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See These Cats “Meow!” Early Detection of Feline Diabetes

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

While our profession originated in preventive medicine, many veterinarians today spend most of their time on chronic disease detection and management. Some of this shift is due to cats living inside the home with longer lifespans. However, other significant factors include pet parents waiting longer to seek veterinary care due to myths about cat health and the rising costs of veterinary medicine.

As Fear Free Certified Professionals, we don’t just consider physical health but also the emotional health of the feline patient, pet parent, and our teams. When specifically thinking about how this applies to the diagnosis and management of our feline diabetic patients, there are two fundamental tenets for success: educating cat caregivers on signs of diabetes for earlier detection and offering alternative treatment options for qualifying patients to ensure complete health.

With a diagnosis of diabetes, some colleagues may question why we need another treatment besides insulin. For one, owner compliance with needles, insulin administration, and insulin overdosing are of concern. Also, we know that there is an increasing number of cats being diagnosed with diabetes. An estimated 600,000 cats in the U.S. are diagnosed with diabetes during their lifetime, with the prevalence of this devastating disease increasing over the past decade. However, the most crucial statistic from research shows that 125,000 cats go untreated1.

Early Detection

We must continue to educate pet parents about the more common signs of diabetes. Urban myths circulate with inaccurate information, such as the idea that indoor cats don’t need routine veterinary care and that these cats vocalize when they don’t feel well.

Instead of acquiescing, let’s provide simple early-detection guidelines. Here are the four most common signs of feline diabetics displayed through the mnemonic “MEOW:”

  • More eating and drinking
  • Excessive appetite
  • Overweight
  • Weight loss that occurs suddenly

This can be used in several social media posts—be sure to communicate this to pet parents where they can best receive information!

In addition to the most common signs, it’s also helpful to give pet parents an idea of other risks. Some of the increased risk factors for dogs hold for cats, like chronic pancreatitis, being middle age, and use of steroids, but there are definite differences

that your cat’s parents want to know! This is especially true with how much of a role obesity plays – cats with an obese body condition score are four times more likely to develop diabetes! Besides the other complications of obesity, this is a big reason to ALWAYS give our patients a body condition score and discuss appropriate weight management guidelines. Indoor cats, neutered males, chronic kidney cats, and hyperthyroid kitties are also at risk.

When pet parents call for an appointment based on the clinical signs observed at home, continuing the education process during the physical exam is essential. Cats are very similar in pathophysiology to overweight adults; 80% (or more)2 have Type 2 diabetes. This is due to either an insensitivity or resistance to insulin in tissues. Pancreatic beta cells don’t like a high glucose environment or being overtaxed. When that happens, we see the progressive loss of beta-cell insulin production and burnout.

Diagnosis of diabetes also requires diagnostics. Let’s recommend a foundational diagnostic workup instead of just a blood glucose spot check. This includes a full CBC (complete blood count), a chemistry panel with electrolytes, a concurrent urinalysis with culture (preferably low colony count), a UPC (urine protein: creatinine ratio), blood pressure, and a thyroid panel. While many of our patients develop their diabetic state secondary to adipocyte inflammation, we can see other associated disease states like chronic kidney disease, hypertension, hyperthyroidism, and acromegaly.

Fear Free Treatment Options

Insulin is a successful treatment option for many diabetic cats. However, a large population remains completely untreated, and for those yet to be diagnosed, insulin may not be a good fit for the family’s lifestyle. Veterinary teams must provide safe and effective treatment alternatives.

Bexacat™ (bexagliflozin tablets) is the first sodium-glucose cotransporter 2 (SGLT2) inhibitor approved by the FDA in any animal species. Bexacat™ introduces a mechanism of action for veterinarians and pet owners that offers a non-insulin, needle-free, once-daily oral medication specifically designed for cats with diabetes mellitus. This first-in-class therapeutic is indicated to improve glycemic control in otherwise healthy cats with diabetes mellitus NOT previously treated with insulin.

Let’s consider what’s different about the mechanism of Bexacat™ vs. traditional insulin. Insulin drives glucose into the cells, whereas Bexacat™ drops blood glucose levels by promoting urinary excretion or preventing renal glucose reabsorption.

Several differentiating features of Bexacat™ help promote physical and emotional health. First, unlike traditional insulin, Bexacat™ does not require dosing calculations or titration, measuring in syringes, or potential dosing errors. It’s one flavored tablet per cat daily and can be given in food. Not only does this streamline the process for clients, but it also helps them efficiently manage their schedules or travel demands by

having other caregivers participate. The tablet has been shown to have 96-97% palatability in studies3, which also encourages easing client compliance!

Another unique characteristic of Bexacat™ is that dosing is independent of our patient’s blood sugar or if the cat gains or loses weight. This is incredibly helpful in easing the minds of cat parents, especially as we start to talk about the possibility of remission monitoring. We need a minimum weight of 3kg for cats taking Bexacat™.

The essential piece of success is case selection. At this point, Type 1 Diabetics and feline patients who have been on traditional insulin are not candidates for Bexacat™ use. This is because when cats have been diabetics for a long time or are Type 1 (insulin-dependent), they don’t have enough healthy B-cells in their pancreas to produce insulin – an essential qualification to use Bexacat™. The longer a cat has diabetes mellitus, the higher the risk of amyloidosis and beta cell depletion. A newly diagnosed cat will likely have a larger beta cell mass and be more likely to be able to produce at least some insulin. Cats also need to be able to secrete endogenous insulin. However, no accurate test exists to determine this. Glucose toxicity from hyperglycemia is toxic to beta cells.

Finally, patients also need qualifying lab work. Any significant renal (Stage III IRIS or higher) or significant hepatic disease disqualifies the patient. We also need to rule out DKA (diabetic ketoacidosis). But, the final piece, and what may be very new to many of us, is a beta-hydroxbutyrate (BHBA) level of <37 mg/dL or 3.6 mmol/L and precaution of <25 mg.dl or 2.4 mmol/L if history of renal disease or metabolic acidosis. We can use a BHBA level of 2.4 mmol/L if using a handheld monitor. If ketones are in the urine, exclude the cat from being a good candidate.

References:

  1. https://www.businesswire.com/news/home/20221209005431/en/Elanco-Announces-FDA-Approval-of-Bexacat%E2%84%A2-bexagliflozin-tablets-%E2%80%93-the-First-of-its-Kind-Oral-Feline-Diabetes-Treatment-Option
  2. Chandler M, Cunningham S, Lund EM, Khanna C, Naramore R, Patel A, Day MJ. Obesity and Associated Comorbidities in People and Companion Animals: A One Health Perspective. J Comp Pathol. 2017 May;156(4):296-309.
  3. Elanco Animal Health. Data on File.

Important Safety Information:

Before using Bexacat, you must read the entire package insert, including the boxed warning. Cats treated with Bexacat may be at an increased risk for conditions called diabetic ketoacidosis or euglycemic diabetic ketoacidosis, both of which may result in death. It is critical that cats taking Bexacat be examined by a veterinarian promptly if sudden decreases in appetite or water consumption occur, or if weight loss, tiredness, vomiting, diarrhea, or weakness are seen. Discontinue Bexacat and call your veterinarian immediately if any of these occur as they could be signs of diabetic ketoacidosis or

euglycemic diabetic ketoacidosis. Before giving Bexacat, be sure to talk with your veterinarian about any past illnesses your cat has had including if your cat has ever been on insulin, as cats that have been treated with insulin should not receive Bexacat. Do not use Bexacat if your cat has experienced pancreatitis, liver disease or reduced kidney function as serious side effects may occur. Bexacat is available by veterinary prescription only. Not for human use. Keep out of reach of children. Contact a physician immediately if swallowed accidentally.

Bexacat, Elanco and the diagonal bar logo are trademarks of Elanco or its affiliates.

©2024 Elanco or its affiliates. PM-US-24-0954

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.

Empowering Pet Parents for Effective Parasite Prevention

This is Part Three of a three-part series on effective parasite prevention and preserving the human-animal bond through the entire process.

Parasite infestations are more than a gross nuisance. In addition to increasing the risk of vector-borne diseases for pets and pet parents, the complications that come with fleas and ticks can potentially compromise the human-animal bond, significantly impacting the emotional wellbeing of both pets and owners.

Client education and empowerment can shine a much-needed light on this rising concern and ensure pet parents and their pets enjoy uninterrupted comfort, health, and companionship.

