Feline cholangiohepatitis syndrome (CCHS) and hepatic lipidosis are 2 of the most common feline hepatopathies.

 Signs of both conditions are mostly varied and nonspecific.

 In these conditions, icterus results from decreased clearance of bilirubin, diarrhea results from portal hypertension or cholestasis, and vomiting results from decreased toxin clearance or direct vagal stimulation.

Hepatic encephalopathy (HE) occurs either from portosystemic shunting

 or is caused by hepatic lipidosis from amino acid imbalance. HE manifests as ptyalism, dullness, ataxia, and/or seizures.4 Polyuria/polydipsia may result from medullary washout (low urea), dehydration, or HE. Dysuria may be noted from ammonium biurate urolithiasis.

 Anesthesia intolerance may result from decreased hepatic metabolism of GABAergic drugs (benzodiazepines). Gastrointestinal bleeding can be seen with portal hypertension or coagulopathy.

The minimum data base should include a complete blood count (CBC), chemistry profile, urinalysis, coagulation testing, and diagnostic imaging. Liver function testing (serum bile acids; ammonia level) is redundant with icterus. CBC may reveal target cells and/or acanthocytes caused by altered lipoprotein or cholesterol synthesis and transport. Leukocytosis and/or inflammatory leukogram may be present relative to primary pathology. Heinz bodies are common, with hepatic lipidosis as a result of oxidative stress and glutathione deficiency. Elevated aspartate aminotransferase (AST)/alanine aminotransferase (ALT) are seen with hepatic damage, and elevated alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) are seen with cholestasis. Decreased synthetic function can result in hypoalbuminemia, hypocholesterolemia, hypoglycemia, decreased blood urea nitrogen, and hyperbilirubinemia. Hyperbilirubinuria precedes hyperbilirubinemia and can be an earlier indicator of decreased hepatic function in the cat. Urinalysis may also reveal ammonium biurate and/or bilirubin crystalluria, and lipid droplets are common with hepatic lipidosis.

Subclinical coagulopathies are common, especially with cholestatic hepatopathies like hepatic lipidosis that result in decreased enterohepatic circulation and relative vitamin K deficiency.

Abdominal radiographs may be useful to assess liver size or look for choleliths, but abdominal ultrasound is more sensitive to assess hepatic parenchyma, biliary tree, gall bladder, and adnexal structures.

CCHS has been classified by the World Small Animal Veterinary Association Liver Standardization Project into 4 categories: neutrophilic cholangitis, lymphocytic (non-neutrophilic) cholangitis, destructive cholangitis, and chronic cholangitis associated with liver fluke infestation. CCHS can occur in cats of any age, often with vague signs, acute to chronic, including weight loss, anorexia or polyphagia, lethargy, vomiting, fever, jaundice, hepatomegaly, polydipsia, ptyalism, pallor, nonregenerative anemia, poikilocytosis, and elevated liver enzymes, with or without neutrophilic leukocytosis. It is often seen in conjunction with pancreatitis and enteritis, in which case the term triaditis is used.

Neutrophilic CCHS commonly occurs in younger cats with more acute signs. Biliary/pancreatic inflammation is common, ie, triaditis. CBC reveals neutrophilia with or without left shift. Chemistry profile can reveal a moderate increase in ALT, AST, and GGT; variable increases in ALP and bilirubin; and normal cholesterol unless there is concurrent extrahepatic bile duct obstruction (EHBDO) or diabetes mellitus. Diagnostic imaging may reveal mineral densities, choleliths, regional ileus, sternal lymphadenopathy, biliary tree thickening, biliary sludge, and/or pancreatitis. Primary bacterial infection is common. E coli is the most common isolate, but many bacteria have been implicated.

 Bacteria can be seen on cytology more commonly than histopathology, so cytology of liver tissue imprint and bile may be helpful in addition to histopathology and cultures. Neutrophilic CCHS may transform into lymphocytic CCHS.

Lymphocytic CCHS most commonly occurs in middle-aged to older cats who have been ill more than several weeks and who usually have a predisposing condition such as inflammatory bowel disease, primary cholangitis, pancreatitis, EHBDO, cholelithiasis, cholecystitis, neoplasia, chronic extrahepatic or systemic bacterial infection, or chronic trematode infection. CBC reveals inconsistent anemia, poikilocytosis, and/or lymphocytosis. Chemistry profile and diagnostic imaging findings are similar to those with neutrophilic CCHS. Lymphocytic CCHS requires liver biopsy with histopathology for diagnosis. Samples reveal lymphocytic or lymphoplasmacytic inflammation around the portal triads with fibrous tissue deposition over time. Chronic disease can result in lymphoproliferation, which can evolve into lymphoma, or immune-mediated destruction of the bile ducts, which can cause complete biliary tree occlusion.

