This paper describes dog owner and veterinarian perceptions around the use of a validated canine quality of life (QOL) survey to facilitate wellness conversations in two clinical settings: a veterinary teaching hospital (pilot, Phase 1) and five corporate general practice hospitals (Phase 2). Phase 1 results showed that dog owners felt the survey was valuable for understanding their dog's QOL, with 81% of owners expressing interest in learning more about canine QOL. Phase 2 reinforced owner perceptions about the survey conveyed during the pilot phase, and veterinarians reported that the survey facilitated client communication related to preventive care without increasing consultation time. These results demonstrate that beyond using QOL assessments to track patient health, the use of a QOL survey during veterinary visits could improve owner-veterinarian discussions around QOL, wellness, services and preventive care. To fully realize these benefits in clinical settings, veterinary staff preparation may be needed to communicate the purpose of QOL assessments to clients and thus facilitate deeper conversations about client needs and concerns. Key tools for achieving these could therefore include (1) sufficient veterinary team training to understand the QOL assessment and its purpose (2) training in how to communicate QOL to clients, and (3) reflexive use of QOL assessment results to engage clients in preventive care discussions. The veterinarian and client can then discuss the pros and cons of the various aspects of QOL and preventive care to arrive at a cooperative decision.

In dogs, optimal growth is critical for future health and wellbeing. Recently, a series of evidence-based growth standards, based on bodyweight, were developed for male and female dogs across 5 different size categories. The aim of the current study was to compare growth curves depicted by the standards with patterns of growth in dogs that were either healthy, had abnormal body condition, or had various diseases with the potential to affect growth. The data came from 2 research colonies in Europe (France and UK), and a large corporate network of primary care veterinary hospitals across the USA. Age and bodyweight data were used to model growth in healthy dogs, in dogs that became overweight or underweight by 3 years of age, and in dogs with diseases associated with altered growth. Centile line crossing during the growth phase was uncommon in healthy dogs, with <5% of dogs crossing >2 centile lines. In contrast, centile line crossing was more frequent in dogs with abnormal growth patterns or abnormal body condition. Dogs that developed obesity by 3 years grew faster than the growth standards predicted, and 68% crossed ≥2 centile lines in an upwards direction. Dogs with conditions associated with accelerated growth also grew faster than expected, and 54% crossed ≥2 centile lines. In contrast dogs that became underweight by 3 years gained weight slower than expected, and 49% crossed ≥2 centile lines in a downwards direction. These results suggest that the growth standards are useful for monitoring healthy growth in dogs. Prospective studies are now required to confirm these findings and to determine whether early intervention can prevent the development of diseases.

The objective of this population-based retrospective cohort study was to identify factors associated with lifespan in pet dogs evaluated at primary care veterinary hospitals. Dogs ≥3 mo of age that visited any of 787 US hospitals at least twice from January 1, 2010, through December 31, 2012, were included. Survival curves were constructed for dogs by reproductive status, breed, body size, and purebreed (versus mixed-breed) status. Multivariate Cox proportional hazard regression was performed to identify factors associated with lifespan. There were 2,370,078 dogs included in the study, of whom 179,466 (7.6%) died during the study period. Mixed-breed dogs lived significantly longer than purebred dogs, and this difference was more pronounced as body size increased. Controlling for other factors, dogs of either sex had a greater hazard of death over the study follow-up period if sexually intact rather than gonadectomized. For dogs who lived to 2 yr of age, the hazard of death decreased with increasing frequency of dental scaling. Our findings support previous reports of the impact of body size and gonadectomy on lifespan and provide new evidence in support of ultrasonic dental scaling and mixed breeding.

