Veterinary Clinics of North America. Small Animal Practice

The future may be difficult or even impossible to predict with any accuracy, but appreciating the likely path forward for small animal veterinary practices is possible with some defensible assumptions. With advancements in technology, a growing appreciation of the human-animal bond, and changing societal norms, the role of small animal veterinary teams will become even more important in the years to come. Although there may be challenges, there will also be new opportunities and a greater need for qualified professionals and paraprofessionals in this field, who can deliver services that clients want and pets need...

With over 70 years of experience and having consulted with nearly 2000 veterinary hospitals in the United States and abroad, this top 10 list has been consistent through the years with some different approaches since the pandemic. Beyond consulting and advising, we teach practice management for veterinary students at Washington State University (Rick) and University of Georgia (Jeff). As a part of the 4th year curriculum, we conduct on-site evaluations for practices where the veterinary students observe appointments, interpret practice and financial data, and make recommendations for improvement to the owners...

Veterinary practices must be forward-thinking to effectively serve today's pet owners and move into the future. The progressive practice considers every aspect of a pet owner's journey, from searching for a veterinarian to paying their invoice, and seeks ways to improve their experience. Many tools and methods can be used to reach these goals, while also improving efficiency and veterinary team well-being. Digital tools and artificial intelligence in particular provide significant advances that allow veterinary practices to better serve and build relationships with their clients and patients...

Recent economic cycles and unique factors like the COVID-19 pandemic have all affected small animal veterinary practice, changing both demand and supply-side factors. One-time events exacerbated cyclical macroeconomic factors, increasing the highs and worsening the lows. Behind the perceived labor shortage, the mental health concerns, and the challenges of staff turnover in the profession's daily work to meet client expectations and provide the best possible medical care lurks a productivity problem. The good news is that veterinary practices can take steps to improve productivity and resilience in the face of these challenging trends...

No abstract text is available yet for this article.

Both open surgical repair and a hybrid-interventional option are now available for mitral valve repair (MVR) at select veterinary centers worldwide, making the need for awareness of options and the intricacies around case selection of increasing importance. This article will overview both options currently available and their current stages of progress.

As animals can develop significant side effects or remain refractory while on antiarrhythmic medical therapy for tachyarrhythmias, interventional therapies are progressively being explored. This review will highlight the principles and utilities of implantable cardioverter-defibrillators, electrophysiological mapping and catheter ablation, three-dimensional electroanatomical mapping, and stereotactic arrhythmia radiotherapy. In particular, three-dimensional electroanatomical mapping is emerging as an adjunct electrophysiology tool to facilitate activation, substrate, and pace mapping for intuitive analysis of complex tachyarrhythmias...

Cardiogenic arterial thromboembolism (CATE) is a devastating complication in cats with cardiomyopathies with significant morbidity and mortality. Despite recent advances in the diagnosis and treatment of CATE, its recurrence and mortality remain high. This highlights the urgent need for a greater understanding of CATE pathophysiology so that novel diagnostic tests and therapeutics can be developed. This comprehensive review aims to summarize existing literature on pathophysiology, clinical diagnosis, and current recommendations on the prevention and treatment of CATE...

Pulmonary valve stenosis represents the most common congenital heart defect of dogs and appears to be increasing in prevalence due to the growing popularity of brachycephalic breeds. Current treatments include beta-blockade and balloon pulmonary valvuloplasty, though evidence-based approaches to this disease are lacking. Balloon pulmonary valvuloplasty is most effective for fused, doming valves leaving a large population of dogs with thick, dysplastic valves that fail to respond adequately to balloon dilation...

The renin-angiotensin-aldosterone system (RAAS) consists of bioactive angiotensin peptides, enzymatic pathways, receptors, and the steroid hormone aldosterone. The RAAS regulates blood pressure, sodium, and electrolyte homeostasis and mediates pathologic disease processes. Within this system is an alternative arm that counterbalances the vasoconstrictive, sodium and water retentive, and pro-fibrotic and inflammatory effects of the classical arm. Improved biochemical methodologies in RAAS quantification are elucidating how this complex system changes in health and disease...

