Content submitted by Sylvester.AI, a dvm360® Strategic Alliance Partner.

Lexi, a 20-year-old feline, has been under the careful watch of her owner Kristin Wuhrman for over 2 decades. However, Wuhrman isn’t your average cat owner. She brings years of experience working with veterinarians across various sectors, including pet insurance, genetics, pharmaceuticals, and animal welfare. With 4 senior cats under her wing, Wuhrman’s approach to pet care has always been proactive, characterized by regular vet visits, in-home wellness, and close partnerships with pet health professionals, such as Ken Lambrecht, DVM, founder and chief executive officer at Healthy Pet Connect.

Lexi, a 20-year-old feline (Image courtesy of Kristin Wuhrman)

As Lexi advanced in age, her health presented a complex puzzle. Despite Wuhrman’s meticulous care and frequent consultations with a feline expert specializing in micro-dosing methimazole for hyperthyroidism, there were still lingering uncertainties. How do you truly understand a senior cat who has grown adept at masking discomfort?

The introduction of Tably, created by Sylvester Ai, is an AI-powered platform Ken Lambrecht, DVM, recommended for Wuhrman. Its unique ability to interpret Lexi’s expressions and behaviors gave Wuhrman valuable data directly from Lexi’s perspective, giving Lexi a “voice.”

Wuhrman recounts her initial encounter with the platform as eye-opening. Tably confirmed suspicions when Lexi came down with an upper respiratory infection — her discomfort was palpable through the data provided. It was a reality check for Wuhrman, who realized she had a new ally in understanding and managing her cat’s health. This partnership with Tably fostered a sense of collaboration and trust, enhancing Wuhrman’s ability to care for Lexi.

A notable moment came when Lexi was experiencing worsening side effects from her antibiotic. Sylvester Ai’s facial recognition features allowed Wuhrman to communicate effectively with Lexi’s veterinarian, leading to an informed decision to discontinue the medication early. This choice would have been fraught with uncertainty otherwise. Lexi recovered well and was back to her normal self.

Tably also helped Wuhrman manage the health and behavior of her other cats. It reassured her when the AI suggested that one of her cats simply needed space and time—crucial guidance in a multi-cat household.

The benefits of Tably for cat owners and veterinary clinics

Wuhrman believes Tably could revolutionize pet care by establishing baselines for individualized feline behavior patterns, making it easier for other cat owners to spot subtle changes. The technology could also be transformative for vet clinics, potentially preventing health issues through stress reduction, which has been identified as a significant factor in feline conditions like cystitis.

Wuhrman has developed a strong trust in Tably’s AI technology and feels more confident about the future of pet health management. Tably is not just another app for Wuhrman —it’s an essential component of Lexi’s care. She envisions a future where technology like Tably and veterinarians work together for the most accurate remote monitoring, a service she finds invaluable regardless of cost.

Articles

How artificial intelligence technology transformed one senior cats health journey

A senior cat finds her voice 

Creating a safe space for veterinary professionals, clients, and patients is a crucial aspect of working in or owning a veterinary clinic. There are measures taken to ensure that needles are stored and thrown away safely, security systems may be installed, and drugs are kept in proper storage. But when it comes to the psychological safety of the veterinary team, are your team members safe? Josh Vaisman, MAPPCP, CCFP, cofounder of Flourish Veterinary Consulting in Boulder, Colorado, explained the importance of creating a workplace that encourages people to speak up to create a learning environment for everyone during his lecture at the Veterinary Meeting & Expo 2024 in Orlando, Florida.

Many bosses, managers, or owners will tell employees that if there is a problem or a mistake, “Come to me.” However, something that is easily said and done has proven to be a struggle for some. Vaisman explained that even with good intentions of having employees come to you for help, they might be worried about how they will be viewed or judged for an error they made.

“When we have something in our lives that feels like it could damage the impression that other people have of us, our natural inclination is to run away from that. Our natural inclination is to protect ourselves so that we can continue to fit in,” Vaisman said.