There is an association between overweight status and life span in kenneled dogs, but a similar association has not been reported for pet dogs. To examine the effects of being overweight in middle age on the life span of neutered client-owned dogs. Fifty-thousand seven-hundred eighty seven middle-aged neutered client-owned dogs attending a network of approximately 900 veterinary hospitals across North America. Retrospective case-control study. For each of 12 breeds, groups of dogs aged between 6.5 and 8.5 years were identified as being in “overweight” or “normal” body condition. Within each breed and sex, differences in life span between dogs in normal body condition and overweight body condition in the 2 groups were then analyzed by Cox proportional hazards models. For all breeds, instantaneous risk of death for dogs in overweight body condition was greater than those in normal body condition throughout the age range studied, with hazard ratios ranging from 1.35 (99.79% confidence interval [CI] 1.05-1.73) for German Shepherd dog to 2.86 (99.79% CI 2.14-3.83) for Yorkshire Terrier. In all breeds, median life span was shorter in overweight compared with normal weight dogs, with the difference being greatest in Yorkshire Terriers (overweight: 13.7 years, 99.79% CI 13.3-14.2; normal: 16.2 years, 99.79% CI 15.7-16.5) and least in German Shepherd dogs (overweight: 12.1 years, 99.79% CI 11.8-12.4; normal: 12.5 years, 99.79% CI 12.2-12.9). Veterinary professionals should consider promoting healthy body condition for dogs, particularly from midlife onward.

OBJECTIVES:The aim of the study was to identify any dietary, signalment, geographic and clinical factors associated with hematuric struvite crystalluria (HSC) in a population of cats that visit general care veterinary hospitals in the USA. METHODS:In total, 4032 cats that had a first-time diagnosis of HSC and 8064 control cats with no history of hematuria or crystalluria were identified from medical records of all cats examined between 2007 and 2011 at 790 US veterinary hospitals. Extracted variables included age, sex, neuter status, breed, diet, urinalysis results and history of cystitis. Potential associations between these variables and HSC were estimated. RESULTS:Controlling for other factors, young cats fed a dry diet had an increased likelihood of HSC relative to young cats fed a non-dry diet. However, as age increased, the likelihood of HSC declined for cats fed a dry diet and increased for cats fed a non-dry diet. Moreover, the odds of HSC were significantly greater when cats were unneutered (vs neutered; odds ratio [OR] 45.52) or had a thin (vs heavy) body condition (OR 23.81), diagnosis of cystitis (OR 2.84), urine protein concentration >30 mg/dl (OR 4.72), alkaline (vs neutral) urine pH (OR 3.34), pyuria (OR 23.67) or bacteriuria (OR 2.24). CONCLUSIONS AND RELEVANCE:The present study provides estimates of the strengths of association between HSC and certain signalment and clinical characteristics of cats. This information could help clinicians to perform a more directed screening for struvite crystalluria in certain cat populations. Follow-up studies that build on the findings of this study could explore the clinical importance of HSC in cats.

Spectrum of CareVeterinarians have a wide spectrum of diagnostic and treatment options they can provide for their patients.These options range from technologically advanced and expensive interventions to less advanced and less costly options.The specific care provided

OBJECTIVE To examine potential associations between periodontal disease (PD) and the risk of development of chronic azotemic kidney disease (CKD) among cats and determine whether the risk of CKD increases with severity of PD. DESIGN Retrospective cohort study. ANIMALS 169, 242 cats. PROCEDURES Cats were evaluated ≥ 3 times at any of 829 hospitals from January 1, 2002, through June 30, 2013. Cats with an initial diagnosis of PD of any stage (n = 56,414) were frequency matched with cats that had no history or evidence of PD (112,828) by age and year of study entry. Data on signalment, PD, and other conditions potentially related to CKD were extracted from electronic medical records. Cox proportional hazards modeling was used to estimate the association of PD with CKD after controlling for covariates. RESULTS PD was associated with increased risk of CKD; risk was highest for cats with stage 3 or 4 PD. Risk of CKD increased with age. Purebred cats had greater risk of CKD than mixed-breed cats. General anesthesia within the year before study exit and diagnosis of cystitis at any point prior to study exit (including prior to study entry) were each associated with increased CKD risk. Diagnosis of diabetes mellitus or hepatic lipidosis at any point prior to study exit was associated with decreased CKD risk. CONCLUSIONS AND CLINICAL RELEVANCE The findings supported the benefit of maintaining good oral health and can be useful to veterinarians for educating owners on the importance of preventing PD in cats.