Treatment of CCHS should center on management of the underlying concurrent disease if present. Broad-spectrum antimicrobial therapy should be given for 3 to 6 months for neutrophilic CCHS and until biopsies return and based on clinical signs for lymphocytic CCHS. Empiric antimicrobial therapy should include coverage for gram-negative and anaerobic bacteria. Biochemical abnormalities should normalize if disease and bacteria are eradicated. If there is failure to improve, the clinician should consider whether the underlying condition was adequately treated, whether there is chronic infection somewhere, whether there is transformation to lymphocytic CCHS, or whether there is concurrent hepatic lipidosis.

Lymphocytic CCHS is often treated with prednisolone for immunosuppressive and anti-inflammatory effects, but full remission is rare with monotherapy. Concurrent metronidazole can be helpful to modulate cell-mediated immunity and decrease endotoxin. Chlorambucil may be effective in some cases. Methotrexate is used for biopsy-confirmed sclerosing cholangitis. It is important to maintain adequate nutrition to prevent secondary hepatic lipidosis. Fluid therapy should ensure supplementation of B vitamins and maintenance of normal serum potassium. Ursodeoxycholic acid should be given after extrahepatic biliary duct obstruction has been ruled out. Antioxidant therapy with vitamin E and/or SAMe (S-adenosylmethionine) should be implemented.

CCHS can have a very long remission or cure with chronic medical management. The disorder commonly spontaneously cycles, and clinical flare-ups can occur. There are no long-term prospective studies on treatment efficacy. Death is most commonly due to biliary cirrhosis or progression to lymphoma or related to progression of underlying primary pathology (ie, enteropathy).

Hepatic lipidosis is an acquired cholestatic disorder resulting from excessive accumulation of triglycerides in hepatocytes (> 80%). It typically occurs secondary to another disease such as other hepatopathies (ie, cholangiohepatitis), pancreatitis, gastrointestinal disease (ie, irritable bowel disease), diabetes mellitus, respiratory disease (ie, asthma), septicemia, neoplasia (ie, lymphoma), renal/lower urinary disease, cardiomyopathy, hyperthyroidism, anemia, neurologic disease, and/or trauma.

Clinical signs are varied and can include vomiting, anorexia, weakness and/or cervical ventroflexion, history of weight loss, icterus, hepatic encephalopathy, bleeding, diarrhea, hepatomegaly, dehydration, and/or pallor. CBC may reveal poikilocytosis (63%), nonregenerative anemia (22%), Heinz bodies, acute hemolysis, hyperbilirubinemia (95%), elevated ALP (80%), ALT (72%), AST (89%) with normal GGT (if idiopathic/no primary pathology), hypokalemia (30%), hypophosphatemia (17%), hypomagnesemia, prolonged clotting times (25% to 60%), elevated bile acids, hyperammonemia, or elevated serum β-hydroxybutyric acid.

 More than 80% of hepatocytes are vacuolated and lipid filled on cytology. Cytology is important to rule out lymphoma and decrease the odds of significant neutrophilic inflammation, but histopathology may be needed for definitive diagnosis and an optimal long-term treatment plan.

Cats have a unique metabolism, which informs us of certain nutritional supplements in the treatment of hepatic lipidosis. Cats continue to use protein for the production of energy even with low protein availability. They depend on dietary intake of arginine, taurine, methionine, and cysteine; are adapted for a low-carbohydrate diet; have an increased requirement for dietary B vitamins compared with other mammals; and require vitamins A and D from animal tissues. Taurine stabilizes membranes and can reduce hepatic lipid content. Carnitine is an essential cofactor of fatty acid metabolism, urea cycle, and GSH synthesis. Vitamin E protects against oxidative damage. SAMe, a carnitine and glutathione precursor, protects the liver against oxidant injury and is an important cofactor in many reactions. Vitamin B deficiencies may be one of the causes and consequences of hepatic lipidosis, as they are necessary for the synthesis of carnitine and SAMe.

The cornerstone of treatment for hepatic lipidosis is nutrition. Once the patient is stable, feeding tube placement should be considered. It is important to monitor for refeeding syndrome, which occurs from insulin release and intracellular shifting of electrolytes like potassium and phosphorus. Fluid therapy should be supplemented with potassium, magnesium, and phosphorus as indicated, and lactated or acetated solutions avoided. Other therapies should include vitamin K, vitamin E, vitamin B complex, vitamin B12, L-carnitine, SAMe (or N-acetyl cysteine for acute crisis), taurine, and omega fatty acids.

Negative prognostic findings include older age, dullness, weakness, ptyalism, hypoproteinemia, hypoalbuminemia, elevated creatine kinase, hypocholesterolemia, hepatic failure at presentation, anemia, hypokalemia, and lack of aggressive nutritional and supportive care. Survival ranges from 50% to 85%. Decrease in serum β-hydroxybutyrate during hospitalization is associated with survival.

 Hepatic lipidosis is considered frequently fatal without intervention and treatment.

