[This corrects the article DOI: 10.3389/fvets.2025.1565922.].

The American College of Veterinary Anesthesia and Analgesia (ACVAA) in collaboration with the North American Veterinary Anesthesia Society and the Academy of Veterinary Technicians in Anesthesia and Analgesia have revised and expanded the 2009 guidelines. The 2025 guidelines include updated recommendations for monitoring circulation, oxygenation, ventilation, body temperature, neuromuscular blockade, and anesthetic depth in feline and canine patients. Monitoring during sedation (sedation-specific guidelines are in the Monitoring During Sedation Section), recommendations for personnel managing the patient, and the use of cognitive aids have been incorporated. This document is meant to establish guidelines for monitoring small animals during sedation and in the perianesthetic time period. Further information concerning techniques, reference values, differential diagnoses, and details of various interventions can be found in the reference literature cited at the end of this paper. These guidelines use objective, evidence-based criteria whenever possible; however, some of the recommendations are a consensus of expert opinion and clinical experience. This document is intended to guide monitoring of small animal patients during sedation and anesthesia; it is not to be construed as a standard of care as the choice of monitoring techniques and methods can vary depending on the type of practice and spectrum of care considerations. Alternative methods are suggested if a minimally recommended technique is unavailable.

Osteoarthritis (OA) is a ubiquitous problem affecting dog joints, particularly the hip, elbow, stifle, and spine. OA most often results from developmental orthopedic problems such as hip dysplasia, elbow dysplasia, and patellar luxation and from injuries to the cranial cruciate ligament. Several management approaches have been proposed to manage OA, including steps to modulate growth, physical activity, and exercise, nutrition and nutritional supplementation, medications, physical rehabilitation, and surgical procedures. This article is the first in a series of articles that propose steps for practical OA management in dogs at various life stages. The review presented here focuses on growing dogs. The text describes the early pathophysiology and diagnosis of OA. The physical, nutritional, analgesic, and surgical management options of OA in growing dogs are presented. The application of these management options is described for three dogs. The overall approach to the management of OA in growing dogs is discussed.

Chapter 33 General Anesthesia in the Recumbent Horse Tamara Grubb, Tamara GrubbSearch for more papers by this author Tamara Grubb, Tamara GrubbSearch for more papers by this author Book Editor(s):DVM, DACVS, DABVP-EP Claude A. Ragle, DVM, DACVS, DABVP-EP Claude A. RagleSearch for more papers by this author First published: 16 April 2024 https://doi.org/10.1002/9781119859352.ch33 AboutPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShareShare a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract His chapter contains sections titled: Introduction, Preparation for Anesthesia, Premedication, Induction to Anesthesia, Maintenance of Anesthesia, Analgesia, Local and Regional Anesthesia, Recovery from Anesthesia and References. References Andersen , M.S. , Clark , L. , Dyson , S.J. , et al. ( 2006 ) Risk factors for colic in horses after general anaesthesia for MRI or nonabdominal surgery: absence of evidence of effect from perianaesthetic morphine . 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Background Acetaminophen is utilized in human infants for pain management and fever. Neonatal foals might benefit from administration of acetaminophen but effective and safe dosage regimens for neonatal foals remains to be determined. Objective The objective was to determine the plasma pharmacokinetics of acetaminophen following oral administration of a single dose of 20 mg/kg or 40 mg/kg to neonatal foals. A secondary objective was to evaluate any changes in hematology and biochemistry profiles. Study design Randomized study. Methods Eight clinically healthy 7–9-day old Quarter Horse foals (3 colts and 5 fillies) received a single oral dose of acetaminophen either 20 (n = 4) or 40 (n = 4) mg/kg. Hematology and biochemistry profiles were evaluated before and 7 days after drug administration. Blood samples were collected before and 8 times after acetaminophen administration for 48 h to quantify plasma acetaminophen concentrations. Plasma pharmacokinetic parameters were estimated using non- compartmental analysis. Results The median peak plasma concentrations (and range) occurred at 1.5 (0.5–2) hours, and 1.0 (1–2) hours for the 20 and 40 mg/kg doses. The maximum plasma concentration (and range) was 12 (7.9–17.4) μg/mL for the 20 mg/kg dose and 14 (11–18) μg/mL for 40 mg/kg dose. The median AUC0-∞ ranged from 46 to 100 and 79 to 160 h*-μg/mL for the 20 and 40 mg/kg dose, respectively. Hematology and biochemistry profiles remained within normal limits. Conclusion Plasma disposition of acetaminophen after oral administration of 20 and 40 mg/kg to neonates is comparable to adult horses. However, safety and the optimal dosage regimen of acetaminophen for treating pain and or pyrexia in neonates in this age group remains to be determined.

BACKGROUNDAcetaminophen is a common analgesic and antipyretic drug used in human medicine and might be an alternative to nonsteroidal anti-inflammatory drugs for treating pain and pyrexia in foals. The pharmacokinetics and safety of differing doses of acetaminophen have not been investigated in foals.OBJECTIVESTo determine the plasma pharmacokinetics and any changes in haematology and biochemistry profiles following oral administration of single doses of acetaminophen at 10, 20, and 40 mg/kg to foals.STUDY DESIGNRandomised cross-over pharmacokinetic study.METHODSSix Quarter Horse (two colts and four fillies) foals received 10, 20, and 40 mg/kg acetaminophen orally once. Haematology and biochemistry profiles were performed before and 7 days after each drug administration. Blood samples were collected over 64 h after drug administration and were used to quantify plasma acetaminophen concentrations by liquid chromatography. Pharmacokinetic parameters were determined using compartmental analysis.RESULTSMedian (range) acetaminophen plasma concentrations were 4.4 (1.8-5.1), 6.3 (2.6-12.6), and 14 (7.3-18) μg/ml for the 10, 20, and 40 mg/kg doses, respectively. Median acetaminophen area under the concentration versus time curve (AUC)0-∞ ranged from 25 (11-32), 41 (22-74), and 105 (82-142) h × μg/ml for the 10, 20, and 40 mg/kg doses, respectively. Dose-normalised maximal concentrations and AUC0-∞ values were similar across dose concentrations (p > 0.05). Median terminal half-life for all doses was 2.7-2.8 h. Haematology and biochemistry profiles were normal except for blood urea nitrogen and alkaline phosphatase concentrations.MAIN LIMITATIONSFoals were growing throughout the study, starting at 1 month and ending at 3 months. Deposition of drugs changes with age. The sample size was small and only single doses were evaluated. No liver biopsies were performed.CONCLUSIONPlasma disposition of acetaminophen after a single oral dose of 10, 20, and 40 mg/kg to 1-3-month-old foals varies greatly with the dose. The analgesic and antipyretic effect in foals is unknown.