BackgroundThere is an association between overweight status and life span in kenneled dogs, but a similar association has not been reported for pet dogs.ObjectivesTo examine the effects of being overweight in middle age on the life span of neutered client‐owned dogs.AnimalsFifty‐thousand seven‐hundred eighty seven middle‐aged neutered client‐owned dogs attending a network of approximately 900 veterinary hospitals across North America.MethodsRetrospective case‐control study. For each of 12 breeds, groups of dogs aged between 6.5 and 8.5 years were identified as being in “overweight” or “normal” body condition. Within each breed and sex, differences in life span between dogs in normal body condition and overweight body condition in the 2 groups were then analyzed by Cox proportional hazards models.ResultsFor all breeds, instantaneous risk of death for dogs in overweight body condition was greater than those in normal body condition throughout the age range studied, with hazard ratios ranging from 1.35 (99.79% confidence interval [CI] 1.05‐1.73) for German Shepherd dog to 2.86 (99.79% CI 2.14‐3.83) for Yorkshire Terrier. In all breeds, median life span was shorter in overweight compared with normal weight dogs, with the difference being greatest in Yorkshire Terriers (overweight: 13.7 years, 99.79% CI 13.3‐14.2; normal: 16.2 years, 99.79% CI 15.7‐16.5) and least in German Shepherd dogs (overweight: 12.1 years, 99.79% CI 11.8‐12.4; normal: 12.5 years, 99.79% CI 12.2‐12.9).Conclusions and Clinical ImportanceVeterinary professionals should consider promoting healthy body condition for dogs, particularly from midlife onward.

Limited information is available on what constitutes optimal growth in dogs. The primary aim of this study was to develop evidence-based growth standards for dogs, using retrospective analysis of bodyweight and age data from > 6 million young dogs attending a large corporate network of primary care veterinary hospitals across the USA. Electronic medical records were used to generate bodyweight data from immature client-owned dogs, that were healthy and had remained in ideal body condition throughout the first 3 years of life. Growth centile curves were constructed using Generalised Additive Models for Location, Shape and Scale. Curves were displayed graphically as centile charts covering the age range 12 weeks to 2 years. Over 100 growth charts were modelled, specific to different combinations of breed, sex and neuter status. Neutering before 37 weeks was associated with a slight upward shift in growth trajectory, whilst neutering after 37 weeks was associated with a slight downward shift in growth trajectory. However, these shifts were small in comparison to inter-individual variability amongst dogs, suggesting that separate curves for neutered dogs were not needed. Five bodyweight categories were created to cover breeds up to 40kg, using both visual assessment and hierarchical cluster analysis of breed-specific growth curves. For 20/24 of the individual breed centile curves, agreement with curves for the corresponding bodyweight categories was good. For the remaining 4 breed curves, occasional deviation across centile lines was observed, but overall agreement was acceptable. This suggested that growth could be described using size categories rather than requiring curves for specific breeds. In the current study, a series of evidence-based growth standards have been developed to facilitate charting of bodyweight in healthy dogs. Additional studies are required to validate these standards and create a clinical tool for growth monitoring in pet dogs.

OBJECTIVE To identify risk factors for anesthetic-related death in pet dogs and cats. DESIGN Matched case-control study. ANIMALS 237 dogs and 181 cats. PROCEDURES Electronic medical records from 822 hospitals were examined to identify dogs and cats that underwent general anesthesia (including sedation) or sedation alone and had death attributable to the anesthetic episode ≤ 7 days later (case animals; 115 dogs and 89 cats) or survived > 7 days afterward (control animals [matched by species and hospital]; 122 dogs and 92 cats). Information on patient characteristics and data related to the anesthesia session were extracted. Conditional multivariable logistic regression was performed to identify factors associated with anesthetic-related death for each species. RESULTS The anesthetic-related death rate was higher for cats (11/10,000 anesthetic episodes [0.11%]) than for dogs (5/10,000 anesthetic episodes [0.05%]). Increasing age was associated with increased odds of death for both species, as was undergoing nonelective (vs elective) procedures. Odds of death for dogs were significantly greater when preanesthetic physical examination results were not recorded (vs recorded) or when preanesthetic Hct was outside (vs within) the reference range. Odds of death for cats were greater when intra-anesthesia records for oxygen saturation as measured by pulse oximetry were absent. Underweight dogs had almost 15 times the odds of death as nonunderweight dogs; for cats, odds of death increased with increasing body weight (but not with overweight body condition). CONCLUSIONS AND CLINICAL RELEVANCE Several factors were associated with anesthetic-related death in cats and dogs. This information may be useful for development of strategies to reduce anesthetic-related risks when possible and for education of pet owners about anesthetic risks.

