t view - informa marketsimages2.advanstar.com/pixelmags/vetmedicine/pdf/2014-11.pdf · development...

Social media

INCLUDES THE

November 2014 | Volume 109 | Number 11 | PEER-REVIEWED | dvm360.com

Don’t forget to count!The consequences

of a preventable

surgical complication 346

Journal ScanWhy you should be

looking harder for

CKD in cats 342

Feline diabetesWhat factors infl uence

spontaneous clinical

remission? 344

Idea Exchange▸ A measured way

to keep an eye

on skin masses 360

▸ A super approach

to getting cats

into carriers 360

p351

T e

VIEWfrom

BOTH SIDES

ES519833_vetm1114_CV1.pgs 10.27.2014 20:01 ADV blackyellowmagentacyan

© 2014 Abbott Laboratories. AlphaTRAK is a trademark of Abbott Group of companies in various jurisdictions. AT2-2109

Humans sharea lot of things with their pets.Blood glucose meters shouldn’t be one of them.

Portable blood glucose meters designed for blood glucose monitoring in humans are not validated for veterinary use on pets.

AlphaTRAK is specifi cally calibrated and validated for dogs and cats for accurate readings.

Now with a reduced price, accuracy is affordable for your practice and your clients. With a recommended Starter Kit price of just $70 to pet owners, there is no better time than now to upgrade to AlphaTRAK.

For more information call 866-257-8807 or visit www.AlphaTRAKmeter.com

NOW AT A REDUCED

PRICE

ES521303_VETM1114_CV2_FP.pgs 10.29.2014 00:27 ADV blackyellowmagentacyan

dvm360.com | Veterinary Medicine | November 2014 | 341

Subscriber Services: Call (800) 815-3400 in the United States, or (888) 527-7008 or (218) 740-6477 in Canada; fax (218) 740-6417; or write to: Veterinary Medicine, 131 W. 1st St., Duluth, MN 55802-2065. If you are un-able to connect with the 800 numbers, email [email protected]. Reprint Services: Call 1-877-652-5295 ext. 121 or email [email protected]. Outside US, UK, direct dial: 281-419-5725. ext. 121 Back Issues: Individual copies are available for one year; to order, call (800) 598-6008. Permissions/International Licensing. Call Maureen Cannon at (440) 891-2742. List Sales: Please contact List Account Executive Renée Schuster at (440) 891-2613. Editorial Offices: Write to 8033 Flint, Lenexa, KS 66214; or call (913) 871-3800. Visit our websites: dvm360.com; thecvc.com; industrymatter.com.

MissionVeterinary Medicine is a peer-reviewed journal dedicated

to providing concise, credible, and essential information

on the most common and crucial clinical problems seen

in companion-animal practice.

Editorial Advisory Board

Leading specialists who direct our content and ensure

our editorial quality and integrity

Joseph W. Bartges, DVM, PhD, DACVIM, DACVN

David S. Bruyette, DVM, DACVIM

Barret Bulmer, DVM, MS, DACVIM

John Ciribassi, DVM, DACVB

Timothy M. Fan, DVM, DACVIM

Juliet R. Gionfriddo, DVM, MS, DACVO

Karen A. Moriello, DVM, DACVD

Jennifer Wardlaw, DVM, MS, DACVS

Practitioner Advisory Board

Progressive practitioners who keep our content

practical, timely, and relevant

Mili Bass, DVM, DABVP

Robin Downing, DVM

Corey Entriken, DVM

Wayne L. Hunthausen, DVM

Thomas McCoy, DVM

Melissa M. Mckendry, DVM, DABVP

Fred L. Metzger Jr., DVM, DABVP

Robert M. Miller, DVM

Gary D. Norsworthy, DVM, DABVP

R. Wayne Randolph, VMD

Michael H. Riegger, DVM, DABVP

David Robbins, DVM

Philip VanVranken, DVM

Laura L. Wade, DVM, DABVP

Content Group

Editor/Medicine Channel Director | Mindy Valcarcel

[email protected]

Medical Editor | Heather Lewellen, DVM

Content Manager | Adrienne Wagner

Senior Content Specialist | Alison Fulton

Assistant Content Specialist | Katie James

Technical Editor | Jennifer Vossman, RVT

Consulting Technical Editor | Avi Blake, DVM

Digital Channel Director | Jessica Zemler

Senior Designer/Web Developer | Ryan Kramer

Art Director | Shawn Stigsell

Multimedia Contributor | Troy Van Horn

Advanstar Veterinary

Vice President/General Manager | Becky Turner Chapman

Group Content Director | Marnette Falley

Medical Director | Theresa Entriken, DVM

Director, Electronic Communications | Mark Eisler

Director, The CVC Group | Peggy Shandy Lane

Sales Group

Sales Director | David Doherty

Senior Account Managers, Advertising

Terry Reilly | Chris Larsen

Account Manager, Advertising | Angela Paulovcin

Senior Account Manager, Projects | Jed Bean

Sales and Projects Coordinator | Anne Belcher

Books/Resource Guides | Maureen Cannon(440) 891-2742

List Rental Sales | Renée Schuster(440) 891-2613, [email protected]

Chief Executive Officer | Joe Loggia

Chief Executive Officer Fashion Group,

Executive Vice-President | Tom Florio

Executive Vice President, Chief Administrative Officer

& Chief Financial Officer | Tom Ehardt

Executive Vice President | Georgiann DeCenzo

Executive Vice President | Chris DeMoulin

Executive Vice President, Business Systems | Rebecca Evangelou

Executive Vice President, Human Resources | Julie Molleston

Senior Vice President | Tracy Harris

Vice President, Legal | Michael Bernstein

Vice President, Media Operations | Francis Heid

Vice-President, Treasurer & Controller | Adele Hartwick

Veterinary Medicine (ISSN 8750-7943 print; ISSN 1939-1919 online) is published monthly by Advanstar Communications Inc., 131 West First St., Duluth, MN 55802-2065. One year subscription rates: $60 in the United States and Possessions; $72 in Canada and Mexico; $97 in all other countries. Single issue orders: $18 in the United States and Possessions; $22 in Canada and Mexico; $24 in all other countries. Periodicals postage paid at Duluth, MN 55806 and additional mailing offces. POSTMASTER: Please send address changes to Veterinary Medicine, P.O. Box 6087, Duluth, MN 55806-6087. Canadian GST Number: R-124213133RT001. Publications Mail Agreement Number: 40612608. Return undeliverable Canadian addresses to: IMEX Global Solutions, P.O. Box 25542, London, ON N6C 6B2, Canada. Printed in the U.S.A. © 2014 Advanstar Communications Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording, or information storage and retrieval without permission in writing from the publisher. Authorization to photocopy items for internal/educational or personal use, or the internal/educational or personal use of specifc clients is granted by Advanstar Communications Inc. for libraries and other users registered with the Copyright Clearance Center, 222 Rosewood Dr. Danvers, MA 01923, 978-750-8400 fax 978-646-8700 or visit http://www.copyright.com online. For uses beyond those listed above, please direct your written request to Permission Dept. fax 440-756-5255 or email: [email protected]. Advanstar Communications provides certain customer contact data (such as customers’ names, addresses, phone numbers, and e-mail addresses) to third parties who wish to promote relevant products, services, and other opportunities which may be of interest to you. If you do not want Advanstar Communications to make your contact information available to third parties for marketing purposes, simply call toll-free (866) 529-2922 between the hours of 7:30 a.m. and 5 p.m. CST and a customer service representative will assist you in removing your name from Advanstar’s lists. Outside the United States, please call (218) 740-6477. Veterinary Medicine does not verify any claims or other information appearing in any of the advertisements contained in the publication, and cannot take responsibility for any losses or other damages incurred by readers in reliance on such content. Publisher assumes no responsibility for unsolicited manuscripts, photographs, art, and other material. Unsolicited material will not be returned. Address correspondence to Veterinary Medicine, 8033 Flint, Lenexa, KS 66214; (913) 871-3800; e-mail [email protected]. To subscribe, call toll-free 888-527-7008. Outside the U.S. call 218-740-6477.

ES519837_vetm1114_341.pgs 10.27.2014 20:03 ADV blackyellowmagentacyan

JOURNAL SCAN from the literature to your exam room

342 | November 2014 | Veterinary Medicine | dvm360.com GETTY IMAGES/BANANASTOCK

Why they did itEarly intervention for cats with

chronic kidney disease (CKD)

allows an opportunity to slow

disease progression. Identifying

risk factors for disease devel-

opment before the onset

of clinical signs would

provide clinicians

with clues of an

emerging prob-

lem and facilitate

discussion with

owners about the

need for preemp-

tive screening.

What they didAs part of a retrospective review,

researchers evaluated the medi-

cal records of 1,230 cats from

Banf eld clinics across the United

States that were diagnosed with

CKD between Jan. 1, 2010, and

Dec. 31, 2010. Cats included

in the study had to have been

seen at least once before the

qualifying 2010 visit. CKD was

diagnosed based on a creatinine

concentration > 1.6 mg/dl and

urine specif c gravity (USG).

What they foundBeing a neutered male; having

a thin body condition; having a

history of previous periodontal

disease or cystitis, anesthesia,

or documented dehydration

in the preceding year; or living

anywhere in the United States

other than the northeast were

all found to be risk factors for

the development of CKD. T e

reason for the regional dif er-

ence was not elucidated in the

study. Cats with a previous

history of diabetes mellitus ap-

peared to have a decreased risk

of CKD development.

Body condition and diet were

recorded for a subset of cats.

Among CKD cats and control

cats, thin body condition was

identif ed in 66.3% (396/597)

and 38.4% (167/435), respec-

tively. Pyuria (which was used

as a surrogate marker for the

presence of a bacterial urinary

tract infection) was identif ed in

72% (175/243) of cats with CKD

and 35.8% of control cats, con-

sistent with the known associa-

tion between CKD and bacterial

urinary tract infections. T e

exact cause of the pyuria, how-

ever, was not determined.