Hepatic sampling is important for diagnosis. Ultrasound-guided liver aspirate and cytology can reveal lipidosis, vacuolar change, or diffuse hepatic neoplasia like lymphoma. Bleeding can be seen from coagulopathy, especially with cholestasis secondary to hepatic lipidosis. Stabilization of the patient and treatment with 2 to 3 doses of vitamin K1 is recommended prior to liver aspiration.

Cholangiohepatitis cannot be diagnosed with liver cytology and requires liver biopsy and histopathology. Ultrasound-guided biopsy has approximately 50% discordance compared with surgical and laparoscopic biopsies, according to the results of one study, and may not give enough tissue to reveal accurate diagnosis or quantitate copper. Surgical biopsies or laparoscopy allow for obtaining large biopsies and assessment of other organs. Liver samples should be submitted for histopathology, cultures (aerobic/anaerobic) with or without quantitative copper analysis, special stains, immunohistochemistry, and/or molecular testing as indicated.

, is vice president of medical excellence and education at Thrive Pet Healthcare, with over 20 years of veterinary experience. A graduate of Colorado State University’s veterinary program in Fort Collins, she completed a small animal rotating internship at Cornell University in Ithaca, New York, and an internal medicine residency at The Ohio State University in Columbus, earning board certification as a small animal internal medicine specialist. Cairns is an adjunct faculty member at Lincoln Memorial University College of Veterinary Medicine in Harrogate, Tennessee, and serves on several boards, including the Chicago Veterinary Medical Association. A dedicated member of the Feline Veterinary Medical Association for 20 years, she has specialized in feline internal medicine, building a subpractice that drew patients from across the US. Cairns is passionate about advancing veterinary education and supporting the profession’s well-being.

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Articles

Understanding feline cholangiohepatitis syndrome and hepatic lipidosis

The icteric cat: diagnosis and treatment of common feline hepatopathies

On this special Pride Month episode of The Vet Blast podcast presented by dvm360, our host welcomes Jennifer Scanlon, LCSW, to talk about the human-animal bond, especially for those in the LGBTQ+ community

From snouts to souls: Celebrating the spectrum of love

This podcast is sponsored by VCA Animal Hospitals.

 readers! To celebrate and recognize Pride Month, this episode of the 

, welcomes Jennifer Scanlon, LCSW, to the show to talk about the importance of the human-animal bond for those in the LGBTQ+ community. Throughout the episode, Scanlon and our host, Adam Christman, DVM, MBA, share personal stories on the impact pets have on emotional well-being, a pet that has had a profound impact on their lives, and how pets can facilitate social interactions and bridge social gaps for LGBTQ+ individuals.

Below is a partial transcript, edited lightly for clarity.

 I think what some of the listeners and...viewers may not know is...we all have a special bond with our pets. We know that they're our companions, or our world. And...the LGBTQ+ community is very, very bonded to them. So, let's chat about that and...[how] pets serve as companions for the community, especially during times of social isolation or even discrimination. We know pets serve as vital sources of our emotional support, connection, and identity affirmation. So, what does that look like from your perspective?

Pets just create a nurturing environment. [LGBTQ+] individuals can truly be themselves, and pets just offer such a comforting and...nonjudgmental presence. The 2 most common words I hear from pet owners that our pets give to us is...unconditional love. So this bond is especially important during difficult times and even very vulnerable times. That companionship actually helps combat those feelings of isolation, discrimination, and even loneliness, and the bonds we have with our pets [are] genuine, right? They're very genuine, and it creates a sense of belonging. 

Every moment they're having with their pets together is just a source of joy and emotional support. So, in a world that can sometimes feel unaccepting, pets serve as allies. And with the work that I do within the community, I often hear...that their pets are often their first allies in their lives. That is powerful, and it just reminds us [of] the importance of pets and how they provide us with love, connection, and acceptance. I just feel like...we can always find light in our pets' presence, and that's just a wonderful thing.

Explore how pets can provide unconditional love and acceptance to clients and veterinary professionals in this special episode of the Vet Blast Podcast.

Pruritus is a frequent presenting complaint in small animal primary care practice. Allergic dermatitis, a common cause of pruritus,has been the most common cause for canine pet insurance claims for over a decade.

 This is inflammation in the skin caused by any allergen and may include hypersensitivity to fleas, cutaneous adverse food reactions, and atopic dermatitis. Atopic dermatitis is a reaction to environmental allergens and can affect up to 15% of dogs.

Pruritus negatively impacts the quality of life of both pets and their family. Because of the numerous potential underlying causes and the complications of secondary infections, these cases can be frustrating for both the veterinary team and clients. Determining the underlying cause, while controlling symptoms and treating secondary infections, can take multiple visits, which requires an investment of both time and finances.