In an effort to recognize and address communicable and point-source epidemics in dog and cat populations, this project created a near real-time syndromic surveillance system devoted to companion animal health in the United States. With over 150 million owned pets in the US, the development of such a system is timely in light of previous epidemics due to various causes that were only recognized in retrospect. The goal of this study was to develop epidemiologic and statistical methods for veterinary hospital-based surveillance, and to demonstrate its efficacy by detection of simulated foodborne outbreaks using a database of over 700 hospitals. Data transfer protocols were established via a secure file transfer protocol site, and a data repository was constructed predominantly utilizing open-source software. The daily proportion of patients with a given clinical or laboratory finding was contrasted with an equivalent average proportion from a historical comparison period, allowing construction of the proportionate diagnostic outcome ratio and its confidence interval for recognizing aberrant heath events. A five-tiered alert system was used to facilitate daily assessment of almost 2,000 statistical analyses. Two simulated outbreak scenarios were created by independent experts, blinded to study investigators, and embedded in the 2010 medical records. Both outbreaks were detected almost immediately by the alert system, accurately detecting species affected using relevant clinical and laboratory findings, and ages involved. Besides demonstrating proof-in-concept of using veterinary hospital databases to detect aberrant events in space and time, this research can be extended to conducting post-detection etiologic investigations utilizing exposure information in the medical record.

Neutering of cats has been associated with significant weight gain in the weeks following surgery. The present study aimed to evaluate the effectiveness of a moderate fat, low-energy dry expanded diet in reducing weight gain in growing pet cats when fed as part of a weight-control regimen over the 6 months post-neutering. Cats in participating primary care veterinary hospitals were enrolled at neutering and assigned to receive one of the two dietary treatments based on the hospital of origin. Owners of cats in the treatment group were instructed to feed the trial diet at maintenance (324.7 kJ/kg BW0.711 per d). Instructions for the control group were to feed the cat's regular diet according to the manufacturer's recommendations. Body weight and condition were evaluated by veterinarians at enrolment, 2-weeks, and 1-4 and 6 months after surgery. Body condition score (fivepoint scale) was compared between enrolment and each subsequent visit, controlling for enrolment age and sex. Percentage change in body weight was evaluated via multivariate mixed modelling to account for repeated measures. A total of 187 cats (eighty-seven females and 100 males) with a mean age of 5.2 (SD 0.8) months and mean weight of 2.8 (SD 0.6) kg from fifty-one hospitals completed the trial. The odds of being scored as overweight were 4.1 times as great for cats in the control v. treatment groups (95 % CI 2.1, 8.2). Percentage change in body weight differed significantly with enrolment age (P = 0.007) and approached significance between diet groups (P = 0.08). Cats fed the trial diet had a significantly reduced incidence of overweight in the 6 months following neutering.

Chronic kidney disease (CKD) is a common disease in cats, and its prevalence increases with age. CKD is progressive and irreversible and diagnosis often occurs relatively late in the course of the disease. Treatment and monitoring can alleviate clinical signs and slow progression of the disease, but prognosis depends on the severity of the disease at the time of diagnosis. Research aims to improve the diagnosis and management of CKD to benefit the health and welfare of cats with the disease. VetMed Resource contains a wealth of information on feline CKD including studies of the causes, risk factors and prevalence of the disease and developments in diagnosis, monitoring and management.

