Five Essential Veterinary Practice Financing Questions

When it comes to opening your own veterinary practice, financing may be one of the most important—and most daunting—hurdles to overcome.

Since most practice-owners-to-be don’t have a large cash reserve saved up or an angel investor waiting in the wings, chances are you’ll need to look for financing.

Every situation is different, and working with financial experts and veterinary consultants can help you make the best decision for your future.

Here are a few good questions to ask yourself along the way…

What Do I Need Financing For?

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Evaluating the following factors can help you figure out how much you’ll need to borrow…

The Practice Space

The most obvious thing you’ll need to finance is the space in which you intend to practice.

This could mean acquiring an existing practice, leasing a new space, or breaking ground and building your own practice from the ground up.

Less commonly, this could also mean a buy-in option at a practice where you currently work as an associate, or even a franchise opportunity.

Major Equipment

Your veterinary practice can’t operate without equipment like an x-ray machine, exam room tables, surgery lighting, a dentistry unit, computers, and more…

Fortunately, you have options

Financing may be available directly from the equipment seller, or from a bank (often called a “capital lease”), so you can pay as you go and start making a return on your investment right away. 

Also, consider purchasing used equipment. Sites such as usedvetequipment.com offer high-quality used equipment you can score at a great bargain.

Daily Supplies

All those little costs add up, including needles, syringes, pharmaceuticals, cleaning supplies, surgical scrub, gloves, and anything else you need for your practice’s daily operation.

Other Operating Costs

When making a business plan, don’t forget to factor in costs such as wages, insurance, utilities, landscaping, licenses, and more.

How Much Can I Afford to Live On?

Most new businesses don’t make a profit for the first 1-3 years… and unfortunately, veterinary practices are no exception.

It takes time to grow a business to the point where the money coming in each month is more than your expenses. And until that happens, you might not be taking home a salary.

This doesn’t impact everyone in the same way, though. For example…

• Purchasing an established practice may mean you have more clients initially than if you start up a brand-new practice.

• Some new practice owners have a spouse whose income can cover all of their household expenses in the meantime, while others do not.

• You may have other life factors that limit you from taking risks with a new business, such as dependents or health considerations.

If owning a practice is your dream but you’re concerned about limited income while your practice gets up and running, talk to a veterinary consultant to figure out if practice ownership is right for you, and see what’s the safest path for you to realize your dream.

How Do My Student Loans Factor In?

According to an article in Today’s Veterinary Business, veterinary lenders don’t typically expect you to have your student loans paid off before you start a practice of your own. 

That makes sense because with today’s growing costs of veterinary education, paying off student debt quickly isn’t always a realistic expectation.

However, be sure your student loan and other debts are in good standing. Very few lenders are going to trust you with a practice loan if your student debt is in default.

And, of course, you’ll have to factor your student loan payments into your own income needs and overall financial picture.

When in doubt, it never hurts to find out more, rather than assuming student loan debt would prevent you from starting the veterinary practice of your dreams. You’ll never know for sure if you don’t do the research.

Where Do I Find a Good Lender?

There are some veterinary-specific lenders out there. These businesses can be a good option because they understand your industry and may have realistic expectations in terms of starting costs and a repayment timeline.

Small Business Administration loans (government-backed lending funded and serviced by banks) may be another good option, with flexible terms and conditions.

And, local banks or lenders may offer great customer service and community knowledge. 

So, explore your options and see which lender works best for you. 

Ask a lot of questions to see what your lender’s customer service and communication style are like, and to find out important information such as…

• The required down payment.

• The term of the loan.

• The interest rate.

• Fees associated with the loan.

• Penalties for late payments or pre-payment.

• Any available special arrangements, such as graduated repayments (loan payments that start small when your business is new, then gradually increase over time as your business becomes more established and successful).

In general, many lenders require a business plan and financial projections to fund your new practice. 

How Do I Figure All of This Out?

While there are never any guarantees when you start a new business, doing your due diligence before you finance will help you make the best possible investment.

This will likely involve a CPA or financial advisor, a veterinary management consultant, and experts in demographics and feasibility for new practices—to name a few.

These experts can offer invaluable advice, and also help you with the business plan and financial projections you’ll need.

Be sure to put in the time to research. And, invest in expert advice to help you make the best decisions for yourself and your future.

If you need help with financing, Call me - I can help you - 530-722-4977 Brad Haven, Jr.

Written by: Dr. Tammy Powell, DVM

Starting a Veterinary Practice: The Importance of Your Online Presence

You might have the best veterinary clinic in the world, with stellar medical care, an amazing team, and great customer service…

But, for clients to bring their pets to you, those clients must be able to easily find your practice and learn how great it is.

So, when you open a new veterinary practice, how will your clients find you?

The First Place Your Potential Clients Will “See” You

In modern times, many pet owners locate and research their next veterinarian via an online search.

That’s even more true during the 2020 pandemic, when physically “stopping by” a veterinary practice to meet you is difficult.

Even if you have a prime hospital location with a lot of foot traffic and nearby businesses, pet parents who see your hospital in passing will probably Google your practice before bringing their pets to you. So, it’s still important to have a strong online presence.

For that reason, we’re talking about websites and social media in today’s article. 

Because even though you’ll have a lot of important decisions to make before you open your practice—such as financing, equipment, staffing, and more—it’s never too early to start thinking about messaging and marketing strategies for your clinic’s success.

Your Veterinary Practice’s Website

Think of your practice’s website as an online hub where clients can come to learn more about you, your staff, your services, and your facility.

But, creating an effective website can be tricky. There’s a lot to think about, including searchability. 

And, it’s crucial to make sure your website paints a clear picture of who you are and all the wonderful things you do to help pets.

Here are a few tips to help make your practice’s website effective…

• Use warm, inviting photos and images. 

For example, images of your caring team members—smiling, in action, and holding cute pets—is much more effective than a picture of the outside of your hospital. 

This creates the right mood for your website and also helps potential clients know what to expect when they bring their dog or cat to see you. 

Just remember: If using pictures of client-owned pets on your website, get the client’s permission in writing first.

• Focus on your clients’ needs and wants. 

When writing about your practice, be sure to include your experience, expertise, and services offered… But, don’t forget to tell clients HOW these things benefit them. 

For example, instead of saying, “We have 40 years of combined experience,” say, “Our 40 years of combined experience means your pet will receive excellent care from experienced veterinarians.”

• Make all key information easy to find. 

Place your practice’s physical address and contact information right at the top of the page, where it’s easy for a potential client to find it.

• Pay attention to SEO. 

SEO stands for search engine optimization, and it’s what makes your practice’s website show up higher in Google’s search results (which makes it easier for clients to find you!). 

Don’t worry, you don’t have to be an expert in SEO… Actually, it’s a pretty broad field that can take some time and dedication to truly master. And, it’s constantly evolving.

But it’s important, so consider hiring a consultant—or, if you’re creating your own website content, at least be familiar with SEO basics. 

We’ll have an article with more details on SEO basics later in this series, so keep an eye out for that.

Do You Need Social Media?

Social media is an excellent way to extend the reach of your website.

By posting on Facebook, Instagram, or other social media platforms, your posts can make pet parents smile and prompt them to learn more about you by following a link back to your website.

However, the world of business-related social media may seem nebulous and confusing if you’re new to it…

So, we’ll have a more in-depth article on social media further into this series. But for now, here are a few things to keep in mind…

• Start with one platform at a time. 

If you try to master Facebook, Twitter, Instagram, LinkedIn, and more all at the same time, you’ll probably feel overwhelmed—and then give up. So, just start with one platform. When you feel comfortable, consider expanding. 

On that same note, set a realistic schedule for how often you are going to post.

• Where do your potential clients spend the most time? 

Facebook is a very common and effective platform. But, if you have a younger clientele, maybe they spend more time on Instagram and would be more likely to see your posts there? 

A veterinary consultant or marketing expert could help you determine factors like this.

• Use photos or images as much as possible. 

Images are more likely to catch attention than posts that contain just text. 

As with your website, obtain a client’s permission if you post their pet’s picture.

• Try to engage your followers. 

Ask them questions, ask them to post pictures of their pets, and so on—anything that encourages them to interact with you in a positive way.

While you’re planning the veterinary practice of your dreams and working out the more material aspects of financing, equipment, and so on, go ahead and start thinking about how you want potential clients to see your practice.

Think about your practice’s philosophy and culture, as well as the impact you would like it to have on pets and pet owners in the community.

Then, think of how to express that message in everything you do online—on your practice’s website and all of your social media posts.

