Ultrasound vs. X-Rays for Monitoring Dog and Cat Pregnancies

When it comes to pregnancy in pets, sometimes it’s hard for clients to wait… 

They want to know right away whether there are puppies/kittens present… how many there are… and if the babies are doing OK.

It’s understandable—whether this is a professional breeder or a pet parent who’s decided to proceed with a litter, the arrival of new puppies and kittens is an exciting time.

There are a few ways to check for pregnancy in dogs and cats. Each method has its own pros and cons, which you can explain to your clients to help set up realistic expectations and develop a plan that best suits their pet’s needs.

Early pregnancy checks may include…

Abdominal palpation

• This method of pregnancy detection can yield information as soon as 3-4 weeks into the 9-week pregnancy.

• Abdominal palpation has been used by vets for many years—and can often result in the detection of fetal “bumps.”

• However, this method isn’t always accurate. There are plenty of things that could render palpation inconclusive. For example, in large breeds or overweight dogs, palpation is more difficult. 

Relaxin testing

• Testing for the relaxin hormone—a hormone unique to pregnancy—can be performed as soon as 20 days into gestation. 

• This test gives your client a very important “yes or no” answer—and helps to distinguish between true pregnancy versus pseudopregnancy—but it doesn’t provide information on how many fetuses are present.

The next test to consider is an abdominal ultrasound. 

Canine and Feline Abdominal Ultrasound

The procedure of abdominal ultrasound in veterinary medicine involves examining the internal organs of dogs and cats. To begin the ultrasound study, transverse scanning is performed to locate the urinary bladder and colon, with the uterine body positioned between them.

Once the uterine body is identified, the scan is directed cranially towards each kidney, following the uterine horn towards the ovary. Along this path, each fetus can be identified by its appearance as a round, fluid-filled gestational sac.

Compared to other imaging methods like X-rays, abdominal ultrasound offers several advantages in veterinary practice.

One significant advantage is the ability to confirm pregnancy several weeks earlier than X-rays. Typically, an ultrasound is performed around 30 days into the pregnancy, although it's possible to detect a pregnancy as early as 20 days. At 30 days, it becomes easier to detect fetal heartbeats.

In addition to early pregnancy detection, ultrasound provides other valuable benefits for veterinarians, including:

1. Counting the number of puppies or kittens: The ideal time for this is between 30 and 35 days of pregnancy. After 50 days, the uterine horns may overlap, making it more challenging to accurately count the fetuses.

2. Assessing fetal viability: Ultrasound can confirm the presence of viable fetuses by detecting their heartbeats or movement.

3. Predicting gestation duration: Measurements of fetal size or certain anatomical structures can help estimate the gestation duration.

Another advantage of abdominal ultrasound in veterinary practice is its ability to involve clients in the process. Unlike X-rays, clients can be present during the ultrasound, allowing them to witness the heartbeats of the puppies or kittens.

This experience enhances the bond between the client and their pet, as well as strengthens their connection to the veterinary practice.

However, in the later stages of pregnancy, X-rays also play a valuable role in veterinary medicine. X-rays provide more information when the fetuses have developed significant skeletal structures, usually around 45 to 55 days after breeding.

At this stage, a single set of X-rays is safer for the fetuses compared to earlier in the pregnancy.

Radiographs (X-rays) are particularly useful for:

1. Confirm the fetal count.

2. Assessing the size ratio between the fetal skulls and the pelvic canal. This information helps in planning for potential dystocia and the need for a C-section.

As a veterinary practitioner, you have various diagnostic tools at your disposal to detect and monitor a healthy pregnancy in dogs and cats.

By utilizing the best combination of methods, you can reassure your clients along the way, and increase the chances of a healthy delivery of puppies or kittens!

Written by: Dr. Tammy Powell, DVM

How to X-Ray a Cat Safely Without Sedation or Anesthesia

If you’ve ever tried to radiograph a fractious cat without sedation or anesthesia, then you know what a difficult challenge it can be.

In addition to blurry, crooked, non-diagnostic images, maybe you or your team members received some scratches and scars to show for the experience.

So, it’s understandable you might not want to try that again—both for your safety and for the cat’s safety.

However, there are some situations where you may want to avoid sedation or anesthesia—or, if it can’t be avoided entirely, to use the lowest dose possible to get the results you need—during an x-ray study on a feline patient. For example…

• Cats with advanced heart disease or other conditions that could make sedatives and anesthetic drugs dangerous.

• Patients with kidney disease or other conditions that cause less predictable metabolism of anesthetic drugs—possibly resulting in a cat that’s excessively drowsy for a whole day, and an unhappy client.

• A patient who’s otherwise friendly and great to work with, just very wiggly for their x-ray shots. A few tweaks may make the experience more comfortable for them and make sedation unnecessary.

• Contrast studies such as a barium GI study, where the patient has to be awake to avoid aspiration of the barium.

Of course, sometimes sedation or anesthesia may be safer, decreasing the kitty’s stress and risk of injury.

Only you know what’s best, using your clinical judgment. However, if you do have a situation where it’s worthwhile to try the radiographs WITHOUT sedation or anesthesia, here are a few tips…

Tips to get diagnostic radiographs on an awake cat

• Practice feline-centered protocols from the beginning.

• Have team members use quiet voices throughout the clinic, especially near the x-ray room or area.

• Use pheromone products, including diffusers or spraying the products directly on towels your patient will be in contact with.

• Lock the door to the x-ray room or area if possible. That way, no one will walk in by surprise and cause your patient to suddenly look in the direction of a swinging door.