He continued, “Because if I look bad to you, you may not want me to be part of the group, and that’s really problematic. That’s what drives this withholding. It’s that impression management, [that] desire to try to manage the impression that other people have of us. Most of these behaviors, most of these things that we’re doing to manage the oppression of others, they’re kind of, if not unconscious, a little bit subconscious.”

Vaisman credits Amy C. Edmondson, the Novartis Professor of Leadership and Management at Harvard Business School in Boston, Massachusetts, with being the creator of psychological safety, defining it as a belief within a team that individuals will not be punished or risk retribution for speaking up with questions, concerns, ideas, or mistakes.

 Vaisman explained to attendees that this is fearless collaboration. It means that when there is an issue or a call for ideas, the employees feel comfortable speaking up.

The veterinary clinic is a team and even though there are times when doctors or practice owners must make a call and that is that, opening the floor to other staff members to hear what they think could lead to better practices being put into place. It also may mean a better understanding of coworkers and more, which can improve the clinic for everyone.

Vaisman concluded his presentation by saying that there is no perfect way to create psychological safety. There will almost always be individuals who have ideas that they do not share, and there will be times that leadership messes up. For Vaisman, it is not about being perfect, it’s about excellence.

“We need high standards for high performance; we should expect excellence from ourselves and each other. I’m using that word on purpose, by the way. I would love to see every single one of us, in both internal and external dialogue, replace the word perfection with excellence,” Vaisman said.

“The problem is when we have an environment that expects excellence or pursuit of perfection and it is not psychologically safe. [This is] what we get. We get people going to work and feeling [anxious] all day, every day, because they’re spending emotional and psychological capital on protecting themselves. We need to reduce that need to elevate the psychological safety to match our standards,” he concluded.

Vaisman J. Safe to soar: the secret sauce of highly effective team. Presented at: VMX 2024; January 13-17, 2024; Orlando, FL.

Psychological safety. Amy C. Edmondson. Accessed January 14, 2024. https://amycedmondson.com/psychological-safety/

Providing a psychological safe place for team members to collaborate creates better workflow and a high standard of care for patients

Fearless collaboration in the clinic

Wherever you are in your veterinary career, looking for a new job can be simultaneously exciting and daunting. There’s a lot to consider—much more than just what kind of work you like and what type of position you want. From geography to lifestyle to workplace culture, many factors influence what position ultimately will give you the greatest satisfaction. Here are some tips to guide you, along with recent data and resources from the American Veterinary Medical Association (AVMA) that can aid you in understanding and reviewing your choices.

The wealth of veterinary job opportunities across the nation makes geography a good starting point for any job search. Certain locations may appeal for personal reasons—like family and social support, climate, recreational opportunities, cultural amenities, and overall quality of life. There also are practical considerations, including the local job market, cost of living, housing expenses, and commuting needs or options. Indeed, the same compensation has different purchasing power and supports a different standard of living depending on where you are.

For help with the practical part, or simply to sate your curiosity, the AVMA’s new online JobFIT tool (avma.org/JobFIT) for job seekers can help. This free tool lets you see veterinary jobs across the country, juxtaposed with local data such as housing prices, cost of living, and more. The information is displayed in map form and you can zoom in to view at the county, community, or even neighborhood level.

Another important factor to consider in evaluating job options is the amount of support you can expect while transitioning into your new role. In fact, mentorship is the No. 1 reason new veterinarians accept a particular job offer

 and it can be an important component of onboarding programs for new team members at any experience level. Both can be key to setting you up for success and happiness in a new role. Therefore, it’s worth asking potential employers (1) whether they have a mentorship or onboarding program, (2) what that program consists of, and (3) when and how your mentorship or onboarding will be revisited and reviewed.

A strong mentorship program starts with an agreement between the mentor and mentee that includes clearly defined goals, such as building the mentee’s skills, confidence, and competency. A strong onboarding program will have a well-defined plan and outline the activities and goals for the employee over a specified period. This should include whatever the newcomer needs to thrive in their role, such as staff introductions, a designated onboarding buddy, a facility tour, clear role expectations, gaining clinical experience, training where needed (eg, new medical records software), and access to the resources needed to perform effectively. Discover what is effective onboarding and how to implement it in the CE webinar, Onboarding on Purpose, at 

. It’s the first in a series that explores how to join a new team and advocate for your needs as a new employee.