Acetaminophen is a common analgesic and antipyretic drug used in human medicine and might be an alternative to nonsteroidal anti-inflammatory drugs for treating pain and pyrexia in foals. The pharmacokinetics and safety of differing doses of acetaminophen have not been investigated in foals. To determine the plasma pharmacokinetics and any changes in haematology and biochemistry profiles following oral administration of single doses of acetaminophen at 10, 20, and 40 mg/kg to foals. Randomised cross-over pharmacokinetic study. Six Quarter Horse (two colts and four fillies) foals received 10, 20, and 40 mg/kg acetaminophen orally once. Haematology and biochemistry profiles were performed before and 7 days after each drug administration. Blood samples were collected over 64 h after drug administration and were used to quantify plasma acetaminophen concentrations by liquid chromatography. Pharmacokinetic parameters were determined using compartmental analysis. Median (range) acetaminophen plasma concentrations were 4.4 (1.8–5.1), 6.3 (2.6–12.6), and 14 (7.3–18) μg/ml for the 10, 20, and 40 mg/kg doses, respectively. Median acetaminophen area under the concentration versus time curve (AUC) 0–∞ ranged from 25 (11–32), 41 (22–74), and 105 (82–142) h × μg/ml for the 10, 20, and 40 mg/kg doses, respectively. Dose-normalised maximal concentrations and AUC 0–∞ values were similar across dose concentrations ( p  > 0.05). Median terminal half-life for all doses was 2.7–2.8 h. Haematology and biochemistry profiles were normal except for blood urea nitrogen and alkaline phosphatase concentrations. Foals were growing throughout the study, starting at 1 month and ending at 3 months. Deposition of drugs changes with age. The sample size was small and only single doses were evaluated. No liver biopsies were performed. Plasma disposition of acetaminophen after a single oral dose of 10, 20, and 40 mg/kg to 1–3-month-old foals varies greatly with the dose. The analgesic and antipyretic effect in foals is unknown.

Abstract Background The repeated administration of high doses of gabapentin may provide better analgesia in horses than current clinical protocols. Hypothesis and Objectives Administration of gabapentin at 40 and 120 mg/kg PO q 12 h for 14 days will not alter serum biochemistry findings or cause adverse effects. Our objectives were to evaluate the effect of gabapentin on serum biochemistry, physical examination, and plasma pharmacokinetics of gabapentin. Animals Six healthy adult mares. Methods Horses received 40 and 120 mg/kg of gabapentin orally q 12 h for 14 days. Horses were examined and scored for ataxia and sedation daily. Serum biochemistry variables were analyzed before treatment and days 7 and 14 after gabapentin administration. Plasma disposition of gabapentin was evaluated after the first and last drug administration. Pharmacokinetic parameters were estimated using noncompartmental analysis. Results No changes occurred in physiologic or biochemical variables. Median (range) maximal plasma gabapentin concentrations (μg/mL) after the last dose (day 15) were 7.6 (6.2‐11) and 22 (14‐33) for 40 mg/kg and 120 mg/kg doses respectively. Maximal concentration of gabapentin was reached within 1 hour after drug administration. Repeated administration of gabapentin resulted in a median (range) area under the curve (AUC0‐12 hours) last/first dose ratio of 1.5 (1.00‐2.63) and 2.92 (1.4‐3.8) for the 40 and 120 mg/kg regimens, respectively. Conclusion and Clinical Importance Our results suggest that horses tolerate gabapentin up to 120 mg/kg PO q 12 h for 14 days. The analgesic effect of the dosage regimens evaluated in our study warrants further research.

Once pet-specific care has been considered for a practice and clients are "on board" with the philosophy, it is important to consider how the veterinary team can best deliver this level of care and embed the concepts in the practice workstream. The "rooming" process provides the perfect opportunity for the technician/nurse on a pet's care team to review with the client the aspects of their pet's care plan that are anticipated for that visit and to ask the client if they have any questions about the diagnostics, treatments, or other anticipated aspects of their pet's visit. Forward booking of appointments, procedures, and other visits is an easy and effective way to increase the likelihood that the clients will actually show up for the care that their pets need and benefit from. Pet-specific care allows specific competencies to be developed which can lead to career fulfillment regardless of the career ladders available in a particular practice. To keep the very best employees, and for them to remain challenged and motivated, staff development must be part of the practice's core strategies. Pet-specific care focuses heavily on prevention, early detection, evidence-based treatment and attention to closing compliance gaps, and practices need systems in place so that implementation is as close to seamless as possible. Core competencies are important in staff development, because they can be tiered and considered in terms of reward-based compensation. The individual development plan is an agreement between the organization and the employee and both must be involved in its creation. Staff who feel empowered and competent are better able to engage clients and advance pet care initiatives. Staff should be encouraged to develop competencies needed by the practice. Accountability is a critical attribute in the functioning of a veterinary hospital. For a hospital to function at its best, especially when delivering pet-specific care, every employee must not only be accountable for their own duties but also deliver on implied promises to all stakeholders regarding the mission and vision of the practice. The challenge with veterinary hospitals is to make accountability a scalable attribute. Accountability is important for the organization in general because without it, bad leaders drive out good staff and it is very easy for even high-producing teams to be reduced to mediocrity. Veterinarians are often hesitant about empowering employees, for fear that they will overstep their authority or discount goods and services to clients, but there is no evidence to support such fears. Alignment is critical for a variety of reasons, not the least of which is that without alignment, it is impossible to deliver on a unified mission and vision to pet owners. Every hospital has its own reasons to harness alignment, and yet hospital goals are not difficult to enumerate. Accountability is a critical attribute in the functioning of a veterinary hospital. As was mentioned from the very start, running an efficient and effective veterinary hospital doesn't happen by accident — it takes planning. In a well-designed strategic plan, there is a division of duty between the management team and the hospital staff who will be implementing the changes. Pet-specific care relies on the successful interaction and collaboration of all hospital team members. Alignment begins with effective leadership. Including team members in strategic planning efforts, and sharing metrics that allow them to see the impact of their actions, help assure alignment around best practices. Emotional Intelligence (EI), also referred to as Emotional Quotient, has become a popular topic but its roots can be traced back over 100 years. EI is important in the workplace, but its relationship to actual intelligence has been disputed. The mixed model of EI focuses on the skills and competencies that drive leadership performance. These skills are: self-awareness, self-regulation, social skills, empathy, and motivation. There are several tests for the mixed model, including the Emotional Competency Inventory, the Emotional and Social Competency Inventory, and the Emotional Intelligence Appraisal; 360° assessments are also considered measures of this mixed model. For most veterinary practices, the primary method of assessing EI will likely be to increase self-awareness with the use of self-tests, or 360° evaluations which look at the interactions of individuals with other stakeholders. Effective nursing leadership is associated with a culture of high-quality care and continuous improvement. The increasing complexity of veterinary healthcare makes it difficult for one member of staff to lead alone. The ability and willingness to delegate and share leadership responsibilities is a valuable skill that can streamline a leader's workload and empower employees, raising levels of job satisfaction and motivation. The requirement every nurse has to ensure their knowledge and skills are up to date is a fundamental leadership behavior, for nurses must be self-aware and self-critical and seek out the relevant training to facilitate their professional development. The democratic open approach of transformational leadership can be a barrier to effective working as it can be difficult to make rapid decisions when every member of a large team requires consultation. Nursing care plans are the written records of nursing care intended for a patient. They can support holistic approaches, pet-specific care, continuity of care, and clinical governance. Implicit care planning may come naturally to veterinary nurses, but there are several advantages to explicitly planning patient care and creating a detailed nursing care plan. One of the most useful tools in planning nursing care is the nursing process. This is a cyclical, continuous process of assessment, planning, implementation, and evaluation. Planning the nursing care of a patient is a two-stage process. First, goals of care should be set. The second part of the planning process is preparation. Patient goals