That way, new clients who find you online can get to know you and feel happy about scheduling their pet’s first visit.

Written by: Dr. Tammy Powell, DVM

Tips for Starting a New Veterinary Hospital or Clinic

If you’re looking to start your own veterinary practice, congratulations!

You’ll have a lot to think about and plan. But, there’s nothing like being able to run your practice exactly the way you want to—to make your dream come to life.

This article is the first in a 10-part series discussing the different aspects of practice ownership—everything from location, to staffing, to equipment, to marketing.

This will help you think through some of the key decisions that come with opening a practice of your own.

Veterinary Practice Location

Of course, one of the very first questions you might ask yourself is where your new business should be located.

In some cases—such as if you have a spouse with a long-term local job commitment—you may not be able to relocate.

But, even then, you could look at nearby cities within an hour’s drive (or, however long of a commute you are willing to make).

Whether staying in place or relocating, when looking at your desired location, here are some things to ask yourself…

• What’s my ideal clientele? 

When looking at local socioeconomic factors, does this line up with the level of care and pricing strategy you intend to offer? Also, is your clientele younger and more likely to want things like telehealth and online appointment scheduling?

• What’s my competition? 

Knowing whether your ideal location is already saturated with veterinary hospitals can help determine whether it’s wise to open a new practice there—or, at least help you think of some way to differentiate your practice from the crowd.

• Which logistics do I need to consider? 

For example, what’s the parking situation like? Are you conveniently located near major roads or shopping areas? And, where on the property can dogs go to the bathroom?

Services Offered

Are you a general practitioner? A specialist? 

Knowing EXACTLY what you offer will help determine where you fit within the local community.

For example, a neurologist or ophthalmologist may fit in nicely even if the area is already filled with GPs.

And, if you are a GP, maybe there’s some other way to distinguish your practice and provide something new and unique to the community. For example…

• Emergency hours.

• Urgent care hours.

• Care for exotic pets.

• House calls.

• Hospice care.

• Acupuncture or holistic care.

• Large animal care and farm calls.

Will You Be On Call?

Depending on your state’s practice license requirements, you may need to provide access to 24-hour pet care—whether at your hospital alone or by recommending a local 24-hour facility to your clients.

So, if you don’t intend to be on call for emergencies, research what’s available in your area to fill this need for round the clock emergency services.

To Build or Not To Build?

Do you want to build an entirely new facility, tailored to your specific vision? 

This may be to your benefit, especially if you want to integrate some of the Fear Free standards for lighting, insulation, separate entrances, and more.

On the other hand, you may have found a practice for sale at a location that’s hard to beat, with an established clientele.

While less common, franchising may also be an option.

In any case, you’ll also have to decide whether to buy or lease the property.

The Legal Stuff

If you don’t have the right business permits and licenses, that could result in severe financial or disciplinary penalties.

You’ll need to research what’s required in your area, but examples include…

• Veterinary licenses for yourself and all associates.

• A veterinary practice permit.

• Local business licenses for your city or state.

• Registration for taxes.

• Forming an LLC, corporation, or other legal entity.

• A DEA license for controlled substances.

And in addition to licenses and permits, you’ll also need to plan for…

• A CPA or other professional for bookkeeping, financial planning, and filing your taxes.

• Liability insurance.

• Occupational health and safety requirements (OSHA).

• Hazardous waste and EPA requirements.

• Employment contracts.

• Developing a business plan.

Considerations for Modern Times

Modern times have resulted in the need for changes to the way most veterinarians practice.

At the time of this writing, curbside service is the norm because of the coronavirus pandemic. And, telemedicine is being added to many practices.

Because of the convenience of telemedicine in your clients’ busy schedules, many pet owners may expect this service to continue even after social distancing precautions are lifted.

So, what modern services and conveniences do you think your potential clients will want? How can you stay competitive?

It’s Best to Work With A Consultant

Before you make a big investment, it’s a good idea to work with a consultant—or, more likely, a team of several experts and advisers.

These specialists can walk you through legal, financial, demographic/feasibility information for start-ups, valuation for the sale of established practices, HR management and compliance, real estate, equipment and supplies, and various other aspects of practice ownership.

This will not only save you time but also ensure you’ve considered all angles and have the best chance of finding success as a veterinarian and business owner.

One helpful resource is Vet Partners, where you can search for experts and consultants by location and specialty.

Look for veterinary consultants, and for businesses (such as banks and real estate agents) who are used to working with veterinary practices and understand the nuances of your business.

Also, consider talking to other veterinarians who have been in your shoes and purchased a practice recently, who can share the wisdom of their experience. 

How Will Your Clients Find You?

Once you establish your dream practice, you need to ensure new clients know you exist, and that they want to bring their pets to you.

In this day and age, your online presence (your website and social media) will play a large role in helping new clients find you.

So, in the next article, we’ll have some tips for making sure your online presence truly conveys how great your practice is.

Stay tuned!

Written by: Dr. Tammy Powell, DVM

Don't Miss A Thing! Why You Want Dental X-Rays For Your Extractions...

Dental Extractions And Radiographs Go Hand In Hand

Teeth extractions are performed when a patient has an obvious or underlying periodontal disease with bone loss, gingivitis, or pathology where extraction of the affected teeth will improve and benefit the overall health of the patient.

Extractions are performed to remove diseased and infected teeth, broken and retained tooth roots, supernumerary teeth, as well as various other conditions including stomatitis, and are also performed on pets with healthy teeth where there is an anatomical anomaly such as malocclusion and crowding causing damage to surrounding structures.

Decrease your dental extraction stress: with dental radiographs

Extractions are performed at any age in the dog and cat.

For some animals, tooth extraction is the only option to resolve oral problems. The extraction of the tooth is only part of the treatment.

Eliminating the disease in the tissue and the bone is important to the proper healing of tooth extraction sites, and includes curetting the alveolus after extraction, and proper closure of the surgical site.


Dental extractions can be either surgical or nonsurgical in nature. In both cases, the extraction site should be sutured to prevent infection, pain, and complications.

Nonsurgical extractions can be performed on patients with severe gingivitis or advanced periodontal disease, where the teeth are mobile and often easily extracted, but do not need actual drilling of the alveolar bone to extract the tooth and root.

Teeth extractions should be performed by licensed veterinarians who are very familiar with dental and craniofacial anatomy, particularly blood supply, and who have appropriate tools, skills and training.

Tooth fractures, eye injuries, oronasal fistulas, injury to the salivary duct, misplacement of root fragments into the sinus cavity or into the mandibular canal, leaving retained roots, traumatic bleeding and jaw fractures are complications associated with dental extractions.

Teeth with fractured roots must be surgically extracted, or a root tip will be left behind. Patience is important when performing extractions and flaps, and intra-oral anesthesia is important for pain management.

Before beginning a dental with extractions, intraoral x-rays should be the first step in every dental procedure to better understand each case. For instance, there may be curved tooth roots that if known ahead of time, will help facilitate extraction.

Furthermore, dental x-rays are used after extractions to verify the extractions were complete and that the operator did not inadvertently cause injury to surrounding teeth and structures.

Dental x-rays before and after extractions are an important tool in diagnosing problems, as well as helping determine an appropriate and effective treatment plan in dental patients.

Dental x-rays are taken to confirm that the entire tooth has been extracted, as well as help ensure no root or bone fragments are left behind in the alveolus.

The first step to proper tooth extraction is to have high quality, sanitized sharp dental instruments. A dull instrument can damage the surrounding bone while attempting to break down the periodontal ligament.

An important aspect of extraction is to gently twist and hold around the perimeter of the tooth root, thus allowing the operator to easily elevate and complete the extraction.  

Sectioning multirooted teeth with a high-quality high-speed drill with the appropriate burr, will facilitate effective extraction and lessen damage to surrounding areas.

Keeping the fingertip close to the end of the elevator prevents inadvertent trauma from accidentally running the elevator into surrounding structures.

Surgical flaps should be implemented to allow access to the alveolar bone, then the high-speed drill used to expose the roots.

The gingival flaps and surrounding soft tissues should be handled carefully as they are used to close the extraction site and prevent debris from getting into the site, as well as alleviate pain for the patient.

Once the roots are exposed and removed, the socket is cleaned free of debris, and the flap closed. Occasionally a flap may break down for various reasons, necessitating the need for second intention healing.

How do dental x-rays help with difficult extractions?

In summary, early dental examination in dogs and cats is important. Intraoral x-rays will help establish a treatment plan to ensure optimal dental health in dogs and cats. Extractions should be carefully performed by a skilled operator with advanced training and knowledge in craniofacial anatomy to avoid injury, and intraoral x-rays before and after a dental with extractions should always be performed.