Median weight loss in the

preceding six to 12 months

was 10.8% and 2.1% among the

CKD and control cats, respec-

tively, and was associated with

a diagnosis of CKD. Interest-

ingly, there appeared to be no

association between type of

diet (wet or dry) and the de-

velopment of CKD despite the

belief that a dry diet is more

taxing on the kidneys.

Take-home messageT ese early indicators may

provide subtle hints of the need

for increased screening for

CKD before the development

of overt clinical signs. T ese

f ndings are not evidence of a

cause-and-ef ect relationship;

rather they provide a sound

basis for recommending more

aggressive screening among the

older cat population. Specif -

cally, evidence of weight loss

> 10%, which may have previ-

ously simply been attributed to

aging, should now prompt more

aggressive screening for emerg-

ing disease such as CKD. In

older cats, the presence of pyuria

should also prompt bacterial cul-

ture to rule out occult infection.

In cases of asymptomatic

CKD, early intervention with

a therapeutic diet may delay

the onset of uremic signs, may

prolong survival time, and

would be easier to implement

before the development of

CKD-associated gastrointesti-

nal problems.

Greene JP, Lefebvre SL, Wang M, et al. Risk factors associated with the development of chronic kidney dis-ease in cats evaluated at primary care veterinary hospitals. J Am Vet

Med Assoc 2014;244:320-327.

Early signs of chronic kidney disease:

Are we looking hard enough?

T ese “Journal Scan”

summaries were

contributed by Jen-

nifer L. Garcia, DVM,

DACVIM, a veterinary

internal medicine spe-

cialist at Sugar Land

Veterinary Specialists

in Houston, Texas.

Read more summaries

at dvm360.com

/JournalScan.


ES521254_VETM1114_343_FP.pgs 10.29.2014 00:06 ADV blackyellowmagentacyan

Hear all

about it!Listen to Dr. Scott-

Moncrieff explain

why monitoring for

diabetic remission is

crucial by scanning

the QR code

below or by visiting

dvm360.com/

CVC14remission.

CVC highLight

344 | November 2014 | Veterinary Medicine | dvm360.com

A look at which factors might make spontaneous normalization of glycemic control more likely in one of your feline patients. By J. Catharine Scott-Moncrief, MA, Vet MB, MS, DACVIM, DECVIM

A unique feature of

diabetes mellitus in

cats is that some cats

become non-insulin-dependent

after treatment has been initi-

ated. From 17% to 67% of cats

with diabetes mellitus have been

reported to go into spontaneous

clinical remission after insulin

treatment is initiated.1-4

Diabetic remission is usu-

ally defned as normoglycemia

that persists for more than

four weeks without the use of

exogenous insulin,2 although

some studies have defned it as

euglycemia for only two weeks.5,6

Te duration of remission var-

ies, with some cats requiring

insulin treatment again within a

few weeks to months and other

cats remaining in remission for

months to years.

Factors that have been

hypothesized to infuence the

likelihood of diabetic remission

include the duration of diabetes

mellitus, whether the cat initially

presented in a ketoacidotic crisis,

the carbohydrate content of the

diet, the type of insulin used for

treatment, the cat’s breed, the

presence of underlying disease,

and how closely the blood glu-

cose concentration is maintained

within the normal range with

insulin treatment. Stimulation

tests with secretagogues such as

glucagon and arginine have also

been investigated to identify cats

that have residual insulin secre-

tion from the pancreas, but the

presence of glucose toxicosis in

cats complicates the interpreta-

tion of these tests, and they have

not proved useful in predicting

the likelihood of remission.7,8

In a study of factors infuenc-

ing diabetic remission in cats,

remission was found to be more

likely with increasing age and

increasing cholesterol concen-

tration.2 Overall, 21 cats treated

with insulin glargine and 23 cats

treated with Lente insulin went

into remission. A slightly higher

percentage of cats (53%) treated

with insulin glargine went into

remission than cats treated with

Lente insulin (47%).

Influence of dietIt has been proposed that low-

carbohydrate diets increase the

chance of diabetic remission in

newly diagnosed diabetic cats.

A prospective study comparing

a low-carbohydrate, low-fber

diet to a moderate-carbohy-

drate, high-fber diet in 63

diabetic cats showed improve-

ments in glycemic control in

both groups, but there was a

higher rate of remission of dia-

betes mellitus in the low-carbo-

hydrate, low-fber diet.6 Tese

fndings support the clinical

opinion that low-carbohydrate

diets in conjunction with good

glycemic control increase the

likelihood of diabetic remission.

If diabetic remission occurs in

cats, it is most commonly in the

frst few months of treatment.

Influence of insulinIt has been shown that strict

glycemic control is important

in achieving diabetic remission,

and it is clear that diabetic cats

can go into remission with any

insulin (e.g. Lente, protamine

zinc [Prozinc—Boehringer

Ingelheim Vetmedica], insulin

glargine) if good glycemic con-

trol is achieved. Many clinicians

What infuences

in catsdIabetIC remIssIon


CVC highLight

Getty ImAGes/DsGpro dvm360.com | Veterinary Medicine | November 2014 | 345

believe that cats have better

glycemic control with long-act-

ing insulins (protamine zinc or

insulin glargine), so most clini-

cians recommend these insulins

as the initial insulin choice for

treatment in diabetic cats.

It is currently unclear wheth-

er some long-acting insulin

formulations are more likely to

result in remission than others,

or whether the critical factor is

the glycemic control itself. In

a study of 24 newly diagnosed

diabetic cats treated with either

glargine, protamine zinc, or

Lente insulin and fed a low-

carbohydrate, high-protein diet,

a higher rate of diabetic remis-

sion occurred in the cats treated

with insulin glargine than in

the cats treated with protamine

zinc or Lente insulin. However,

because of the limitations of this

study, further studies in larger

groups of diabetic cats are re-

quired to confrm this fnding.5

Influence of clinical presentationAlthough presentation in a

diabetic ketoacidotic crisis was

thought to occur predominant-

ly in cats with type I diabetes

mellitus, suggesting that cats

with diabetic ketoacidosis

should not go into remission, a

recent study documented that

some cats that initially pre-

sented with ketoacidosis can go

into remission with adequate

glycemic regulation and control

of concurrent illness.9

other factorsOther factors that have been

documented to increase the

likelihood of diabetic remission

in cats include1,2

> A short duration of diabetes

mellitus (< 180 days)

> Administration of glucocorti-

coids before diagnosis

> A low insulin dose required

to achieve glycemic control

> A lack of polyneuropathy

> An older age

> A lower cholesterol

concentration.

Sex, body weight, presence

of renal failure, presence of

hyperthyroidism, or presence

of obesity at diagnosis have not

been shown to infuence the

likelihood of remission.1

Diabetic remission tends

to last longer in cats of higher

body weight.2 Serum concen-

trations of glucose, fructos-

amine, insulin, glucagon, and

insulin growth factor 1 are not

diferent between cats that do

and do not achieve remission,

but cats achieving remission

have a higher glucagon-to-

insulin ratio.7,10Vm

reFerenCes

1. roomp K, rand J. Intensive blood

glucose control is safe and effective in

diabetic cats using home monitoring and

treatment with glargine. J Feline Med

Surg 2009;11(8):668-682.

2. Zini e, Hafner m, osto m, et al. predic-

tors

of clinical

remission in cats with

diabetes mellitus. J Vet Intern

Med 2010;24(6):1314-1321.

3. michiels L, reusch Ce, Boari A, et al.

treatment of 46 cats with porcine lente

insulin—a prospective, multicentere study.

J Feline Med Surg 2008;10(5):439-451.

4. roomp K, rand J. evaluation of detemir

in diabetic cats managed with a protocol

for intensive blood glucose control. J

Feline Med Surg 2012;14(8):566-572.

5. marshall rD, rand Js, morton Jm.

treatment of newly diagnosed dia-

betic cats with glargine insulin improves

glycaemic control and results in higher

probability of remission than protamine

zinc and lente insulins. J Feline Med Surg

2009;11(8):683-691.

6. Bennett N, Greco Ds, peterson me, et

al. Comparisons of a low carbohydrate-low

fiber diet and a moderate carbohydrate-

high fiber diet in the management of

feline diabetes mellitus. J Feline Med Surg

2006;8(2):73-84.

7. tschuor F, Zini e, schellenberg s,

et al. remission of diabetes mellitus

in cats cannot be predicted by the

arginine stimulation test. J Vet Intern Med

2011;25(1):83-89.

8. Nelson rW, Griffey sm, Feldman eC,

et al. transient clinical diabetes in cats:

10 cases (1989-1991). J Vet Intern Med

1999;13(1):28-35.

9. sieber-ruckstuhl Ns, Kley s, tschuor F,

et al. remission of diabetes mellitus in cats

with diabetic ketoacidosis. J Vet Intern Med

2008;22(6):1326-1332.

10. Alt N, Kley s, tschuor F, et al. evalua-

tion of IGF-1 levels in cats with transient

and permanent diabetes mellitus. Res Vet

Sci 2007;83(3):331-335.

J. Catharine Scott-Moncrief, MA,

Vet MB, MS, DACVIM, DECVIM

Department of Veterinary

Clinical Sciences

School of Veterinary Medicine

Purdue University

West Lafayette, IN 47907


Gossypiboma-induced tumor peer-reviewed

346 | November 2014 | Veterinary medicine | dvm360.com

This potentially deadly surgical complication is preventable. Let this case report remind you about—and reinforce the importance of—counting surgical sponges. By A. Catherine Peace, DVM, and Michael W. Riggs, DVM, PhD, DACVP

A5-year-old 82.3-lb

(37.3-kg) spayed Ger-

man shepherd was

presented to a referral center for

evaluation of lethargy, constipa-

tion, tenesmus, dysuria, and in-

appetence. Te dog had ingested

rib bone and cartilage within

fve days of presentation. It also

had reportedly had a subjective-

ly distended abdomen since a

cesarean section and ovariohys-

terectomy were performed two

years prior to presentation.