The emotional toll of parasite infestations

Flea and tick infestations can disrupt daily life and create significant fear and stress for pets and their owners. While health-related concerns such as vector-borne disease transmission, allergic reactions (such as flea allergy dermatitis), and pet discomfort are the priority, negative impacts on the pet and pet parent’s emotional wellbeing must also be considered and addressed. These include:

  • Behavior changes — Affected pets may be more irritable and restless or seek isolation. Such uncharacteristic changes can be frightening for the pet and stressful for the owner, especially when the underlying cause goes undiagnosed.
  • Altered routines — After an infestation is discovered, pet treatment and environmental eradication measures can disrupt the household routine.
  • Physical distance between pet and owner — Owners may change how they interact with their pet, including new sleeping arrangements or avoiding close contact. This can create apprehension and uncertainty for pets and decrease the sense of comfort and security previously provided by the human-animal bond.
  • Guilt and worry over the pet’s condition — Parasite infestations can cause pet parents to feel shame and guilt over their pet’s condition. Watching the pet struggle with discomfort or associated disease can lead to pronounced worry and fear, which can heighten the pet’s already stressful state.

Knowledge gap: Pet parents and parasiticide awareness

Despite the availability of numerous safe and effective parasiticide products, many pet parents remain unaware of how easy it is to protect their pets from flea and tick infestations and related diseases. To help pets and owners avoid unnecessary suffering, veterinary teams should address common knowledge gaps, such as:

  • Risk — Pet parents may not understand that a clean home or indoor-only living arrangement doesn’t preclude their pet from parasitic infestation. They also may not realize that it takes only one flea or tick to cause suffering, illness, infestation, or zoonotic risk.
  • Prevention—Pet parents may not know that year-round preventives don’t merely keep fleas and ticks away; they can also prevent harmful disease transmission from fleas and ticks.
  • Product efficacy and safety — Pet parents may not understand the significant differences between over-the-counter, “all-natural,” and prescription-only products. Educating pet parents on the value, safety, and quality of research-backed and FDA-approved products, including how they work and proper administration techniques, can ensure greater protection, health, and peace of mind.

Client education and creating a Fear Free experience

Educating the pet parent can alleviate parasite-related fears by raising awareness about parasitic diseases and prevention. By building trust and confidence, pet parents can take a more proactive role in their pet’s care, knowing how to identify, address, and prevent fleas and ticks. The veterinary team can further empower pet parents and drive parasiticide compliance by promoting a Fear Free approach to parasite prevention. This includes:

  • Determining product preferences — Matching the right preventive type to each patient and client can increase compliance by decreasing administration-related stress. For example, pets who are fearful about topical applications and associated handling and restraint may readily accept a chewable tablet.
  • Understanding product administration and use — Talking clients through the process and letting them see the preventive and how it is administered can increase confidence and comfort when they handle the product themselves.
  • Creating positive associations with parasite prevention tasks — Parasite-related pet care tasks such as medicating the pet, checking for fleas and ticks, and removing parasites from the skin or coat can trigger fear and anxiety and create barriers to compliance. Coach pet parents on how to pair these tasks with something the pet loves, such as a special treat, toy, or experience, through classical conditioning. Remind them that repetition and consistency are key to ensuring better cooperation and a positive, lifelong result.

Despite their tiny stature, fleas and ticks can have an enormous impact on the physical and emotional health of pets and owners, including the all-important human-animal bond. Comprehensive protection begins with effective client education and empowerment. This ensures that pet parents not only understand the need for appropriate preventive actions but know how to provide them in a way that strengthens their pet’s defenses as well as their shared love and trust.

PM-US-24-1348

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Continue learning through Part One & Part Two of this series.

Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.

Tick-Tock: Comparing Speed and Duration of Tick Treatments

This is Part Two of a three-part series on effective parasite prevention and preserving the human-animal bond through the entire process.

The prevalence of tick-borne diseases is increasing across the United States, endangering canine and human health and the dog-owner bond. While year-round use of tick protection products, diligent visual checks, and environmental management can reduce tick exposure, these methods may still leave pets and people vulnerable to tick attachment, disease transmission, and associated stress and anxiety.

Although isoxazoline-based products are generally considered effective against ticks, a head-to-head study revealed significant differences in two critical categories: speed of tick* kill and duration of efficacy.1 Understanding the differences, and why they matter, may help reduce tick-borne disease transmission in dogs while preserving the closeness of the human-animal bond.

Understanding isoxazolines

Four isoxazolines are currently approved to treat and control ticks in dogs, including lotilaner, afoxolaner, and sarolaner.1 Isoxazolines work by selectively binding to the calcium channels in muscles and nerves, blocking the transmission of neuronal signals, and causing tick paralysis and death. 2

Tough target: Tick* species

While multiple tick species carry concerning pathogens, the lone star tick is considered more difficult to kill because of its reduced sensitivity to isoxazoline treatment, making it an ideal subject for the comparison study.3

Speed matters: Speed of kill and disease transmission

Disease transmission time frames vary by pathogen and are influenced by a variety of factors, but may begin as early as 3 to 24 hours after tick attachment, emphasizing the necessity for a rapid speed of tick kill.4,5 In the study, 32 participant dogs were infested with 50 lone star ticks, which were allowed to attach and feed.1 At 48 hours after tick* application, dog groups were treated with either lotilaner, afoxolaner, or sarolaner.1 The control group received no

treatment.1 Credelio® (lotilaner) demonstrated the fastest speed of tick* kill among all three products and was twice as fast as the two competitive products.1

Duration of effect

Credelio also demonstrated a consistent and sustained effect, providing an initial significant reduction in live ticks* compared to the untreated control group at every 12-hour evaluation.1 At every 24-hour evaluation, only the Credelio-treated group achieved ≥90% efficacy. Credelio was also shown to have a longer half-life than its competitors, providing consistently high efficacy and a rapid speed of kill throughout the 30-day period to ensure protection against ticks* and tick* reinfestation.1

Impact for pet parents

Credelio’s fast, reliable, and effective tick control can provide far-reaching benefits for pets and owners alike, protecting the pet’s health and preserving the human-animal bond. Advantages include:

Reducing pathogen transmission — Rapid speed of kill may lessen the likelihood of tick-borne disease by eliminating ticks before they can feed, aiding in a better quality of life for the dog.

Controlling infestation-related discomfort and stress — Whether two ticks or two hundred, tick infestations create discomfort and anxiety for dogs and owners. Recognizing and reactively addressing a tick infestation requires thorough grooming, cleaning, treatment, and close observation, all of which can heighten stress for pets and create emotional or physical distance between a dog and their owner.

Providing peace of mind — Pet parents can feel confident that their dog’s effective tick control can provide comprehensive protection against ticks they may have overlooked while checking their pet. Additionally, because many tick-borne diseases present with subtle or intermittent changes, owners don’t have to fear that they are missing their pet’s early warning signs.

Promoting convenient, comfortable administration — Medicating pets is a common cause of fear, anxiety, and stress in dogs and their owners. The chewable formulation of Credelio (lotilaner) could potentially help minimize medication-related stress by making the process a mutually positive and rewarding experience.

Providing steady coverage — Consistent efficacy throughout the treatment period can provide greater peace of mind if clients forget to give their dog’s dose on time.

In the battle against tick-borne diseases, speed of tick kill and duration of effect play a critical role in providing steady protection and enhanced peace of mind. Credelio demonstrates key features that stop the clock on ticks* and their impact on the pet-owner bond.

*Lone Star Tick (Amblyomma americanum)

Sources:

  1. Elanco Animal Health. Data on file.
  2. Ramesh C., et al; Isoxazoline Toxicosis in Animals – Isoxazoline Toxicosis in Animals (2002). Merck Veterinary Manual.
  3. McTier, T. L., et al (2016). Determination of the effective dose of a novel oral formulation of sarolaner (Simparica™) for the treatment and month-long control of fleas and ticks on dogs. Veterinary Parasitology, 222, 12–17.
  4. Fernández-Ruiz, N., et al (2023). Passive collection of ticks in New Hampshire reveals species-specific patterns of distribution and activity. Journal of Medical Entomology, 60(3), 575–589.
  5. Kidd L., Breitschwerdt E.B (2003). Transmission times and prevention of tick-borne diseases in dogs. Compendium on Continuing Education for the Practicing Veterinarian, 25(10), 742-751.

CREDELIO INDICATIONS

Credelio kills adult fleas and is indicated for the treatment and prevention of flea infestations (Ctenocephalides felis) and the treatment and control of tick infestations [Amblyomma americanum (lone star tick), Dermacentor variabilis (American dog tick), Ixodes scapularis (black-legged tick) and Rhipicephalus sanguineus (brown dog tick)] for one month in dogs and puppies 8 weeks of age and older and weighing 4.4 pounds or greater.