Lastly, gingival flaps to close extraction sites are important for optimal healing and comfort to the patient.

Written by: Dr. Tammy Powell, DVM

How Can Veterinary Dental Digital X-Ray Help With My Clients Daily Dental Teeth Cleaning In My Animal Hospital?

Veterinary dentistry has become advanced over recent years, particularly with the advent of oral dental radiographs.

The idea of regular dental care for our pets is new to many pet owners who are beginning to realize the importance of regular exams, teeth cleaning, and oral radiographs.

Practice standards are changing, and pet dentistry has become sophisticated and cutting edge. Similar to when humans have an oral examination and teeth cleaning, the dentist will request radiographs to check for underlying problems or concerns.

The same should be expected for pets when they go to the veterinarian for teeth cleaning. Dental radiology is at the forefront of ever changing veterinary practice standards.

With most of a tooth lying below the gum surface (think of an Iceberg), problems cannot be appreciated until a radiograph is taken and reviewed.

It is virtually impossible to practice veterinary dentistry without dental radiographs, which allow visualization of tooth roots, bone, and surrounding structures not visible otherwise.

Dental radiographs today are not taken with the conventional x-ray unit seen at most veterinary clinics. 

Today’s advanced dental x-ray units give exceptional detail and clarity. Dental x-rays are easy to use and typically located adjacent to the patient. They are made using small radiographic films or digital sensors placed inside the patient’s mouth, and can generally be accomplished within 10 or 15 minutes when performed by an experienced and trained technician.

Typically 6-8 images are taken during a routine pet dental cleaning. The radiation risk to the patient from dental radiographs is minimal and outweighs the risk of missing underlying dental problems.

Dental radiographs should be performed early to establish a baseline for future comparison.

Ideally, this can be accomplished at the same time puppies and kittens are undergoing routine spay and neutering and should be performed under anesthesia to effectively diagnose and assist in treating a patient with periodontal disease or underlying pathologic complications.

Anesthesia is important to obtain dental radiographs because the sensor or films must be placed in the pet’s mouth, which would be difficult to accomplish awake.

Studies show that without dental radiographs, up to 75% percent of significant dental problems are missed in pets undergoing routine teeth cleaning.  

In addition, the AAHA (American Animal Hospitals Association) Dental Care Guidelines for Dogs and Cats state that preoperative and postoperative dental radiographs are mandated for all tooth extractions.  

Dental radiographs taken prior to extractions ensure that a procedure can be properly planned and that no underlying issues such as developmental defects surprise the individual performing the extractions.

Post extraction radiographs ensure that all root fragments are removed and that no inadvertent damage was caused.

A pet can be left in discomfort for years if problems are missed during a dental.

Pets showing dental problems may avoid hard food, have red or bleeding gums, bad breath, have problems picking up and dropping food, make noises when they yawn, chew on one side of the mouth, excessively sneeze, express facial discomfort by pawing at the mouth, excessively salivate, exhibit ropey drool, and more.

Any pet exhibiting these signs should have a dental with oral radiographs to allow the veterinarian to make an accurate diagnosis. Once a diagnosis has been established, the proper treatment plan can then be instituted. Without dental radiographs, an accurate diagnosis is not possible, and pets may needlessly suffer. 

Indications for dental radiographs in pets:

• Periodontal Disease and Extractions: Radiographs help to determine a treatment plan, identify retained tooth roots, follow each pet’s dental progression as they age, and to assist the operator during extractions to avoid potential injury such as jaw fractures.

• Trauma: Identify a fracture or foreign body such as shrapnel or other material.

• Defects and Variations in Tooth Density: Identify cavities or resorption lesions in cats.

• Endodontic Issues: Determine if a tooth requires a root canal.

• Developmental Defects/Anomalies: Detection of supernumerary teeth, missing teeth or teeth that have failed to erupt.

• Swellings, Cysts, Tumors: Help determine the source of facial swelling and pain.

• Advanced procedures: Pets receiving advanced procedures such as crowns, braces, jaw fracture repair, oral tumor removal.

With modern medical advances in veterinary dentistry, dental radiographs should always be implemented in the complete periodontal exam and treatment of pets undergoing dental cleaning with extractions.

It is otherwise not possible to provide good quality dental care and documentation without utilizing radiographs.

Dental radiography is the number one diagnostic tool in the practice of complete pet dentistry.

Written by: Dr. Tammy Powell, DVM

What is animal periodontal disease and how does my animal hospital provide high quality oral care with my veterinarians and my veterinarian technicians?

Periodontal disease is an inflammation and infection in the gums around your pet’s teeth caused by bacteria which adheres to a sticky substance called plaque.

Left untreated, this turns into hard tarter (calculus), which builds up under the gum line and surface of the teeth. Periodontal disease is characterized as gingivitis and periodontitis. Gingivitis is inflammation or reddening of the gums (gingiva), and periodontitis is loss of bone and soft tissue around the teeth leading to non-salvageable loose teeth, malodorous breath, and potential jaw fractures.

This is a very common issue in pets. Periodontal disease is a painful disease and is thought now to be an epidemic. When it starts, periodontal disease shows no outward signs and symptoms, and many pet owners are unaware of the problem in the pet’s mouth until the disease has advanced.

Some symptoms of severe periodontal disease include:

• Pawing at the mouth

• Red or bleeding gums with bad breath

• Loose teeth

• Problems picking up food and dropping food

• A swelling on the muzzle near the eye caused by an abscessed tooth root (often pet owners think this is a bite).

• Making noises when a pet eats or yawns

• Head shyness

• Bloody or ropey saliva seen in water or toys

• Chewing on one side of the mouth

• Sneezing or nasal discharge – the nasal cavity can become infected

All breeds and sizes of dogs and cats are at risk of periodontal disease.

This disease not only affects the mouth, but bacteria entering the bloodstream affects the immune system. The risk of associated health complications can be reduced by proper dental hygiene.

Multiple health problems linked to periodontal disease include internal organ problems such as heart and lung disease, liver and kidney disease, bladder infections, pancreatitis, weight loss, and behavioral issues such as biting or suddenly becoming isolated, among others.

Periodontal disease can almost always be prevented or minimized with a combination of home dental care and veterinary dental cleaning.

Once tartar is formed, it cannot be brushed off with a toothbrush. Routine daily teeth brushing can remove the sticky plaque, however, not the tarter.

Trying to brush the teeth when the mouth is inflamed and teeth are loose and Infected will cause your pet to resent brushing and oral care.

Once your pet has undergone a thorough dental and the mouth heals, daily brushing will prevent further dental disease.

A deep thorough subgingival cleaning under the gum line is important and necessary to remove the tarter and infected teeth and must be performed under anesthesia. Non-anesthesia teeth cleaning is solely cosmetic and does not address the source of the problem laying under the gum line. It is important to start brushing as a puppy and kitten and make this a daily routine.

As long as the surfaces of the teeth are cleaned frequently, the gums will stay healthy. The sooner you start to clean your pet’s teeth, the less likely your pet will need extractions.

Periodontal disease prevention includes:

• A veterinary examination of your pet’s mouth and teeth at all ages is important. Early detection of problems such as teeth crowding and retained baby teeth can be addressed and resolved.

• On-going plaque and tarter control are key to the prevention of oral disease. Teeth brushing daily is the most important way to prevent gum disease.  Many pet owners are concerned that they will not be able to perform this task. Many dogs and cats will actually enjoy the daily interaction and like the taste of the dental products.

• Look for products with the Veterinary Oral Health Council (VOHC) seal of approval such as toothpaste, oral rinse, and water additives, made to keep your pet’s teeth clean and the gums and bone healthy.

• Canned food tends to stick to the teeth more than dry food. Look for dental diets that help pet’s teeth as they chew. A good quality dry kibble works best. Your veterinarian has information about dental based diets.

• Offer Dental treats and chews. This is a good way to help prevent periodontal disease in pets. Look for bendable, soft toys and treats and avoid hard treats such as antlers. Use rope toys, rubber balls, and rubber toys where you can hide treats.

Oral health is fundamental to the general health of pets and essential to preventing periodontal disease. Teaching the pet owners that your animal hospital serves to get into the habit of daily dental care with their pet allows bonding time, and can be fun and looked at as “treat time” for their pet.

Written by: Dr. Tammy Powell, DVM

Get The “Whole Picture” For GI Foreign Bodies

Sometimes, Foreign Bodies In A Pet’s Stomach Or Intestines Are Obvious On X-Ray Images—For Example, A Bright White Metallic Object, Or A Whopping Big Children’s Dinosaur Toy.