OBJECTIVE:To identify risk factors associated with diagnosis of chronic kidney disease (CKD) in cats.DESIGN:Retrospective case-control study.ANIMALS:1,230 cats with a clinical diagnosis of CKD, serum creatinine concentration > 1.6 mg/dL, and urine specific gravity < 1.035 and 1,230 age-matched control cats.PROCEDURES:Data on putative risk factors for CKD were extracted for multivariate logistic regression analysis from the medical records of cats brought to 755 primary care veterinary hospitals. For a subset of cats evaluated 6 to 12 months prior to the date of CKD diagnosis or control group inclusion, the percentage change in body weight between those dates as well as clinical signs at the earlier date were analyzed for associations with CKD development.RESULTS:Risk factors for CKD in cats included thin body condition, prior periodontal disease or cystitis, anesthesia or documented dehydration in the preceding year, being a neutered male (vs spayed female), and living anywhere in the United States other than the northeast. The probability of CKD decreased with increasing body weight in nondehydrated cats, domestic shorthair breed, and prior diagnosis of diabetes mellitus and increased when vomiting, polyuria or polydipsia, appetite or energy loss, or halitosis was present at the time of diagnosis or control group inclusion but not when those signs were reported 6 to 12 months earlier. Median weight loss during the preceding 6 to 12 months was 10.8% and 2.1% in cats with and without CKD, respectively.CONCLUSIONS AND CLINICAL RELEVANCE:The probability of CKD diagnosis in cats was influenced by several variables; recent weight loss, particularly in combination with the other factors, warrants assessment of cats for CKD.

Calcium oxalate urolithiasis results from the formation of aggregates of calcium salts in the urinary tract. Difficulties associated with effectively treating calcium oxalate urolithiasis and the proportional increase in the prevalence of calcium oxalate uroliths relative to other urolith types over the last 2 decades has increased the concern of clinicians about this disease. To determine factors associated with the development of calcium oxalate urolithiasis in dogs evaluated at general care veterinary hospitals in the United States, a retrospective case-control study was performed. A national electronic database of medical records of all dogs evaluated between October 1, 2007 and December 31, 2010 at 787 general care veterinary hospitals in the United States was reviewed. Dogs were selected as cases at the first-time diagnosis of a laboratory-confirmed urolith comprised of at least 70% calcium oxalate (n=452). Two sets of control dogs with no history of urolithiasis diagnosis were randomly selected after the medical records of all remaining dogs were reviewed: urinalysis examination was a requirement in the selection of one set (n=1808) but was not required in the other set (n=1808). Historical information extracted included urolith composition, dog's diet, age, sex, neuter status, breed size category, hospital location, date of diagnosis, and urinalysis results. Multivariable analysis showed that the odds of first-time diagnosis of calcium oxalate urolithiasis were significantly (P<0.05) greater for dogs<7 years, males (OR: 7.77, 95% CI: 4.93-12.26), neutered (OR: 2.58, 1.44-4.63), toy- vs. medium-sized breeds (OR: 3.15, 1.90-5.22), small- vs. medium-sized breeds (OR: 3.05, 1.83-5.08), large- vs. medium-sized breeds (OR: 0.05, 0.01-0.19), and those with a diagnosis of cystitis within the previous year (OR: 6.49, 4.14-10.16). Urinary factors significantly associated with first-time diagnosis of calcium oxalate urolithiasis were acidic vs. basic pH (OR: 1.94, 1.22-3.10), presence of RBCs (OR: 6.20, 3.91-9.83) or WBCs (OR: 1.62, 1.03-2.54), and protein concentration>30 mg/dL (OR: 1.55, 1.04-2.30). Patient demographics and urinalysis results are important factors that can support risk assessment and early identification of canine oxalate urolithiasis. Therefore, periodic urolith screening and monitoring of urine parameters should be encouraged for dogs at risk of developing these uroliths.