CREDELIO IMPORTANT SAFETY INFORMATION

Lotilaner is a member of the isoxazoline class. This class has been associated with neurologic adverse reactions including tremors, ataxia, and seizures. Seizures have been reported in dogs receiving this class of drugs, even in dogs without a history of seizures. Use with caution in dogs with a history of seizures or neurologic disorders. The safe use of Credelio in breeding, pregnant or lactating dogs has not been evaluated. The most frequently reported adverse reactions are weight loss, elevated blood urea nitrogen, polyuria, and diarrhea. For full prescribing information see Credelio package insert.

Credelio, Elanco, and the diagonal bar logo are trademarks of Elanco or its affiliates. Other company and product names are trademarks of their respective owners.

©2024 Elanco or its affiliates. PM-US-24-1345

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Continue learning through Part One & Part Three of this series.

Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.

Preserving the Human-Canine Bond Through Superior Flea and Tick Control

The relationship between clients and their dogs has deepened as more people integrate their pets into daily routines, sharing everything from the food on their plates to the places they sleep. While this close harmony strengthens the mutual benefits of the human-animal bond, it also increases the chance of sharing unwanted parasites.

Ensure nothing—including fleas, ticks, and their associated diseases—can come between your clients and their canine companions with effective parasite education and prevention.

Making room for Fido: Is letting your dog sleep with you OK?

Before we explore the unseemly world of parasites, let’s pull back the covers on canine sleeping arrangements.

According to veterinary behaviorist Dr. Meghan Herron, DVM, DACVB, FFCP-V, sharing the bed with a dog is acceptable and, in some cases, advantageous for the dog or pet parent. “More and more people want that comfort and affection,” Herron said. “Having a canine companion [share your bed] can be helpful.” However, the dog’s and their owner’s comfort should be a priority. “Not every dog is going to enjoy sharing the bed,” said Herron, citing the need for undisturbed sleep or cooler temperatures as common reasons why. “Some dogs do great in a crate or sprawled out on a hardwood floor.”

While some owners worry that treating their dogs like humans (i.e., anthropomorphism) may lead to a sense of dominance or behavior problems, Herron says this is not the case, adding “there is no known correlation between these interactions and behavior issues.”

When sharing isn’t caring: Health risks

Physical closeness is an everyday way for people and dogs to grow their relationships, but without proper precautions, it can also increase their risk for certain health hazards. Fleas and ticks can easily move from dogs to humans, often unbeknownst to us as we sleep or rest. While ticks are less nimble than fleas—who can jump two feet high and 40 to 100 times their body length—unattached ticks can easily migrate from dog to owner.

In addition to causing painful bites, fleas and ticks can infest the client’s home, trigger flea allergy dermatitis, and transmit harmful diseases, including Lyme disease, Rocky Mountain Spotted Fever, ehrlichiosis, and anaplasmosis, through their saliva. Such challenges can potentially compromise the human-animal bond, as discomfort, illness, or household changes (e.g., alternative sleeping arrangements) can cause fear, anxiety, and stress in pets and people alike.

Ultimate comfort: Protecting the dog-owner bond with effective parasite prevention

Fortunately, many parasite preventive options are available for dogs that can prevent undesirable bedfellows such as fleas and ticks and help dogs and owners preserve their close relationship. “There are preventions out there that can stop parasite-related problems before they even start and help treat the problem if it has started,” Herron said.

The best product for each canine patient will depend on the dog’s preferences and comfort, and practical matters such as convenience and efficacy. The two parasiticide types include:

  • Topical products — These liquid medications are applied to the skin between the dog’s shoulder blades and are absorbed rapidly. While most dogs tolerate these products well, some may be sensitive to the physical restraint required during the application or to the applicator’s or product’s sensation on their skin. In these situations, topical products and their application can create stress for the dog and pet parent.
  • Oral products —  Oral parasiticides are available as chewable tablets or flavored chews. They can be a convenient, mess-free, and fast-acting option for dogs who readily take medication by mouth. According to Herron, these products “provide the same level of protection [as topical products], but the dog can eat it like a treat,” creating a less stressful experience for both the dog and owner.

Effective parasite prevention isn’t only about safeguarding health but nurturing and enhancing the human-animal bond by preventing infestation and disease, and associated fear, anxiety, and stress. Educating pet parents about how proper prevention protects their dog’s physical wellbeing and their ability to share in all aspects of life—from mealtime to bedtime—can help ensure more dogs and people enjoy greater health, happiness, and harmony.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.

Brought to you by our friends at Elanco.

Endocannabinoid System in Dogs & Cats: A Complete Overview

Endocannabinoid System in Dogs & Cats: A Complete Overview

Have you ever wondered how pets stay healthy or what manages their sleep, stress, or pain? Much of it has to do with something called the endocannabinoid system in dogs and cats. Pets have this internal network in their bodies, just like us humans. This system is intimately involved in everything from mood to appetite to immune function and more.

Understanding the endocannabinoid system, or ECS, in dogs and cats is cool because it opens new ways to help them stay happy and healthy. Scientists and vets are learning more about this system and finding better ways to help our furry friends. It’s a big deal in pet care and veterinary medicine, making a huge difference in the lives of many animals and their owners.

Introduction to the Endocannabinoid System (ECS)

The endocannabinoid system is crucial to how our bodies—and those of dogs and cats—maintain balance. It’s the body’s natural way of ensuring that mood, appetite, and health are all held in check.

This system relies on a network of cannabinoid receptors found throughout the body. The cannabinoid receptors react to natural substances in the body called endogenous cannabinoids. What’s even more interesting is that these receptors also react to plant-based cannabinoids found in the hemp plant.

Endogenous cannabinoids help the body balance itself by influencing how cells work. This includes helping manage different physiological processes, such as mood, pain response, metabolism, and immune function.

Then, special enzymes break down the cannabinoids. These enzymes stop the action and keep everything in balance. The whole cycle keeps the body’s systems working well, helping with overall health.

Understanding the ECS in Pets

Diving deeper into how the endocannabinoid system works in pets, we find it’s all about balance or homeostasis. Think of it as the body’s natural way of keeping everything in perfect harmony. When something’s off, like if your client’s pet is feeling stressed or in discomfort, the ECS steps in to address the issue.

This system is about more than just responding to problems, though. It’s always active, helping to regulate things like mood, sleep, and appetite. Whether it’s a dog chasing a toy or a cat lounging in the sun, the endocannabinoid system is working behind the scenes.

In addition, scientists think this system might be similar in all mammalian species. This includes horses, rabbits, monkeys, dolphins, elephants, and even sea urchins, to name a few. So, studying canine and feline patients could help us find new ways to utilize the endocannabinoid system in veterinary medicine.

The Role of the ECS in Maintaining Homeostasis

As we’ve already mentioned, the endocannabinoid system plays a huge role in maintaining homeostasis or balance. Homeostatic balance is all about keeping things in the body steady and stable, no matter what’s happening outside. For pets, this means their mood, body temperature, and energy levels stay just right no matter the situation.

The endocannabinoid system uses its network of cannabinoid receptors and natural chemicals to communicate with different parts of the body. This helps manage many functions of the body, ensuring that important physiological processes carry on without a hitch. Research is also ongoing into how the endocannabinoid system influences hindbrain structures in pets, which point to basic life functions like breathing and heart rate.

Essentially, the endocannabinoid system helps pets adjust to different situations by telling the body what it needs to stay balanced. If a pet is too hot, stressed, or even really hungry, the endocannabinoid system kicks into gear. It sends out signals to help adjust the body’s responses, whether that’s cooling down, calming down, or regulating hunger.

Cannabinoid Receptors and Their Functions

Now, let’s zoom in on a chief part of the endocannabinoid system: cannabinoid receptors. These receptors are like tiny sensors found all over the body, in both pets and people. They are present in the brain and spinal cord areas, immune cells, blood vessels, and other organ systems.

There are two main types of cannabinoid receptors: the CB1 receptor and the CB2 receptor. Differentiating between cannabinoid receptor type 1 and cannabinoid receptor type 2 is essential for understanding their roles in the body.

CB1 receptors mostly hang out in the brain and central nervous system. They are key in neurotransmitter release, affecting mood, memory, motor activities, and pain response. CB2 receptors are more abundant in the peripheral immune system and help manage inflammation and immune response.

These receptors wait for signals from cannabinoids. Among the cannabinoids, 2-arachidonoylglycerol (2-AG) and anandamide (AEA) are notable for their ability to bind to CB1 receptors. 2-AG also binds to CB2 receptors.

Furthermore, cannabinoid receptors can engage with plant-derived cannabinoids like Cannabidiol (CBD) and Tetrahydrocannabinol (THC). THC binds directly to CB1 receptors and is not typically recommended for pets as it’s mainly utilized for its “euphoric” effects on humans.

In comparison, CBD indirectly influences both CB1 and CB2 receptors. While THC is beneficial for humans, offering potential therapeutic effects, CBD is particularly suitable for pets and humans alike, providing therapeutic benefits without affecting cognition!