However, sometimes GI foreign bodies and obstructions are trickier to detect…

For example, certain fabric objects—like socks or pieces of a blanket—don’t show up well on radiographs.

Here’s a quick guideline for how to get the “whole picture” and diagnose GI foreign bodies with confidence…

Clinical Evaluation

If you suspect a foreign object in the stomach or intestines, there’s a good chance the patient presented to you with symptoms—may be protracted vomiting with a full obstruction, or milder GI upset if there’s an object in the stomach that’s not digestible but also not causing an obstruction yet.

You proceed by taking a thorough history from the owner and then performing a physical exam.

Then, based on your findings, you perform radiographs.

Radiographs

Be sure to take orthogonal views to get as much information as possible about the dog or cat’s digestive tract.

For some patients, this may be enough information to give you a clear answer. Maybe you see obvious signs of an intestinal blockage, such as plications or extreme fluid and gas retention that doesn’t move over time. Or, maybe you see a mineral-dense rock or other radiopaque objects.

If you don’t have an obvious answer, there are some additional tactics you can pursue, including…

• Repeating the radiographs later for comparison, if the patient is healthy enough to wait.

• Performing a barium contrast study. This is a good option for many patients, but something you may wish to avoid if the patient is vomiting a lot, due to the risk of barium aspiration.

• Performing an ultrasound evaluation. This is a quick and non-invasive way to get more information but may require a waiting period or referral if you don’t have an ultrasound in-house.

• Performing abdominal exploratory surgery. This may give you a definitive answer and allow you to treat right away if a foreign body is present, but is obviously more invasive and requires a thorough discussion with the client to set up expectations.

Ultrasound

An ultrasound is a great way to gain additional information about your patient’s digestive tract, and it can work hand-in-hand with x-rays.

Now that your radiographs have given you a good overview, the ultrasound allows you to “zoom in” on the finer detail of soft tissue structures.

For example, if there’s a radiolucent cloth or foam children’s toy stuck in the intestines, the ultrasound can help you locate and characterize the obstruction.

These additional details may help you decide what to do next, and determine whether or not the patient needs surgery.

If you don’t have an ultrasound in-house, you may need to refer to a specialist or emergency center, and there may be a short waiting period if you use a mobile ultrasonographer.

By having an ultrasound in-house, and gaining the training and confidence to use it, you can potentially have your answers sooner—for more peace of mind for you, and the ability to provide faster answers to your worried client.

Treatment

Based on your findings, you’ll use your clinical judgment to decide the next step—whether that’s surgery right away or a period of observation and supportive care followed by a recheck and a repeat of your images.

As you know, some GI foreign bodies are harder to diagnose than others…

However, the more tools you have in your toolbelt, the easier it is for you to make timely decisions about the best care for your patients.

Written by: Dr. Tammy Powell, DVM

Ultrasound Techniques: Evaluating the GI Tract

An abdominal ultrasound is a tool that can help you with visualizing and diagnosing a variety of conditions in your canine and feline patients.

Today, we’ll be talking about evaluating the gastrointestinal tract.

Depending on your patient, you may be doing an ultrasound exam of the stomach, small intestines, and colon to look for…

• Inflammation and wall thickening

• Foreign bodies

• Neoplasia

• Pyloric outflow obstructions

• Intussusceptions

• Enlarged mesenteric lymph nodes

This isn’t an exhaustive list…

But basically, if the patient is having GI symptoms and your x-rays haven’t provided the answer you need, an ultrasound is often a good next step.

That’s because it provides more details about tissue structure in real-time, as opposed to just the silhouette of radiographs. Often, x-rays and ultrasound work well together.

It may take a little bit of practice, but with experience you can catch on to ultrasound technique and do your ultrasound exams in-house rather than referring.

Here are a few tips for getting the diagnostic information you need during a simple ultrasound evaluation of the GI tract…

• If possible, have the patient fast beforehand. That way, you can get a clear picture of the GI tract without a lot of food or fecal matter to block your view of certain structures or create artefacts such as shadowing. You can also consider an enema if needed.

• Position the patient. Dorsal recumbency is most common, although lateral recumbency may also be used, especially for visualization of deeper structures. Use a trough for comfort, and if appropriate consider sedation (most patients don’t need to be sedated, though).

• Experts recommend having a systematic approach to look at the entire abdomen. Whichever viewing order works best for you, it’s good to be consistent so nothing is forgotten. And, the GI tract will be an important part of your evaluation.

• Choose a machine and probe that work best for your needs, then practice and develop comfort using the different settings, especially adjusting depth and gain (brightness). That way, you can focus on seeing what you want to see, rather than fussing with settings during your ultrasound exam.

• Start at the stomach by locating it just caudally to the liver. Rock and fan the probe to systematically obtain orthogonal views of the whole stomach from fundus to pylorus.

• Next, examine the intestines and cecum. 

  • The duodenum, ileum, cecum, and colon are examined individually. 

  • For the jejunum, you don’t need to follow every loop from beginning to end. Instead, scan the abdomen starting at the level of the stomach. Slide or sweep the probe from side to side, gradually moving cranially to caudally until you’ve visualized the entire field (usually you would stop at the level of the urinary bladder trigone).

• Along the way, take notes to help you prepare your report for your patient’s medical record. Be sure to include what was normal, as well as any abnormalities you found, such as masses or thickened intestinal walls. 

While scanning, you can freeze images for your records and take measurements if you feel anything may be enlarged.

When you develop your ultrasound skills, having this tool at your disposal can often give you quick information when you need it—for example, looking for a GI mass or obstruction when x-rays were inconclusive.

It’s a great way to offer an additional service to your patients and clients, and possibly to stand out from other clinics in your region.

Written by: Dr. Tammy Powell, DVM

A Beginner’s Guide to Pathology Using Ultrasound

Sometimes, radiographs just don’t show the whole picture…

That’s especially true for analyzing the details of soft tissue structures—especially in the abdomen, but in other parts of the body as well.

Limitations of radiographs

One problem you may run into with radiographs is a “silhouette sign,” which basically means that two areas with a similar opacity border one another in your x-ray views. This makes it difficult to tell where one structure begins and the other ends.

A good example of a silhouette that could cause confusion is when the abdomen is full of fluid. Since fluid is approximately the same opacity as the abdominal organs, they may blend together, making it difficult to evaluate the abdominal structures.

In cases like this, an ultrasound can provide additional information. And, ultrasound has many other uses…

What an ultrasound is especially useful for

Radiographs can provide a lot of valuable information. But, they can’t always provide fine detail about texture, small defects, or other abnormalities of soft tissue structures. That’s especially true if the abnormalities don’t result in a big change in opacity or in organ size.

Therefore, ultrasound is often superior for detecting changes within an organ, especially if the change is small, in the early stages of a disease, or otherwise difficult to view on radiographs.

This may include conditions such as…

• Nodules or masses within an organ such as the liver, which aren’t large enough to change the radiographic silhouette/size of the organ.

• Pancreatitis or certain other disorders of the pancreas.

• Calculi of the urinary bladder that are radiolucent.

• Details of the gallbladder, an organ that is often difficult to see on radiographs since it is overshadowed by the liver.

• Abnormal blood vessels, such as a portosystemic shunt.

• Detailed cardiac evaluation, including diagnosing enlargements, congenital abnormalities, neoplasia, and more.

These are just a few examples—an ultrasound has many uses clinically!

Of course, there are some lesions that are better diagnosed using radiographs rather than ultrasound, especially in areas of the body that don’t transmit sound waves well (such as the lungs).

And, by looking at your x-ray views and ultrasound study together, you’ll get more information than you would with either technique by itself. 

So, it’s not a matter of choosing between radiographs and ultrasound—instead, they work very well when used together to see the whole clinical picture.

How to use an ultrasound

It takes some experience to get the hang of directing your ultrasound probe and interpreting the images. Taking a course is often the best and fastest way to become proficient.

However, even though the process of performing an ultrasound study is different from obtaining radiographic views, some of the basic principles of interpretation remain the same for both. 

Rely on the same good practices you do when reading a radiograph, such as…

• Have a system and evaluate each organ (and spaces between the organs) in an order that works for you. Do it the same way each time, to be sure you don’t miss anything.

• Examine cross-sectional images together—meaning views that are 90-degrees apart—of each area of study. An ultrasound, like an x-ray, produces a two-dimensional image. So, you’ll want to move the probe to look at each area at different angles (just like orthogonal views provide a complete picture when taking radiographs).

• When in doubt, seek a consultation with a radiologist who can help you interpret your images.