Feline HCM is the most common cardiovascular disease in cats, leading to devastating outcomes, including congestive heart failure (CHF), arterial thromboembolism (ATE), and sudden death. Evidence demonstrating long-term survival benefit with currently available therapies is lacking. Therefore, it is imperative to explore intricate genetic and molecular pathways that drive HCM pathophysiology to inspire the development of novel therapeutics. Several clinical trials exploring new drug therapies are currently underway, including those investigating small molecule inhibitors and rapamycin...

In cats, age-related pathologic condition and neurologic degeneration can produce changes in activity, vocalization, appearance, appetite, litter box use, sleep-wake cycle, personality, and cognitive ability. These changes can influence the relationship between owner and pet. Although cognitive dysfunction syndrome (CDS) can cause altered behavior later in life, other medical or behavioral causes may mimic these clinical signs or complicate diagnosis. Management and treatment of CDS can be accomplished through pharmacologic intervention, diet and nutritional supplementation, and environmental enrichment aimed at slowing the progression of the disease...

No abstract text is available yet for this article.

Repetitive behaviors in companion animals have been compared with obsessive-compulsive disorders in people. There is evidence that repetitive behaviors may go unrecognized because they have a high level of comorbidity with other, more salient, behavior problems and may be overshadowed or regarded as amusing eccentricities. To assess repetitive behavior problems, we propose a standardized approach involving 5 categories or axes. This approach aims to identify the nature of the problem and the balance among medical, environmental, and temperamental factors...

Pain is a subjective, aversive sensory and emotional experience and can cause or exacerbate problem behaviors. In this review, the biobehavioral model of pain is introduced and used to improve understanding by veterinarians of pain mechanisms and their relationship with problem behaviors. A range of potential indicators of discomfort are presented, illustrated by selected cases from the authors' behavior and pain referral clinics. Various myths exist around pain resulting in barriers to reporting assessment and treatment...

Working dogs perform complex tasks that require both physical and behavioral soundness. Two case studies demonstrate how fitness training moderated arousal levels, facilitated training, and improved performance measures in different situations. Fitness training can be beneficial when integrated as part of a working dog's training regimen because it can have a significant influence on their overall health, behavior, and ability to perform their working role effectively.

Behavior changes may indicate primary physical disease or primary behavioral disorders in veterinary patients. It is imperative to recognize that secondary behavioral problems can develop due to medical causes. The incidence of systemic disease increases with age and behavior manifestations can be similar to those expected with cognitive dysfunction syndrome. In this article, we review basic concepts of cognition, aging, and cognitive dysfunction syndrome. Additionally, we provide information regarding factors that influence cognition, and the role medical conditions have on the behavior of aging pets...

Sickness is a normal response to infections or stress triggered by proinflammatory cytokines that drive local and systemic inflammatory responses. Proinflammatory cytokines act on the brain causing the so called "sickness behavior,"which is thought to improve recovery but can become maladaptive in the long term. Chronic inflammation characterizes many diseases and there is some evidence that dogs and cats experience age-associated increases in inflammation, a condition named "inflammaging." A complex and multifactorial relationship exists between these inflammatory mechanisms, pain, and psychological illness that may complicate veterinary diagnosis and affect the outcome...

Behavioral and physical health are intricately interconnected in most animals, and the rabbit is no different. Medical or physical conditions can lead to anxiety and stress, and anxiety and stress can lead to physical illness. Rabbits are very prone to fear, anxiety, and stress, especially when their husbandry is not appropriate and their environmental and behavioral needs are not met. Any rabbit presenting for acute behavior changes should be examined thoroughly for underlying medical conditions and the appropriateness of their environment examined equally closely...

The condition of separation-related problems (SRPs) is common in companion dogs and clinicians should be comfortable diagnosing it. There are numerous diagnoses related to physical disease that have clinical signs similar to SRP, that exacerbate SRP, or may cause regression in treatment of SRP. Common examples include conditions affecting the following systems: musculoskeletal, neurologic, gastrointestinal, and dermatologic. Therefore, it is important for clinicians to rule out causes of physical disease and address them accordingly...