Controlling pruritus is an essential part of the treatment plan, which is often multi-modal. Finding an effective, safe medication to control itch is essential to maximize patient comfort. Compliance is improved when medications work quickly and are cost-effective, especially those needed for long-term use.

Introducing an Option for Canine Pruritus Control

 (ilunocitinib tablets) is a once daily oral medication for the treatment of pruritus associated with allergic dermatitis and contr of atopic dermatitis in dogs over 12 months of age. It breaks the itch-scratch cycle by interrupting inflammatory cytokine signaling pathways through the inhibition of Janus kinase (JAK) enzymes.

In a double-blind, placebo-controlled, randomized, multi-site field study of 268 dogs with atopic dermatitis, owner-reported pruritus was measured using the Pruritus Visual Analog Scale (PVAS) and skin lesions were measured by veterinarians using the Canine Atopic Dermatitis Extent and Severity Index (CADESI-4). Patients receiving Zenrelia had significant improvement in PVAS and CADESI-4 scores at day 28 compared to placebo.

Zenrelia has a boxed warning which veterinarians should read and understand prior to using the product. It’s well-tolerated at label dosages, and its safety for long-term administration at label dose has been demonstrated across multiple studies. The most common adverse effects reported in clinical field trials include vomiting, diarrhea, and lethargy. Laboratory abnormalities identified in the clinical field studies included thrombocytopenia, leukopenia, neutropenia, lymphopenia, eosinopenia, monocytopenia, and decreased RBC count.

Zenrelia has not been studied with concurrent use of corticosteroids, cyclosporine, or other immunosuppressant medications, or in pregnant or nursing dogs.

 Due to JAK inhibitors having the potential to cause immunosuppression, Zenrelia is not recommended in dogs with concurrent severe infection.

How Does Zenrelia Compare to Oclacitinib?

A multi-site, randomized, controlled, blinded, head-to-head study was performed to compare the efficacy of Zenrelia to oclacitinib in 338 atopic dogs. Zenrelia was administered once daily, and oclacitinib was administered twice daily for 14 days then reduced to once daily administration, per label dosing instructions for each drug.

Similar reductions in itch were noted between treatment groups over the first 2 weeks (days 1-14). Zenrelia was as effective as oclacitinib at the primary study endpoint, day 28, based upon improvement in both PVAS and CADESI-4 scores. The rate of adverse events reported were similar between groups. In an optional continuation phase through day 112, Zenrelia showed promising results for pruritus reduction and the potential for clinical remission.

Because Zenrelia does not require a loading dose and is administered once daily, Zenrelia may help improve owner compliance and can be cost effective* for pet owners. Additionally, when oclacitinib dosing is decreased from twice-daily to once-daily dosing, a transient increase in pruritus has been reported, called rebound pruritus.

 Because Zenrelia is dosed once daily from the start, it avoids rebound itch.

The Zenrelia label contains a boxed warning that states: “Based on the results of the vaccine response study, dogs receiving Zenrelia are at risk of fatal vaccine-induced disease from modified live virus vaccines and inadequate immune response to any vaccine. Discontinue Zenrelia for 28 days to 3 months prior to vaccination and withhold Zenrelia for at least 28 days after vaccination.”

It is important to note that this warning is based on a single study of post-vaccine antibody titers that included 8, 10-month-old beagles with concurrent illness (Coccidia) receiving the drug at 3 times the label dose.

Additional studies are needed to investigate serologic response to vaccination in healthy adult patients receiving the label dose of Zenrelia.

Because Zenrelia does not require a loading dose and is administered once daily, Zenrelia may help improve owner compliance and can be cost effective* for pet owners.

Remi was evaluated by her veterinarian following a longstanding history of dermatitis, which started when she was approximately a year or two old. Clinical signs included persistent pruritus and excessive licking of the abdominal area, resulting in raw and irritated skin. Previous therapies failed to deliver adequate control of her symptoms.

According to her veterinarian, Remi is “an example of one of the most frustrating cases” he manages, as available treatment options had consistently failed to resolve her condition. He ultimately prescribed once daily Zenrelia.

During a follow-up evaluation 8 weeks later, Remi’s owner reported that Remi’s itch was effectively under control. Remi’s owner expressed peace of mind in having finally identified an effective treatment, ending the ongoing search for alternatives.

Missy began showing clinical signs of frequent itching and gnawing, particularly around her tail and leg. Suspecting the symptoms were allergy-related, she was evaluated by her veterinarian, who prescribed once daily Zenrelia.

During a follow-up exam 2 months later, Missy’s veterinarian reported that her condition had fully resolved, confirming remission. On evaluation, there was no evidence of active inflammation or skin redness. Her itch level was rated at 0—consistent with that of a healthy dog—and her skin score was also 0. According to her veterinarian, Missy is a “rousing success” on Zenrelia.

Zenrelia is indicated for control of pruritus associated with allergic dermatitis and control of atopic dermatitis in dogs at least 12 months of age.