Just like any other part of your clinical skills, ultrasound technique and interpretation will come with time.

After all, they call it clinical “practice” for a reason—practice makes perfect. 

But with a little time, you’ll likely see a good ROI on your investment, since you can diagnose in-house rather than referring—and may find your ultrasound very useful if you need more diagnostic information in a pinch.

Ask for a free demo at your hospital to learn more.

Written by: Dr. Tammy Powell, DVM

Diagnosing Tumors Of The Heart In Dogs And Cats

Cancers of the heart are uncommon in dogs and cats. When they do occur, it’s important to differentiate a tumor from other conditions that could cause generalized or focal enlargement of the heart and cardiovascular symptoms.

Which Cancers Occur In Cardiac Tissues?

A cancerous lesion based at the heart could be a primary tumor, or due to metastasis. 

Primary tumors that occur at the heart include:

• Hemangiosarcomas—the most common heart cancer in dogs, usually occurring at the right atrium. These occur most frequently in larger dogs with longer noses, such as Golder Retrievers, Doberman Pinschers, and German Shepherds.

• Chemodectomas, also known as aortic body tumors or heart base tumors. Generally thought to be slow-growing, these tumors occur most commonly in brachycephalic breeds like Boxers, Bulldogs, and Boston Terriers.

• Myxomas.

• Sarcomas.

• Ectopic thyroid tumors.

• Lymphoma/lymphosarcoma—the most common heart cancer in cats.

Other cancers are possible, but these are the most commonly diagnosed types. Breeds may vary as noted above, but most pets with tumors of the heart are middle-aged or older. 

How Are Heart Tumors Diagnosed?

If slow-growing, tumors near the heart base are often an incidental finding, seen on thoracic radiographs that are taken for another reason.

Other times, diagnostics are pursued because of clinical symptoms—which are often sudden in onset.

Once a mass is large enough to push on the heart and major blood vessels, many cardiovascular symptoms are possible, such as:

• Coughing

• Ascites

• Lethargy

• Weakness

• Vomiting

• Loss of appetite

• Difficulty breathing

• Collapse

• Sudden death

Note: If a dog presents with some of these symptoms, especially sudden weakness and collapse, a quick ultrasound scan may help to identify pericardial effusion and aid in guiding a needle for emergency pericardiocentesis.

Finding Heart Masses Early

As with most cancers and disease processes, discovering a problem earlier rather than later can allow for more treatment options.

General screening radiographs or ultrasound checks—such as with a senior wellness health check—can be a good opportunity to discover heart base tumors before they cause cardiovascular dysfunction and symptoms.

An echocardiogram performed via ultrasound can help to provide more information on the location, size, and invasiveness of the mass. 

In some cases, a presumptive diagnosis may be made based on the appearance and location of the mass on an ultrasound study, along with the patient’s signalment. If possible to perform without undue risk, an ultrasound-guided aspirate of the mass can provide more information about which type of tumor is present.

Treatment Options For Cancers Of The Heart

Treatment will be based on the type of neoplasia, how fast the mass is growing, whether metastasis is present, and whether or not the pet is symptomatic.

When a tumor of the heart is diagnosed, a good next step is to screen for metastasis and concurrent conditions via chest x-rays (if not already done), bloodwork, lymph node evaluation, and abdominal ultrasound.

Once a diagnosis is made, treatment options may include:

• Periodic monitoring with a cardiologist (especially for slow-growing chemodectomas/heart base tumors) prior to pursuing more invasive treatments.

• Surgery to remove the tumor.

• Pericardiectomy to remove the pericardium and prevent life-threatening cardiac tamponade or pericardial effusion. 

(A pericardiocentesis may be necessary on an emergency basis prior to diagnostics in a pet who presents with acute symptoms. After that, a planned pericardiectomy can help to prevent further emergency episodes of fluid buildup around the heart.)

• Chemotherapy, often in conjunction with surgery.

• Radiation therapy—either conventional, or via Cyberknife therapy.

Even though cancers of the heart are uncommon in pets, they can be scary to pet owners because of the possibility of sudden onset of serious clinical symptoms (especially with hemangiosarcomas).

By performing diagnostics, referring to specialists as needed, and giving your clients as much information as possible, you can help them make an informed decision for their pet.

Disclaimer: This article is for general informational purposes only, and not intended as a guide to the medical treatment of any specific animal.

Written by: Dr. Tammy Powell, DVM

Fear Free Certification® for Your Veterinary Practice

As a veterinarian, you go out of your way to make your patients comfortable. 

So, if you can do something to help dogs and cats have a better, less stressful doctor visit—while also giving your practice a competitive advantage—it’s a win-win!

Fear Free Helps Patients and Clients

Fear Free is a voluntary set of standards that can be implemented to the benefit of your patients’ mental and emotional health. It helps dogs and cats feel more at ease while visiting your practice.

As the Fear Free motto says, you’ll be “taking the ‘pet’ out of ‘petrified’.”

This improves your patients’ wellbeing. It can also make it easier for clients to bring their pets to see you since clients are more comfortable when their pets are at ease during a visit.

Also, Fear Free principles involve client education and empowerment. There are even online resources you can recommend to clients at Fear Free Happy Homes.

What Does It Mean to Be Fear Free?

Fear Free involves alleviating fear, anxiety, and stress in pets. To do this, it’s important to think about the visit from a pet’s perspective.

Along these lines, there are a few different aspects to think about for your practice, including…

• A pet’s physical and emotional comfort. To improve their experience, you could…

  • Have a calm, quiet place for treatments and procedures, with nonslip surfaces on floors and tables.

  • Use treats to distract pets during any unpleasant procedures such as vaccines or blood draws.

  • Make all needles single use only (i.e. change to a new needle to administer a vaccine after drawing it up).

  • Offer elevated platforms and hiding places for cats.

  • If possible, use separate entrances and waiting rooms for dogs and cats.

• Consideration for a pet’s sensitive nose. 

  • Clean with products that don’t have irritating, residual odors or cause “nose blindness” (this is where a strong odor causes temporary loss of a pet’s ability to explore the environment via smell, and this can create fear or nervousness).

  • Use pheromone products.

  • Consider air sterilizers to reduce odors that may be distressing to a dog or cat, such as odors of other pets, cleaning supplies, etc.

• Consideration for other senses such as hearing.

  • Instruct all staff to use calm behavior and “inside voices.”

  • If possible, integrate insulated walls to block noises from barking, or background noise from medical equipment.

• Client education.

  • Schedule appointments in a way that not only gives enough time for pets to acclimate to the environment but also allows for non-rushed appointments and adequate client education.

  • Make take-home Fear Free resources available to clients.

• Medical records.

  • Add standardized measures of the patient’s emotional health, physical pain, and level of stress during each visit to the medical record.

  • Use this information to improve a patient’s experience and emotional health.

• Team culture and training.

  • Educate all team members on Fear Free principles, and use standard operating procedures.

  • Recognize and celebrate successes.

• Maintaining a high standard of Fear Free care.

  • Teach staff to observe a pet’s body language so improvements can be made if a pet shows signs of fear, anxiety, or stress.

  • Include pre-visit preparation to help clients bring their pet in as calm a state as possible.

How to Seek Fear Free Certification®

If you decide to implement Fear Free principles, you can seek certification. 

This certification is something you can display so clients understand the measures you’ve taken to set yourself apart as a practice, and how it all makes for a better experience for their pets.

Fear Free Certification® can be sought by individual veterinarians, by pet professionals (trainers, groomers, etc.) and by animal shelters.

You can also seek certification as a veterinary practice.

Individual certification is great. But, certification of your entire practice promotes Fear Free culture as a part of everything your team does.

To seek certification, check out the Fear Free website, where you can do a self-assessment, and when you’re ready to schedule an onsite visit with a Practice Certification Veterinarian to get your Fear Free Certification®.

Certification even includes marketing materials, to help you show off your amazing achievement to clients so they understand the value you deliver.

Written by: Dr. Tammy Powell, DVM

Ultrasound Techniques: Visualizing the Adrenal Glands

The adrenal glands, those tiny but very important glands, can be tricky to find and evaluate during an ultrasound exam.

However, having a system and knowing where to look can make your job much easier.

There are many reasons you want to visualize the adrenal glands on every scan, including checking for neoplasia and other masses and looking for any changes that could be associated with Cushing’s or Addison’s disease.

Here are some tips to help save you time and allow for a clearer view of these small glands…

Have a repeatable system

When you perform an abdominal ultrasound, it’s important to have a systematic approach to look at everything. And that includes keeping small structures like the adrenal glands and abdominal lymph nodes on your list, so they don’t get overlooked.

