVIM, chief medical officer of One Health, said in a news release.

 “Traditional chemotherapy and radiation therapy are often ineffective, cause toxic side effects, and are expensive.”

The patent, No. 12036281-B2, protects FidoCure’s technology for 20 years following its priority date.1 Lopes, alongside her FidoCure cofounder Benjamin Lewis and other key team members, are named as inventors on the patent. The company currently has an additional 8 pending patents, covering novel therapeutics and biomarkers, and will be seeking approval from the FDA for their products in the near future, according to the release.

FidoCure came together with the goal to improve outcomes for canine cancer patients. More specifically, the founders wanted to put an end to blanket chemotherapy and radiation treatments, regardless of cancer type, citing the use of target therapies in human oncology. They’ve since partnered with a board of medical and veterinary advisors with multidisciplinary knowledge, spanning the fields of human and canine oncology.

Among the company’s achievements is the FidoCure Next Generation Sequencing Test, through which the results allow care providers to better customize treatment options using targeted therapies. In early 2022, 

, a company focused on global pet healthcare innovation, to provide access to the test to its’ veterinary clients throughout the US and Canada.

FidoCure Receives Patent for AI-Driven Drug Development, Accelerating a Novel Portfolio of Precision Therapeutic for Cancer. News release. FidoCure. August 13, 2024. Accessed August 15, 2024. 

https://www.businesswire.com/news/home/20240813574729/en/FidoCure-Receives-Patent-for-AI-Driven-Drug-Development-Accelerating-a-Novel-Portfolio-of-Precision-Therapeutic-for-Cancer

Understanding Bladder Cancer in Dogs. American Veterinary Internal Medicine and Oncology. Accessed August 15, 2024. 

FidoCure. AI Driven Precision Medicine Platform for Canine Cancer. One Health Company. Accessed August 15, 2024. 

One Health Company partners with IDEXX to enhance canine cancer care. 

. January 20, 2022. Accessed August 23, 2024. 

https://www.dvm360.com/view/one-health-company-partners-with-idexx-to-enhance-canine-cancer-care

FidoCure used AI technology to aid in the development of the new oncology drug

Novel, targeted canine cancer therapy receives US patent

Flatbush Veterinary Clinic (Images courtesy of Tim Murphy | Foto Imagery)

Lack of access to veterinary care is one of the major risk factors for pet relinquishment to animal shelters around the United States and Canada. According to a 2020 American Veterinary Medical Association report, approximately 27% of pets did not see veterinarians routinely in 2016.

Many veterinarians and animal welfare groups are working hard to address access to care through multiple avenues. One such avenue is the proliferation of low-cost community veterinary clinics. Some of these clinics use for-profit funding, whereas others are nonprofit. Regardless, they all tend to rely on streamlined services and high-volume models. 

With a high-volume model, it is critically important to maintain quality of care and veterinary care best practices. Care should be provided in an ethical manner that is good for the patients, clients, and care providers. As veterinary architects, we worked with many more of these high-volume, high-quality, low-cost care clinics in recent years. Through this, we learned a lot about how they function, how they need to be designed, and how to keep the costs of construction to a minimum. We will use Flatbush Veterinary Clinic in Brooklyn, New York, to discuss the design of a low-cost care clinic. If a low-cost care model works in Brooklyn, it can work in most locations in the United States, where real estate and construction costs are likely lower.

It is important to visit and talk with other low-cost care clinics, as well as to assemble a team of advisers and designers who are both familiar with and sensitive to the needs of these clinics.

If you are building a business model based on a lower cost of care, the cost of construction must be less than in a typical clinic. Here are some design and construction priorities, as well as areas where clinics can potentially save money.

When performing surgery at high volume, it is even more important to align with best practices. Do not skimp on surgical facilities. Follow the American Animal Hospital Association’s best practices for surgical facilities, as well as the following guidelines: 

Do not replace handwashing with waterless scrubbing, as handwashing removes soiling. Waterless scrubbing can be used in addition to handwashing, but handwashing is still a best practice. 

The surgery room is only for surgery. Large benches and recovery areas should be located outside surgery suites. Sinks, pack and prep, and all other functions should also be outside surgery suites.

Flatbush Veterinary Clinic Surgery Suite (Photo Courtesy of Tim Murphy | Foto Imagery)

Use active gas scavenging for staff safety and follow safety requirements for oxygen delivery to patients. 

Keep patients warm during surgery and recovery. Provide enough HVAC to overcome warming devices, lighting, and other heat loads in surgery and recovery spaces. 

Design an aseptic environment with seamless finishes. 

Provide good lighting and ergonomics so the veterinarians working in high-volume care can do their best work.