For additional support outside the workplace, free mentoring is available to any AVMA member in their first 10 years as a veterinarian through the MentorVet Connect program. Find out more at 

Our earnings and benefits are important to our financial health, job satisfaction, well-being, and ability to pay off any student loans. Yet job seekers and employees alike often are uncertain about what compensation and benefits are appropriate based on skills, qualifications, location, and other factors. Benchmark data can help.

Compensation and benefits can be compared with industry averages or summaries to help you gauge the competitiveness of a job offer or your current compensation. In addition to JobFIT, where job postings may feature potential salary ranges and benefits, these resources can offer important insights:

The AVMA’s salary estimator for early-career veterinarians (avma.org/SalaryEstimator) provides potential salary ranges based on different scenarios. This gives a rough idea of what the average veterinarian in their first 10 years after graduation might receive under specific circumstances.

The AVMA 2024 Report on the Economic State of the Veterinary Profession

—free to AVMA members—includes information on the various types of benefits veterinarians receive and on compensation in various types of roles and practices.

This information is just a start. It is also important to consider what matters to you in terms of lifestyle and other personal preferences. For example, a job seeker with multiple dependents may highly value an employer that provides health and dental insurance covering the whole family. A veterinarian who wants more control over their earning potential may prefer production-based compensation over straight salary. For help navigating the different compensation schemes, visit 

AVMA surveys have shown repeatedly that work-life balance is important to many veterinarians

 and that hours worked can be a pain point, with long hours associated with lower satisfaction and burnout.3,4 Don’t be afraid to seek or negotiate a work schedule that supports your health, well-being, and preferred lifestyle. Flexible work schedules are now featured in many job postings in the AVMA Veterinary Career Center, and some employers even offer remote work.

While negotiating a work schedule, keep in mind that this may impact other aspects of your compensation package. A job seeker who agrees to work 3 days per week will likely find that they’re compensated at a lower rate or receive fewer benefits than someone working 5 days per week.

One final—but critical—factor for job seekers to consider is the people and workplace culture of potential employers. A welcoming, collegial, and supportive environment can go a long way toward fostering your own sense of well-being, belonging, and satisfaction.

Once you have narrowed down your list of job opportunities, a great way to determine which opportunity might be the best fit for you is to spend some time with the employer, getting to know the people who work there, how they interact, how a normal day runs, and how the general workplace culture feels. Be sure to ask for details on team-building efforts and how the team strives to promote diversity, equity, and inclusion.

The AVMA offers several resources that can help employers attract and retain staff.

 To keep wages competitive and promote retention, employers are encouraged to factor in the cost of living in their area (as can be found in the AVMA JobFIT tool).

Bain B, Ouedraogo FB, Hansen C. Wellbeing. In: 

2023 AVMA Report on the Economic State of the Veterinary Profession

. American Veterinary Medical Association; 2023:31-34.

2024 AVMA Report on the Economic State of the Veterinary Profession

. American Veterinary Medical Association; 2023.

AVMA Trust 2022 Trend Report: U.S. Veterinarians’ Work-Life Experience

https://avma.avmaplit.com/acton/fs/blocks/showLandingPage/a/43421/p/p-00d3/t/page/fm/0

Ouedraogo FB, Lefebvre SL, Hansen CR, Brorsen BW. Compassion satisfaction, burnout, and secondary traumatic stress among full-time veterinarians in the United States (2016-2018). 

. 2021;258(11):1259-1270. doi:10.2460/javma.258.11.1259

AVMA Veterinary Economics Division staff. How to attract and keep staff in a job seeker’s market. 

 July 12, 2023. Accessed March 25, 2024. https://www.dvm360.com/view/how-to-attract-and-keep-staff-in-a-job-seeker-s-market

Understanding your choices and reviewing options are important for securing the right fit

5 tips for rewarding job searches

In the world of veterinary practice, where the love for animals meets the demands of running a business, understanding finances becomes crucial. The focus of veterinarians is the well-being of patients and the humans who care for them. However, caring for animals and providing treatments can push discussions about money to the back seat. The discomfort around these talks usually comes from the genuine passion for putting patient care above everything else. After all, most veterinarians chose this profession to heal animals, not to deal with budgets and numbers.