need to be planned with the support and consent of pet owners. The evaluation stage is key to the nursing process and supports the continuum of care. Care plans can also be a valuable tool for retrospective clinical audit to support clinical governance. Care bundles are used within human-centered healthcare to facilitate the use of strong evidence-based practice to improve clinical outcomes. Evidence from human-centered healthcare demonstrates the positive impact of care bundles when applied to the management of chronic disease. One of the most important principles of patient safety in healthcare is the empowerment of all staff members to speak out if they have concerns about safety. The use of care bundles can contribute to an improvement in patient safety. A robust care bundle can be a useful tool to measure care and support clinical governance. Recruiting enthusiastic and knowledgeable members of the team to support the implementation of the care bundle can be invaluable. Robust and detailed education with theoretical concepts and simulation practice will result in a team ready and able to take full advantage of the use of the care bundle. Procedure manuals and reference manuals are helpful management tools in any size or type of veterinary practice. They serve as a convenient reference tool to ensure that standards of care and standard guidelines are in place. The practice should make a master list of all of the types of manuals they need. The number of manuals will depend on the size, scope, and complexity of the practice. While each manual should have a specific project manager, the more people involved in the creation and review of the manual, the better the final product will be. Manuals should be reviewed and updated as needed each year. Each update should result in a new revision date. Electronic manuals are easier to create, distribute, and maintain than hard-copy manuals, but at least one of each manual should be maintained in hard copy so it is available during network, internet, or power failures. Patient and procedure logs play a vital role in any practice and work best in conjunction with well-designed and well prepared procedure manuals. Logs are created in response to specific disasters that the practice leadership hopes to prevent from recurring, so the information gathering can be quick and easy. Logs exist to support quality assurance and compliance. They also help the practice leadership identify trends quickly. Logs help the practice manage product recalls in an efficient manner. Logs can help identify team members who need additional training, or are not fully compliant with practice policies. Computer automation does not negate the need for logs and manual auditing. In many cases, the use of software increases the number of errors and omissions within a specific process. The frequency of checking the log against the computer varies from practice to practice. In every aspect of veterinary medicine, the accurate recording of health assessment, recognition of lesions and therapy provided generates a useful medical record. While often underused in some practices, becoming familiar with the terminology and their application is important for the practice team to be able to effectively communicate and record dental conditions, treatment, and instructions for our patients and clients, to provide optimal oral care. A SOAP style of medical record can be utilized with areas to record radiographic assessment, physical findings, assessment, and treatment provided. The most efficient way to denote these findings is "four-handed charting" with one person probing the teeth to determine periodontal pockets, GR (RE), missing teeth, etc. and calling out the measurements as a second person records the findings on the dental chart. Every person who owns or works around animals is considered to have assumed the risks of being potentially injured – whether from an animal's kick, bite, scratch, or even an infectious zoonotic disease resulting from an animal's secondary sources. Even though a veterinarian's liability or an animal owner's liability might be at issue when injuries or damages occur to people and property, this chapter discusses ways to prevent or minimize being injured by animals at the workplace. In addition to being the legal duty and responsibility of the veterinary practice owner, ensuring a safe working environment for employees is essential. Employees working at a veterinary facility are considered to have knowingly assumed the risks that might arise from animal-related injuries. Unlike employees, clients do not necessarily assume all risks of injuries from their own animals or other animals when visiting a veterinary facility. Animal hospice, a philosophy of care that addresses the end of life care of the pet, as well as the needs of the human caregiver, is an evolving movement that harnesses the skills and abilities of an interdisciplinary team (IDT). While some of the IDT team members might be in employee relationships, most people working in animal hospice today are small businesses or volunteers that form a referral network to care for hospice families. Palliative care can occur at all stages of life, but is especially important at end of life. It is patient-focused care to improve quality of life (QOL). The hospice philosophy does not preclude euthanasia, but it does take an approach to palliative care and assessing QOL that often delays euthanasia significantly without significant suffering. Medical errors are infrequently discussed in veterinary practice. Few reports in the current literature describe their incidence; however, they do occur and they have the potential to cause harm, if not death, to our patients. More patients die annually from preventable medical errors than automobile accidents. Medical errors result from either cognitive limitations or system failures. The former refers to deficiencies of the individual, whereas the latter reflects the deficiencies of the work environment. Medical errors should be disclosed to the veterinary team and the client, and considered as teachable moments rather than badges of shame. Several communication models help veterinary teams to discuss medical errors with clients, including the acronym TEAM: "T" stands for truth, teamwork, and transparency; "E" stands for empathy; "A" stands for apology and accountability; and "M" stands for management. Consistency in practice communication with clients is a constant battle. Communication styles differ from person to person, as does emotional intelligence, and with that comes differences in how people hear and retain information. There are some basic aspects of communication that should be taken into consideration: verbal, nonverbal, and preverbal. A better approach that will resound clearly with a client is to talk about the "why" first. As technology continues to advance, it will be important to adapt to client expectations. Currently, social media is dominating marketing communication, but there are still many clients who like postcard reminders. Telemedicine is another growing platform to convert phone conversations to healthcare for clients who are not able/willing to come into the clinic. The golden rule of effective communication is: speak to others the way they want to be spoken to. Compassion fatigue and burnout are common occupational stressors in veterinary practice. Compassion fatigue and burnout have an impact on more than just the individual experiencing them. The field of veterinary medicine attracts individuals who are passionate about animal care and have high levels of compassion and empathy. Compassion fatigue and burnout can negatively affect patient care and the overall performance of a veterinary practice. Compassion fatigue results from emotional and physical depletion from continual exposure to, and the relief of, others' suffering. Burnout results from chronic exposure to a stressful work environment. There are three dimensions to burnout: emotional exhaustion, low sense of personal achievement, and cynicism. Effectively managing compassion fatigue and burnout is essential to preserving the mental, emotional, and physical health of veterinary professionals. Organizational solutions for compassion fatigue and burnout involve maintaining an even balance between job demands and job resources. Compromise fatigue is an insidious disorder experienced by many who work in the animal health field. Early in their careers, most animal healthcare workers focus on desirable outcomes, and the best evidence-based ways to achieve them. Compromise fatigue should be considered an occupational hazard in the companion animal healthcare marketplace. Compromise fatigue should be expected, since inevitably veterinary care of companion animals must be responsive to the pet owner's ability to pay. Since compromise fatigue is often associated with the financial constraints of pet owners, reasonable expectations of pet care expenses should be communicated to pet owners early and often, as well as the particular healthcare risk factors for the individual pet. Risk management strategies should be discussed with pet owners at the very first office visit. Compromise fatigue can be mitigated somewhat by having proactive discussions with pet owners regarding financial risk management, before problems occur. Canine atopic dermatitis is a common and often frustrating disorder to manage for both pet owners and veterinarians. Most atopic pets do have a genetic predisposition to develop allergies, and the clinical presentation is often characteristic, but that is typically where the simple part ends. Pet owners can often predict the costs of such things as feeding, grooming, and boarding, but the