CB1 Cannabinoid Receptors: Locations and Functions

CB1 receptors are mainly found in the brain and nervous system. They act as the body’s mood and sensation managers, helping control emotions, appetite, and pain response.

In the brain, they are densely concentrated in areas such as the cerebral cortex (for higher thought processes), the hippocampus (for memory and learning), the basal ganglia and cerebellum (for movement and coordination), and the amygdala (for emotion processing).

CB1 receptors also extend throughout the spinal cord and the central nervous system. Their presence in the peripheral nervous system is less pronounced but still significant. In these areas, they help manage pain signals and sensations. This can help pets experiencing chronic pain or acute discomfort feel relief.

These receptors can also be found in some other organ systems. These include the gastrointestinal tract, which helps modulate metabolism and appetite and ease symptoms of gastrointestinal disorders. CB1 receptors are also found in the liver and fat tissue, where they help control how the body uses and stores energy.

Fatty acid amide hydrolase (FAAH) enzymes break down the cannabinoids bound to the CB1 receptors after they’ve done their job. This ensures that the body’s responses are appropriately regulated and temporary.

CB2 Cannabinoid Receptors: Roles in Immune Response

CB2 receptors have their main posts in the immune system. This includes areas like the spleen, tonsils, and white blood cells. But that’s not all. They’re also hanging out in the bones and skin, ready to jump into action if an injury or something else needs healing.

These receptors are key in helping manage inflammation and promote healing. When the body is injured, CB2 receptors work to calm down the response by helping reduce swelling and pain. They also aid in cell migration, which is crucial for healing. This response benefits pets with skin problems, joint pain, or any issue related to inflammation.

CB2 receptors also help strengthen pets’ immune systems, making it easier for their bodies to ward off infections. They help make immune cells more efficient at attacking germs and regulate the production of these cells. This ensures that the body defends itself without triggering an excessive immune reaction.

Enzymes are important for how CB2 receptors work, too. For instance, an enzyme called monoacylglycerol lipase (MAGL) helps break down 2-AG after they’ve worked with CB2 receptors. This makes sure the body’s immune response doesn’t go on too long or too strong.

The Impact of Cannabinoid Receptors on Pet Health

Endocannabinoid receptors play a crucial role in maintaining pet health. Each type of cannabinoid receptor works like a health manager to help maintain a happy and healthy balance in the different organ systems.

CB1 receptors help manage how pets feel and react to different situations. They play a key role in reducing discomfort and stress, making sure pets can relax and not feel too much pain. In addition, CB1 receptors can positively influence appetite, memory, and neurological health.

On the flip side, CB2 receptors are more focused on the immune system and help in reducing inflammation. Inflammation is the body’s response to injury or infection. By managing it, CB2 receptors help pets heal faster and feel less discomfort from conditions like arthritis, allergies, or autoimmune disorders.

Together, CB1 and CB2 receptors work to keep pets’ health in check, from their brain to their paws. By understanding endocannabinoid receptors, we can utilize them for pets’ overall health.

Endogenous vs. Exogenous Cannabinoids

There are two key types of cannabinoids: endogenous cannabinoids and exogenous cannabinoids. Endogenous cannabinoids, also called endogenous ligands, are produced naturally by the body. Exogenous cannabinoids, on the other hand, come from external sources, such as hemp plants.

Endogenous ligands work within the endocannabinoid system to maintain balance. Meanwhile, exogenous cannabinoids, like CBD, offer the ECS support from outward sources. They can mimic the effects of their endogenous counterparts and support the same benefits.

Understanding the interaction between these two types of cannabinoids is important for optimizing pet health. Whether the body’s cannabinoids maintain homeostatic balance or plant-based cannabinoids offer extra support, both may contribute significantly to a pet’s wellbeing.

The Effects of CBD on the Pet’s ECS

CBD has gained a lot of attention for its potential health benefits. Research suggests, in many cases, that dogs and cats experience the same benefits from cannabinoids as humans. Unlike THC, CBD doesn’t affect a pet’s cognition. Instead, it interacts with their endocannabinoid system in ways that may positively contribute to their health. That’s why, at Holistapet, we focus on crafting the best natural CBD options for pets!

When CBD enters a pet’s body, it can bind to both CB1 and CB2 receptors. This may help regulate and support various functions like mood, appetite, and discomfort. For example, nervous or scared pets might find a sense of calm, and those with physical discomfort may experience relief with CBD.

One of the most exciting things about CBD is its potential to help with various issues without causing serious side effects. It’s like giving the endocannabinoid system a helping hand, supporting the body’s natural efforts to keep everything in balance.

THC-free CBD Products: Safety and Efficacy

One big concern for pet owners regarding CBD for their dogs and cats is safety. That’s where THC-free CBD products come in. These products offer the benefits of CBD without the risk of THC’s effects. Keep in mind that THC can be toxic to pets, even in small amounts.

THC-free options aim to provide the benefits of cannabinoids while ensuring pets don’t experience any unwanted effects. This means pets can enjoy CBD’s calming and relieving benefits without worries.

Research and anecdotal evidence suggest that THC-free CBD products can effectively manage a variety of pet issues, from nervousness and stress to discomfort and appetite issues. The key is choosing high-quality, tested products, like the ones we offer, to ensure they are truly THC-free and safe for pet use.

Exploring CBD Products for Pets

CBD comes in different forms to address pet’s various needs and preferences. We’ll soon go over them in detail, but first, let’s have a quick look at the variety of CBD products available for pets:

Tincture (CBD Oil): This is a liquid form of CBD that you can measure and mix into food or give directly.
Edible Treats: These perfectly dosed CBD-infused snacks are loved by pets. They are simple to give, just like regular treats.
Topical Creams: CBD-infused creams can be applied directly to the skin to help relieve itchiness or support joint health.
CBD Capsules: Flavorless capsules filled with CBD and other ingredients, usually powder, can be split open and mixed with wet food or given whole. Capsules also work great with pill pockets or wraps.

CBD Tinctures for Dogs and Cats

CBD tinctures are convenient liquid drops designed for a pet’s wellbeing. They’re easy to use, allowing pet owners to measure out any size dose and administer it directly into their pet’s food or mouth. This method is particularly beneficial for picky eaters or pets requiring immediate relief from issues like anxiety or discomfort.

What makes tinctures remarkable is their rapid onset of action, especially when administered orally. They provide swift results, often taking effect within 30 minutes of application.

When selecting a good CBD tincture, make sure to choose a high-quality CBD product formulated specifically for pets, like HolistaPet’s CBD oils. Holistapet’s CBD pet tinctures are crafted with pure Broad Spectrum CBD Oil and Hemp Seed Oil, creating a potent concentration that offers numerous benefits for the pet. Plus, we only use 100% natural, non-GMO ingredients, guaranteeing a pristine final item.

You’ll also want to find tinctures with clear dosage instructions based on a pet’s size. Additionally, opt for products like ours that undergo third-party testing to ensure safety and efficacy. It’s wise to start with a small dose and monitor the pet’s response. You’re on the right track if they seem happier and more comfortable.

Edible CBD Treats: Benefits and Considerations

CBD dog treats and CBD cat treats are powerful snacks that contain the perfect dose in each piece. They come in flavors that dogs and cats love, making it super easy for pet owners to administer.

One of the best things about CBD treats is that they’re simple to use. Each snack contains a specific amount of CBD, so you know exactly how much the pet is getting. This is handy for making sure pets get the right amount every time. In addition to CBD, some treats may include other helpful active ingredients.

For instance, the Holistapet CBD dog treats are enhanced with targeted ingredients like L-theanine and Chamomile to promote calmness or Turmeric Root and Boswellia to support joint health. These beneficial herbs are combined with Hemp Seed Powder, which is a superfood, to ensure the pet maintains optimal health, comfort, and mood.

Choose CBD treats, like Holistapet, made with high-quality, natural ingredients without artificial additives or preservatives. If a pet owner is trying CBD treats for the first time with their pet, encourage them to start with a little and see how their pet does. You’ve found a good thing if they seem happier and more comfortable.

Topical CBD Applications for Skin, Coat, and Joint Health

Topical CBD products, like creams and balms, are great for dogs and cats with skin or joint issues. Rub these products directly onto the skin, targeting the area that needs help. CBD is absorbed locally when applied to the skin and can usher relief without entering the pet’s internal system.

CBD topicals can make moving around easier for pets with sore joints, especially older ones. Rubbing these creams on their joints can help reduce discomfort, prolonging an active lifestyle. For skin problems, CBD topicals may help soothe irritation and promote healing.