OBJECTIVE:To determine whether gonadectomy or age at gonadectomy was associated with the risk that dogs would subsequently become overweight.DESIGN:Retrospective cohort study.ANIMALS:1,930 dogs gonadectomized between 1998 and 2001 at ≤ 6 months of age (n = 782), > 6 months to ≤ 1 year of age (861), or > 1 to ≤ 5 years of age (287) and 1,669 sexually intact dogs.PROCEDURES:Dogs were followed-up through medical records for ≥ 10 years or until a diagnosis of overweight (defined as overweight, obese, or having a body condition score ≥ 4/5) was recorded. Information extracted included age at study entry, sex, breed, breed-size category, hospital visit frequency, and diagnosis (yes or no) of overweight or diseases that might affect body condition. Relative risk of a diagnosis of overweight was assessed among age groups of gonadectomized dogs and between gonadectomized and sexually intact dogs.RESULTS:No difference was detected among dogs grouped according to age at gonadectomy with respect to the risk of being overweight. This risk was significantly greater in gonadectomized dogs than in sexually intact dogs, but only during the first 2 years after gonadectomy. Sexually intact male dogs were approximately 40% less likely to have this diagnosis (hazard ratio, 0.61; 95% confidence interval, 0.52 to 0.72) than were sexually intact female dogs; no difference in risk between the sexes was evident for gonadectomized dogs.CONCLUSIONS AND CLINICAL RELEVANCE:Gonadectomized dogs had a greater risk of being overweight than did sexually intact dogs, but this risk was not influenced by age at gonadectomy. Opportunities exist for veterinarians to provide counseling during the first years after gonadectomy to help dogs maintain a healthy weight.

OBJECTIVE:To identify factors associated with development of struvite urolithiasis in dogs evaluated at general care veterinary hospitals in the United States.DESIGN:Retrospective case-control study.ANIMALS:508 dogs with a first-time diagnosis of struvite urolithiasis and 7,135 control dogs.PROCEDURES:Electronic medical records of all dogs evaluated at 787 general care veterinary hospitals in the United States between October 2007 and December 2010 were reviewed to identify dogs that developed struvite urolithiasis and 2 groups of control dogs with no history of urolithiasis. Information extracted included diet, age, sex, neuter status, breed size category, hospital location, and date of diagnosis. Urinalysis results, urolith composition, and other disease conditions were recorded if applicable. Potential risk factors were assessed with univariable and multivariable regression analysis.RESULTS:Toy- or small-sized breeds had significantly greater odds of struvite urolithiasis, compared with medium- or large-sized breeds. Neutering significantly increased the odds of this outcome in females only; sexually intact females were more likely to develop struvite urolithiasis than were sexually intact males, but only up to 5 years of age. Urinary factors significantly associated with the outcome were basic (vs acidic) pH, presence of RBCs or WBCs, protein concentration > 30 mg/dL, and ketone concentration ≥ 5 mg/dL.CONCLUSIONS AND CLINICAL RELEVANCE:Evaluation of demographic characteristics and urinalysis results may be useful in the early identification of struvite urolithiasis in dogs. Periodic urinalysis in dogs is recommended because of the potential health impact of a late diagnosis of urolithiasis.

Estimates of the prevalence of intestinal infection of dogs with Giardia spp. in the United States vary widely. Risk factors for infection in a large sample of dogs over an extended period of time have not been well characterized. A national, electronic database of medical records was used to estimate the prevalence and identify risk factors for Giardia spp. infection among dogs visiting Banfield Pet Hospital™ located in 43 states in the United States. The overall prevalence of Giardia spp. Infection was 0.44% (95% CI: 0.43-0.45%) in approximately 2.5 million owned dogs who had a fecal flotation test performed from January 2003 to December 2009. A steady decrease in annual prevalence was observed, from a high of 0.61% in 2003 to 0.27% in 2009. Seasonal increases in prevalence were noted during the winter and summer months. Giardia spp. prevalence was highest in the Mountain region, especially Colorado (2.63%; 95% CI: 2.53-2.73%), and in puppies ≤0.5 year of age (0.63%; 95% CI: 0.61-0.64%). It was lowest for dogs of mixed breeding compared with pure breeds. Infection risk was 25-30% greater in sexually intact dogs compared to spayed and neutered dogs.