However, avoiding financial conversations can have consequences. It’s not just practice owners; even associate veterinarians stand to benefit from a good understanding of practice finances to ensure the long-term success of the clinic. Every decision we make within the practice—from setting service prices to managing expenses and investing in equipment—has financial implications. Without a solid grasp of these financial intricacies, we risk compromising the very foundation that allows us to provide top-notch care to our patients.

Below are 3 specific scenarios where financial discussions can get uncomfortable in veterinary practice. Shedding light on these situations and offering practical strategies to manage them may empower veterinarians to create balance between compassion for animals and the financial realities of running a practice.

Before delving into the examples, it’s essential to understand the framework of practice revenue allocation. Every dollar generated by the practice ends up in 1 of 5 major categories (we’ll call these the 5 buckets), including the following:

Cost of goods sold (anything related directly to veterinary services, such as medications or sutures)

Operating expenses (business expenses not related to veterinary services, such as rent)

Every decision made within the practice—from equipment purchases to staff compensation—has implications for these buckets and ultimately affects the bottom line. Importantly, 4 of these buckets are expense categories, each removing money from the practice. The last bucket, profit, is the money that’s left for the practice owner as a return on the investments made and risks taken to set up the practice, and it is money that can be reinvested into the business.

If revenue stays the same, every dollar in the practice gets allocated to a bucket. If you want to give the team raises or hire new staff, without an increase in revenue, this will reduce the amount of money available for operating expenses, or it needs to come out of profit. If there’s no profit, the flexibility around spending decisions becomes much harder.

In my work with early-career veterinarians in the Ready, Vet, Go community and mentorship program, I commonly hear about how difficult it is to navigate certain financial situations in veterinary practice. There are many themes that come up time and again, but below are 3 very common ones.

One common scenario is the reluctance to charge clients or an inclination to pass along discounts for certain procedures deemed “quick” or “inexpensive” by veterinarians. This not only undervalues veterinarians and their expertise, but it also has a huge effect on the 5 buckets. For example, the case of a $40 skin cytology being waived or discounted under the guise of being a simple procedure. I do a lot of skin and ear cytology in my practice, and it helps me know how to best treat my patients.

Additionally, follow-up cytology after treatment helps me feel confident that the problem has been resolved, or it makes me change my treatment plan if the problem persists. Cytology can also generate a significant amount of revenue for the practice (if we do 5 per week, that is $10,400 in revenue for the year). We often forget how much is involved in performing this simple procedure, things like materials, equipment, staff time, and training and expertise.

Veterinarians can see that the true cost of performing this cytology extends beyond the nominal fee, encompassing labor, skill, equipment, and overhead expenses. By not charging for this service, veterinarians are not only losing revenue, but they are also costing the clinic money. By failing to charge for such procedures, veterinarians unknowingly chip away at the 5 buckets, jeopardizing the financial stability of the practice. If you discount or waive this fee 50% of the time, that is a loss of $5000.

Many veterinarians approach the topic of raises without fully grasping the financial implications for the practice. I hear this all the time from the early-career veterinarians I work with—they want a raise and feel they deserve one but may not have considered the implications of that raise and what it takes to provide it.

Let’s say you make $100,000 annually and you want to make $120,000. If you ask your boss for that $20,000 raise, they need to figure out where it’s going to come from. I posed this question to Martin Traub-Werner, founder and CEO of VetBooks, and he said, “Let’s say you have a $1 million practice—that money is already divided up into the 5 buckets. If I were the practice owner, I either have to take $20,000 from somewhere, such as letting another employee go, which is a zero-sum game, or you can grow the pie.”

Growing the pie might involve seeing more patients, increasing fees, or doing more procedures—and charging for them. Suddenly, that discount provided to the cytology carries more weight. Without a clear plan to boost revenue, any increase in wages directly impacts the 5 buckets, potentially leading to financial strain for the practice.