Read the entire package insert before using this drug, including the Boxed Warning. For full prescribing information call 1-888-545-5973 or visit 

WARNING: VACCINE-INDUCED DISEASE AND INADEQUATE IMMUNE RESPONSE TO VACCINES.

Based on results of the vaccine response study, dogs receiving Zenrelia are at risk of fatal vaccine-induced disease from modified live virus vaccines and inadequate immune response to any vaccine. Discontinue Zenrelia for at least 28 days to 3 months prior to vaccination and withhold Zenrelia for at least 28 days after vaccination

. Dogs should be up to date on vaccinations prior to starting Zenrelia. Do not use in dogs less than 12 months old or dogs with a serious infection. Monitor dogs for infections because Zenrelia may increase susceptibility to opportunistic infections. Neoplastic conditions (benign and malignant) were observed during clinical studies. Consider the risks and benefits of treatment in dogs with a history of recurrence of these conditions. The most common adverse reactions were vomiting, diarrhea and lethargy. Zenrelia has not been evaluated in breeding, pregnant, or lactating dogs and concurrent use with glucocorticoids, cyclosporine, or other systemic immunosuppressive agents has not been tested. 

For full prescribing information see package insert

Davis K. Skin allergies, gastrointestinal disease among most common conditions that prompt veterinary visits nationwide. April 24, 2024. Accessed November 16, 2024. https://news.nationwide.com/ most-common-conditions-that-prompt-veterinary-visits-2024/

Collins B. Atopic dermatitis (atopy). Cornell University College of Veterinary Medicine. Accessed November 16, 2024. https:// www.vet.cornell.edu/departments-centers-and-institutes/ riney-canine-health-center/canine-health-information/ atopic-dermatitis-atopy

Forster S, Boegel A, Despa S, Trout C, King S. Comparative efficacy and safety of ilunocitinib and oclacitinib for the control of pruritus and associated skin lesions in dogs with atopic dermatitis. Vet Dermatol. 2025;36(2):165 176. doi: 10.1111/vde.13319

Olivry T, Lokianskiene V, Blanco A, et al. A randomised controlled trial testing the rebound-preventing benefit of four days of prednisolone during the induction of oclacitinib therapy in dogs with atopic dermatitis. Vet Dermatol. 2023;34(2):99-106. doi:10.1111/vde.13134

*At label dose the average price for a monthly supply of Zenrelia is less than Apoquel. Cost may vary depending on a dog’s weight. [2024 Zoetis Petcare Products Veterinary Price List vs. 2025 Elanco Zenrelia Veterinary List Price] 

Zenrelia, Elanco, and the diagonal bar logo are trademarks of Elanco or its affiliates. PM-US-24-2203.

Finding an effective, safe medication to control itch is essential to maximize
patient comfort. Because Zenrelia does not require a loading dose and
is administered once daily, Zenrelia may help improve owner compliance and
can be cost effective* for pet owners

Zenrelia™ (ilunocitinib tablets): An Innovative, Once Daily Canine Treatment That Targets Itch

A humane society in North Carolina has announced plans to open a $2.5 million veterinary clinic for shelter animals and pets in the upcoming years. Meanwhile, an urgent care as well as an emergency care veterinary facility have opened new locations in Michigan and California, respectively.

Below are those 3 new or upcoming animal care facility openings:

UrgentVet in Canton, Michigan. (Image courtesy of UrgentVet)

UrgentVet has opened a new clinic in Canton, Michigan. The new location offers treatment for non-emergent conditions like limping, gastrointestinal upset, minor wounds and lacerations, and toxic ingestion, combining routine veterinary visits with emergency care.

The clinic features an in-house laboratory, imaging equipment, species-specific exam rooms, and non-slip floors. It is also staffed with Fear-Free Certified professionals and contains pheromone diffusers and soothing lighting. Additionally, its pet enclosures are built from tempered glass from Casco that are 70% quieter than traditional metal cages.

“UrgentVet is crucial because we function as an urgent care clinic. Just like humans, not every pet emergency requires an emergency room, especially if your regular vet is fully booked.” Stephanie Smith, DVM, vice president of medicine for UrgentVet, said in a news release.

 “That’s where UrgentVet comes in, we’re here to provide same-day care for your dogs and cats.”

Papaya Veterinary Care (Los Angeles County, California)

Papaya Veterinary Care recently announced the opening of a new 4000 sq ft location in Culver City, Los Angeles. The facility contains a dedicated dental suite, a “spacious” lobby, surgical and treatment areas, an in-house pharmacy and laboratory, and quiet staff spaces.

“Veterinary care should feel both advanced and deeply human,” Tony Nitido, DVM, executive medical director of Papaya who will lead the new clinic, said in an organizational release.

 “It’s a privilege to open our doors to the Culver City community and deliver the kind of thoughtful, informative care that pet owners deserve. We’re here to build trust, offer guidance, and treat every pet with the most appropriate care tailored to their unique needs.”