• Give the cat a place to hide between views and try to complete the views as quickly as possible. Less time is usually better when it comes to felines. Try a test view to confirm your settings, and then either use digital radiographs or if using film shoot all views at once and then develop them while the cat is resting comfortably in a kennel or carrier. 

• If the patient is just too stressed that day and it’s not an urgent matter, consider rescheduling. Sometimes starting fresh—having the kitty return first thing in the morning and completing the radiographs quickly—is better for you and the patient (and the client may feel better about it when they see the decreased stress level in their pet).

• Make the cat as comfortable as possible during radiographs. For example, use a trough for VD views—it’s a lot more comfortable for them than having their spine right up against the x-ray table.

• Remember the machine’s noise. Many cats are fine during positioning, but then panic, wriggle and squirm once they hear the whirring and “beep” that happen when you push the button to take the shot. To avoid this problem, try talking to the cat in soothing tones, or have another background noise such as a white noise machine or calm music. That way, the sudden noise from the machine won’t stand out so much compared to the other background noises.

Remember, making the whole experience less stressful for the cat can also make everything less stressful for you and your staff.

So if possible, making a little extra effort to accommodate a feline patient can help you get diagnostic views more quickly, with a better time for everyone.

Written by: Dr. Tammy Powell, DVM 

How to Talk to Pet Owners about Radiographs

“Does he really need an x-ray? Can’t you just give him some medicine and see how he does?

“Why is this so expensive? You just want to make money while my cat is sick!”

As a veterinarian, you’ve probably heard all of this and more.

Of course, most clients want the best for their pets, and many will understand why you want to perform certain tests like radiographs. However, even the most loving of pet parents may show some hesitation or “sticker shock” when you present the estimate…

Often, this isn’t personal. Many pet owners just aren’t prepared for a sudden expense, even if they want to do the best for their furkids. Here are some tips that may help take the conversation in a more positive direction…

Stay calm during the initial reaction

If an owner’s initial response is similar to the examples listed above, try to ignore the knee-jerk reaction to defend yourself. Get comfortable with allowing a moment of uncomfortable silence.

Often, clients will try to fill the silence themselves and offer more of their thoughts and questions. But even if they don’t do this, a quiet moment may give everyone the chance to take a breath and start over, calmly.

Don’t pile onto an owner’s guilt

Of course, you’ll need to explain why the radiographs are important for your treatment decisions, and what dangers exist for the pet if radiographs are delayed. 

However, if a pet owner understands this and is just having trouble affording the x-rays, they’re probably already feeling guilty. This causes them to lash out.

In this case, having empathy during the conversation can really help. Think about your tone of voice, body language, and anything else that may help elicit a productive conversation.

If you make an owner feel understood and accepted, they’re likely to come back to you as soon as they CAN afford the tests, rather than seeking care elsewhere.

Bundle your radiographs when possible

Often, estimates are presented as “a la carte,” with different options presented by cost, line by line. 

While this may work well in some situations, the client may try to pick and choose, asking which items can be eliminated in order to decrease the cost of treatment.

Instead, try estimates that list a total cost, with radiographs included. Some situations where this may work well include:

• Dental procedures with dental rads.

• Senior wellness testing, with bloodwork and screening rads.

• A blocked cat, with x-ray views included as part of the treatment plan.

• For three-view thoracic radiographs, bundle them together rather than listing the individual “per view” charges separately.

Of course, you can still list each item of the treatment plan, so the client knows the value they are receiving. But, list it as a total cost, rather than an itemized estimate.

Explain the benefits and limitations of radiographs

Many pet owners nowadays, especially Millennials, want to be fully involved in their pet’s care—that’s part of the reason why so many owners seek answers from Dr. Google prior to coming for a vet visit.

Those clients will want to receive answers about their pet’s condition right away—so, let the client know that radiographs will help to provide the answers they’re looking for. And since radiographs are available the same day, they can get answers to their concerns very quickly.

On the flip side, also prepare an owner that a radiograph might show normal results. If the pet is feeling well, then the client gets peace of mind. If the pet is ill, further testing may be required—by preparing the owner for this possibility ahead of time, you can avoid upset reactions as much as possible.

Ask about their biggest concern

Even though you probably already know the biggest concerns and questions clients have about x-rays, it never hurts to ask an owner why they’re hesitant. They may appreciate you listening to them, and it saves you time so you can address their biggest concern.

Some examples you may encounter include:

• Finances. In this case, you can suggest third-party financing options, such as Care Credit.

• Fear for their pet’s comfort, or having to leave their pet at the hospital. Here, discuss the procedure. If sedation is used, explain how this can minimize pain. Or, if digital radiographs are used, explain how this allows the views to be done fast so the pet can go home sooner.

Show clients the value you offer, even after the x-rays are finished

Be sure to go over the results of the radiographs with your client. Try using a quiet exam room rather than the treatment area, so they won’t be distracted.

Give the client a brief “x-ray orientation,” so they know which end is toward the pet’s head and what is abdomen versus chest, etc. Then, explain your findings. 

Whenever possible, bring a normal x-ray for comparison, so clients can really see the difference with an abnormal finding.

If you have digital images, share a copy with the client that they can look at after the visit. Offer to let them record you talking about the findings. That way, when the client goes home and shares the findings with their partner or family, everyone is more likely to understand and be on board with your recommendations.

With a little planning of the whole x-ray experience from the client’s perspective, you can make things easier on them—while at the same time, increasing compliance and getting better care for the pets you see.

Written by: Dr. Tammy Powell, DVM