Veterinarians returning from conferences or continuing education events often come armed with innovative ideas to enhance patient care. They quickly run into the manager’s office, asking for new equipment, medications, and gadgets. However, requesting new equipment without understanding the associated costs can strain the practice’s financial resources.

Let’s consider the example of an end-tidal carbon dioxide monitor for anesthesia monitoring. Although this is invaluable for patient safety, this equipment comes with significant up-front costs, including the machine itself, staff training, and ongoing maintenance. After considering the costs, think about how utilizing this new equipment will increase revenue. How much can you charge for this? How often will you use it? How soon will the equipment be paid off? Once it’s paid off, it’s even more profitable for the practice. You will be much more likely to get buy-in for the new end-tidal carbon dioxide monitor if you have a well-thought-out plan to present to your manager that addresses the costs and financial benefits.

Amid these financial considerations, veterinarians grapple with the tension between providing excellent care for patients and managing practice finances. It’s a delicate balance, where deep compassion for animals and the humans who love them intersects with the realities of running a successful business. Many veterinarians, like me, went to veterinary school because we love animals and want to help them, not because we love business. Understanding the financial implications of our decisions empowers us to make informed choices that benefit both our patients and our practices.

, then-4-year-old Dani Rabwin, DVM, wrote that she wanted to be a trapeze artist or animal doctor. She decided against the circus, and today Rabwin is a veterinarian, communication coach, and mentor. She is the founder of Ready, Vet, Go, a remote veterinary mentorship program and community that supports new and early veterinarians, and complements the clinical mentorship that practices provide to their new associates. She graduated from University of California, Davis, and completed an internship at Michigan Veterinary Specialists. She feels privileged to be able to help veterinarians thrive in this profession that she loves so much.

Navigating financial conversations in veterinary practice

Balancing care with capital

Texas A&M School of Veterinary Medicine and Biomedical Sciences (VMBS) researchers recently discovered that proton pump inhibitors (PPIs), commonly used to treat acid reflux and heartburn in people and animals, could potentially be effective at fighting cancer and other immune disorders in dogs.

 These findings are also building on similar ongoing research in human medicine.

“While we can’t use PPIs alone to treat cancer, we’re hopeful that we may be able to improve the effectiveness of chemotherapies by combining them with PPIs sometime in veterinary medicine in the future,” explained Emily Gould, DVM, MS, DACVIM (SAIM), PhD, an assistant professor in the Department of Small Animal Clinical Sciences at VMBS, in an organizational release.

 “Using them at certain stages of cancer treatment may improve treatment success.”

According to the release, proton pumps are considered “channels" that regulate how different molecules are distributed throughout the bodily systems.

 Although they have been designed to govern stomach acid production, recent research suggests these medications could also affect other types of pumps within the body, including immune cells or cancer.

A study that was recently published in the journal 

Veterinary Immunology and Immunopathology 

investigated which cellular systems affect PPI, with hopes the findings will give both human and animal medicine experts a more holistic understanding of PPI effects.

 The researchers found that their work demonstrated treatment of neoplastic in vitro MCs from multiple species with esomeprazole, more so than famotidine, alters cell structure, induces significant cytotoxicity, and could even alter murine mast cells.

“Cancer cells have their own microenvironment; acidic conditions help drive inflammation and metastasis — the growth of additional cancer tumors,” said Gould.

“They have their own proton pumps called vacuolar ATPases, or V-ATPases, that, among a lot of other factors, help create those acidic conditions. Our research suggests that PPIs might inhibit these pumps in addition to the ones in gastrointestinal cells.”

V-ATPases are one mechanism some tumors will use to assist cancer cells in resisting chemotherapies, in addition to a pro-tumor microenvironment. Gould explained combining PPIs with chemotherapy could make the treatment more successful because it could potentially turn off or stop the ability of cancer cells to resist chemotherapy.

However, using PPIs to treat cancer has its challenges. For example, PPIs appear to inhibit proton pumps inside immune cells, including mast cells. The researchers at Texas A&M believe that timing would be a crucial element in using PPIs in cancer treatment.