When picking a CBD topical for pets, always check that the product is pet-friendly. Some products made for humans might have ingredients that aren’t safe for pets. The product must be free from fragrances, essential oils, or other additives that might irritate the pet’s skin or be harmful if licked.

Dosing Guidelines for CBD in Pets

CBD dosing is all about starting slow and paying attention to how the pet reacts. Whether it’s for already healthy dogs, cats with joint health concerns, or pets needing support for their immune system, getting the dosage right ensures they experience all the health benefits without any issues. Encourage your clients to approach CBD dosing for pets in this way:

Start Small. Begin with a tiny dose, especially if the pet has never had CBD before. For example, you might want to start below the suggested amount and monitor the pet before you up the dosage.
Watch. Observe the pet closely to see how they respond. Do they seem more relaxed? Are they moving around easier if they were sore before?
Wait. It is advisable to keep the initial dose for at least a week, as CBD can take time to show effects in some pets.
Adjust as Needed. Trying a slightly higher dose might be okay if you don’t notice any changes after some time. Like people, pets react differently to CBD.
Talk to the Vet. As their trusted veterinarian, you can give advice based on the pet’s specific health and needs before starting the pet on CBD.

Remember, every pet is different, so what works for one might not work for another. For more guidance on CBD dosage for pets, you can check out Holistapet’s CBD Dosing Guide. For additional pet CBD-related information you can trust, check out more through https://www.holistapet.com/.

The Significance of the ECS in Dogs

The endocannabinoid system is important in canine species because it helps them stay healthy and feel good. This system is all about keeping things balanced for dogs, the same as for humans. It’s like a system working quietly inside pets, looking after how they handle pain, emotions, and illnesses.

Cannabinoid receptors are found throughout a dog’s body, which means the system can affect many different parts of its health. The ECS also helps keep a dog’s immune system strong, which is important for keeping them well, especially as they age.

How the ECS Contributes to Dogs’ Health

The endocannabinoid system plays a huge role in keeping dogs healthy. It acts like an internal support system that manages different body processes.

It’s especially important for helping dogs deal with discomfort. When dogs are in pain, maybe from running around too much or because of joint issues, the endocannabinoid system steps in to soothe their soreness.

The endocannabinoid system also helps dogs regulate their emotions, making stressful situations easier to handle. Dogs that feel anxious or stressed, whether from loud noises or being alone, can gain relief through the endocannabinoid system.

This system also plays a role in the digestive system, making sure dogs can digest their food properly without issues. Plus, it supports immune function to fight off sickness.

In short, the endocannabinoid system is critical for maintaining a dog’s health in various ways. By understanding and supporting this system, perhaps through the safe and targeted use of CBD products, we can greatly enhance dogs’ quality of life.

Research Insights: ECS and Canine Conditions

Studies in veterinary medicine are finding out how the endocannabinoid system can be a game-changer in addressing health conditions in canine species. Research points to the endocannabinoid system as a possible therapeutic target in dogs.

Studies have shown that activating the endocannabinoid system can help soothe arthritis symptoms in dogs. This is big news for canine patients who suffer from chronic conditions, as it offers a potential new way to help improve their quality of life.

Moreover, the endocannabinoid system is being looked at for how it can help with issues in the nervous and immune systems. Keeping everything balanced with the endocannabinoid system might be the key to addressing all sorts of conditions, from stress behaviors to illnesses where the body attacks itself.

The ECS in Cats: Insights and Research

Research in veterinary medicine regarding the endocannabinoid system in cats is still growing, but what we know so far is pretty exciting. It shows that the endocannabinoid system can help cats in many of the same ways it helps dogs.

For example, it can help ease their pain, help them stay calm, and aid their immunity. In addition, the endocannabinoid system helps keep endothelial cells healthy, which is good for cats’ heart health. All these show how the ECS affects many parts of a cat’s health.

Further studying the molecular characterization of cannabinoid interactions within the endocannabinoid system can help us find better health solutions for pets. Using the endocannabinoid system as a guide, we can potentially uncover more ways to keep our feline friends healthy and happy.

Unique Aspects of the Feline ECS

Using CBD for cats can be a good way to help them cope with stressors, deal with discomfort, or simply stay healthy. But since cats are different from dogs and people, we must be careful about how we use CBD with them.

First, it’s important to pick the right CBD product for cats. This means choosing something, like Holistapet’s CBD cat treats, that’s made especially for felines and doesn’t have any THC. Even small amounts of THC can be toxic to cats. Next, you’ll want to work with your clients to choose an option with healthy ingredients and a flavor that their cat prefers. This is important because cats can be selective with what they eat, and you want to provide a healthy option they’ll enjoy.

Holistapet CBD cat treats are felines’ favorite, featuring a delightful salmon or chicken flavor they love. Their grain-free treats are crafted with natural ingredients and are free from gluten, dairy, artificial colors, and preservatives. They contain no wheat, animal by-product meal, corn, artificial flavors, or colors. We believe that a healthy cat is a happy cat.

Last but certainly not least, the amount of CBD we give to cats matters a lot. That’s why Holistapet’s cat treats contain exactly 2mg of broad-spectrum CBD, ensuring the perfect increment for dose management. The best approach is to start with a very small dose and watch how the cat reacts. If they seem to feel better, that’s great! If not, work with your client to advise on the best dose and even suggest specific CBD products that are safe for cats.

Final Thoughts – Endocannabinoid System in Dogs & Cats: A Complete Overview

Understanding the endocannabinoid systems in dogs and cats is essential to ensuring their optimal health and happiness. From assisting with stress and discomfort to supporting their overall wellbeing, the endocannabinoid system is key.

Using CBD carefully, with attention to the right products and doses, may support this system. To get started, you can visit Holistapet’s shop to see their line of quality CBD products for pets. Always remember to start small and watch how the pet reacts. By learning more about the endocannabinoid system and how to support it, we can help our furry friends lead happier, healthier lives.

Original post

Brought to you by our friends at Holistapet.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

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How Low-Volume Vaccines Can Help Support a Fear Free Vaccination Experience

Vaccinations are critical for a pet’s health and safety, but some pet parents may be hesitant to agree with your vaccine recommendations. Pet owners may have needle phobias, be concerned about over-vaccination, or remember past visits when their pets became fearful or stressed about vaccination. Unfortunately, these reservations can mean missed appointments and unprotected pets.Fear Free Certified® Professionals now have a new tool in their arsenal to reduce fear, anxiety, and stress (FAS) surrounding vaccination visits: highly purified, low-volume vaccines from Elanco’s TruCan™ and TruFel™ Ultra line. When vaccinations are more comfortable and less stressful for pets, pet parents are more likely to follow your recommendations and keep their pet’s vaccines up to date.

Fear Free® vaccination techniques

Vaccines are one of the most common services performed in veterinary clinics, which creates daily opportunities to improve the process. Since vaccines are given as subcutaneous injections, we can apply many standard Fear Free principles to reduce FAS. Considerate approach, gentle control, touch gradient, and—of course—a steady stream of treats are great ways to reduce the chances of your patient noticing or reacting to the injection. Allowing vaccines to warm to room temperature, using small-gauge needles, and always changing the needle after pulling up the vaccine are additional techniques you can use to reduce discomfort during injections.

Pets with long-standing needle sensitivities may require pre-visit pharmaceuticals (PVPs) or in-clinic sedation to update vital core vaccines when time is limited. Otherwise, implementing a desensitization and counterconditioning program at home can help pets experiencing fear learn to accept injections.

The Elanco Ultra vaccine technology

Once pets reach a point of vaccine acceptance and cooperation, the last thing you want to do is administer a painful injection that causes them to backslide. Choosing the right vaccines can significantly impact a pet’s reaction to the injection and the likelihood of a successful Fear Free visit. Elanco’s TruCan™ and TruFel™ Ultra vaccines were designed specifically to create a better vaccination experience.

The Ultra vaccine line provides a smaller vaccine volume (0.5 mL) and up to 75% fewer proteins, attributed to Elanco’s PureFil™ technology. Unique combinations, including FVRCP plus feline leukemia for cats (TruFel™ Ultra HC2P-FeLV) and DAP plus leptospirosis 4-way (TruCan™ Ultra DAP + L4) for dogs, ensure that pets are protected with fewer needle sticks and less stress.

Talking points for clients

Vaccine conversations can be sensitive. Vaccine hesitancy isn’t new, but a great deal of misinformation about vaccines during the pandemic may leave lingering doubts in some pet owners’ minds. Clients may also worry about vaccinating their pet too much, and causing pain, discomfort, or a negative reaction.

Elanco vaccines can help you compassionately address client concerns. When a client demonstrates vaccine hesitancy, use the following points to explain how your vaccines support a Fear Free visit and lifestyle.