INITIAL FINDINGSAt presentation, the

patient was bright,

alert, and responsive

and had an elevated

body temperature of

102.8 F (39.3 C). Te

dog’s heart rate was

168 beats/min, its

mucous membranes

were tacky, and it

was estimated that

the dog was 5% to 7%

dehydrated. Te dog’s

abdomen was tense

and distended. No

other signifcant fnd-

ings were identifed.

A serum chemis-

try profle revealed

hyperglobulinemia,

hyperphosphatemia, hypo-

natremia, hyperkalemia, and

decreased lipase activity. A

complete blood count revealed

neutrophilia, monocytosis, and

leukocytosis (see Table 1 at

dvm360.com/gossypiboma

for specifc values).

Two-view abdominal radiog-

raphy demonstrated decreased

serosal detail (Figures 1 & 2). An

approximately 18-x-17-x-14-cm

soft tissue opacity was visual-

ized in the right cranioventral

abdomen, displacing the stom-

ach in a craniodorsal direction

and the intestines caudally.

An approximately 8-x-1-cm

folded, linear, mineral-opaque

foreign structure was in close

association with and possibly

within the abnormal-appearing

opacity.

Relevant fndings from an

abdominal ultrasonographic

examination included a large

volume of focculent ascites and

an approximately 12-cm-wide

cystic structure that contained

additional focculent fuid and

Gossypiboma-induced abdominal fbrosarcoma in a German shepherd

>>>1 & 2. Right lateral and ventrodorsal abdom-inal radiographs reveal-ing a round soft tissue opacity (edges marked by black arrows) and a linear mineral-opaque object in the cranial abdomen (white arrow).

2

1


CALL 800.255.6864, ext. 6 CLICK TheCVC.com EMAIL [email protected] FOLLOW

© 2015 Advanstar Veterinary CVCAT024

A member of the dvm360 family of veterinary resources

dvm360 dvm360.com veterinary medicine veterinary economics firstline

ourapproach

to the delivery of

veterinarycontinuing education

is so simple it’s...

tunity to earn CE credits.

ses, and workshops centered

est Coast, or Midwest location to suit

vention atmosphere

alking distance of your

egistration options to meet your available time and interests.

vention.

e free

or special savings.

ES514616_VETE1114_INSERT1_FP.pgs 10.09.2014 00:00 ADV blackyellowmagentacyanPerforation

MAXIMUM CE IN MINIMUM TIME

¡ A schedule built to maximize your opportunity to earn CE credits.

More than 500 hours of courses over 4 days.

¡ Exceptional programming, led by the industry’s most

accomplished educators and experts.

¡ Seminars, Clinical Techniques Courses, and workshops centered

on speaker interaction.

¡ RACE-approved programming; New York State-approved

CE provider.

SIMPLE TO P LAN AND TO NAVIGATE

¡ Select an East Coast, West Coast, or Midwest location to suit

your available time and budget, each with a convention atmosphere

conducive to your learning experience.

¡ Enjoy dining and entertainment within easy walking distance of your

hotel and convention venues.

¡ Build a program that best meets your needs.

REGISTRATION AND TRAVEL COSTS THAT MAKE SENSE.

¡ Registration options to meet your available time and interests.

¡ Breakfast, lunch, and snacks provided onsite at the convention.

¡ Hotel prices negotiated to save money and add extras like free

internet and discounts on food and parking.

Take a break

from the

traditional.

Try CVC’s

unconventional,

attendee-centric

approach to

veterinary

continuing education

conventions.


Which CVC will you choose?

Don’t wait! Visit thecvc.com for details. Register now and use Priority Code CVCAT024 for special savings.



© 2015 Advanstar Veterinary CVCAT024

A member of the dvm360 family of veterinary resources

dvm360 dvm360.com veterinary medicine veterinary economics firstline

ourapproach

to the delivery of

veterinarycontinuing education

is so simple it’s...

tunity to earn CE credits.

ses, and workshops centered

est Coast, or Midwest location to suit

vention atmosphere

alking distance of your

egistration options to meet your available time and interests.

vention.

e free

or special savings.



dvm360.com | Veterinary medicine | November 2014 | 347

material with a hyperechoic

appearance (Figure 3). A sample

of the ascites was collected via

abdominocentesis for evaluation

in-house by the veterinarian.

Tis fuid had a serosanguineous

appearance with a total protein

concentration of 3 g/dl, specifc

gravity of 1.025, a packed cell

volume of 5%, and a glucose

concentration of 132 mg/dl.

Microscopic evaluation revealed

red blood cells and nondegener-

ate neutrophils. No intracellular

or extracellular bacteria were

seen. Aerobic culture of the

abdominal fuid was negative for

growth after 72 hours.

Although not performed in

this case, further evaluation of

the ascites by a pathologist can

yield critical diagnostic infor-

mation. Specifcally, a difer-

ential cell count is required to

classify the efusion into a tran-

sudate or exudate. Additionally,

a more through microscopic

evaluation or sedimentation

examination may have resulted

in information regarding the

focculent material noted dur-

ing the ultrasound.

DIFFERENTIAL DIAGNOSESTe main diferential diag-

nosis at this time was cystic

encapsulation of foreign

material located outside of the

gastrointestinal tract. Potential

causes included gossypiboma,

penetrating injury, or migration

of ingested foreign material.

EXPLORATORY LAPAROTOMYAn abdominal ex-

ploratory surgery was

performed. Numerous

fbrous adhesions were

found throughout the

entire abdomen. Te

cystic structure had

a frm capsule that

adhered to the stomach, spleen,

intestines, and peritoneum. Te

small intestines were adhered

together and were sequestered

to the caudal abdomen. Te

intestinal serosa was bright red,

and fbrous adhesions covered

all serosal surfaces. No intesti-

nal motility was noted.

Te small intestinal adhe-

sions were dissected by using a

combination of bipolar electro-

cautery and digital manipula-

tion. Te abnormal tissue was

removed en masse and saved

for histologic examination. A

Jackson-Pratt drain was placed

in the abdomen and secured

with 3-0 Prolene (Ethicon)

suture in a Chinese fnger-trap

pattern. Te abdomen was

lavaged and drained before clo-

sure. Anesthesia and recovery

were uneventful.

POSTOPERATIVE CAREA 75-μg fentanyl patch (2 μg/

kg cutaneously) was placed for

continuous analgesia. Postop-

erative care included admin-

istering a balanced hypotonic

crystalloid fuid (150 ml/hr

intravenously), hydromorphone

(0.1 mg/kg intravenously q.i.d.

as needed for pain), cefazolin

(22.7 mg/kg intravenously

t.i.d.), and tramadol (4 mg/kg

orally b.i.d.).

Te Jackson-Pratt drain was

maintained for an additional

two days and was emptied every

two to four hours during that

time. Te fuid volume collected

ranged from 640 to 750 ml (17

to 20 ml/kg) per 24-hour period.

Te drain was removed three

days after surgery. Te pa-

tient’s vital signs were normal

at that time, and the dog was

discharged to its owners later

that day.

SECOND PRESENTATIONTirteen days after the surgery,

the patient was presented to the

referral center for evaluation of

weakness, persistent vomiting,

and anorexia. Te admitting

physician assessed the patient

to be hypovolemic. Te dog

exhibited pain upon palpation

of the abdomen.

Hospitalization and diag-

nostic testing to determine

the cause of the vomiting and

>>>3. An ultrasono-gram revealing a large fluid-filled cyst and hyperechoic shadow. The edges of the cyst are marked by red ar-rows, and the shadowing representing the foreign material is marked by a white arrow.

3See larger versions

of all the images

in this article at

dvm360.com

/gossypiboma.




supportive care to control the

clinical signs were recommend-

ed and declined. Te owners

said that they had previously

discussed euthanasia because

of the dog’s deterioration and

would request that service from

the referring veterinarian. How-

ever, the patient died at home

the day after its last evaluation

at our referral center.

HISTOLOGIC

EXAMINATION

Te abdominal cyst was fxed in

10% neutral bufered formalin

and submitted to the University

of Arizona Veterinary Diagnos-

tic Laboratory for examination.

Gross examination revealed a

fbrous-connective-tissue-

encapsulated cystic mass con-

taining a largely intact cotton

gauze foreign body and green

metal radiographic marker strip

surrounded by fbrinohemor-

rhagic exudate, consistent with a

gossypiboma (Figures 4A & 4B).1

Sections of the cyst capsule

and its contents were prepared

and processed routinely and

stained with hematoxylin and

eosin for histologic examination.

Histologically, the cyst capsule

was composed principally of

organizing fbrous connective

tissue containing multifocal lym-

phocytic aggregates and areas

of mineralization. Numerous

longitudinal and cross-sectional

profles of clear refractile fbrillar

foreign material were embed-

ded in the inner aspect of the

capsule and present in the lu-

men. Individual fbers contained

a hollow core and had collective

morphologic features consistent

with cotton fbers. Cotton fbers

were surrounded by amorphous

eosinophilic matrix and cellular

debris within the lumen (Figure

5) and by numerous macro-

phages within the inner aspect

of the capsule.

Multifocally, within the

capsule, there was an infltra-

tive population of moderately

pleomorphic polygonal-to-

spindle-shaped neoplastic cells

arranged in bundles, transition-

ing from areas of fbroplasia

(Figures 6A & 6B). Neoplastic

cells contained large ovoid-

to-spindle-shaped nuclei with

prominent nucleoli and were

invested within eosinophilic

stroma with indistinct cytoplas-

mic borders. Tere was an aver-

age of fve mitotic fgures per

10 400X-magnifcation felds.