Services that the new Papaya clinic in Culver City will offer include spay/neuter and soft tissue surgery, wellness and preventive care, dental cleanings with digital dental x-rays, microchipping and vaccinations, health and travel certificates, and parasite screening and prevention. Additionally, the clinic will also offer urgent care and same-day appointments.

CHHS Veterinary Clinic (Sapphire, North Carolina)

Cashiers-Highlands Humane Society veterinary clinic interior rendering. (Image courtesy of Cashiers-Highlands Humane Society)

The Cashiers-Highlands Humane Society (CHHS) announced it plans to build a new veterinary clinic for shelter animals and publicly-owned pets. The facility will be 2 stories with a 2280 sq ft clinic on the main parking lot level containing 2 exam rooms, a main treatment and dental area with a lab and pharmacy, a surgical suite, a room for pre- and postoperative recovery, x-ray room and isolation area. In the lower level of the building will be a 2280 sq ft apartment with 2 bedrooms and 2 baths for a veterinarian to live onsite. According to CHHS, its shelter manager and assistant shelter manager currently live on campus in 2 of the CHHS “caretaker cottages.”

The clinic will be open to the public 5 days a week and will offer examinations, x-rays, lab tests, surgeries, dentals, pharmaceuticals and preventatives, and more. The initial team is expected to consist of one veterinarian, 2 veterinary technicians, and one office administrator.

“We provide low-cost spay/neuter and low-cost rabies vaccinations for local animals, and our community outreach programs include our free food pet pantry for families facing financial hardship, and our innovative humane education program for children: the CHHS Critter Camp,” said David Stroud, CHHS executive director, in a news release.

 “But having an onsite veterinary clinic that not only cares for shelter pets but also public pets fills the gap to complete our lifesaving mission for local animals and the people who love them.”

The construction of the building is estimated to cost $2.5 million and is expected to open in summer 2027, during the CHHS’ 40th anniversary.

New Canton UrgentVet to Offer After-Hours Veterinary Care. News release. UrgentVet. June 3, 2025. Accessed June 25, 2025. https://urgentvet.com/news/new-canton-urgentvet-to-offer-after-hours-veterinary-care/

Papaya Veterinary Care Opens New Culver City Clinic. News release. Papaya Veterinary Care. June 10, 2025. Accessed June 25, 2025.

CHHS to Open New Veterinary Clinic in 2027. News release. Cashiers-Highlands Humane Society. Accessed June 25, 2025. https://www.chhumanesociety.org/vetclinic#:~:text=Help%20Us%20Reach%20Our%20Goal,200%20Gable%20Drive%20in%20Sapphire.

The latest updates relating to animal care establishments and platforms.

Clinic center: Upcoming $2.5 million veterinary clinic for shelter animals and pets, and more

 Our doctors and technicians struggle with how to respond when we ask history questions and clients say they still have preventives but our records show they do not. How can we have honest discussions instead of confrontational conversations?

 Although most clients are honest, some may lie or provide incomplete answers for many reasons. They may fear being judged, want to please their veterinarians, have an aversion to being lectured, or desire to be seen as good pet owners. To avoid the embarrassment of not knowing how often they give preventives, clients may invent answers. Embarrassment is also an extension of guilt, causing them to claim they gave doses as instructed.

Don’t call out clients for lying, because you may trigger defensive attitudes and shut down communication. Criticizing pet owners will break trust in the veterinary-client-patient relationship. You risk losing clients and opportunities to treat patients.

Here’s how to encourage honest discussions:

. Review the patient’s medical record and identify gaps in adherence to care plans. You may see that a dental treatment was recommended last year but was never scheduled. When checking product purchase history, you may find the client bought 6 doses of preventives 12 months ago but didn’t refill the remaining 6 doses. Knowing adherence gaps up front will help technicians and veterinarians fix them during today’s appointment. Sending online wellness appointment forms with confirmations also allows clients to answer history questions in advance. Your medical team can read answers before appointments, letting you zero in on follow-up questions and saving 10 to 15 minutes of history taking.

“Prep work is one of those simple things that often gets lost in the chaos of a busy day,” Ryane E. Englar, DVM, DABVP, associate professor at the University of Arizona College of Veterinary Medicine in Oro Valley, wrote in her book 

A Guide to Oral Communication in Veterinary Medicine

 “We can set ourselves up for success before we even enter the consultation room if we take the time to prepare. You would not sit for a test cold. You would study first. Each consult is a test that can either make or break a client’s relationship with the practice. ”

ESTABLISH TRUST AT THE BEGINNING OF APPOINTMENTS

. Introduce yourself, shake hands, maintain eye contact, make personal connections, and keep notes about clients’ hobbies, careers, and families—details that make you relatable and a valued adviser.