  • Possible reduced reaction risk — Ultra purification reduces proteins and debris, which may reduce the chance of a negative reaction.
  • Comfortable injections — 0.5mL vaccines, which are often used in human medicine, are half the volume of traditional vaccines and allow for faster administration with a smaller needle.
  • Fewer injections —  A variety of vaccine combinations reduces the number of injections required to achieve complete protection, which means fewer needle sticks.

Together with a Fear Free approach, Elanco Ultra vaccines can help transform the vaccination experience and reduce FAS for pets and their families. Learn more about Elanco’s innovative products here, or visit our Fear Free website to access our continuously updated member resources.

The label contains complete use information, including cautions and warnings. Always read, understand, and follow the label, and use directions.

PM-US-24-0284

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

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Brought to you by our friends at Elanco.

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Recover DogCover

Positive social connections are known to improve human health, so might this be true for dogs as well? Like us, dogs experience the same surge of stress-reducing oxytocin during canine-human interactions.

The desire to lavish sick or injured canine companions with love and support, without compromising the recovery process, is what led to the creation of ReCover DogCover—a disposable stress-free garment that protects healing areas while allowing dogs to maintain their mobility, confidence, and independence.

What is the ReCover DogCover?

When Duke II, a happy and playful dog owned and loved by ReCover’s founder, was diagnosed with cancer, his life changed. The skin beneath Duke II’s once luxurious coat developed painful sores, creating a heartbreaking barrier between him and the gentle snuggles and loving caresses that once punctuated his daily life. Despite trying every commercially available product as well as DIY options for dressing Duke II, there was simply no way to simultaneously keep him clean and comfortable while maintaining his physical freedom and ability to enjoy an affectionate touch.

Duke II’s owner noticed a dip in Duke’s spirits, as well as her own. Then, in a conversation with her dog’s veterinary oncologist, inspiration struck—and the ReCover DogCover was born.

A different breed of healing: DogCover benefits

Unlike other pet bodysuits, the ReCover DogCover is a completely disposable step-in garment designed to protect healing areas from bites, scratches, and other physical irritants. The DogCover’s material is entirely breathable, creating positive airflow to the pet’s skin and supporting natural thermoregulation to keep pets comfortable. Additional benefits to the DogCover include the following:

  • Step-in, suit-up design — No tugging, pulling, or pinching! The DogCover can be placed with the dog in a standing position—simply put their paws in the leg holes and prepare to suit up.
  • Custom fit — The full-stretch tear-away fabric ensures a completely personalized fit for every dog, including a tearable perforation along the underside so males can freely urinate without soiling the fabric.
  • All day and night wearability — The DogCover’s customizable fit ensures you won’t have to remove the suit for bathroom breaks. The dog stays clean and dry.
  • Flexible, full-stretch material — Whether a dog is on post-surgical crate rest or is allowed to run and play, the DogCover’s soft, stretchy material ensures full-body comfort and coverage.
  • Antibacterial surfaces — Bacteria-resistant inner layers protect wounds and incisions from irritation and secondary infections.
  • Water-repellent outer layer, internal absorbency — The DogCover protects the pup from the elements (e.g., rain, puddles), while the moisture-wicking interior draws natural fluids away from the pet’s wound or incision—ensuring a clean and dry environment.
  • UV-resistant, flame-retardant material — All DogCover materials are thoughtfully selected to ensure the dog’s safety.
  • Disposable and biodegradable — Don’t worry about disinfecting the DogCover. To ensure the desired hygiene level, each garment is designed for a single use. And because we’re equally passionate about environmental responsibility, the DogCover is 35 percent biodegradable.

In addition to its at-home applications, the DogCover’s convenient, stress-free design and consistent benefits have made it an asset in veterinary clinical settings, including the highly-regarded Animal Medical Center in New York City, where it is being used with great success.

Dressed for success: Reducing post-surgical stress with the DogCover

In addition to protecting your patients physically, the ReCover DogCover enhances their emotional wellbeing by reducing stressors typically associated with the recovery process, allowing them to live a more normal life. Some positive impacts:

  • Enhanced comfort  — DogCover’s soft, flexible fabric and personalized fit are non-irritating, ensuring the pet can enjoy restful sleep—a critical aspect of healing.
  • Fewer changes to the dog’s daily routine — Dogs thrive on consistency and the ability to predict what happens next. By minimizing potentially stressful changes (e.g., putting on and removing a bandage, wrap, or other recovery device, and limiting specific physical activities or interactions), dogs feel more relaxed and confident.
  • Inclusion in household activities — Dogs can perform all their normal behaviors while wearing the DogCover, including elimination, eating, drinking, sleeping, going for walks, playing with toys, and simply being part of the family.
  • Optimal healing and recovery — Recovery complications can delay your patient’s healing and their return to normal, resulting in additional pain, medications, confinement, and stress. The 24/7 protection provided by the DogCover increases the likelihood of a smooth and timely recovery.
  • Uninterrupted affection — When you don’t have to worry about disrupting your patient’s healing or contaminating their incision, you can feel free to spoil them with affection. These positive interactions provide powerful reassurance and can help your patient feel at ease—even when everything else seems out of sorts.

With the ReCover DogCover premium post-surgical recovery suit for dogs, your patients can experience an enhanced recovery journey with less fear, anxiety, and stress, while you can feel confident and empowered to appropriately manage their care.

 

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Jaime Bast RVT, CCRP, KPA-CTP, FFCP is a copywriter and registered veterinary technician from St. Louis, Missouri. In her free time, Jaime loves learning about canine nutrition, behavior, and training and competing with her American cocker spaniels in a variety of dog sports.

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Brought to you by our friends at ReCover.

Fear Free Point of Care Ultrasound (POCUS) Guidelines

By Marc Bordelon, DVM, MBAThe contemporary use of ultrasound in veterinary medicine has evolved from its inception solely as a referral tool for use by specialty veterinarians to a practical and useful diagnostic tool in general practice and emergency medicine. Veterinarians and staff should be prepared to explain the purpose and procedures involved in point of care ultrasound (POCUS) as well as possible pros and cons to pet parents. Despite being a non-invasive procedure that is virtually painless and quick to perform, there may be concern around logistics, outcomes, and cost. The vet team should be prepared with information to make ultrasound examinations comfortable and pleasant for patients and clients alike.

Client conversations will include questions regarding how ultrasonography and POCUS is used in veterinary practice. Consider the indication for the ultrasound recommendation: is it routine, preventive, diagnostic, or emergency? Routine and preventive medicine ultrasounds are becoming more common. Practices create bundle packages with their wellness exams that are customizable depending on the pet’s age and physical exam findings. It is feasible to say that by looking early and often, a baseline for normal will be established for each patient, and evolution to disease states may be diagnosed sooner, rather than waiting for clinical changes to prompt an ultrasound investigation. Early diagnosis has an immediate impact on patient health and well-being and client experience. Providing routine ultrasounds at an affordable price is simply smart medicine.

Today, routine ultrasonography doesn’t require expensive equipment purchases. Affordable, hand-held ultrasound tools, like the Butterfly iQ+ Vet, are extremely durable, easily connected to a cell phone or tablet, and carried in the clinician’s or technician’s pocket. This model dramatically increases access to ultrasound for every veterinary hospital. Additionally, handheld ultrasound can be utilized in any exam room, with the educated client actively witnessing and perhaps even participating in the process, never having to leave the side of their fur baby.

POCUS examinations are indicated in both routine and emergency care. POCUS is performed using protocols to scan known areas of interest in the thoracic cavity, including heart and lungs, and four quadrants of the abdominal cavity. Abnormalities such as free fluid or air can be quickly identified and may help determine patient stability in the emergency setting, often in 10 minutes or less. This allows the veterinary team to determine the appropriate next steps and monitor patient progress. Questions to consider during the emergency POCUS exam may include the following:

  • Do these findings explain the pet’s clinical disease state?
  • What are the next steps in this treatment plan?
  • Is there an abnormality that requires further exploration?
  • Should this patient be referred to a specialist?

Utilizing POCUS examinations in practice is a valuable and effective diagnostic tool. Scanning sick patients on the first presentation offers an important baseline for each case. Embedding the ultrasound cost into the exam and making it affordable ensures better compliance. This approach helps forge a strong veterinary-client-patient relationship and may add the satisfaction of an early and accurate diagnosis for the veterinarian.

Multiple studies have proven that early implementation of procedures like POCUS can lead to better case outcomes, quicker workups, increased client satisfaction, and the ability to get a diagnosis early on in the disease state.

Getting Patients Comfortable

Now let’s look at patient protocols. Depending on the type of ultrasound exam needed and the reason for presentation (routine, sick, or emergency) there are several ways to make the ultrasound procedure more comfortable for both patients and clients.