Multiple extracapsular venules

contained emboli composed of

neoplastic cells similar to those

in the wall but having greater

pleomorphism and higher mi-

totic activity (Figures 6C & 6D).

Immunohistochemistry

revealed that neoplastic cells in

both the capsule and venules

were strongly positive for vimen-

tin expression and negative for

smooth muscle actin expression,

consistent with a fbrosarcoma.

DISCUSSION

Te term gossypiboma is de-

rived from the Latin gossypium,

meaning cotton, and the sufx

-oma, meaning growth. It is a

general term used to refer to

surgical equipment or textiles

accidentally left in a body cavity

>>>5. A photomicro-graph of the foreign body matter in the cystic lumen. Note the multiple longitudinal and cross-sectional profiles of clear refractile fibers (arrow) surrounded by amorphous eosinophilic matrix and cellular de-bris. The hollow core of individual fibers and oth-er morphologic features is consistent with cotton (hematoxylin-eosin stain; bar = 50 μm).

>>>4A. The opened cystic mass after partial fixation in formalin. Note the irregular fibrous connective tissue capsule, cystic cavity, and fibrinohemorrhagic exudate with embedded cotton gauze foreign matter along the inner aspect of the capsule. >>>4B. The contents of the cystic mass after partial fixation in formalin. Note the largely intact cotton gauze foreign body and green metal marker strip (arrow), consistent with a retained laparotomy towel.

4

5



dvm360.com | Veterinary medicine | November 2014 | 349

after surgery. Reports of granu-

lomas and malignant tumors

induced from surgically derived

foreign material are infrequent-

ly reported in the veterinary

and human medical literature.

Reported cases To our knowledge, this case

report is only the second report

involving the development of

an intra-abdominal fbrosar-

coma associated with a sponge

gossypiboma in a dog.2 Case

reports regarding malignant

tumors in the human medical

feld include the development

of angiosarcoma3,4 and nu-

merous other sarcoma types.4

Veterinary reports include the

development of an extraskeletal

osteosarcoma in a dog5 and

fbrosarcoma development in a

cat6 and in a mouse model.7

An accurate frequency of oc-

currence of gossypiboma is im-

possible to determine given the

lack of standardized reporting

mandates and asymptomatic

nature of most veterinary cases.

Induction of a malignant tumor

by a gossypiboma is likely to

represent only a small percent-

age of this population.

In veterinary reports, foreign

bodies have been inadvertently

left behind during cranial cruci-

ate ligament repair,5 ovariohys-

terectomy (elective or pyome-

tra),2,6,8-11 laparotomy (retained

testicle or intestinal biopsy),11

and wound repair11 but frequent-

ly did not induce a malignancy.

Although several case reports

involved fabric-derived foreign

material inadvertently left at the

time of surgery, other foreign

bodies frequently reported are

metal and are the result of trau-

matic events (bullet, shrapnel,

wire) or medical implants.4

Models to determine the

carcinogenic properties of sur-

gically implanted sterile foreign

material have been developed

in animals.7,12 Te surface of

the implanted foreign material

is soon covered with plasma

proteins and surrounded by

neutrophils, lymphocytes, and

monocytes. Te monocytes

diferentiate into macrophages

and form multinucleated giant

cells, making up most of the

cells surrounding the foreign

material.12 Eventually a fbrous

connective tissue capsule forms

around the foreign material to

create a microenvironment for

the proliferation of abnormal

mesenchymal stem cells,

making this microenviron-

ment possibly the most

important determinant

of transformation into a

neoplastic process.3,4 Te

generation of free radicals3

and mutation of normal

cells appear to play a role in

the perpetuation of chronic

infammation and the even-

tual development of tumors

and is described in detail

elsewhere.12-14

Clinical signs of gossypibomaPatients may not become

symptomatic for weeks

to years, and discovery is

often incidental.6,8,11,15,16 In

symptomatic cases, reported

clinical signs have included

vomiting and diarrhea11;

depression, weight loss,

and anorexia10; infection,

abdominal cramping, and

>>>6A. A photomicrograph of a fibrosarcoma arising in the cyst capsule and invading venules. Note the infiltra-tive population of neoplastic cells arranged in bundles, transitioning from areas of fibroplasia within the cyst capsule. Arrows indicate the interface between fibroplasia and neoplasia (hematoxylin-eosin stain; bar = 200 μm). >>>6B. A photomicrograph of higher magnification of the neoplastic tissue noted in Fig-ure 6A. Note the polygonal-to-spindle-shaped neoplastic cells containing large ovoid-to-spindle-shaped nuclei with prominent nucleoli and indistinct cytoplasmic borders invested within eosinophilic stroma. Also note the mitotic figure (arrow) (hematoxylin-eosin stain; bar = 50 μm). >>>6C. A photomicrograph of a representative tumor embolus in an extracapsular venule (hematoxylin-eosin stain; bar = 200 μm).>>>6D. A photomicrograph of higher magnification of the tumor embolus depicted in Figure 6C. Note the high mi-totic rate and pleomorphism. Also note the mitotic figures (arrows) (hematoxylin-eosin stain; bar = 50 μm).

6




small bowel obstruction16; and

hematuria and pain.8 Physical

examination fndings have in-

cluded swelling, a palpable ab-

dominal or subcutaneous mass,

and draining sinus tracts.5,9,11,15

ImagingA gossypiboma can be discov-

ered and confrmed by using

a combination of imaging

modalities including radiogra-

phy,5,11 ultrasonography,10,11,17

fstulography,9 computed

tomography,17 and magnetic

resonance imaging.18

Radiographic fndings can be

unremarkable if a gauze foreign

body does not contain radi-

opaque material similar to what

was seen in this case.9 Te most

frequent radiographic fnding

in a case series of eight dogs

with retained surgical sponges

was a localized gas lucency that

appeared either speckled or in

a whirl-like confguration.11 In

another case study, the gauze

foreign body was diagnosed

when radiopaque mono-

flaments within the surgical

sponge were observed during

survey radiography of the af-

fected limb.12

If survey radiographs are

nondiagnostic, then an ultraso-

nographic examination of the

afected area or abdomen can

be performed. Reports of the

ultrasonographic appearance

of a foreign body have varied

and include an ill-defned mass

with acoustic shadowing,9 a hy-

perechoic mass,15 a mass with

a hypoechoic outer layer and

a hyperechoic inner layer with

acoustic shadowing seen deep

to the mass (for an encapsu-

lated mass),10 and a hypoechoic

mass with an irregular hyper-

echoic center.11 Te fndings

in this report included echo-

genicities that were consistent

with encapsulated, hyperechoic

abnormal material and fuid.

Masses may be associated with

granulomas, abscesses, calcif-

cation, or gas pockets, and the

acoustic shadowing for each

will difer.10

Treatment and preventionSurgery is the treatment of

choice to remove any foreign

material and any abnormal tis-

sue with which it is associated.

Adhesions found throughout

the abdomen complicated the

complete removal of all ab-

normal tissue in this case. Te

severity of the adhesions found

in this case is not uncommon

and has been reported in other

cases involving the bladder and

small intestines8 and the jeju-

num, colon, arteries, kidneys,

and ureter.18

Te aggressive nature of the

foreign body-associated tumor

described in this case report

underscores the importance of

appropriate surgical technique,

including accurate preopera-

tive and postoperative sponge

counts. Risk factors associ-

ated with a gossypiboma in

people include an unplanned

procedure, distractions in

the operating gallery, poor

communication between the

technical staf and surgeons,

staf changes, patient obesity,

and surgeries performed on an

emergency basis.16 Although

veterinary studies to evaluate

specifc risk factors are lacking,

these events should be consid-

ered risk factors in veterinary

patients as well.

Standardized processes for

communication and for ac-

counting for all instruments,

laparotomy towels, and gauze

and an established protocol

to further investigate missing

materials are simple strategies

that can prevent this surgical

complication. Furthermore,

the use of radiopaque markers

embedded within laparotomy

towels and gauze can facilitate

the rapid discovery of a re-

tained surgical foreign body by

using survey radiography.

A. Catherine Peace, DVM

BluePearl Specialty and Emergency

Medicine for Pets

11950 W. 110th St.

Overland Park, KS 66210

Michael W. Riggs, DVM, PhD,

DACVP

Veterinary Diagnostic Laboratory

School of Animal and Comparative

Biomedical Sciences

University of Arizona

Tucson, AZ 85705

View the references

for this article at

dvm360.com

/gossypiboma.


social media

Managing your social media in

1 hour per week

A special monthly package

designed to help boost client

compliance and make it

easy for your team to educate

pet owners about regular

pet wellness care.

November 2014 | dvm360.com/toolkit

Your social media tools:

PLU

S

p2

Team handoutA social media policy for your

practice

>> PLUS 4 social media

mistakes you DON’T

want to makep04

Facts & fi guresWhat your peers think about

social media—and how they

actually use itp05

Videos>> Dr. Ernie Ward on how team

members help make your

clinic’s social media successful

>> Drs. Andy Roark and Dave

Nicol with the top 10 ways to

blow it on social media

>> Dr. Andy Roark on the

importance of being funny to

increase engagementp06

Marketing tool>> Prewritten posts and

tweets on annual exams

>> The comprehensive

post & tweet topicsp07

Take Action>> Easy video ideas

for YouTube

>> Handout: Help clients

show love for your clinic p08

Get social!

Social media is here to stay—and in order to see and be seen,

you have to participate! For expert ideas on how to get started,

fi nesse your current strategy, or avoid common mistakes, head

over to dvm360.com/socialtoolkit.

ES517516_dvmtoolKit1114_001.pgs 10.21.2014 19:02 ADV blackyellowmagentacyan

2 | November 2014 | dvm360.com/toolkit

social media

Your clients are using Facebook, Twitter and LinkedIn. If you want them to see you, use these 6 steps to manage your presence. (And stop wasting your time!)