Do your scan in the same order every time—whether that’s cranial to caudal, clockwise, or some other system that works for you—and it’s much less likely that anything will be missed or any abnormalities overlooked.

Adrenal gland landmarks

The right and left adrenal glands are respectively located near the right and left kidneys. However, the kidneys are relatively large, whereas the adrenal glands are small. So, the kidneys can overshadow these small glands.

The kidneys are the first things you’ll locate because they’ll point you in the right general direction. After that…

Vascular landmarks are most helpful when it comes to locating the adrenals.

Specifically, the aorta, caudal vena cava, renal vessels, and mesenteric artery are what you’re going to be looking for.

Color Doppler can help you visualize the vessels.

Also note, if the patient allows you to apply gradual pressure, it helps to minimize the distance between your probe and the glands as much as possible.

Finding the LEFT adrenal gland

The left adrenal gland is located ventrolateral to the aorta and cranial to the left renal artery. 

Start by scanning the left dorsal mid-abdomen and visualizing the aorta in a long view. 

Find the spot where the left renal artery branches off from the aorta, and just cranial to that you’ll see the left adrenal gland.

Finding the RIGHT adrenal gland

The right adrenal gland is dorsolateral to the caudal vena cava, and just cranial to the cranial mesenteric artery. It’s also more cranial and dorsal compared to the left adrenal gland.

Scan the right cranial abdomen, with the caudal vena cava in long view.

Apply some pressure with the transducer which will cause compression of the caudal vena cava and help you visualize the right adrenal gland. The gland is right next to the vessel, slightly oblique to it.

Are the adrenal glands normal?

Evaluate the qualitative properties of the gland, and then measure the glands from their cranial pole to caudal pole. Also, measure the thickness of each pole.

Normal adrenal glands are hypoechoic to surrounding fat, and have a characteristic “peanut” shape (although the right adrenal may have more of an “arrowhead” appearance). Typically, adrenals are 4-7mm thick in dogs and 3-4mm thick in cats. 

Abnormalities may include…

• Evidence of hyperadrenocorticism. 

  • If pituitary-dependent, the adrenal glands may be normal in appearance, or they may be “plump” (symmetrically enlarged). An ultrasound exam alone is not enough to diagnose Cushing’s, but may be helpful in context with additional diagnostic tests.

  • If adrenal-tumor related, you may be able to visualize a mass. 

• Evidence of Addison’s disease or hypoadrenocorticism.

  • You may notice smaller or thinner adrenal glands. As with Cushing’s, you’ll want to use this information in conjunction with clinical symptoms and other diagnostic tests.

• Adrenal masses.

  • Many are incidental findings only.

  • Pheochromocytoma is a possibility.

  • Malignancies are possible and may lead to invasion of adjacent tissues, especially blood vessels. 

  • You’ll use your clinical judgment and the patient’s clinical signs to help you determine whether more diagnostics are needed, or to start by monitoring the growth with repeat ultrasound exams over time.

• Age-related changes.

  • Nodular changes and remodeling may be normal in old adrenal glands. Practice will help to develop clinical judgment of what’s normal and what’s not.

The ability to find the adrenal glands quickly will come with experience, and knowing the right tips and techniques will make it easier to get the information you need even when you’re first learning.

Written by: Dr. Tammy Powell, DVM

10 Steps To Complete Dental Cleaning Procedures In Dogs & Cats

Ensure a pre-anesthetic checklist has been performed to include thorough patient history, physical examination, lab work, chest x-rays, and prophylactic medication use has been considered, particularly in the senior patient.

Ensure all equipment is functioning properly and that all essential instruments are available and sanitized. Ensure the CPR plan and CPR medications are in place, as well as resuscitation status for each patient. 

Provide a safe heat source such as a warm air blanket.

Continually check the patient by placing your hand directly on the patient under the heat source. Include this step on your anesthesia monitoring sheet.

Ensure the patient is warm during the pre-anesthetic phase where a patient’s body temperature can lower.

1. During the onset of anesthesia while intubating, use caution when handling the tongue, ensuring it is not pulled forcefully. Gently place the patient in position – note; placing a pet on their back during the entire procedure minimizes anesthesia time and is an effective and expeditious way to perform a dental.

Ensure the tracheal tube is adequately inflated, and an aspiration guard or gauze is in place. Consider the use of intraoral suction to prevent aspiration of water and debris during the procedure.

Continually replace gauze as it becomes saturated with water. Continually check the tracheal tube during the procedure as it may need adjusting depending on the depth of anesthesia and tracheal relaxation

2. While under anesthesia, take before and after photographs of all areas of the mouth to show the pet parent, as well as keep for documentation in the medical record.

3. Begin by irrigating the pet’s mouth with a dilute Veterinary Oral Health Council approved Chlorhexidine based rinse such as CET. Evaluate the oral cavity, and remove obvious calculus at this time to expose gingiva and soft tissues.

4. Perform intraoral regional nerve blocks prior to probing the teeth and gingival tissues, as this procedure may cause pain in the anesthetized patient, requiring a deeper plane of anesthesia. 

5. Thoroughly probe and chart each tooth, and perform full-mouth radiographs

6. Clean the teeth, perform extractions, and required orthodontic procedures needed. Ensure hand scalers and a curette are employed to remove subgingival calculus, particularly where periodontal pockets have been identified.

7. Thoroughly irrigate and lavage away oral debris.

8. Polish all surfaces of each tooth and subgingival areas thoroughly and carefully.

9. Rinse the mouth and each tooth with air and water and ensure all debris is removed from the tongue. Take post-procedure photographs.

10. Finally, apply a plaque prevention gel or dental sealant

Recover the patient quietly and employ pain management and anti-inflammatory medication. The post-anesthetic patient should be monitored closely post-surgically.

Written by: Dr. Tammy Powell, DVM

Post Dental Maintenance Of Dogs & Cats

Much attention is focused on the time leading up to and during dental work in dogs and cats, with much attention being placed on the dental procedure itself.

Without education of the pet parent, preventative care can fall to the wayside, leading to continued periodontal problems in the pet. 

Dental calculus can form hours after teeth cleaning, thus making the education of the pet parent a vital part of their pet’s dental health.

Properly educating the pet parent about post-dental preventative care entails a recheck visit a week or sooner after the dental, where the pet’s mouth is rechecked, handouts and dental preventative products are introduced to the pet parent, and a demonstration performed to demonstrate proper oral care techniques.

The best way of preventing gum and tooth disease in dogs & cats is to actively brush the pet’s teeth at least 3 to 4 times weekly.

There are some excellent products, including enzymatic toothpaste-like C.E.T. which can break down much of the tartar and debris on the teeth. 

During their recheck examination, pet parents can be shown how to brush their pet's teeth using a standard toothbrush, finger brush, and even gauze.

Emphasis should be placed on emphasizing the importance of making the effort to get the habit of home oral care started.

Other products that the pet parent can offer their dog or cat are chewable products such as C.E.T Hygiene chews, Greenies, and other over the counter dental products such as powders, sprays, and gels, as well as water additives.

During the post dental recheck visit, importance should be placed not only on the aforementioned but mentioning diet as well.

Pets eating canned food may be more susceptible to periodontal disease due to the sugars in the food, as well as the wet food sticking to the teeth.

Regular visits to the veterinarian for an oral health exam can give the pet owner an indication of how well they are maintaining the oral health of their pet.

Written by: Dr. Tammy Powell, DVM

Patient Injury & Complications In Veterinary Dentistry

The nature of anesthesia brings risk in general. In veterinary medicine, during dental procedures, pets are often placed in vulnerable positions which can lead to increased risk of injury and medical complications.

These risks can be minimized or entirely avoided with careful consideration, and proper training and continuing education of staff. Listed are a few of the more common injuries that can occur during a dental procedure.

Aspiration Pneumonia

Aspiration pneumonia in pet patients occurs when the patient inhales a foreign substance and develops lung inflammation and infection as a result.

The most common occurrence during dentistry is water and debris entering an unprotected airway, hence allowing fluid and debris to enter the lungs. This can occur from an underinflated tracheal tube, or repositioning during the procedure that allows fluid to enter the airway.

Aspiration pneumonia can also occur if the patient vomits or regurgitates during anesthetic recovery.. To reduce the incidence of dental-related aspiration pneumonia, maintaining the patient on their back during the procedure, and avoiding repositioning has proven to not only lessen the risk of aspiration but also lessens the amount of anesthesia needed during the procedure.