Diagnostic imaging presents a unique challenge because it is important for the animal to remain quiet, comfortable, and still. The use of a sedative, and in some cases anesthesia, will be necessary to collect the desired images for some patients. Use of the following practices can decrease stress for patients and help them remain calm and still during an ultrasound examination in the Fear Free environment:

  • Introduction and positive conditioning to ultrasound probes and POCUS for kittens and puppies
  • Non-slip comfortable surface
  • Warmed ultrasound gel
  • Calming scents such as lavender and canine or feline pheromones
  • Relaxing background music or white noise.
  • Low traffic area with limited distractions
  • Minimal noise pollution (other animals, people talking, equipment alarms, intercoms)

Positioning is also important in ultrasound examinations. Patients should feel safe and secure during preparation and procedure. Evaluation of fear, anxiety and stress (FAS) should be monitored throughout. Here are several ways to position a pet while helping them to remain comfortable, while first considering physical limitations.

  1. Determine if the procedure can be performed with the patient in a non-traditional position such as standing or laying comfortably on their side.
  2. Determine if the pet can get into position on cue; for instance, rolling onto their side.
  3. If the pet does not know such a cue, use a lure to help guide the pet into position.
  4. If luring doesn’t work, the pet can be physically guided into position, but this is the most stressful option. It is imperative that the pet feels supported and stable when being guided into position.

When the above positioning options aren’t possible, Dr. Caroline Conn of Sweetwater Veterinary Clinic in Santa Clarita, California, an Elite Fear Free Certified Professional, routinely uses the following techniques in her ultrasound exams:

  • Sedation (after approval from owner, mainly for emergencies and diagnostic abdominal scans)
  • Performs ultrasound in client presence when possible (increased value for client)
  • *Cooperative Care technique: This technique takes time for both the veterinarian to teach and client to practice. Absolute buy-in is a must before using this for pre-scheduled appointments. The Cooperative Care technique utilizes the client teaching their pet how to get in lateral recumbency and/or dorsal recumbency on their own at home beforehand, to simulate the positioning of an ultrasound exam.
  • When the pet is properly positioned, the owner places cool water or non-scented hand sanitizer on the area to be ultrasounded to stand in for ultrasound gel, and uses an object like a remote to simulate use of an ultrasound wand. (Advise clients to wipe off hand gel after use as it can be toxic if ingested.)
  • Patients remain in position for a few minutes to start, gradually building up to 10 minutes. During this time, the owner gives treats to their pet, which act as a distraction and reinforcement for remaining in position to create a positive experience.
  • However, it is done, safe handling is a must for both pets and the veterinary team. Utilizing the core Fear Free concepts, such as Gentle Control, Touch Gradient, Considerate Approach, FAS evaluation, and communication, ensure the physical and emotional wellbeing of all involved.

Pain and Fear Reduction

In an emergency situation, medications for pain and fear are often needed. Analgesia and anxiolytics not only help the pet physiologically and emotionally, they also help to reduce the client’s stress when they see that their pet is comfortable.

Reducing pain and fear also has an emotional and physiological advantage because the pet is now more approachable and feels safe being examined or undergoing blood draws or other emergency procedures. This also translates to a safer environment for staff.

Keeping Clients Comfortable

Keeping the client comfortable and informed is almost as important as keeping the pet comfortable. A comfortable patient makes for a happier, satisfied client. In addition to the benefits of hand-held ultrasound devices, here are some additional ways to increase client comfort and decrease their stress:

  • Have a veterinary technician/nurse or veterinarian greet the client at the door. This lets them know right away that their pet will not have to wait for treatment.
  • Have their animal’s medical records accessible. If possible, in an emergency situation, speak to their regular veterinarian for background information on the pet.
  • Take time to connect by greeting the client and the pet, and sharing what information you have about the pet’s condition.
  • Remember that honesty is the best policy. Be upfront with clients about possible wait times, cost, and the severity of their pet’s emergency.
  • Reduce pain, fear, anxiety, and stress ASAP. Get approval from the client to administer medications as soon as you have enough information on the case and can determine which medications are appropriate.
  • Over communicate. If you must take the pet away from the owner for treatment, provide updates every 10 minutes on how the pet is doing. As the case progresses, you can customize the frequency of updates depending on how critical the pet’s situation is.

Summary of Fear Free POCUS

Hand held ultrasound has made the use of POCUS more feasible in all areas of veterinary medicine. As its use and acceptance grow, Fear Free techniques will be incorporated into these procedures. Clients should be educated on the benefits offered by POCUS in routine, sick and emergent cases. Patient comfort must be considered and addressed in all cases (FAS) as the patient is positioned and the scan is performed. Client participation is optimal if it is safe and quiets the pet. If the pet parent cannot be with their fur baby, frequent communication is imperative.

Consider the following guidelines for POCUS procedures, in addition to established Fear Free protocols:

  • Early introduction and positive conditioning to ultrasound probes for kittens and puppies
  • Non-slip comfortable surfaces are safest and create less anxiety
  • Warmed ultrasound gel
  • Use calming scents such as lavender, or canine or feline pheromones
  • Relaxing background music or white noise
  • Utilize low traffic area with limited distractions
  • Minimal noise pollution (other animals, people talking, equipment alarms, intercoms)

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Marc Bordelon, DVM, MBA, is veterinary clinical senior manager for Butterfly Network. Dr. Bordelon regularly lectures at several veterinary colleges and participates in wet labs and with other professionals in conference settings. Dr. Bordelon formerly owned multiple veterinary practices including a 24/7 hospital and specialty practice, and has routinely performed over 2,000 ultrasounds a year. To contact Dr. Bordelon, you can email him at MarcBordelon@butterflynetwork.com.  To contact the Butterfly Veterinary Team please email vetsupport@butterflynetwork.com

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Brought to you by our friends at Butterfly.

Managing Patients with High Fear, Anxiety, and Stress: When Clients Refuse Your Recommendations

A four-part “from the trenches” series, written by a Fear Free veterinarian for Fear Free veterinary professionals.This is Part Four of a four-part series on helping Fear Free Certified Veterinary Professionals handle patients with high levels of FAS and communicate with their owners.

By Julie Liu, DVM

Despite our best efforts and education, we may encounter client barriers with providing Fear Free care such as refusal of PVPs or sedation, objections to safety tools like basket muzzles, and declining referral to a positive trainer to help with vet visits. It’s worth exploring other ways to help lower FAS such as regular happy visits, outdoor exam rooms, and calming supplements. However, these options are often insufficient for staff members to handle a high FAS pet safely and compassionately.

Emphasizing the safety component can help get some of these clients on board. Just as with other signs of FAS, we should educate clients when their pet is growling, hissing, snapping, swatting, baring their teeth, or showing whale eye. Some high FAS pets are in such a state of panic and “flight” that they bruise, scratch, and otherwise injure staff members when trying to get away. Clients should be informed that staff safety is non-negotiable (“We need to keep our team members safe”), and that because their pet is showing the highest level of stress possible, we are unable to proceed safely without a change in the plan. The client-facing FAS spectrum handouts for cats17 and dogs18 help illustrate these body language cues in a non-judgmental way. We should think as well about the safety of the pet as they could easily come to harm themselves. I had one high FAS canine patient who became so stressed at one visit that she had a seizure the second she walked through the clinic door, and have seen multiple dogs rub their noses raw or bite frantically at kennel bars after being dropped off.

Unfortunately, team safety, emotional health, and all of the myriad reasons to take a Fear Free approach may not be enough to convince some clients. The thought of giving their high FAS pet an anxiolytic or briefly placing a basket muzzle may be so antithetical to a client’s personal beliefs as a pet parent that they will not be swayed regardless of how many options you present.

At this point you need to ask yourself:  What will be the emotional toll on me, my team, and my patient if I continue? Is it worth placing myself and my team at risk of injury? How will my decision affect Fear Free clinic culture? These are especially important questions to consider if you’re a hospital leader. Staff members may not feel comfortable voicing their ethical concerns, and leaders must always advocate for the wellbeing of their team. In 2018, the Journal of Veterinary Internal Medicine surveyed nearly 900 North American veterinarians regarding ethical conflict and moral distress19. When respondents were asked, “How often have you had a conflict of opinion with pet owners about how they wish to proceed in the treatment of pets?”, roughly 53 percent noted “sometimes,” 32 percent replied “often,” and 1 percent answered “always.” In the same survey, over 73 percent of vets responded that “not being able to do the right thing for a patient caused their staff moderate to severe stress” and 78 percent responded that this caused moderate to severe distress in themselves.