Small talk—even for just a minute—builds rapport and creates a comfortable and trusting environment. This leads to better communication and improved understanding of concerns, and may improve patient care. Casual conversations let you connect with clients on a personal level, whether through a shared favorite sports team or hobby.

Relationship-centered interactions let veterinarians engage clients in a partnership of care, improving client adherence to recommendations and increasing positive patient outcomes, advises April A. Kedrowicz, PhD, associate professor of communication at North Carolina State University College of Veterinary Medicine in Raleigh, in an interview with 

 She advocates 4 communication skills to promote trust: open-ended inquiry, reflective listening, nonverbal cues, and empathy.

. The close-ended question, “Do you give your pet heartworm disease preventives?” may provide incomplete answers. Instead, ask, “Which heartworm disease preventive do you give your pet, and when did you give the last dose?”

Pet owners who consistently give doses will immediately tell you: “I use <brand> and give it on the 15th of each month.” If clients hesitate before answering, this may indicate inconsistent dosing, another caregiver administers medications, or they may assume a flea/tick product also protects from heartworm disease. “Tell me more about…” is a nonconfrontational way to get them talking.

APPROACH THE SITUATION WITH EMPATHY AND KINDNESS

. Empathy is the ability to understand and share the feelings of others. Gently question inconsistencies while emphasizing the importance of honesty for pets’ well-being. Say, “We both want <pet name> to be protected from heartworm disease and parasites. <Pet name>’s medical record shows that you purchased 12 doses of <brand> 18 months ago, which indicates there may have been 6 months without protection. We know clients sometimes miss or forget a dose occasionally. It’s easy to forget—I’ve done it myself. Did you buy preventives elsewhere or miss doses?”

If the client explains he is buying preventives from an outside pharmacy, you have an opportunity to win back the business and the client’s loyalty. Share the benefits of buying medications from your practice. Say, “Our hospital offers competitive prices and has safe, guaranteed drugs that we buy directly from pharmaceutical companies. <Drug name> has a $__ instant rebate when you buy 12 doses from us. We can refill the medication today, or if you prefer home delivery, we can help you place your first order through our online pharmacy. Which do you prefer?”

In another scenario, the client shares that he is giving preventives left over from a deceased pet. Express empathy for the loss of the pet and then ask about the medication. Say, “We were honored to have cared for <deceased pet’s name> and know you loved and cared for him/her. Let me check the medical record to confirm the dose is the correct size for <current pet name> and the expiration date of the medication. We both want <current pet name> to be protected from heartworm disease.”

. Clients may avoid eye contact, fidget, and nod dutifully in agreement. Nonverbal clues are unreliable, Jeffrey Knuppel, MD, a psychiatrist in Lancaster, Wisconsin, said in an interview with Physicians Practice, a dvm360 sister publication.

 “Lying comes naturally for some people. The truth may cause them more anxiety.” 

It’s easier to read clients if you’ve treated their pets for years. It may be harder to interpret expressions or tone of voice in conversations with new clients or those whom you’ve only seen a few times.

. If your standard of care is to perform an annual heartworm/tick test, you can assess patients’ health and reinforce the medical necessity of testing and preventatives. Say, “It’s OK to share if you are unsure whether you missed a monthly dose. We will perform a heartworm/tick test today. If the test is negative for heartworm disease, we will renew the prescription so you can safely restart medication. We also will help you remember to give the dose every month with a text/email reminder. We want to be your partner in protecting <pet name>.”

FIX COMPLIANCE BREAKS WITH PROACTIVE REMINDERS AND CALLBACKS. 

Relying on clients to remember to refill medications is unreliable. Just as your practice sends vaccine reminders, send refill reminders.

Set up dosing reminders in your practice information management software or third-party reminder service. Include action buttons, which increase click-through rates by 15% over hyperlinks (Table).

 Lead clients’ actions with positive choices of “dose given,” “remind me later,” and “change reminder date.” If clients choose “remind me later,” set up an automation so another text is sent the next day.

If clients fail to refill preventives, call them. As part of morning tasks, client service representatives will run a report of patients whose preventives were empty or expired as of today. Because the daily callback report is short, it will be manageable and easy to consistently complete.

In this scenario, the client bought 6 doses of preventives and is eligible for a refill of the remaining 6 doses. If you talk to the client, say, “Dr <Name> asked me to call you because <pet name>’s prescription for <brand> for flea/tick, heartworm, and intestinal parasite prevention is now overdue. We don’t want <pet name> to be at risk for parasites. Dr <Name> has approved your refill. Do you want us to refill the medication for pickup at our hospital, or shall I text you a link to order through our online pharmacy with home delivery?”

Use the veterinarian’s name to bring credibility and authority to the conversation. Reinforce the medical necessity of parasite protection. Rather than ask, “Do you want a refill?” lead pet owners with the yes-or-yes technique, asking whether they want to get medications at your hospital or through your online pharmacy.