There is no doubt that

people today are looking

online for their veteri-

nary care providers. Tat being

said, there is also a valid need

to expend marketing resources

wisely. With that in mind, here

is a six-step plan for maintain-

ing a useful social media pres-

ence by devoting just one hour

per week. Let’s get started.

1 Set reasonable expectationsJust like with a work-

out routine, you can’t expect

to put in minimal time and get

herculean results. However,

focusing your eforts in an ef-

cient, meaningful way can give

you results in the long term.

You shouldn’t expect to get

thousands of fans, but rather to

communicate with—and stay

in the minds of—people who

may actually bring their pets to

you for care. You’re going for

quality in your connections,

not quantity.

2 Remember your brandYes, the photo of the

cat smoking a pipe you saw on

the Internet may have been hi-

larious, but is that the picture

you want associated with your

clinic? Every post or tweet you

put out should ft the brand

image you want to build in

people’s minds. If in doubt,

err on the side of caution and

come across as caring and

professional.

3 Pick a platformIt’s better to have a sin-

gle, well-run presence

than a half-dozen neglected

and disorganized eforts that

all make you look bad.

For most practices, I recom-

mend a Facebook business

page. Te other social media

sites are great, but Facebook

is easy to learn. It’s also the

largest network by far, and

the number of posts you need

to stay visible is manageable.

Facebook’s recommendation

system also helps put your

page in front of people who

live in your geographic area,

and that’s a big plus.

4 Find your contentNo one wants to

see you pitching your sales

and services 24/7. Tey want

follow your practice because

you share information that’s

interesting, educational, help-

ful, funny and engaging. You

should give them what they

want (with a moderate dose of

information about your prac-

tice, of course).

One easy way to do this is

to let other people create the

content and deliver it to you so

that you can share the best of

it with your own clients. Email

newsletters are a wonderful

way to get articles, blog posts

and videos delivered right to

your inbox. Some of the best

media outlets you can sub-

By Andy Roark, dvm

1 hour a weekManage your social media in

Dr. Andy Roark is the

founder/managing

director of veterinary

consulting frm Tall

Oaks Enterprises,

LLC. Check him out

on Facebook or

@DrAndyRoark

on Twitter.


dvm360.com/toolkit | November 2014 | 3

social media

scribe to are from the AVMA,

(gratuitous plug alert!) dvm360.

com and ASPCA Poison

Control. When you need great

content for your social media

outlet, voila!

5 Use a schedulerNow that you have

clear goals, your brand

on your mind, and a host of

helpful, funny, interesting, edu-

cational and engaging content

that you’re ready to share, it’s

time to take action.

First, schedule one hour per

week as social media time.

Ten create a plan for what

content you want to put out

over the next seven days. Use a

web-based program to sched-

ule your posts automatically at

designated times.

My favorite scheduler is

Hootsuite (hootsuite.com). Us-

ers can write their posts, attach

fles or links, and then set the

date and time for the informa-

tion to appear on Facebook,

Twitter and other outlets. It’s

free to use, and once you decide

how often you want to put out

information, you can set your

entire week in a single sitting.

Te greatest activity on Face-

book is on weekdays at 3 p.m.,

followed by 11 a.m. and 8 p.m.

Wednesday at 3 p.m. is consis-

tently the busiest time in the

week, while Sunday is the slow-

est day. Keep these patterns in

mind when deciding how best

to schedule your posts.

6 Monitor what’s happeningOnce your social media

initiative is up and rolling,

you can’t take your hands

totally of the wheel. You

must be responsive when

clients communicate

through your social media

channel. Have notifca-

tions about client com-

ments sent to your clinic

via a regularly checked

email address. And decide

up front who will address

these comments.

When clients reach out in

this way, don’t panic. You don’t

have to respond immediately,

like you would if they showed

up in person. Twenty-four

hours (48 on a weekend) is a

good response time and won’t

leave clients feeling ignored.

Like global warming and

Justin Bieber, social media is an

unstoppable force. It’s undeni-

ably changing and improving

the way we communicate with

pet owners. Even if you have

the

most

cutting-

edge medical

practice, you run

the risk of seeming

outdated without a presence in

social media. So carve out an

hour a week to log in and have

fun with it. Ten get back to the

work of being a vet.

Ready-made content makes your “social” life a breeze

cut down your time spent by using the prewritten

posts and tweets from dvm360. You’ll find client-

facing posts and tweets on topics including pain

management, behavior and nutrition—just to name

a few! copy and paste the content right into your

Hootsuite account, scheduling it out at your leisure.

check it out at dvm360.com/postnow or go to page 7

of this toolkit for examples.

geTTY ImAges/eseNkArTAL



SOCIAL MEDIA

BoundariesComputer, email, and Internet usage:

Veterinary Specialty Care’s e-mail and Internet must

be used in an ethical and professional manner. E-mail

and Internet access may not be used for transmitting,

retrieving, or storing communications of a defama-

tory, discriminatory, or harassing nature or materials

that are obscene or X-rated. Messages with deroga-

tory or inflammatory remarks about an individual’s

race, age, disability, religion, national origin, physical

attributes, or sexual preference shall not be transmit-

ted. Abusive, offensive, or profane language in trans-

missions as well as harassment of any kind is strictly

prohibited.

Electronic communications sent on our computers

are considered hospital property and are not guaran-

teed to be private or confidential. Veterinary Specialty

Care reserves the right to examine and monitor files,

emails, and Internet usage. Do not download files

from the Internet and do not open files if you do not

know the sender.

Employees must not transmit copyrighted materi-

als on the practice’s network. Staff must respect all

copyrights and may not copy, retrieve, modify, or

forward copyrighted materials. If you wish to share

something of interest on the Internet with others,

do not copy it to a network drive. Instead, supply the

URL (uniform resource locator, or “address”) for the

recipient to look at.Veterinary Specialty Care has a strict social media

policy. Unless specifically authorized by the hospital

administrator, you are not permitted to blog or use

other forms of social media or technology on the In-

ternet during working hours. Tis applies to personal

electronic and mobile devices, as well. Tese actions

can include, but are not limited to:• Video or wiki postingsª Personal or professional blog postings

• Chat room conversations• Facebook updates

• MySpace updates• Twitter updates• YouTube searches and videosVeterinary Specialty Care recognizes and encourages

your rights to self-expression and the use of social

media on your own time. Please be aware of, and

follow these professional guidelines for independent

self-expression:• Bloggers are personally responsible for their

commentary.• Employees cannot use the Internet to harass,

threaten, discriminate against, or disparage other

employees or anyone associated with the Veterinary

Specialty Care. Negative statements about Veteri-

nary Specialty Care, its products and services, its

team members, its clients, or any other related entity

may lead to disciplinary action up to and including

termination of employment. In addition, appropriate

legal action may be taken if warranted.

• Employees who identify themselves as employees of

any of Veterinary Specialty Care must state that the

views expressed are their own and not those of Vet-

erinary Specialty Care or of any person or organiza-

tion affiliated with Veterinary Specialty Care

• Employees cannot post the name, trademark, logo,

or any other privileged information associated with

Veterinary Specialty Care or any business connect-

ed to Veterinary Specialty Care. Tis includes post-

ing advertisements and selling hospital products.

• Employees cannot post photographs or videos of

clients, vendors, other team members, suppliers

or people engaged in business or events without

express written consent and authorization from the

hospital administrator.• Employees cannot link to internal or external web-

sites without obtaining written permission.

• Veterinary Specialty Care reserves the right to use

content management tools to monitor, review, and

block content on hospital blogs and websites that

violate Veterinary Specialty Care Internet and Social

Media rules and guidelines.

Internet usage and Social media policy for Veterinary Specialty Care

To download this policy and

more, just head over to

dvm360.com/socialtoolkit.

Set the team on the right social-media track at your practice with

this customizable policy.

As everybody dives

into the world of

online networking

and social media, you need to

be sure your team members

know their boundaries when

it comes to talking about

work on the web. Try cus-

tomizing this sample policy

for your practice.

4 social media mistakes you DON’T want to make

1Humble pie

When owners of Amy’s Baking

Company went on Gordon Ramsay’s

“Kitchen Nightmares” show, it got hot

in the kitchen. In addition to the fi ery

on-air exchanges between Ramsay

and the restaurateurs, the show

aired footage that made the owners

seem downright nutty. They took

to social media sites to explain—or

rather hysterically rant—their side

of the story. The couple’s postings

went viral and caused an enormous

backlash, forcing the restaurant to

close for several days.

2 Post politics

There are many stories about

employees accidently posting their

personal views. That’s what hap-

pened when a Kitchen Aid employee

discussed his negative opinion of

President Obama. This accident cost

the tweeter his job and proved to

be a mess for Kitchen Aid that took

weeks to clean up.

3 McMayhem

In 2012 McDonalds asked

customers to post their stories

about McDonalds using the hashtag

#mcdstories. And customers came

through. In just two hours, there

were more tales of unhealthy food

and bad service than calories in a

Big Mac. This tweet proved to be the

real fat in the fryer.

4 TMI FTW!

Imagine one manager’s surprise

when her veterinarian turned in her

notice ... on Facebook! It was against

company policy and TMI for this

DVM’s online followers. The resulting

swirl of online traffi c had prospective

employers gasping OMG.

KNOWING THE

For your own

customizable

version of this

tool, go to




SOCIAL MEDIA

SOURCE: DVM360’S “WHAT VETERINARIANS THINK” STUDY, 2014.

77% 81%of survey respondents

own a smartphone.

Of those 77%,

of social media users use one or more

of these platforms: Facebook, Twitter,

Pinterest, Google+, LinkedIn, YouTube,

Instagram.

For millenials, this jumps to 96.7%

63%use their smartphone

for social media.

This is what they use those platforms to do:

42%

Top answer

from men: To

educate and

connect with

veterinary clients.

49%

Top answer from women:

To connect with

veterinary peers.