In many cases, it will be best for your team to set a boundary and either decline to continue with the visit, or even initiate a respectful conversation about why your clinic may not be the best fit. Boundaries can be scary because many of us in vet med are people pleasers20, and we feel guilty or “bad” for saying no to a client. However, boundaries are essential for protecting the emotional and physical welfare of every member of the team. When it comes to setting a Fear Free boundary, it’s also an animal welfare issue. We shouldn’t feel guilty for refusing to perform surgery on a pet when a client is against pain medications; adequate analgesia is the surgical standard of care. Similarly, we shouldn’t feel guilty for stopping with a high FAS pet when a client doesn’t respect team member safety or value their pet’s emotional health, because Fear Free is the emotional standard of care. Cultivating and retaining clients who are invested in their pet’s emotional needs will help the pet, the client, and the team succeed.

Summary

Vet clinics are often highly stressful places for pets, making high FAS pets common.  Focusing on client education, being flexible during the visit, and knowing when to draw an ethical boundary will help team members navigate a safe and humane approach to the patient while keeping their own wellbeing at the forefront.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Dr Julie Liu is a Fear Free and Cat Friendly veterinarian, speaker, and freelancer based in Austin. She serves as the Vice President of the Relief Veterinary Medical Association and recently launched My Family Cat, an in-home and virtual feline behavior consulting practice serving the cats of Austin. Learn more about Dr. Liu and her work at www.fluxvet.com and www.myfamilycat.com.

Continue learning about managing patients with high FAS through Part One, Part Two & Part Three of this series.

 Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.      

Resources

  1. Moral stress the top trigger in veterinarians’ compassion fatigue | American Veterinary Medical Association
  2. https://journals.sagepub.com/doi/full/10.1177/1098612X221128760
  3. https://fearfreepets.com/pain-and-fear-two-sides-of-the-same-coin/
  4. https://icatcare.org/our-campaigns/pledge-to-go-scruff-free/
  5. https://fearfreepets.com/treat-ladder/
  6. https://fearfreepets.com/top-10-treats/
  7. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2019/01/Keep-Calm-and-Muzzle-On-1.pdf
  8. https://fearfreepets.com/courses/fear-free-certification-program/
  9. https://fearfreepets.com/courses/fear-free-certification-level-3/
  10. https://fearfreepets.com/fas-spectrum/
  11. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2020/08/Dog-Sedation-Pain-Algorithm-2020.pdf
  12. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2020/08/Cat-Sedation-Pain-Algorithm-2020.pdf
  13. https://fearfreepets.com/calming-pet-owners-concerns-sedation/
  14. https://www.felinegrimacescale.com/
  15. https://fearfreepets.com/courses/fear-free-level-2/
  16. https://www.avma.org/resources-tools/practice-management/communicating-clients-using-right-language-improve-care
  17. https://fearfreepets.com/resources/fear-free-store/fear-anxiety-and-stress-spectrum-cat/
  18. https://fearfreepets.com/resources/fear-free-store/fear-anxiety-and-stress-spectrum-dog/
  19. Moses L, Malowney MJ, Wesley Boyd J. Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians. J Vet Intern Med. 2018 Nov;32(6):2115-2122.
  20. https://www.youtube.com/watch?v=ExaL-pp9Kok&t=1531s

Managing Patients with High Fear, Anxiety, and Stress: Communicating with Owners

A four-part “from the trenches” series, written by a Fear Free veterinarian for Fear Free veterinary professionals.This is Part Three of a four-part series on helping Fear Free Certified Veterinary Professionals handle patients with high levels of FAS and communicate with their owners.

By Julie Liu, DVM

Communicating with clients is an art and can be especially difficult when managing a high FAS patient. Clients don’t always see what we do when it comes to signs of FAS, and they may have different priorities or ethics as a pet parent compared to us as Fear Free practitioners. Words such as “fearful,” “anxious,” or “stressed” may seem meaningless or exaggerated from their perspective.

Communicating Fear Free techniques should start with a discussion of body language, which transforms emotional abstracts into non-judgmental, objective observations that the client can see and hear. You don’t have to be a veterinary professional to witness when a dog is panting and whining or when a cat has flattened ears and dilated pupils. Once the client understands the body language of FAS, we can then communicate the implications of untreated FAS and suggest interventions.

One common scenario is when a pet’s FAS levels escalate during a visit, and none of the Fear Free techniques you’re using are helping. At this point you need to initiate a client discussion about PVPs, sedation, or otherwise changing the initial plan to achieve a Fear Free approach.

This can be stressful because you can’t predict the client’s reaction. Will they be open? Angry? Frustrated? Shocked and skeptical, because “They always do great at the vet!” and “No one’s ever mentioned anything before.” As discussed in Fear Free level 2 module 415, understanding the client’s needs and finding ways to meet those needs will help the pet parent get on board with your recommendations. For clients with time constraints, offer a drop-off slot or reschedule with PVPs on a day that works for them. For clients with budget concerns, consider invoicing a lower, “brief exam” fee for the follow up and setting in-hospital PVPs/sedation fees at a price that improves compliance. For clients who feel embarrassed or upset about their pet’s FAS, normalizing signs of FAS and using success stories of your own pets can help clients relate.

Think creatively and have some flexibility when making a plan for a client. I recently saw a dog for acute, non-weight-bearing lameness in a rear leg. While I suspected a torn CCL, on examination the dog was so tense and anxious that I couldn’t be sure. I recommended sending the dog home with pain medications and returning them for sedated rads and a repeat orthopedic exam, but the client had budget concerns, time constraints, and concerns about sedation. We made a plan to administer gabapentin at drop off, wait a couple of hours, and then give an opioid injection about 20 minutes before trying the rads, with the agreement that we would not continue if the dog was still painful or stressed. The tech informed me that she was unable to administer gabapentin because the dog was trying to bite. I asked the client to return to the clinic to help us give the medication, and when the client offered the meds in a treat, the dog took them immediately. After an hour, he was lying down sternally in his kennel, had stopped whining, and was coming to the front of the kennel for petting. When it was time for his rads, we still placed a basket muzzle as a precaution, but the dog was an FAS of 1, semi-sedate, eating treats, and much more amenable to the ortho exam and imaging. It wasn’t my initial plan, but it still worked for the client and the pet, who did have a torn CCL.

According to the AVMA Language of Veterinary Care Initiative16, “Clients want a strong relationship with their veterinarian. To clients, the word ‘relationship’ signals that the veterinarian is trustworthy, will make their pet feel comfortable, and goes out of the way to provide personalized service.” Focusing on long-term thinking and relationship-building can also help with client communication and Fear Free, especially for high FAS pets. We’re not just thinking about how to get through this visit, we’re thinking ahead to the next 5 or 10 years of vet visits. If we push your pet now when he’s already so stressed, the next visit is going to be that much harder for him. We want to build a relationship with you and your pet, and provide them with a lifetime of humane veterinary

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Julie Liu is a veterinarian and freelance writer based in Austin, Texas. In addition to advocating for fear free handling, she is passionate about felines and senior pet care. Learn more about Dr. Liu and her work at www.drjulieliu.com.

Continue learning about managing patients with high FAS through Part One, Part Two & Part Four of this series.

 Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.    

Resources

  1. Moral stress the top trigger in veterinarians’ compassion fatigue | American Veterinary Medical Association
  2. https://journals.sagepub.com/doi/full/10.1177/1098612X221128760
  3. https://fearfreepets.com/pain-and-fear-two-sides-of-the-same-coin/
  4. https://icatcare.org/our-campaigns/pledge-to-go-scruff-free/
  5. https://fearfreepets.com/treat-ladder/
  6. https://fearfreepets.com/top-10-treats/
  7. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2019/01/Keep-Calm-and-Muzzle-On-1.pdf
  8. https://fearfreepets.com/courses/fear-free-certification-program/
  9. https://fearfreepets.com/courses/fear-free-certification-level-3/
  10. https://fearfreepets.com/fas-spectrum/
  11. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2020/08/Dog-Sedation-Pain-Algorithm-2020.pdf
  12. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2020/08/Cat-Sedation-Pain-Algorithm-2020.pdf
  13. https://fearfreepets.com/calming-pet-owners-concerns-sedation/
  14. https://www.felinegrimacescale.com/
  15. https://fearfreepets.com/courses/fear-free-level-2/
  16. https://www.avma.org/resources-tools/practice-management/communicating-clients-using-right-language-improve-care
  17. https://fearfreepets.com/resources/fear-free-store/fear-anxiety-and-stress-spectrum-cat/
  18. https://fearfreepets.com/resources/fear-free-store/fear-anxiety-and-stress-spectrum-dog/
  19. Moses L, Malowney MJ, Wesley Boyd J. Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians. J Vet Intern Med. 2018 Nov;32(6):2115-2122.
  20. https://www.youtube.com/watch?v=ExaL-pp9Kok&t=1531s
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