Provide enough spaces for staff and volunteers to properly monitor patients during recovery.

Clean and sterilize all instruments properly and provide a good layout for pack and prep with a dirty-to-clean flow.

In a high-volume practice, it is important to reduce stressors. Pet families are already stressed and relying on your help. Thus, we like to see separate flow for dogs and cats, as much separation of species as possible, noise reduction, and areas for staff to take a break so they can continue to provide the best care.

Do not skimp by using that 1995 x-ray machine that you got for free; it is not worth it. A team member or patient will get hurt using old or antiquated equipment. We often take the approach that these types of clinics must spend more money on equipment than other infrastructure. They often have no money for other nice things, but quality equipment will keep everyone working carefully and safely. Equipment also provides an accounting advantage over fixed cabinetry and custom-built items, as it depreciates each year.

Low-cost clinics are best placed in communities where the care is needed most. Expensive locations are probably not accessible to these communities, and expensive buildings will not support the creation of functional business models for low-cost care. Therefore, funky locations are probably fine—just make sure the clinic is on public transportation routes, is easy to get to, and feels safe during the day and at night.

Flatbush Veterinary Clinic Lobby (Photo courtesy of Tim Murphy | Foto Imagery)

You simply do not need it, and fancy architecture can be disrespectful to the clients served and the model being promoted. We keep things simple, clean, and professional. At Flatbush Cats, a photo wall personalizes an otherwise simple lobby space. Although the desk looks nice—if not fancy—we worked hard to select the most inexpensive materials that still provided a nice, professional look.

We often will make decisions such as using plastic paneling in heavy-use rooms instead of tile and using colorful paint instead of expensive wall coverings.

For flooring, luxury vinyl tile or sealed concrete floors can be fine in client areas. In medical zones, we tend to use sheet vinyl, which is both low cost and cleanable.

Do not be afraid to be scrappy. Cabinets and chairs instead of built-in benches from IKEA? Fine.

Flatbush Veterinary Clinic Cat Holding (Photo Courtesy of Tim Murphy | Foto Imagery)

Use cages on wheels rather than built-in versions, as they cost less and are more flexible. You can also use rolling shelf units rather than built-in shelves.

Other unique requirements of high-volume, low-cost clinics

Many low-cost care clinics do not take appointments, whereas others do take appointments but mostly for drop-offs. In either case, there can be large crowds of people showing up at the same time. We have seen people stand in heat of 90 

F for hours with their pets while waiting for $11 vaccines. The number of people who arrive needing care can be astonishing.

Design for crowd control. If possible, have outdoor waiting options. Consider in/ out flow of clients at busy times of the day. Possibly use a crowd management option to limit the number of people in the lobby at any given time. Use examination rooms to move clients in and out of lobby spaces to control flow, even if the pet is taken back to treatment for care. In a perfect model, we would love to collocate a low-cost care clinic adjacent to a large classroom not only for outreach options but also crowd control (within the classroom) for large events such as vaccine clinics.

Although this would not have been possible at Flatbush in Brooklyn, drive-through drop-off/ pick-up models can be useful in other parts of the country. It would be possible to manage crowds via a Jiffy Lube–style design, where spay/neuter clients could pull through enclosed garage bays to drop off their pets.

Surgery must be set up for patient monitoring and high-volume services. We design the following features into these surgical zones:

A direct line between induction table and the surgery room, for direct flow into the surgical spaces, without having to turn or maneuver patients.

Patients should be visible to technicians and doctors from the surgery and surgical prep areas.

Benches and other recovery zones must be abundant, as many patients might be recovering at the same time.

Because low-cost clinics tend to be crowded, monitoring client behavior can become difficult. Ensure that there is a secure back-of-house zone that the clients cannot enter. Keep drugs securely locked up and out of view, including both scheduled drugs per law and expensive pharmaceuticals, such as flea and tick medications. Ensure that the lobby is designed for incidents, includes panic buttons for calling police, and has quick escape routes for customer service staff and clients.

Overall, helping pets whose families cannot afford care can be incredibly rewarding and important work. Spread your message and tell your story, just as Flatbush has done via its social media and design of their space. Bring in light, color, imagery, playful graphics, and other simple and inexpensive design elements to create a welcoming, inclusive atmosphere. Build the space with joy and spend less money during design and construction.


1. Burns K. Pet ownership stable, veterinary care variable. American Veterinary Medical Association. December 31, 2018. Accessed July 2, 2024. https://www.avma.org/javma-news/2019-01-15/pet-ownership-stable-veterinary-care-variable#:~:text=Americans%20still%20love%20their%20pets,visit%20the%20veterinarian%20in%202016.

Like all models of veterinary medicine, low-cost care clinics must be designed with finesse