40% use social media

several times a day

6% use social media

once a week

60% use Facebook both

personally and professionally

38% use YouTube both personally

and professionally

Let’s say your practice Facebook

page receives 200 Likes this

month. If the average Facebook

user has 234 friends, that’s

46,800 potential exposures for

your business—for free.

Your clients, on social

Each month, 800 million unique users visit

YouTube and 72 hours of video are uploaded

every minute. In 2011, YouTube had more than 1

trillion views, or around 140 views for every per-

son on Earth. More than half of videos on YouTube

have been rated or include comments from the

community. For every click on dislike, YouTube

videos get 10 likes.

200 LIKES

1 TRILLIONVIEWS

by the numbersWhat veterinarians thinkdvm360 conducted

a survey of nearly

3,000 veterinarians and

team members, asking

them to evaluate their

information sources.

Why do theybother?



SOCIAL MEDIA

Scan the QR

codes below

with your

smartphone to

watch these

videos now.

No phone handy? No problem.

The videos are ready to watch at


Watch and learn: Social media made easyWherein cute cat photos can actually save lives.

If our experts agree on one thing, it’s that social media is one of the most powerful business tools

you have at your disposal. It can be a very ef cient way to connect with clients. Best of all? It’s

FREE. So take these tips to heart and watch your business boom.

Involve the teamDr. Ernie Ward explains how team members are

crucial to the success of the clinic’s social media

presence, because team members are the source of

much of the content. Expanding team members’ roles

as content creators will add authenticity and precision

to your social media strategy.

Focus on the funnyIt’s easy to be goofy on Facebook and Twitter, but

not for business, right? Actually, Dr. Andy Roark

says humor fosters the elusive, magical word that

everybody’s after: engagement. By increasing your

funny and otherwise likeable posts and tweets, you

ultimately do a better job of spreading your message.

Don’t blow it Drs. Dave Nicol and Andy Roark are experts at

applying social media in the world of veterinary

medicine. It just so happens that the two are also

experts at playing bumbling novices. Here they

demonstrate the top 10 ways to blow it on social

media. Do you see any similarities to the way your

clinic handles online interaction?



SOCIAL MEDIA

dvm360’s social media marketingUse your social media network to stress the importance of these preventive care topics to your client base.

The dvm360.com team wrote Facebook posts and tweets for your

team to use to raise awareness of key health care issues with your

clients and to help you encourage clients to visit and get the care

their pets need. Get started today by visiting dvm360.com/postnow

and copying the prewritten posts and tweets on these topics:

Scan the QR code

to send this tweet

right now!

If we haven’t seen your pets all year,

then painful conditions could be going

undetected and untreated. Set up an

appointment today so we can be sure

everything is A-OK.

Myth #245: Indoor cats don’t need

preventive care. Schedule Roxy’s annual

exam and we’ll set the record straight.

#pet #pethealth #petcare

When was the last time we saw your

#pet? The more we see your cat or dog,

the sooner we can detect problems.

#petcare

When you don’t bring your pets in for

regular exams, we can’t spot conditions

like heartworm disease or kidney failure.

Set up a time so we can examine your

cat or dog.

Annual exams

>> Adopting a pet

>> Canine aggression

>> Important vaccinations

>> Feline dental care

>> Itchy ears

>> Cat stats, facts & folklore

>> Pain prevention

>> Ways to pay

>> Fleas

>> Year-round fl ea and tick

protection

>> Older pets’ failing senses

>> Inappropriate elimination

>> Life stages

>> Holiday pet hazards

>> Fear free veterinary visits

>> Puppy & kitten care

>> Dermatology

>> Fun pet facts

... and many, many

more!

Check out these posts and tweets about annual exams

GETTY IMAGES/ISTOCKPHOTO


One more tip

Most of our new clients now fi nd

us on the web and potential clients

search reviews and compare the

“star” ratings of each hospital. Writ-

ing those reviews isn’t always easy,

and there are many steps involved.

To encourage reviews we make

it as easy as possible by giving a

brochure to clients that gives them

step-by-step instructions on how to

write a review for our clinic.

—Robert Henrickson, DVM

Manhasset Animal Hospital

Manhasset, N.Y.

FROM YOUR VETERINARIAN

REVIEW US! I

f you love our service, let others know! We’d appreciate your online feedback. To make it easy, we’ve put together this handout that details the steps needed to leave a review on the most popular online review sites. Thank you!

1 Visit yelp.com and find our business using the search bar at the very top of the page. Narrow results by using our exact business name and city.

2 Click on our business page, and click the “Write a review” button.

This button is located underneath the business’ address, telephone number and website.

3 Select a rating for your overall experience of our clinic. Use the

scale they give you (the ratings range between 1 star and 5 stars). The submissions will not let the review be posted without a rating.

How to post a Google review:

1 To write a Google

review you will need a free Google account.

2 To post a review,

Google the name of our clinic.

3 On the right side of the page

you will see reviews that have already been written.

4 Click the “Write

a review” button under clinic’s name.

5 Log in to your Google

account and type your review into the field provided.

6 Just click the

“publish” button and you’re finished!

How to post a Yelp! review:

4 Understand the star ratings. To help you out, as you hover over the rating box, there will be several words that will help you explain your rating. Click the star-rating you believe should best match the conditions of your upcoming review.

5 Write your review, based on the rating you gave it. Below the review, you’ll find a place to write a text-based review-box.

6 Decide if you would like to share this review with (not only your Yelp friends, but also on Facebook). Below this, you’ll find a box to share this with all of your friends on Facebook. In another tab, open and log in to Facebook, then return to this review in this other tab (make sure you save your email for future use). Once again on this checkbox, click the box to place a checkmark in the box.


EASY VIDEO IDEAS for YouTube

Help clients show love for your clinic

SOCIAL MEDIA

Give a hospital tourHave your most charismatic employee give a brief

walking tour of your hospital, from the front desk

through the exam rooms and into the treatment area.

Shoot your video while the hospital is open for business

so viewers can see your team in action. T en, post it

on your practice website and on your Facebook feed.

Ask your Facebook friends to share the video so their

friends can see what your hospital looks like.

Showcase your equipmentNarrate steps while taking dental x-rays and then have

a doctor describe the f ndings. Show what ear mites

look like under the microscope. Make a video of a

technician performing preanesthetic testing. And teach

with instructional videos for clients—show clients how

to brush pets’ teeth, clean ears, give pills and trim nails.

Promote what’s newWelcome a new doctor or staf member with a brief

video interview about his or her areas of medical

interest, expertise and family pets, then post it on the

“About our practice” page on your website, and tweet

a link to that page. If you start of ering a new drug, ex-

plain what it does for pets. If your practice does board-

ing and grooming, show of your suites and describe

the pampering pets will get. Invite people to drop in

for a personal tour. Even if the service isn’t brand new,

showing it on video makes it feel fresh.

This instructional handout for clients explains

how to post a review on the two of the most

popular platforms, Google and Yelp. To download

your copy, visit dvm360.com/socialtoolkit.

TAKE ACTION:


Anger can spill into veterinarians’

relationships with nonprofi t shelters

and rescues, so we’re trying to heal

the divide with information and

advice here and in the pages of our

sister magazines this month ...

Can this relationship be saved?

A close look at the contentious

relationship between private

practice and nonprofi t groups—

plus where there’s more

collaboration than competition.

The war is over. Find out how

one practice wins clients with a

closer relationship with a local

rescue group.

Come together. Get updates on

the veterinary technician shelter

medicine specialty as well as

tips on how shelter and practice

team members work together

to protect pets in need.


SHELTER MEDICINE:

A view from both sidesGet the inside story of one veterinarian’s transition to shelter medicine and, along the way, let’s debunk common myths that some private practitioners hold about shelter practice—and vice versa.

Editor’s note: We cor-

responded with Frank

Bossong, DVM, an

active leader in shelter

medicine in the South-

ern California area,

to get a view of what

practice is like from

both sides of this issue.

Dr. Bossong started his

career in general practice and then became the

staff veterinarian at the San Gabriel Valley Hu-

mane Society in San Gabriel, California. In 2009,

Dr. Bossong became an assistant professor at the

College of Veterinary Medicine at Western Uni-

versity of Health Sciences in Pomona, California,

where he has assisted the college in expanding

and improving its curriculum in shelter medicine.

Q: You started out in private prac-

tice at an AAHA-certifi ed practice.

What prompted your switch to

working in a shelter?

A: I had thought about working in

a shelter setting when I f rst gradu-

ated from the University of Georgia

College of Veterinary Medicine, but

I felt that it would be best as a new

graduate to work at a clinic that prac-

ticed “best medicine” so that I could

develop a solid surgery and medicine

background. After four years out in a

multidoctor practice, I felt conf dent

enough to go out on my own. Al-

though I loved my clients, I felt that

the majority of my time was spent with

the owners in comparison to the time I

was actually spending with their pets; I

felt like I wanted to focus more on the

animals. I also had a client who started

to bring shelter animals for me to see

at the clinic. She was trying to help the

local shelter out. My bosses allowed

me to provide these shelter dogs and

cats with veterinary care and even

discounted the services they received.

A year or so later, I was beginning

to see more shelter patients (unfor-

tunately, the discounts ended). I also

became more aware of the multiple

ILLUSTRATION BY GABRIEL UTASI


Leadership challenge


problems these animals were

facing at the shelter. Te shelter

had no registered veterinary

technicians and no veterinarian.

Te facility also had a very bad

reputation for housing sick and

undesirable animals and had a

high euthanasia rate.

On the fourth anniversary of

my starting date at the clinic, I

began to do some soul search-

ing and felt like I wanted to

dedicate most of my time to

the animals that seemed to be

in desperate need of care. I also

had received a complaint from a

Shelter medicine educational resources> Most major veterinary con-

ferences offer lectures

in shelter medicine. (Join

Cynthia Karsten, DVM, from

the UC Davis Koret Shelter

Medicine Program during

the CVC in Washington, D.C.,

April 23-28, 2015.)