costs of veterinary care are often much harder to predict. Atopic dermatitis can be attributable to the complex interactions of many different genes, and the heritability of the condition is estimated to be quite high. Pets with atopic dermatitis tend to develop recurrent bacterial and yeast infections and so when pets develop such issues, it is important to routinely assess with cytology. Pet-specific care can make allergy management a much more positive experience for clients, patients, and the entire hospital team. Periodontal disease (PD) is one of the most commonly encountered diseases in our canine and feline patients. Some features of veterinary practices that promote good compliance when it comes to dentistry include educating the whole team on the benefits of a dental procedure, including front office staff, assistants and nurses/technicians, and veterinarians. The whole team can also be educated on common concerns that clients have, specifically in regard to anesthesia. Every pet should have quality oral and dental care throughout its life stages, with an oral examination at every visit, professional care at regular intervals, and effective home care. Brachycephalic dogs and cats are also at higher risk of periodontal and dental disease due to crowded and rotated teeth. Strategies for scheduling and dental team workflow can be quite complicated. Managing unexpected challenges is a common problem in dental practice. Degenerative Joint Disease (DJD) and osteoarthritis (OA) are present in many more dogs and cats, including young animals, than generally appreciated. Contrary to conventional concepts, OA is not a disease strictly of older dogs or cats. At least 20% of all dogs are likely affected by OA, and probably many more, and most are diagnosed between 8 and 13 years old; 60% of all cats and 90% of cats over the age of 10 have radiographic DJD changes. Several clinical metrology instruments are validated for assessment and scoring of OA in dogs, including the Canine Brief Pain Inventory and Liverpool Osteoarthritis in Dogs. A response to nonsteroidal antiinflammatory drug therapy will reinforce the diagnosis of OA and create the space for client acceptance of a more detailed plan. The pathophysiology of OA in dogs is often conformational, and exacerbated by common risk factors. The most successful way to provide effective and consistent pain relief for veterinary patients is to approach pain management as a team. The first step in building an effective pain management team is educating the team about animal pain with the goal of ensuring that every team member fervently believes that animals do feel pain and that pain can negatively impact that animal's health, behavior, and welfare. The next steps include assigning specific roles for each team member, providing the training and education that the team member requires to fulfill their role and emphasizing that every team member must constantly strive to meet the practice's goal of relieving pain in every single patient. As with human nurses, the veterinary nurse is generally the primary "voice," or advocate, of the patient. The pet owner should be motivated to work with the veterinary team to ensure that the pet is not experiencing pain, either acute or chronic. Two common causes of infectious diseases that impact populations of cats globally are feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV). Repeat testing is also encouraged following exposure to cats that are either known to be infected or have unknown retroviral status. When a cat is exposed to FeLV, viral particles are first found in lymph tissue near the site of exposure. The presence of the p27 protein can be detected at this time through enzyme-linked immunosorbent assay (ELISA) testing. An ELISA is typically used in-house to test for p27 antigen. Feline leukemia virus and FIV have global presences when it comes to feline infectious disease. Any initial consultation about FeLV and FIV should explore patient- and household-specific risk factors. Recurrent pyoderma is a common and often frustrating disorder to manage for both pet owners and veterinarians. Pyodermas are typically characterized by their depth, or by their particular characteristics. Intermediate pyodermas involve deeper penetration of bacteria, and most often result in folliculitis and perifolliculitis. Deep pyodermas involve yet deeper structures in the dermis and panniculus, including furunculosis, cellulitis, abscesses, and fistulating diseases. The concept of recurrent pyoderma, once again, is that the condition responds entirely to antimicrobial therapy, only to relapse at some point after therapy has been stopped. The most common underlying cause for recurrent pyoderma is allergy, and atopic dermatitis accounts for a majority of cases. Antimicrobial resistance is a significant issue in healthcare and must be taken seriously. Veterinary healthcare teams should practice good infection control with each case of pyoderma, and this includes appropriate hand washing, cleansing, and disinfection. Otitis externa is a common and often frustrating disorder to manage for both pet owners and veterinarians. The management of ear disorders is frustrating for both veterinarian and pet owner. Undiagnosed rupture of the eardrum is very common in chronic otitis externa. To successfully treat ear canal problems, it is important to first understand some of the structures involved. Culture and susceptibility testing is useful when systemic therapy is being considered, but it is important to realize that because microbes are so plentiful in the ear canal, selection of causative microbes is not always assured, depending on sampling technique and laboratory factors. Any process that disturbs the ear canal's barrier function will predispose to otitis externa. The best approach to managing the pet with otitis externa is to suspect from the outset that the problem is secondary to some underlying problem. Most cases of otitis externa can be managed without the use of systemic antibiotics. Obesity in the pet population has reached epidemic proportions in many industrialized countries. The primary treatment for obesity is reduced caloric intake and increased physical activity. Weight management in pets, including obesity prevention and treatment, is a challenge for the veterinary healthcare team and pet owners. The best approach for weight management in pets is a team approach, where all team members are saying the same thing and are part of the weight management program supporting the pet owner and patient. The healthcare team should assess every patient that comes into the hospital, every time they come into the hospital, to establish nutritional needs and feeding goals. The veterinary assistant or credentialed technician/nurse should be leading the nutritional history. Effective follow-up and regular monitoring by the entire veterinary team are crucial parts of a successful weight loss program. A successful weight management program is in the best interest of the pets. Glaucoma is a group of ocular diseases that exhibit increased levels of intraocular pressure (IOP) that are detrimental to the maintenance of vision and health of the eye. Primary glaucoma is typically thought to occur in dogs with a genetic predisposition for anatomical differences which cause an inadequate outflow of aqueous, thereby leading to an increase in IOP. Secondary glaucoma is typically thought to be a result of a decrease of aqueous outflow with an increase in IOP in eyes with open angles. Most feline patients that develop glaucoma do so from chronic uveitis. Various treatments exist for glaucoma, but the team should understand that there is never a cure for glaucoma. Surgical therapies for glaucoma are utilized to prevent vision loss and maintain controlled IOPs. Surgical therapies can be grouped into categories such as vision-sparing procedures versus comfort-restoring procedures. Diabetes mellitus (DM) is frequently diagnosed in companion animal practice. A team approach to medical management of DM is essential. Effective therapy requires commitment to care by both the client and the veterinary team. Obesity is a well-established risk factor for the development of DM. An appropriate time to initiate a conversation about risk factors for DM is when patients present as kittens and puppies for wellness visits. Wellness visits are an excellent opportunity for client education concerning content areas that are essential to pet health. The typical protocol for treatment of DM involves insulin therapy and dietary management. Both arms of therapy target the patient's circulating blood glucose concentration, with the hope of keeping this below the renal threshold for as long as possible. Monitoring the diabetic patient is an essential part of medical management so that clinical signs are controlled without hypoglycemic episodes. Patients with cancer may have numerous co-morbidities, requiring doctors across multiple disciplines to be involved in their care. Regular meetings of the multidisciplinary team (MDT) allow for collective discussion of the patient's case, assuring that all members are aware of the patient's treatment plan and that all the patient's needs are being met. A solution to the standard process of patient care is the implementation of a MDT. An MDT is a group of clinicians and paraprofessionals that include the primary care team as well as specialists across multiple disciplines that collectively coordinate their care of a cancer patient. An effective MDT requires a selected individual to assume a leadership role. The principles and importance of an MDT approach to patient care are essential to impart to those entering the veterinary profession.