In addition, antiemetic medications given during the premedication phase can help reduce the incidence of post-anesthetic nausea and vomiting. Caution should be taken during the recovery phase to wait until the patient is alert and responsive enough to deflate the cuff and remove the tracheal tube.

Tracheal rupture

Tracheal rupture in dogs and cats are more frequent during dental procedures than any other medical procedure. Seventy-five percent of tracheal ruptures are thought to be associated with oral surgical procedures with the incidence more common in cats than dogs.

Tracheal injury can cause symptoms such as mild dyspnea, and even death. The most likely cause of tracheal rupture is thought to be due to an overinflated tracheal cuff, as well as failing to detach the tracheal tube from the anesthesia hose during repositioning, which can cause a torque on the inflated cuff resulting in a tear of the dorsal membrane of the trachea.

Another common cause of tracheal rupture is a patient that is not adequately anesthetized and coughs or lunges upward during intubation, tearing the trachea.

Pressure from an overinflated cuff can cause pressure necrosis of the trachea, showing delayed symptoms of inflammation and scarring.

Avoiding over-inflation of the cuff, using new tracheal tubes, testing the cuff to ensure proper inflation prior to use, avoiding repositioning as much as possible, and ensuring a level plane of anesthesia prior to intubation can help minimize the risk of tracheal rupture.

Artery Damage during Tooth Extractions

Arterial damage to arteries such as the palatine artery which runs the length of the mandible can accidentally occur during routine tooth extractions where the instrument can slip from the practitioner’s hand.

These injuries can be mild to more severe requiring surgical intervention.

The most effective way to avoid this type of injury is to implement extraction techniques involving gingival flaps where the roots are exposed, and more easily undermined, and extracted. 

Written by: Dr. Tammy Powell, DVM

What Could You Miss Without Dental Radiographs?

When it comes to dentistry, sometimes teeth are like icebergs—there’s a lot going on “below the surface.” In this case, under the gumline. 

Unfortunately, the parts of the tooth you can see don’t always tell the whole story. 

That’s where dental radiography comes in.

Here are a few situations when dental x-rays could make your client communications easier, help you provide better patient care, and improve your bottom line…

Finding pesky root tips

If you’re extracting a tooth with a fractured root—whether the root splintered prior to the dental procedure or the tip happened to break off during a difficult extraction—you generally want to be sure you’ve removed each and every piece.

In many cases, root tips left behind can lead to infection, pain, or an abscess, plus another procedure to retrieve the piece and an unhappy client.

Radiographs help because you have confirmation that you’ve removed all pieces of the tooth roots.

For extractions, it can be useful to take “before and after” images that clearly document the successful removal of the tooth and its root(s).

Informing owners of the risk of jaw fractures

Sometimes, periodontal disease has caused so much bone loss that it leads to a pathological fracture in the jaw.

Or, the jaw could have so much bone loss that there’s a high risk of iatrogenic jaw fracture during a dental procedure and extraction.

You can probably imagine what could go wrong without radiographs…

When you extract the bad tooth, a jaw fracture can occur if that area of the mandible is already severely compromised due to disease and bone loss. But without radiographic proof of the underlying condition, the client may be inclined to blame your technique, rather than recognizing the severity of their pet’s periodontal disease.

Taking radiographs beforehand helps to set up realistic expectations of risk.

Discovering retained and impacted teeth

Whenever teeth are missing, dental x-rays are a good idea.

Sometimes, below the gumline, you’ll find retained or impacted teeth. Left in place, they could lead to dentigerous cysts or other problems.

Without radiographs, these “hidden” teeth can be difficult to find and treat.

Detecting damage to neighboring teeth

Maybe there’s one tooth that’s obviously bad… But, bone loss and infection have also affected the integrity of the neighboring teeth.

Dental radiographs will help you determine whether or not neighboring teeth are viable. And, the images provide tangible evidence that a neighboring tooth needs to be extracted.

This visual aid can make it easier to show a client exactly what you’re talking about, and help to reinforce your recommendations.

And more…

Dental radiographs can also help you look for oral neoplasias, feline resorptive lesions, tooth root abscesses, and more.

Sometimes this will help to confirm your clinical suspicions based on the patient’s presentation and symptoms. Other times, the findings may come as a surprise—allowing you to treat before the problem becomes worse.

With all the information dental x-rays provide, they can really help you create a thorough treatment plan that covers everything a patient needs during their dental procedure.

Your treatment recommendations can help to improve your dentistry revenue. And, importantly, your dental images can also help you provide excellent patient care and increase client knowledge and compliance.

Ask us about a free demo for your hospital, to see how dental radiography can fit into your practice space and daily appointment flow.

Written by: Dr. Tammy Powell, DVM

Take The Frustration Out Of FORLs

To extract or not to extract that tooth root?

Is a crown amputation all that’s needed?

When it comes to feline odontoclastic resorptive lesions (FORLs), these may be the questions you’re asking yourself.

FORLs can cause loss of the protective surfaces (enamel, cementum, and dentin) of both the crown and the root(s) of a tooth, resulting in pain.

These lesions come in two varieties:

• Type 1: Where the root appears radiographically normal.

• Type 2: Where the root is radiographically hard to distinguish from the surrounding bone, with loss of visibility of the periodontal ligament space.

As you know, the treatment for these lesions is different—full extraction of the root(s) for Type 1, versus just a crown amputation for Type 2.

Performing a crown amputation and leaving a root in place for Type 1 could result in problems or complications, not to mention continued pain for the patient.

On the other hand, trying to extract the root of a true Type 2 lesion could be a monumental task and a big headache.

So, it’s very important to determine what type of lesion you’re dealing with. Here’s how…

Diagnosing FORLs

Patient presentation

A client brings their pet to you because of halitosis, food dropping, and occasional jaw chattering. 

During the physical exam, you notice bright red, inflamed gums and gingival hyperplasia near one of the mandibular premolars. 

You suspect a FORL—and given that FORLs are one of the most common dental problems in cats, you’re probably right.

You suggest a dental procedure, including dental radiographs, a full cleaning, oral exam, and possible extraction. The client agrees with the plan.

The day of the procedure

After the patient is anesthetized, your technician obtains radiographic images of the entire mouth, which takes just a few minutes to perform.

Then, you look at the radiographs in conjunction with your oral exam.

While probing the tooth in question, you feel a rough patch under the gingival hyperplasia, consistent with a resorptive lesion.

The x-ray confirms your diagnosis. 

Determining the best treatment plan

In this case, the patient’s tooth is clearly Type 1, with a periodontal ligament space still visible. So, you perform a full extraction.

While evaluating the dental rads, you also notice the premolar on the opposite side is starting to show radiographic evidence of a lesion.

Even though it’s mild, you call the owner and inform them of the likelihood of progression. 

To prevent a painful lesion from developing between dentals, the owner decides to go forward with a pre-emptive extraction of that tooth as well.

Documenting the extraction

In addition to being an integral part of your treatment plan decisions, dental radiographs can also help you document that extraction was performed successfully.

A post-procedure x-ray image is a great way to document that there are no root tips left behind.

And, in cases where a crown amputation was indicated, dental rads provide visual proof that this was an appropriate treatment course.

In this way, dental radiographs not only help you to plan and implement a very high quality of medicine—but they also give you peace of mind and are a valuable part of your medical records.

Talking to clients about dental radiographs

Maybe you already know the benefits of dental radiography—but you’re concerned about discussing the additional cost with clients. 

Often, it helps to include the x-rays as part of the dental procedure package. List them on the estimate so the client understands the value they are receiving—just don’t itemize the cost of the radiographs separately. 

Be sure to adjust the estimate of the dental package accordingly, to cover your costs. And remember, with a monthly payment plan for your dental radiography system, just a couple of dental procedures per month can cover your investment.

Client education also helps. Explain how the results of the radiographs allow you to provide the best possible treatment and reduce the likelihood of future complications.

With clients who want the best for their pets, it’s a win-win for both of you.

Written by: Dr. Tammy Powell, DVM

Ultrasound-Guided Cystocentesis: How and Why to Do One

There are several ways to collect a urine sample from your patient, including free catching, using a urinary catheter, and doing a cystocentesis.

A cystocentesis—which involves obtaining a urine sample via a needle placed directly into the bladder—may be the preferred method in many cases.

This is especially true when you need a sterile urine sample, such as for culture and sensitivity testing for UTIs. And in general, a cystocentesis will provide more accurate results than a free catch urine sample, since it reduces contamination from cells or pathogens of the skin.

It’s possible to perform a cystocentesis by palpating the bladder or using anatomical landmarks alone. However, an ultrasound can make the process easier by removing the guesswork and allowing you to visualize everything.