> The UC Davis Koret Shelter Medicine Program

(sheltermedicine.com) has extensive online

resources such as a shelter medicine lecture series,

information sheets, and a reference library.

> The University of Florida has an online course that

provides CE credit and work toward a graduate cer-

tificate in shelter medicine at sheltermedicine

.vetmed.ufl.edu/certificate-programs/online.

> The Association of Shelter Veterinarian’s website,

sheltervet.org, provides information on how to

apply for certification in shelter medicine and

additional resources and guidelines for medical

and surgical care of shelter animals. At sheltervet

.org/smoc you’ll find details regarding shelter

medicine’s official recognition as the newest

veterinary specialty.

client who was concerned about

one of the shelter animals being

in the same lobby as her pet.

Tis was the catalyst for one of

those “clear-life moments” and

I decided I would approach the

director of the shelter to see if

they would hire me as their staf

veterinarian. Tis was 2005, and

in 2001, when I graduated from

veterinary school, I had never

taken a shelter medicine course

and I did not even really see it

as a separate discipline. I simply

wanted to use my veterinary

skills at a facility that needed

some assistance.

Q: What were the reactions

of your colleagues when you

made this decision?

A: My bosses and colleagues

were initially shocked when I

turned down the ofer to renew

my contract for another year. I

had a large clientele and I had

associates that I really loved

working with and respected.

One of my associates was also

a very good mentor. Te sal-

ary was competitive and the

facility was upscale. At frst my

bosses were worried I was leav-

ing to open my own practice.

When I told them where I

was going they initially looked

relieved and then seemed a

little surprised. My colleagues

gave me the impression that I

was making a mistake and that

the facility that I was going to

would refect badly upon me as

a veterinarian. Tey also were

shocked at the signifcant pay

cut I was going to be receiving.

More surprising was the

reaction of my clients. Some

were angry that I was leav-

ing. Some clients requested to

follow me to receive services at

the shelter. Others thought that

I must have been fred or did

something wrong to be going

to a “dirty shelter” and leaving a

well-regarded AAHA-certifed

practice. I did have one client

say that she was “not surprised”

and was very supportive of me

“helping more animals.” She was

the only one.

Q: What did you find

when you started working

at the shelter?

A: Let’s just start by saying that

you can’t make the really shock-

ing stuf up. Where do I begin?

Te place was a real mess. Te

poor reputation was not totally

unfounded. Te place had been

mismanaged for years by highly

unqualifed individuals. A do-

nor to the facility had been the

one to push for my hire.

During the frst several weeks

I was totally overwhelmed. My

frst shock was that none of the

controlled drugs at the prem-

ises were properly locked away.

Tere was an open drawer near

the euthanasia room—a room

that looked like it was out of a

Stephen King novel. When I

opened the drawer, several par-

tially used bottles of euthanasia

solution rolled to the front of

the drawer and about 20 pages

of “logged-out drugs” fell to the


ES521253_VETM1114_353_FP.pgs 10.29.2014 00:06 ADV blackyellowmagentacyan

A healthy relationshipSee how

Cavanaugh Pet

Hospital in Blue

Springs, Missouri,

has found its

relationship with

local shelter and

rescue groups

rewarding for

all involved by

scanning the QR

code below or by

visiting dvm360.

com/cavanaugh.



foor. By the end of my frst day,

I had called and made an ap-

pointment with someone from

the local DEA ofce to stop

by and advise me. Tey were

very helpful and supportive in

getting things in order before I

registered my license there.

On my frst surgery day,

I was using an anesthesia

machine from the 1950s.

Tere was no pulse oximeter,

and I was assigned one kennel

worker to assist me. Tere

were canister rolls of cat gut

and stainless steel for suture

material. Ironically, the surgical

packs were OK and are still

in use today; I was told they

had been donated. Tere was

no pharmacy to speak of and

equipment was limited (e.g. no

microscope, no otoscope).

Tere were no designated

isolation areas for sick animals.

Tere was a room called “infr-

mary” and one called “isolation,”

but there was so much junk and

such unclean (many wooden)

cages that they were essentially

unusable. In one of the back

rooms, I was presented with 20

to 30 boxes of sharps in open

Styrofoam containers. I was

told that Stericycle had stopped

coming a year or so prior (the

account had not been renewed

or kept current). One of the

staf had covered everything

with Christmas decorations!

I had to be careful in ad-

dressing these issues with the

administrators at the time. I

was successful in working out

an arrangement with a medical

waste company to address this

situation. I, also, at a later date,

invited OSHA to the facility

after convincing the “powers

that be” that they were not

the enemy but rather there to

protect us all by ensuring a safe

work environment.

In addition to the shortcom-

ings of the physical plant, I

think the biggest shock was

how untrained and unmoti-

vated most of the staf was.

Te well-attended area was the

smoking area. Animals were

not being properly screened on

intake. Tere was no standard

operating procedure (SOP) for

performing a health examina-

tion or determining an animal’s

sex (I did witness two dogs mat-

ing at a later date). Shots were

sometimes given, sometimes

not. I scanned animals that had

been impounded for weeks and

found microchips and started

calling their owners.

Without any formal shelter

training, my frst impulse (com-

mon sense) was to deliver some

basics to the staf. I started

with training the staf to follow

through on what I called the

three Ss: determine Sex, Scan

for a microchip, and give ap-

propriate Shots upon intake. A

more formal protocol on han-

dling intake evolved from there

as did additional training. Te

animal control ofcers were

sent to Sacramento for certifed

euthanasia training.

I realize in retrospect that

many other area shelters were

not in such a bad state of afairs

as this one. Somehow these

transgressions were overlooked

by many individuals in the

area for quite some time. I was

surprised that no intervention

had occurred sooner, although

most of these issues were not in

public view.

Q: How is everything

at the shelter today?

A: I am pleased to say that the

facility has and is continuing

to make real progress. When

I left as the staf veterinarian

about six years ago, there was a

change in the board of direc-

tors, and a complete change in

the management immediately

followed. I joined the board at

this time and remain a com-

mitted board member. During

my three years there as the

staf veterinarian, I managed to

MORE RESOURCES> dvm360’s complete Leadership Challenge

coverage: dvm360.com/workingwithshelters

> Humane Society of the United States:

[email protected]

> Maddie’s Institute: maddiesinstitute.org

> ASPCA—free webinars recorded and posted

along with slides and materials at

aspcapro.org/training

> State Humane Association of California—

webinars, euthanasia training, and more:

californiastatehumane.org/training.htm

> Pet Smart Charities: learning@

petsmartcharities.org

> VIN, Veterinary Information Network—

consultation, courses, webinars: vin.com


See Dr. Bossong’s

thoughts on his

shelter’s relation-

ship with his

community today

and more in an

extended version

of this Q&A at

dvm360.com

/shelterQA.


hire the facility’s frst registered

veterinary technician (there are

now three). Te surgical suite

was updated, and the facility

provides low-cost spay and

neuter for the public and covers

the majority of the surgical pro-

cedures needed by the shelter

animals they serve. We opened

a low-cost vaccine clinic as well.

Within the last year, the

facility fnally transitioned

from paper records to a shelter

software system. Te mission

statement and bylaws have been

updated and restated, and we

have expanded our board. We

have a website up and running.

Tere are many written SOPs

for managing infectious disease,

cleaning and disinfection, vac-

cination, medical treatments,

etc. Proper euthanasia proto-

cols have been established and,

that being said, the shelter is

at the point where no “healthy

adoptable” animals are put to

sleep. Te shelter now has an

active volunteer program and

they work with local registered

veterinary technician programs

and the shelter club at the local

veterinary school. Much of the

staf has received continuing

education to improve their skills

in serving the animals under

their care. I’m really excited that

the facility has survived and is

being managed by ethical, car-

ing employees and volunteers.

Q: How is practicing shelter

medicine different from

general practice?

A: I think the main diference

is that sometimes you have

to make a decision about an

animal that is in the best inter-

est of the group or herd rather

than the individuals themselves.

I could give so many examples

here. Tis can vary from facility

to facility in terms of the care

that a given shelter can aford to




Shelters are taking away business from private practice.Most clients who come to a shelter for surgeries or

vaccinations would not go to a general practice be-

cause of their fi nancial limitations. By providing these

services, shelters decrease the numbers of litters

entering their facility—thus decreasing the euthana-

sia rate—and the vaccinations help to protect the

community from disease outbreak (public health).

Medical protocols that occur at shelters are usually “second rate.”If you think of the sheer volume of surgeries done

at the shelter by a licensed veterinarian, you might

accept the notion that a shelter veterinarian might

become even more profi cient at these procedures.

Additionally, as more veterinarians train to become

shelter veterinarians, those training them make the

point that “best medicine” should be practiced in all

facilities—both private practice and shelters alike.

Shelter veterinarians are at shelters because they could not handle private practice or were not particularly good veterinarians.Many shelter veterinarians started out in private

practice or still participate part time in private

practice. Some might say that working at a shelter

is a calling, if you will, or vocation. I am now seeing

young graduates who are associates in a private

practice taking part-time positions at shelters be-

cause they want to make a difference.

Shelter and herd health protocols don’t apply to private practice.How often have we seen a kennel cough outbreak

at a private practice that does “medically supervised

boarding”? Any time we have groups of animals

congregated in a limited space, we can be faced

with herd health issues. I personally have learned so

much more about proper cleaning and disinfection

protocols because of my continuing education in

shelter medicine. I think back to my private practice

days and now realize I could have done a better

job in this regard and that much of this information

would also benefi t the animals entering a private

practice facility.

Shelter medicine only involves spays, neuters, and vaccinations.It involves so much more—population management,

shelter facility design and operation, sanitation,

preventive healthcare, diagnosis and management

of infectious disease, animal behavior and welfare,

issues and policies regarding euthanasia, public

relations, adoption strategies, fundraising, abuse in-

vestigation, veterinary forensics, public health—and

the list goes on.