When an animal is born, it receives half of its genetic blueprint from its father and half from its mother. DNA is a fabulous device for conserving everything that makes a living being what it is. Genes represent a region of DNA that influence a particular phene, trait or characteristic. A gene is that portion of DNA that codes for a specific sequence of amino acids, which in turn make proteins, enzymes, or polypeptides. Genetic diseases usually cause problems because a mutation creates a poorly functioning facsimile of the normal gene product. Microsatellites are one way to identify an individual, as well as its progeny, and have become a voluntary part of the DNA identification for the different purebred registries. Genomics is the study of the entire genome, and its combined influence on complex diseases and the impact of environmental factors such as diet, exercise, medications, and toxins on genes. Most traits have polygenic inheritance, in which disease manifestations are controlled by a variety of genes, often with environmental influence. The deeper one delves into genetics and statistics, the more one realizes that, for most conditions, hard statistics do not apply unless a direct test for the genotype exists, and the condition is fully penetrant and expressed. Modifiers, incomplete penetrance, epigenetics, and variable expressivity may have a significant effect on phenotypic outcome. Because accurately predicting genotypes with polygenic traits is difficult and because the environment can have a profound influence, genetic involvement in a trait is typically expressed as heritability, which is a mathematical representation of the variance in breeding values divided by phenotypic variance. Mitochondria contain their own distinct genes, and genetic diseases caused by mitochondrial DNA variants are transmitted from mothers to both male and female offspring. Genes do not cause diseases. They code for proteins that may have developmental or maintenance roles. When those proteins fail to function in a manner consistent with “normal,” an animal may be diagnosed with a phene, trait, or disease of a genetic nature. Still, the relationship between genetics and disease is not as clear cut as one might expect. Fucosidosis is a rare but devastating lysosomal storage disease of English springer spaniels, transmitted as an autosomal recessive trait, meaning a dog would have to inherit an abnormal gene from each parent to be affected by the disease. Epistasis is when the action of one gene depends on the action of another gene. Epistasis is wonderfully illustrated by the coat colors possible with different combinations of alleles from different loci. Oncogenes are genes that when mutated, or expressed at high levels, cause normal cells to transition into cancer cells. Pet-specific care is all about managing risks. All animals have certain risks that pertain to their individual circumstances. For most pets, family history or breed predisposition is a significant contributor to disease susceptibility. Exposure risks constitute another significant contributor to disease susceptibility. Genotypic tests assess a genetic mutation or marker to determine disease susceptibility. Phenotypic tests are those that measure a detectable abnormality or variance from normal, rather than a genetic variant. Collecting relevant information from pet owners is critical to being able to provide truly personalized care for pets. Checklists can be used for more basic functions, such as history taking, presurgical and postsurgical checks, and even to ensure that certain topics are addressed in client educations. Understanding predispositions and risk profiles for individual pets allows veterinarians to create a lifetime care plan for most of their clients, based on the specific risks of each individual patient. In many countries around the world, breeds of pet animals, notably dogs, cats, and rabbits, are becoming more and more extreme in their body shapes. Examples of such extremes could be short legs, long backs, very long ears, excessive hair or hairlessness, pronounced skinfolds, bulging or sunken eyes and, perhaps the most well-recognized, the brachycephalic or flat-faced animals. The veterinary team can make a big difference both throughout the animal's life but also by being involved right from the point of prepurchase decision making. The emotional and financial consequences for the owners can be huge but the whole veterinary team can be affected. Social media can be great for practices, but it is also a powerful tool in getting messages across both consciously and subliminally. Extreme conformation is unnatural and can lead to a variety of health issues and suffering, some of which can be life-threatening. Genetic testing encompasses all evaluations that reveal hereditary predisposition to traits and disorders. These include physical genetic screening for disease as well as DNA tests of the genotype. The majority of genetic diseases and the most commonly seen diseases are complexly inherited and currently have no mutation-based DNA tests available. Some tests measure the phenotype, or what can be seen in the animal. Most tests of the phenotype only identify affected individuals from nonaffected individuals, and not carriers of disease liability genes. Direct mutation-based tests evaluate for specific disease-causing gene mutations. Several breed organizations and/or genetic testing companies list recommended breed-specific genetic tests and screening. The quantity and commercial availability of DNA-based genetic tests are rapidly increasing. Several commercial genetic testing laboratories offer breed-specific “panels” of DNA tests versus running individual tests. Several companies offer DNA testing to identify breed heritage for pets. Genetic health registries compile health data, making that information available to breeders who can then breed with intentionality, owners who can better predict the health of their individual pet, and researchers who can use that information to study disease inheritance and prevalence, and identify emerging health conditions. Many veterinary organizations consider health testing an essential component of veterinary medicine. In their simplest form, genetic health registries are repositories of the results obtained from either phenotypic or genetic health screening test. In general, research into the inheritance and genetic basis of health conditions occurs within university laboratories, institutes, veterinary organizations, and commercial genetic testing enterprises. Veterinarians and owners should explore the information in health registries and use that knowledge in selecting pets to promote overall pet health. Health registries form the backbone of research, which enables the development of genetic tests to reduce disease. The hospital team should be knowledgeable about the genetic tests available, their proper use and interpretation, breed-specific hereditary predispositions, and proper genetic counseling for both owners and breeders of dogs and cats. The predisposition to genetic diseases is lifelong. Consequently, these must be treated as chronic diseases and not just requiring intermittent treatment during clinical episodes. Health-conscious breeders are happy to provide official documentation of the results of health screening. Veterinarians and the veterinary team should be knowledgeable about which genetic disorders have appropriate testing available, and in what patients they should be run. Prebreeding health evaluations should be performed on all prospective breeding cats or dogs, whether for purebred or mixed-breed planned matings. Genetic testing companies are increasingly providing genetic diversity measurements to breeders for individual dogs or cats and their proposed matings. Genetic tests are extremely useful tools to help manage genetic disorders. Veterinary teams need to be prepared for a variety of patients these days, with different breed names, descriptions, and predispositions to disease. In most veterinary practices, approximately half of all canine patients are mixed-breeds, and there are approximately an equal number of purebreds or hybrids. If the information available in practice management software is to be useful for pet-specific strategies, then it is critical that this information be correct in the medical record. Purebred pets are those with a documented pedigree and there are literally hundreds of dog breeds and dozens of cat breeds in the world today. Hybrids are becoming more common in society, as breeders and pet owners attempt to select for specific features by crossing a variety of purebred breeds. Mixed-breed pets have always posed a problem to disease risk prediction, since without knowing breeds, it can be difficult to predict breed predisposition to disease. Many clients acquire a pet without a good understanding of its long-term healthcare needs. This lack of understanding translates both to poor compliance/adherence and to