“Mast cells, and other innate immune cells, also have V-ATPase pumps, and they play a role in regulating when the white blood cells release critical molecules that help fight off disease and inflammation. They keep many of these molecules in what are called granules — they’re basically little toolboxes inside the white blood cells. We think that PPIs can inhibit some white blood cells from using their toolboxes effectively,” said Gould.

“Other types of white blood cells don’t have those toolboxes, but that doesn’t mean PPIs aren’t affecting them, likely via several different mechanisms. That’s something we want to examine in future studies,” she continued.

PPIs have been used to help human and animal patients manage gastrointestinal problems like acid reflux, but there is still a lot researchers do not know about this family of drugs. At this time, Gould is running clinical trials for dogs with mast cell tumors on their skin to determine if PPIs have a positive effect in reducing the adverse effects of their cancer. Anyone interested in learning more about the trial can visit the Texas A&M’s Department of Small Animal Clinical Sciences.

“PPIs can do more than just manage pH levels in the stomach. For example, they also have anti-inflammatory and antioxidant properties. This project really began because we wanted to better understand the drugs that we prescribe very commonly in veterinary medicine. Then we read about the studies being done in human medicine with PPIs and cancer and decided we need to see how they might translate to helping dogs,” Gould concluded.

Price C. Common heartburn medications may help fight cancer and other immune disorders in dogs, Texas A&M researchers find. Texas A&M Today. Published May 23, 2024. Accessed May 24, 2024. https://today.tamu.edu/2024/05/23/heartburn-medications-may-help-fight-cancer/

Gould EN, Szule JA, Wilson-Robles H, Steiner JM, Lennon EM, Tolbert MK. Esomeprazole induces structural changes and apoptosis and alters function of in vitro canine neoplastic mast cells. 

. 2023;256:110539. doi:10.1016/j.vetimm.2022.110539

A study conducted by researchers Texas A&M showed proton pump inhibitors could increase the effectiveness of chemotherapy 

Heartburn medication potential key to fighting cancer and immune disorder in canines 

Canker, or proliferative pododermatitis, is a disease process resulting in chronic hypertrophic proliferation of hoof tissues. Canker typically starts with the frog but can expand to involve the bars, sole, and hoof wall in more severe cases. Wet conditions are thought to predispose to the development of canker; but, it can be seen in horses with access to clean, dry conditions as well. An infectious process has long been hypothesized as a primary or contributing factor in canker development; however, a causal connection between pathogens and disease has yet to be identified. Some examined infectious causes include Treponema bacteria or bovine papillomavirus.

Draft horses are overrepresented; however, canker can occur in any breed in 1 or multiple hooves. Often the first symptom of canker is difficulty for the farrier picking the hooves, likely due to the horse’s discomfort when canker tissue is manipulated. The frogs on these horses may bleed when getting cleaned, and there may be areas that appear wet or exudative, which can lead to a misdiagnosis of thrush. However, thrush is a destructive process, while canker results ultimately in tissue proliferation, which may not be apparent early in the disease process. As canker progresses, you may see small areas of red or white tissue with a soft texture, unlike the surrounding keratinized frog. Continued growth may show finger-like tissue projections, classically described as a cauliflower-like (

 Canker tissue may be accompanied by a foul odor and caseous white exudate.

 Lameness may or may not be present depending on the extent of affected tissue and whether it contacts the ground, but more often, horses will resent palpation or manipulation of the tissue, often quite significantly or violently.

. Examples of canker presentation. A) A draft horse with soft, white, proliferative tissue within the central sulcus of the frog. B) A mix of white to pink soft tissue on the abaxial aspect of the frog. C) A light breed horse with diffuse soft, unkeratinized tissue along the length of the frog, which bled easily with manipulation. D) The same hoof as depicted in C; however, after cleaning, white frond-like tissue could be appreciated within the central sulcus of the frog as well.

Diagnosis of canker is typically made based on clinical signs but histology can be used to confirm the diagnosis. Histologically, this tissue appears as chronic hypertrophic pododermatitis. Culture often reveals a mix of environmental bacteria and does not yield additional insight.