A shelter veterinarian has to euthanize a lot of animals.From my own experiences and from the dozen or so

shelters I work with in my area, shelter veterinarians

are busy with so many other tasks that the technical

staff and animal control offi cers perform the

majority of euthanasia. Certainly there

are times, as in general practice,

where the veterinarian is

performing these procedures.

Personally I euthanized more

animals out in private practice

than I have as a shelter veterinar-

ian. This being said, I realize I have

been fortunate to work with many

shelters that have lower than national

average euthanasia rates.

TOP MYTHS ...

… private veterinary practitioners have about shelters




… shelter workers have about private veterinary practitioners

Most of the time better medicine and surgery occurs out in private practice.Just because the building is a shelter

does not mean that the veterinarian prac-

ticing there needs to change how they

approach a surgical or medical workup. A

well-funded facility can refer cases as well

when appropriate.

Private practitioners are only in it for the money.In order for a shelter or a private practice

to remain in business, services need to

generate fees so that expenses can be

covered. Even shelters charge the cities

they serve fees for animal control services.

Low-cost vaccine and surgery services

have fee schedules as supplies need to

be purchased and medical staff paid. The

whole veterinary community—private and

nonprofi t—must show fi nancial sustainabil-

ity to remain in business.

Private practitioners resent the local shelters as they are fi nancial competition.Many private practices, especially those

providing emergency coverage, often have

partnerships with local shelters. Some

private practitioners provide overfl ow cov-

erage for shelters when necessary. Some

specialists donate their skills or lower the

cost of services for special cases.

give. T e shelter uses the Asilomar

Accords for assessing the animals

that come into their care. An

“unhealthy, untreatable” animal

for this shelter, for example, is

a parvo-positive dog showing

clinical signs. For other facilities

this may be “treatable rehabilitat-

able.” However, this shelter does

not have the funding, medi-

cal oversight, or physical plant

(adequate isolation) necessary to

treat that other facilities might. In

this scenario, the shelter humanely

euthanizes to protect further

spread of infection to the rest of

the young animals in their care.

Out in practice, depending on the

resources of an owner, one usually

treats the individual—the clinician

in practice is generally not think-

ing of herd safety per se.

Ironically, in both private

practice and in a shelter setting

f nances play a role. Additionally,

a general practitioner could see

the rest of your clients (patients in

your care) as a herd so the isolation

and disinfection protocols should

be the same. Actually I think some

small-animal hospitals may have a

lot to learn from proper isolation

and disinfection protocols followed

at our more cutting-edge shelters.

Another big dif erence is that

in general practice, most people

consider their pets as part of the

family. Owners desire to keep

their pets healthy and attempt to

maximize their longevity. In the

shelter setting, a shelter veterinar-

ian is always considering how to

best manage the patients to get

them out of the shelter and into a

home as soon as possible while at

the same time protecting public

health and safety. We are dealing

with an “unwanted” population of

individuals rather than a “cher-

ished” group of dogs and cats. T e

shelter veterinarian’s goal is to

place as many of these shelter ani-

mals into the “cherished group” as

ef ciently as possible.

Q: What can veterinarians do

to connect with shelters in

their area, and why should

they make the effort?

A: Call, volunteer, become a

member of the board of directors.

Find out how your local shelter

impacts the health of the animals

in your community. One example

would be providing information

or insight regarding the early de-

tection of community outbreaks.

As a clinic owner, you could add

your clinic name to the shelter’s

list of veterinarians in the area for

new pet owners to choose from.

Your clinic could be a resource

for referrals such as radiology or

ultrasound (as many shelters lack

this equipment), emergency care,

or surgical overf ow.

I think it is critical for private

practitioners to establish a rela-

tionship with their local animal

control and/or humane society

so that they have a trusted re-

source if they are ever faced with

suspected animal abuse or public

health threats such as rabies or

even animal hoarding.

It is also important to remem-

ber that many of our shelter ani-

mals are your future patients!


Products & Services SHOWCASE | dvm360.com/products

Se

arc

h f

or

the

co

mp

an

y n

am

e y

ou

se

e i

n e

ac

h o

f th

e a

ds i

n t

his

se

cti

on

fo

r FR

EE

IN

FO

RM

AT

ION

!


D E N T A L P R O D U C T S

Searchlebalab

ES521151_vetm1114_358_CL.pgs 10.28.2014 23:33 ADV blackyellowmagentacyan

dvm360.com | MARKETPLACE


ANESTHESIA EQUIPMENT

MEDICAL EQUIPMENT

dvm360.com

TAGS

Outdoor

Tradeshow/POP Displays

Direct Mail

Social Media

Print Advertising

Radio & Television

Marketing solutions ft for:

Logo Licensing • Reprints

Eprints • Plaques

Leverage branded content

from Veterinary Medicine to

create a more powerful and

sophisticated statement about

your product, service, or company

in your next marketing campaign.

Contact Wright’s Media to fnd

out more about how we can

customize your acknowledgements

and recognitions to enhance your

marketing strategies.

For more information,

call Wright’s Media at

877.652.5295

or visit our website at

www.wrightsmedia.com

Content

Licensing for

Every Marketing

Strategy

721 York St PO Box 72430Newport KY 41072-0430 USA

(859) 261-2035 Fax (800) 261-TAGS (8247)

[email protected]

Highest Quality, Faithful Service, Honest Values Since 1902

OnlineInteractiveOrderSystem

Follow us!

Get instant updates on

critical developments

in veterinary medicine,

business, and news by

following dvm360.

facebook.com/

dvm360

twitter.com/

dvm360

ES521150_vetm1114_359_CL.pgs 10.28.2014 23:33 ADV blackyellowmagentacyan

To view this

video, scan this

QR code or visit

dvm360.com

/SuperCarrier.

IDEA EXCHANGE tips from the trenches

360 | November 2014 | Veterinary Medicine | dvm360.com GETTY IMAGES/GREMLIN

Weekly photos illustrate

gradual changes in masses

Whenever I see a patient with a suspected benign

skin mass that will not be immediately biopsied, I

recommend that the owner take a weekly picture

of the mass with a ruler underneath it. Gradual change is often

unnoticed, but this weekly photo provides an objective way to

determine whether the mass is growing or shrinking. It is espe-

cially useful for those owners who want to try a benign-neglect

approach. Since most owners have a camera on their phones or

digital cameras, it is usually easy for them to comply.

Andrew G. Smith, DVM

East Ridge, Tennessee

Watch this easy way to demon-

strate for owners how to get

their cats into their carriers by

using the blind Superman technique.

Mike Karg, DVM

Frederick, Maryland

We need your ideas!

We’ll pay $50 for

regular submissions and

$75 for video

submissions that we

publish in print or online.

Email [email protected],

fax us at (913) 273-9876,

or write to Idea

Exchange

Editor at 8033

Flint, Lenexa, KS

66214.

Read the latest

Miller onlineThe secret to staying youngDr. Robert Miller shares

his inspiration for living life

to the fullest, regardless

of age. Find this and

previous columns by visiting

dvm360.com/Miller.

How to perform a

belt-loop gastropexy

dvm360.com/MedicineVideos

CAPC’s Tick of the Month:

Brown dog tick

dvm360.com/capc

Also online …

Faster than a speeding bullet,

the cat is in the carrier


6


THE CONTINUING EDUCATION YOU WANT

• Exceptional programming, led by the industry’s most

accomplished educators and experts

• A schedule built to maximize your opportunity to earn CE credits

WHERE YOU WANT IT

• Choose an East Coast, West Coast, or Midwestern location to

suit your available time and budget

• Each with a convention atmosphere conducive to your

learning experience

Try CVC’s unconventional, attendee-focused approach

to continuing education conventions.

CVC’s approach to the delivery of

continuing education

is so simple it’s

unconventional!

©Copyright Advanstar Veterinary, 2014 CVCSD14_AT017


© 2014 Virbac Corporation. All Rights Reserved. C.E.T., VEGGIEDENT, and

HEXTRA are registered trademarks of Virbac Corporation. 7/14 14805

C.E

.T.®

HO

ME DENTAL CA

RE

AL

C

OVER 25 YEARS

TAKE A SCIENTIFIC APPROACH

TO YOUR PATIENTS’ DENTAL HEALTH

C.E.T.® VEGGIEDENT® Tartar Control Chews for Dogs

Clinically proven to reduce plaque and calculus and freshen breath4

Great-tasting, free of animal protein and wheat gluten

Exclusive “Z” shape for effective mechanical cleansing

Supported by VOHC* Acceptance for Tartar Control

with the proven technology behind the

C.E.T.® Home Dental Care line of quality chews.

References: 1. Harvey CE, Emily P. Small Animal Dentistry. St. Louis: Mosby;

1993:122. 2. Pader M. Oral Hygiene Products and Practice. New York: Marcel

Dekker, Inc.; 1988. 3. Foulkes DM. Some toxicological observations on

chlorhexidine. J Periodontal Res Suppl. 1973;12:55–60. 4. Clarke DE, Kelman

M, Perkins N. Effectiveness of a vegetable dental chew on periodontal disease

parameters in toy breed dogs. J Vet Dent. 2011; 28(4): 230–235.

HELP REDUCE PLAQUE AND CONTROL TARTAR WITH . . .

C.E.T.® HEXTRA® Premium Chews for Dogs

The unique and proprietary binding-releasing system ensures maximal release

of chlorhexidine, the most effective antiplaque agent1, into a dog’s saliva that:

Readily binds to dental pellicle to exert localized antiseptic activity2

Has a wide margin of safety3

Has been widely accepted by veterinarians for years

Contact your Virbac representative, call 800-338-3659, or visit www.virbacvet.com.

* Veterinary Oral Health Council


t view - informa marketsimages2.advanstar.com/pixelmags/vetmedicine/pdf/2014-11.pdf · development...

Documents