improper planning for a lifetime of healthcare. Most veterinary teams play little or no role in the acquisition of a pet, so clients often begin and complete this process without appropriate healthcare advice. Veterinarians could even provide adoption questionnaires that inquire about health issues in the animals or their parents, and genetic testing that might have been done to mitigate healthcare risks. Helping prospective pet owners understand the ramifications of pet ownership before they actually take on the responsibility of pet ownership is in everyone's best interest. Most selection counseling can be performed by the nonveterinary team and it can be a great bonding experience even without veterinary involvement. To accomplish early detection, both genotypic and phenotypic tests are needed. Genotypic tests examine an individual's DNA for mutations or markers that may be correlated with traits and disease risk. Phenotypic tests measure observable features and diagnostic judgments are made on that basis, and comparisons with so-called “normal” reference intervals. Genotypic tests are available primarily for conditions transmitted as simple Mendelian traits, mostly controlled by one set of genes. Genotypic tests, those that rely on the detection of actual genetic mutations or markers, have a lot of benefits. The best use of genotypic tests is as a health screen rather than a disease screen. Phenotypic tests are more commonly done in practice, including blood tests, urinalysis, imaging, and electrocardiography. Veterinary teams need to be able to effectively counsel clients as how a combination of genotypic and phenotypic testing can help deliver excellent healthcare across a pet's lifespan. From congenital and early-onset conditions, such as angular limb deformities, luxating patella, and hip dysplasia, to developmental conditions that show up later in life, like degenerative joint disease and osteoarthritis, orthopedic conditions can cause significant pain, dysfunction, and secondary complications in canine and feline patients. Orthopedic conditions in cats and dogs can be more common than many people realize and they can often have a significant negative impact on the comfort and quality of life (QOL) of affected animals. Earlier detection and intervention can help improve the QOL for affected pets and their people. While radiographs are a central modality of orthopedic disease screening, they aren't the only diagnostic testing method to use when looking for orthopedic problems in patients. Several suggestions for incorporating orthopedic screening into exams and practice workflows are mentioned. Different breeds have different predispositions to disease states caused by genetic variants. Any personalized care plan should incorporate screening, treatment plans, and client education based on susceptibility to genetic diseases. Disorders caused by a single genetic defect can usually be more easily diagnosed and treated, and more and more genetic (DNA) tests are becoming available all the time. The fact that a pet is not a purebred does not mean that genetic diseases shouldn't be screened for. Diseases caused by recessive genes are less likely to be problems in mixed-breeds but many breeds share susceptibility to the same genetic defects, especially disorders with more complex inheritance that just a single gene mutation. Much of our work in veterinary medicine hinges around the concept of reducing risk. Client education follows risk assessment and management. Breed-specific wellness is the next big leap for educating clients once all the basics have been covered. Patients present with a wide range of ailments. Veterinarians rely upon patient data for clues that explain clinical presentations. Patient data are produced during the comprehensive physical exam and also through diagnostic testing. Reference intervals (RIs) facilitate interpretation of laboratory data because they capture what is considered “normal” for a given species. On complete blood count, Scottish deerhounds have lower than expected RIs for platelets and reticulocytes. Many, but not all, Cavalier King Charles spaniels have moderate thrombocytopenia with larger platelets than is typical. Patients with macro-thrombocytopenia are rarely symptomatic. Elliptocytosis is relatively uncommon in companion animals and is characterized by ovoid erythrocytes. This chapter presents breed-specific hematological and biochemical variations in cats. When the veterinary team keeps current on breed specific clinical pathology, patients are less likely to be misdiagnosed on the basis of values that stray from the norm. Breed-related anesthetic concerns definitely exist in breeds that have a tendency toward anatomical anomalies or development of pathological disease that can impact the safety of anesthesia. Regardless of breed, a good physical exam, history, appropriate diagnostic tests, and a patient-focused anesthetic plan will reduce risk for adverse effects of anesthesia. When the term “breed-related anesthetic adverse events” is mentioned, the brachycephalic breeds (both dogs and cats) are generally at the top of the list of breeds expected to experience these adverse events. Breeds or individuals prone to excitement, anxiety or aggression often need higher dosages of sedatives, and potentially induction drugs, in order to achieve adequate sedation and/or anesthesia. The goal of rational drug therapy is to produce a desired drug effect without causing undue adverse effects. Pharmacogenetics is the study of the genetic determinants of response to drug therapy. Drug absorption, distribution, and elimination can be influenced by polymorphisms, especially in the drug transporter proteins such as P-glycoprotein. The best known breed-related drug sensitivity involves the ABCB1 gene that codes for a P-glycoprotein, a transmembrane protein pump. Intestinal phase I drug metabolism and active drug extrusion by P-glycoprotein transporters are very important in determining oral drug bioavailability. Consequently, genetic variations in these processes dramatically affect oral drug absorption. The P-glycoprotein transporter is an important barrier to the distribution of substrate drugs to protected tissue sites, including the brain, testes, and placenta. Polymorphisms in metabolic pathways may also be involved in idiosyncratic drug reactions. Polymorphisms are genetic mutations that affect drug absorption, distribution, and elimination. The breed should be determined in the initial patient assessment. Different breeds may be at risk for specific diseases or metabolic alterations that require nutritional management. Dogs and cats can be prone to nutritional issues by nature of their size — small breeds vs large breeds. Nutritional recommendations should be based on the individual pet's health and nutritional needs, regardless of breed. Healthcare teams should be familiar with the nutritional feeding goals of large-breed puppies. The primary nutritional considerations implicated in skeletal disease development in growing large-breed/giantbreed dogs are dietary concentrations of protein, energy, and calcium. Proper nutrition has a positive impact on health and disease in all animals. In nutrition for animals, the important point is individualizing the diet for the specific pet, based on the nutritional assessment of that pet. There are many breed inherited disease conditions which can be mitigated or managed with proper nutrition. Many ophthalmic conditions seen in dogs and cats are more frequently observed in certain breeds. While discussing ophthalmic disease, the more common conditions and associated breed predispositions are reviewed. Collie eye anomaly is a recessively inherited ocular disorder seen in a variety of breeds. Primary lens luxation is a condition seen in many breeds where the lens is dislocated from its normal position in the eye caused by abnormal development of the ciliary zonules. This condition can lead to glaucoma, corneal damage, uveitis, and retinal detachments. Genetic testing can further help clients and breeders on improving the breed and helping to reduce or eliminate the disease in future generations. Mixed-breed dogs and cats constitute the majority of pets in most small animal veterinary practices, and there may be misconceptions about their health status compared to purebred animals, as well as their susceptibility to heritable diseases. Hybrid vigor, or heterosis, implies that there are potential health benefits associated with the cross-breeding of different animals. Even in pets that are of mixed heritage, the propagation of heritable diseases is a function of animals with deleterious genetic mutations having the opportunity to contribute offspring to future generations. Genetic testing can provide a lot of information regarding susceptibility to disease. It can be used for screening pets for traits and diseases but in the case of mixed-breed animals, can also be used to infer possible contributing breeds.