Multiple modalities of treatment have been described and used with varying success. Resolution typically requires a multimodal approach, and it has been the author’s experience that the need for several therapeutic sessions

should be anticipated and conveyed to the owner prior to starting therapy. Sharp debridement appears to be key in most cases for successful treatment. This can be performed under general anesthesia or with local anesthesia as a standing procedure. An Esmarch tourniquet will improve visualization of affected tissue. Sharp debridement should be continued down to healthy frog corium, which can be recognized by a change in color and texture; canker tissue is soft and spongy to the touch, while healthy corium will have a firmer texture (

). Although it is inadvisable to debride excessively, more often inadequate debridement occurs, and any remaining abnormal tissue will proliferate again rapidly. The author typically applies a heavy pressure bandage following debridement as the tissue will continue to bleed, and follows up with additional therapy beginning 24 hours after sharp debridement.

. The same hoof as depicted in figure 1 C and D following sharp debridement. The healthy corium can be seen as the pink bleeding issue, which had a firmer texture than the initial canker tissue.

Cryotherapy can be a useful adjunctive therapy in the management of canker and is often recommended following initial sharp debridement. A series of 2 to 3 freeze-thaw cycles over the entire affected area should be performed. Topical therapy is another commonly used adjunctive therapy. The most used topical is 10% benzoyl peroxide in combination with metronidazole. This topical therapy helps to dry out the tissue surface and reduce the microbial burden of healing tissues. Hoof bandages and topical therapy should be changed daily to every other day.

The author prefers to maintain patients in hoof bandages for the first week or so until additional sharp debridement is unlikely, as it can be difficult to work around a shoe. However, a hospital plate shoe should be applied for continued therapy as the hoof can be kept cleaner and drier than what can be maintained with a hoof bandage. This disease necessitates a good working relationship with the patient’s farrier, who will be providing care through a hospital plate and can be key in monitoring for evidence of canker regrowth.

Oral prednisolone has been described in literature as an adjunctive therapy. The author has found it helpful in reducing the duration of initial therapy and the risk for recurrence in horses without contraindication for systemic steroid use. Current recommendations for prednisolone therapy involve an initial dose of 1 mg/kg once daily, followed by a tapering course over 3 to 4 weeks.

The prognosis for canker is considered guarded but is more favorable with aggressive therapy. The author prefers to keep patients hospitalized for the first 2 to 3 weeks as repeated sharp debridement and/or cryotherapy is commonly needed, which can be performed immediately if new canker growth is noted while in the hospital with daily bandage changes. The owner should be made aware prior to starting therapy of the high likelihood of a long therapeutic course and the potential for recurrence in the future.

Early and aggressive treatment of canker, prior to extensive abnormal tissue growth, improves both the short- and longterm prognosis; however, prognosis remains guarded. Horses with a recent change in allowing their hooves to be handled should be closely examined for abnormal tissue growth, as early canker may be difficult to recognize.

A multimodal treatment approach, ideally in a hospital setting where close monitoring and additional therapy are possible, appears to provide the most successful outcome. Owners should be made aware up front of the time commitment along with the guarded prognosis even with appropriate therapy, and close continued communication among owner, farrier, and veterinarian are key to ultimate success.

Marcekova P, Mad’ar M, Stykova E, et al. The presence of 

. in equine hoof canker biopsies and skin samples from bovine digital dermatitis lesions. 

. 2021;9(11):2190-2200. doi:10.3390/microorganisms9112190

Sykora S, Brandt S. Occurrence of Treponema DNA in equine hoof canker and normal hoof tissue. 

. 2015;47(5):627-630. doi:10.1111/evj.12327

Brandt S, Schoster A, Tober R, et al. Consistent detection of bovine papillomavirus in lesions, intact skin and peripheral blood mononuclear cells of horses affected by hoof canker. 

. 2011;43(2):202-209. doi:10.1111.j.2042-3306.2010.00147.x

Redding WR, O’Grady SE. Nonseptic diseases associated with the hoof complex: keratoma, white line disease, canker, and neoplasia. 

. 2012;28(2):407-421. doi:10.1016/j.cveq.2012.06.006

Early treatment and a multimodal approach can help improve patient outcomes