If you get voicemail, leave this message: “Dr <Name> asked me to call you because <pet name>’s prescription for <brand> for flea/tick, heartworm, and intestinal parasite prevention is now overdue. We don’t want <pet name> to be at risk for parasites. Dr <Name> has approved your refill. I am sending you a text now. Let us know whether we should refill the medication and you will pick it up at our hospital. The text will include a link to our online pharmacy if you prefer home delivery. If you have questions, text or call us at <phone number>.”

When your team talks with clients about the use of parasite preventives, remember that you both want the same result—the best medical care for their pets. Honest discussions will help you achieve that goal together.

Need a script for a client conversation? Submit your scenario to info@csvets.com for consideration in future columns.

Best known as the “Queen of Scripts,” 

, knows the right words will lead clients to accept your medical advice, driving patient and practice health. As founder of Communication Solutions for Veterinarians, she teaches practical skills through online courses, conferences, and onsite consulting. Myers’ experience as a partner in a specialty and emergency hospital helped her understand issues that owners and managers face. 

Englar R. A Guide to Oral Communication in Veterinary Medicine. 5m Publishing; 2020.

Kedrowicz AA. Enhancing veterinarian-client relationships with competent communication. Today’s Veterinary Practice. December 8, 2023. Accessed April 1, 2025. https://todaysveterinarypractice.com/personal-professional-development/enhancing-veterinarianclient-relationships-with-competent-communication/#

Schwartz SK. When patients lie to you. Physicians Practice. August 23, 2010. Accessed April 1, 2025. https://www.physicianspractice.com/view/when-patients-lie-you

4. Data on file. Otto. Accessed April 1, 2025. https://otto.vet

Communications expert Wendy S. Myers provides scripts for confident client conversations

When clients lie about preventive dosing

The FDA's Center for Veterinary Medicine announced that it has issued warning letters to Bailey’s Wellness, Holista, and House of Alchemy/Hamet & Love, accusing them of selling unapproved cannabis-derived products, The letters were issued to the companies in question on April 7, 2025, stating that they are marketing and promoting their cannabidiol (CBD) products for uses that are not deemed safe or effective for their intended use under the federal Food, Drug, and Cosmetic Act.

“Under the federal Food, Drug, and Cosmetic Act, products for which therapeutic claims are made must be approved by the FDA to be legally manufactured and marketed. The FDA approval process is how the safety and efficacy of such products [are] demonstrated. Assurance regarding the efficacy and safety of products is obviously important to veterinarians who are considering whether to use them in the treatment of their patients,” the American Veterinary Medical Association explains on its Cannabis Use and Pets resource page.

The letters each addressed the marketing the companies have been doing for a variety of products, including chews, oils, and pellets that suggest unproven benefits across websites and social media platforms. Particularly, the FDA expressed concerns over the selling of unapproved CBD products for food-producing animals.

“In addition to raising potential concerns regarding safety for the animals themselves, CBD products for food-producing animals raise concerns regarding the safety of the human food [meat, milk, and eggs] derived from those animals,” the FDA stated in its letter to Bailey’s Wellness.

“There is currently a lack of data on the formation of residues in edible products of food-producing animals in association with the consumption of CBD products by those animals and on safe levels of any potential residues for the human consumer. We request that you take immediate action to cease the sale of any unapproved CBD products for food-producing animals,” the letter continued.

Holista, which sells products under the name HollistaPet, and House of Alchemy, which sells products under CBD Dog Health, Hamet & Love, and MycoDog, shared similar concerns from the FDA as Bailey’s Wellness.

Within 15 days after receiving the letters, each company is required to notify the FDA in writing of their specific steps to address any violations, including an explanation of each step the companies are taking to prevent recurrence of violations and copies of related documents. If they could not complete corrective actions within the 15 days, they must provide a reason for the delay and when they will be able to submit the needed materials. Any of the companies in question that believe they are not in violation of the act were required to list their reasoning and supporting information for the FDA to take into consideration. 

When receiving a warning letter from the FDA, failure to adequately address the matter can result in legal actions, including, without limitation, seizure and injunction.

FDA issues warning letters to companies selling unapproved CBD products. News release. American Veterinary Medical Association. June 23, 2025. Accessed June 23, 2025. https://www.avma.org/news/fda-issues-warning-letters-companies-selling-unapproved-cbd-products\

Cannabis use and pets. American Veterinary Medical Association. Accessed June 23, 2025. https://www.avma.org/resources-tools/animal-health-and-welfare/animal-health/cannabis-use-and-pets

Food and Drug Administration. Warning Letter to Bailey’s Wellness, LLC dba Bailey’s CBD. April 7, 2025. June 23, 2025. https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/baileys-wellness-llc-dba-baileys-cbd-701066-04072025

The FDA was particularly concerned about the selling of unapproved CBD products for food-producing animals.