Customer service in a pet-specific practice setting requires more thought and preparation. More time spent teaching clients about good pet care means better health for the patients and more income for the practice. Getting a good history in a friendly, conversational way will open up a dialogue with a client and engage them in the process of setting up a personalized plan for the pet owner and the pet. At the same time that the veterinarians are working on individualized plans for each pet, they will need to maintain consistency of care. Begin a pet-specific care project with the leaders in the veterinarians' practice, team training is developed for each step. Value statements increase the perception of our value and also add to the client's perceptions that we care, that we are transparent, and that we are knowledgeable. Veterinary practices must endeavor to keep their clients satisfied, and that means giving them what they want most. Most pet owners today are omnichannel consumers and are looking to optimize the value they receive through whichever commercial channels are available to them. Clients want the facility to meet their expectations of a hospital, they want the veterinarian to "be a doctor," and they want the staff to act informed and professional. Pet owners perceive the compassion of practices that create completely customized care plans for their pets, recognizing the uniqueness of pets and the need to craft approaches to specifically fit their needs. With pet-specific care, it is possible to shift customers toward relationships that advance the organization's strategic goals as well. Pet owners are busy individuals, and they routinely pay a premium for convenience. Clients have so little information on which to judge competence that they become excited whenever clues are available to them. All hospital income is provided by willingly paying clients. Although every client is different, there are some basic rules to providing goods and services that exceed the expectations of the clients. All clients will want to be treated fairly and with respect. All clients also expect that they will be receiving competent medical care. Most veterinary teams may struggle with this pet-specific expectation, yet most will admit that it is fair and reasonable for paying clients to expect such expertise. Improving communication skills of the veterinary healthcare team is one of the most important things that hospitals can do to help meet client expectations. If teams make evidence-based recommendations, clients are likely to get confirmation that this is appropriate when those clients engage with other experts, peers, do their own online research, and so on. Today's pet owner is an informed consumer and has the ability to acquire pet health information from sources other than the veterinary team. There would certainly be books on pet care, and members of the "fancy" had access to periodicals targeted to purebred ownership and healthcareOver 60% of pet owners consider their pet a family member, whereas 36% consider them companions, and only 1% consider them property. With those kinds of numbers, one would expect very high levels of medicalization. One clear determinant of medicalization rates is the human—animal bond. Most businesses today do their best to accommodate clients with disabilities. From the most recent statistics available, the US pet industry represents sales of approximately $80 billion per year and of that, only about a quarter is spent on veterinary care. Younger generations of pet owners are likely to have different expectations of the profession from their parents and grandparents. The veterinary profession has consistently focused on the importance of communicating the value of services to pet owners as one of the primary ways to increase client visits, compliance, and retention. Business strategies and systems need to be put in place aimed at implementing action plans to meet the needs of pet parents. Providing outstanding client education is paramount for all veterinary teams. Veterinary hospitals can communicate value and meet the needs of pet parents by using technologies that help pet owners stay connected to the practice, provide customized service, and save time. Specific communication skills can be used to form a collaborative relationship that empowers pet parents and helps them see the veterinary team as their trusted advisor. Today's pet owners have a need for convenience and will choose veterinary healthcare providers that make it easy to do business with them. The most common pet adoption sources include bricks-and-mortar animal shelters, foster-based pet rescues, breeders, and pet stores. By having a thorough understanding of each, veterinary professionals can help prospective pet owners to support reputable pet adoption sources and make informed decisions. Veterinarians and their teams should be prepared to help prospective pet owners navigate the pet adoption waters. Animal shelters provide places for lost or abandoned animals. Some animal shelters are municipal agencies, owned by local governments and partially funded by taxpayer dollars, while others are private nonprofit organizations. Pet rescues are usually private, nonprofit organizations that are reliant on donations – money, supplies, and volunteer time – from the community to do their work. Rather than investing in bricks-and-mortar spaces to house animals, rescues typically rely on volunteers to foster the animals in their homes until suitable adopters are found. Breeders sometimes get a bad rap. Pet ownership brings many benefits – physical and emotional. Owning a pet can increase exercise, going outside, and socializing. Regular walking or playing with pets has been shown to decrease blood pressure, cholesterol levels, and triglyceride levels. Through companionship, pets can help manage loneliness and depression. Veterinary healthcare teams are often questioned by prospective pet owners and therefore must be ready to discuss the pros and cons of certain breeds and species, potential costs associated with pet ownership, and which pet is a good fit for that individual potential pet owner. An animal adoption counselor may be found in veterinary hospitals as well as in shelters. Some of the basics in the preadoption discussion should center around how to keep the pet healthy such as: proper nutrition, vaccinations, and deworming. When counseling regarding new pets, it is important to educate owners about proper pet hygiene to prevent the spread of germs between pets and people. One of the most important challenges that a veterinary practice faces is the ability to attract new clients. The internet has caused a fundamental shift in the way that pet owners find their veterinary practices. The first step in the buyer's journey is the search and discovery phase. Most of the time spent on the buyer's journey occurs on veterinary website. Team members who contribute to the website's messaging and strategy have an outsized influence on a practice's success. Once the prospective client feels motivation to act, it is imperative that there is a clear and easy path to action. ABC Animal Hospital holds a team-wide meeting to incorporate a biological approach to marketing. The sharing of information and experiences between veterinarians and breeders has always brought, and brings, the potential for great benefits, especially for pets. Breeders may harbor misconceptions that veterinarians understand little or nothing of the specifics of their breed of interest, and that less than pet-specific insight comes at a high price. Veterinarians and breeders can and should work together, cooperate with each other, strengthen positive relationships toward a common goal that is the well-being of pets, and work toward creating healthier pets. Veterinary teams work toward lifelong patient health management, risk assessment, prevention, early detection, and individualized treatment. Veterinary teams are excellent sources of information for potential pet owners, including helping them select appropriate pets. Maintaining good relationships with breeders should be a priority for veterinary teams, along with understanding the specific risks and manifestations of the breed. Some of the genetic tests employ actual detection of the disease-causing variant (mutation) and therefore are very predictive for risk, whereas others detect genetic markers that may be associated with increased or decreased risk of disease. Although pets need personalized and individualized care throughout their lives, breaking down requirements by life stages is often useful in discussions with owners. Integrated parasite control should be considered, evaluating the best combination of products to provide control for both internal and external parasites. Early detection is an important part of pet-specific care, and pet owners need to understand the importance of such surveillance systems. Vaccinations have been important in controlling a variety of diseases in the dog and cat population, including fatal zoonotic diseases such as rabies. Despite the fact that dental care is needed in dogs and cats as much as it is in humans, most pets do not receive the level of oral care required. Effectively communicating finances takes practice, but prevents sticker shock and complaints and helps retain valuable relationships. One of the most challenging things within veterinary medicine is discussing fees. The expectations that clients have of veterinary professionals has substantially increased over the last 10 years, and will continue to do so. There are two different mindsets on what staff should be trained on. One approach is the "product" approach, where staff are trained on the ins-and-outs of a product so that they can better sell it to a client. The other is the "soft skill" approach. Client expectations will continue to grow as they experience different veterinary and nonveterinary services. Education and practice are essential to effective financial communication. Anesthesia for a pet can be very frightening for the pet owner, and this is an understandable reaction since there is some inherent risk of complications during anesthesia. Ensuring that the veterinary hospital team is committed to practicing safe anesthesia, and communicating this commitment to the client, is the most effective way to alleviate the pet owner's anesthetic fears. The most effective means of alleviating pet owner fear of anesthesia-related risk is steadfast commitment to practicing the safest anesthesia possible and communication of that commitment to the pet owner. This chapter presents some frequently asked questions and answers examples regarding risk of anesthesia. By anticipating questions and having standardized answers, the entire veterinary team can present a strong and consistent message regarding the hospital's dedication to decreasing anesthetic risk in their patients. Technology, utilized in multiple formats, can help a veterinary practice better engage with existing and potential clients, educate pet owners, create a loyal clientele base, and even improve clinical outcomes. Online reviews are the new word of mouth, with 90% of customers visiting a business's online review rankings before selecting them. Engaging with clients to encourage them to share experiences and reviews can minimize the impact of negative online reputation comments and reviews if and when they occur. Perhaps the newest and most rapidly growing method of client engagement is via a veterinary practice's telemedicine and telehealth offerings. Combined with remote patient monitoring software, veterinarians can implement programs for: weight management, arthritis/mobility assessment, glucose monitoring, atopy and pruritus scoring, and medication administration compliance. Educating clients is a vital, yet often difficult accomplishment. A deliberate effort to offer recommendations in a consumable, actionable, and relatable form can make concepts contextually relevant for the pet owner and improve overall effectiveness of the education process. One client education challenge inherent to pet-specific care is also an opportunity – the guidance must be unique to a particular pet. Three elements should be considered when selecting client education materials for pet-specific care: relevance – selecting materials that are appropriate; distribution – identifying effective method(s) and times to reach clients; and confirmation – ensuring clients understand what they are being told and are compliant with the guidance given. When discussing recommendations, identify areas of specific client friction for which supporting material could lower barriers. Management of the practice scheduling system and client appointments is a major driver of client satisfaction and practice profitability. Implementation of a standard 20-minute appointment system increases a veterinarian's quality education time per encounter from three to eight minutes. Utilizing 30-minute appointments is rarely an effective strategy in the general practice setting. Most veterinarians are unable to fill the additional 10-minutes with quality client communication and education. In a typical practice, a 10-minute appointment could be a suture removal or a simple recheck exam. Confirming appointments two days in advance can dramatically decrease missed appointment rates. Internet portal systems and client apps allow clients to request and/or confirm their appointments online. These systems offer clients 24-hour convenience for negligible monthly cost. The most important piece of brand equity that veterinary practice owns is the way that its community and customers feel about the practice. The ability to build, strengthen, and nurture relationships is likely the best predictor of success for a veterinary practice. Trust is the foundation of any relationship. Another trust-building strategy is to revel in transparency. Customer success is a business methodology that shapes strategy around ensuring that customers achieve their desired outcomes. The foundation of a sound customer success strategy is education. Digital media gives us the platform to create a scalable and valuable education strategy between visits. Many clients may find value in automated reminders for their pet's healthcare and visits. Every person on the Veterinary team has a unique vantage point about where the most meaningful moments in the practice occur, and where the most important education opportunities exist. In order for veterinary practices to be successful and profitable, client satisfaction must be high. Practices with a pet-specific care emphasis often offer a communication-based and team-based healthcare approach. The key to meeting the client expectations and ensuring satisfaction is to clearly demonstrate the value of the care and services provided. Communication should be emphasized throughout the client cycle. Understanding that clients have different communication and learning styles is key to delivering the information in the best way. Value, and in turn client satisfaction, will be high when clients are happy with the "services delivered" and the "services expected" components of the value equation. Measuring client satisfaction regularly has been identified as a significant opportunity to increase veterinary visits. There are many methods and tools to consider based on practice's needs and capabilities. The most common tool to utilize is a postvisit client survey. Pet-specific care implies a philosophy of caring for pets across their entire lifespans. Wills and trusts are methods for individuals to make their wishes known regarding their pets. Pet owners can include their pets as provisions in their wills, but there are several reasons why this might not be the optimal solution. Wills can take weeks or months to be executed, might have to go through probate, and can be contested by others. The instructions in a pet trust can be very specific, so pet owners can feel confident that the trust is likely enforceable by law and that their wishes regarding their pets will be respected. When the pet dies and there is still money left in the trust, the assets are distributed to a second beneficiary, such as an individual, a charitable foundation, or a corporation. The trust can also be written to cover offspring of the pet beneficiary.

Xylazine, detomidine or romfidine should definitely be part of the protocol for equine anesthesia. Alpha-2 agonists provide dose-dependent sedation and mild to moderate analgesia. Although not a common addition to field anesthesia protocols, acepromazine can be used in combination with an alpha-2 agonist for premedication of horse's anesthetized in-hospital. Opioids provide reversible analgesia and the effects are synergistic with those of the alpha-2 agonists. Opioids can be administered as a premedication with the sedatives or as part of induction. The of onset anesthesia IV ketamine is 1-2 minutes and the effects last for 20-30 minutes, which is a perfect duration for most field procedures. True muscle relaxants like the benzodiazepines and guaifenesin are also commonly added to the ketamine, especially for in-hospital procedures. Butorphanol is the most commonly used opioid in horses but morphine use is increasing. However, they provide more profound analgesia than the other alpha-2 agonists and are occasionally used as constant rate infusions during surgery.

Pain recognition and treatment in companion animals are important aspects of veterinary medicine, yet the teaching of these concepts may not be adequate at all academic institutions. This study was designed to evaluate veterinary students' ability to recall signs of pain and specific analgesic drugs in dogs and cats. We hypothesized that students in the fourth, or final, year of their veterinary curriculum would have a better understanding of pain recognition and be able to recall more analgesic options. A brief, voluntary, and anonymous open question survey was made available to all veterinary students, years 1 to 4, at our institution. The questions included, "How does a cat/dog show signs of pain?" and "What pain medications are used in cats/dogs?" Survey responses were collated according to the students' year in the curriculum, and the most common responses for signs of pain and analgesic medications recalled by the students in both the cat and dog were compared for significant differences. Results showed that students in the class of 2017 (seniors) had no superior recall of analgesic medications or recognition of pain in cats or dogs compared to the other classes. Vocalization was the most common sign of pain recalled with at least 50% responses from all classes. Carprofen was the most commonly recalled analgesic for dogs (the difference between classes, p = .04). Meloxicam was the most commonly recalled analgesic for cats (the difference among classes, p < .001). Based on these results, areas of improvement were identified for our analgesic curriculum.

AbstractBackgroundIn humans, gabapentin an analgesic, undergoes non‐proportional pharmacokinetics which can alter efficacy. No information exists on the pharmacokinetics of dosages >20 mg/kg, escalating dosages or dose proportionality of gabapentin in horses.Hypothesis and ObjectivesGabapentin exposure in plasma would not increase proportionally relative to the dose in horses receiving dosages ≥20 mg/kg. To assess the plasma pharmacokinetics of gabapentin after nasogastric administration of gabapentin at dosages of 10 to 160 mg/kg in adult horses.AnimalsNine clinically healthy adult Arabian and Quarter Horses.MethodsIn a randomized blinded trial, gabapentin was administered by nasogastric intubation to horses at 10, 20 mg/kg (n = 3) and 60, 80, 120, 160 mg/kg (n = 6). Plasma was collected before and at regular times over 64 hours after administration of gabapentin. Gabapentin was quantified using a validated chromatographic method. Dose proportionality was estimated using a power model. Pharmacokinetic parameters were estimated using compartmental pharmacokinetic analysis.ResultsPlasma pharmacokinetics parameters of gabapentin were estimated after nasogastric administration at dosages of 10 to 160 mg/kg. Gabapentin plasma concentration increased with dose increments. However, the area under the concentration curve from zero to infinity and maximal plasma concentration did not increase proportionally relative to the dose in horses.Conclusions and Clinical ImportanceGabapentin exposure in plasma is not proportional relative to the dose in horses receiving nasogastric dosages of 10 to 160 mg/kg.