Here’s how it works…

How to perform an ultrasound-guided cystocentesis for dogs and cats

1. Prepare for the procedure.

   • Use an appropriate size syringe (usually 3ml to 12ml) based on the size of your patient.

   • Choose a needle size and length based on your patient size. A 22g needle works well for many patients.

   • Use a towel, trough, or other cushioning to make your patient more comfortable during the procedure. This may help minimize their movement.

2. Use appropriate patient restraint.

   • For some dogs and cats, this could mean having a trained team member hold them. For very anxious or fractious patients, this might mean chemical restraint.

   • Dorsal recumbency is generally the best way to position your patient.

   • Be sure to clean the area of skin where you’ll be performing the cystocentesis. If needed, consider clipping the fur, too. 

3. Estimate the bladder location.

   • You’ll use your ultrasound to see the bladder, but anatomical landmarks will give you a good starting point for where to place the probe. Try one of these methods…

     • Locate the caudal four mammary nipples and mentally draw an ‘X’ between them. The bladder will often be near the cross point of the ‘X’.

     • Place a small amount of alcohol on the caudal abdomen so it pools. Often, the bladder is located directly under where the alcohol naturally pools on the midline.

4. Visualize the bladder.

   • Place your probe onto the caudal abdomen. You should be able to see the urinary bladder on the screen—it’s a fluid-filled structure that has the appearance of a ‘black balloon’ with gray or white walls.

5. Check for any abnormalities.

   • You could focus on just doing the cystocentesis. However, while you’re visualizing the bladder, it may help to do a cursory exam (or even a more in-depth evaluation, if indicated) to look for any problems contributing to the patient’s urinary symptoms. 

     • For example, note if you see any thickenings, masses, calculi, or other issues in the urinary bladder.

6. Obtain the urine sample.

   • Place the needle directly through the abdominal wall, just in front of the ultrasound probe.

   • Aim the needle slightly caudally.

   • You should see the needle on your ultrasound screen. Use this visual to guide you, to be sure you get a good, clean sample rather than aspirating part of the bladder wall.

7. Prepare your sample for analysis.

   • Right after the cysto, replace the needle on the syringe with a sterile one.

   • Then, divide and prepare the sample in a timely manner (the fresher the sample, the better for testing) for any tests you need to perform, whether that’s in-house or at an outside lab.

In many veterinary hospitals, cystocentesis is safely performed several times per day, and complications are very rare. However, as with all medical procedures, some risks exist.

These may include…

• Hematuria (usually mild and transient).

• Much rarer complications such as bladder injury, leakage of urine into the abdomen, puncture of internal organs or blood vessels, or vagal reactions (retching, panting, hypersalivation, collapse). 

• Seeding of tumors.

  • If you suspect your patient has a bladder tumor such as transitional cell carcinoma, it may be best to avoid a cystocentesis. Otherwise, the needle could ‘seed’ the tumor as you withdraw your sample from the bladder, allowing cancer to spread into the abdominal cavity.

An ultrasound may help you to notice abnormalities such as bladder tumors during the procedure, in which case your recommendation to the client may change.

Fortunately for most pets, a cystocentesis is a quick outpatient procedure that provides a lot of valuable information. And many dogs and cats don’t show any side effects at all.

For patients with urinary symptoms, a cystocentesis is often the way to go for the most accurate diagnostic testing results and to get to the bottom of the issue faster for healthy pets and happy clients.

Written by: Dr. Tammy Powell, DVM

5 Tips for Radiation Safety During Uncertain Times

Your x-ray unit is something you use frequently—probably every day, or multiple times per day—in your practice.

You know radiation safety is important. But recently, if you’ve had to reduce the number of team members in the building at any given time, maybe it feels like there aren’t enough hands on deck for patient restraint and positioning.

The good news is, some of the same principles that reduce radiation exposure can also help your team operate more efficiently.

Here are some tips to maintain safety, even when you’re shorthanded…

A.L.A.R.A.: A Brief Reminder

A.L.A.R.A. stands for “As Low As Reasonably Achievable,” and it’s the guiding set of principles that help you reduce radiation exposure to yourself, your staff, and your patients.

This is important because ionizing radiation from x-rays can damage cells, and cumulative exposure can lead to health risks such as cancer and genetic damage to reproductive cells.

To minimize exposure, there are 3 principles to keep in mind:

• Time

• Distance

• Shielding

Decreasing exposure times, increasing the distance between your team and the x-ray source, and using PPE, all can help to decrease radiation exposure.

Tips for Radiography Safety and Efficiency

Hands-Free Restraint

Increasing the distance between your team members and the x-ray source is one of the most effective ways to decrease x-ray exposure.

Think of the inverse square law, which states that doubling your distance away from the x-ray source results in ¼ of the dose of x-ray radiation.

That’s a significant decrease!

Also, scatter radiation comes from the patient—so by not touching the patient, you’re reducing your exposure.

This can be accomplished by using:

• Chemical restraint.

• Positioning aids such as sandbags and tape.

• A combination of both.

In addition to contributing to safety, hands-free restraint also increases staffing efficiency.

Especially for large or wiggly patients, it takes fewer staff members to position the patient when hands-free restraint is used.

Patient Comfort

A patient who wiggles at the last moment can lead to a crooked radiographic image—and thus, the need to retake that view.

The more shots you take, the higher the x-ray exposure to your team members.

Keeping a dog or cat’s comfort in mind can help you get the shot you need the first time—and decrease the need for retakes.

Here’s how you can do this…

• Minimize fear and pain (for example, pain from stretching a sore leg to get the right position) by using chemical restraint. 

• Use a trough or other aid for comfort. Lying with their back on a cold, hard table can cause even the most cooperative of pets to squirm. Giving them a cozy place to settle into can really help.

• Play white noise or background music. This helps make the big buzzing and beeping sounds from the x-ray machine less startling to a dog or cat.

In addition to a better patient experience and less x-ray exposure, these methods help save your staff time by getting your views more quickly.

Getting Things Right the First Time

The fewer images you take, the less radiation exposure there will be.

In addition to the measures listed above, here are some ideas for taking the fewest views possible…

• Good planning. Be sure to know exactly which views you need ahead of time and what position the patient needs to be in for those views. Communicate these expectations clearly with your staff.

• Proper measurement. Measure the patient in the position they will be in during the shot (lying down rather than standing).

• Have a technique chart, or use appropriate settings in your digital unit. Teach team members how to make quick and accurate adjustments in settings, too.

• Use collimation. In addition to producing a higher-quality image, collimation decreases scatter radiation.

A thorough understanding of x-ray positioning and machine settings will save your staff time and headaches—in addition to minimizing radiation exposure.

Who Should Be in the X-Ray Suite?

Only the team members taking the radiographs should be near the machine. Clients shouldn’t be in the x-ray suite, and other team members should be fulfilling other duties—especially when you’re shorthanded.

Rotating the staff you have on x-ray duty can also help minimize their cumulative exposures. 

So, it’s smart to invest in training multiple team members. That way, you’ll also avoid delays if your “go-to” x-ray staff member ever needs to call out sick or otherwise miss a day.

PPE Care and Use

Even though the nature of your daily practice may have changed, it’s still important to keep up with x-ray safety measures, such as making sure your PPE is in good condition.

Experts recommend checking PPE every six months, and this includes radiographing your aprons, gloves, and thyroid shields to check for cracks. Of course, check and replace sooner if there are any notable defects.

Uncertain times may be stressful, but you and your team can continue to help the patients who need you while keeping yourselves safe.

Written by: Dr. Tammy Powell, DVM

Your Autoclave: Equipment Sterilization Is More Important Now Than Ever

In 2021, you’ve probably thought more about sterilization and disinfection than you ever have before.

Of course, you’ve always practiced safely and hygienically. But, this year’s pandemic brought the need for drastic measures like curbside service, face masks during everyday interactions, and washing your hands even more frequently…

… and, you and your staff probably feel like you’re cleaning, cleaning, cleaning all day long!

Best practices for cleaning surfaces and equipment

According to many experts, the best way to avoid viral exposure is the elimination of the risk. 

This is where isolation and social distancing protocols come in. Your distancing measures of curbside service, telemedicine, and a limited number of people inside your hospital can all help.

Social distancing within the practice and avoiding the sharing of spaces and equipment as much as possible can also help.

Then, there’s PPE to help minimize any potential exposures—as well as your cleaning and disinfection protocols.

You wear gloves and face masks, you wash your hands and use hand sanitizers, and you clean the surfaces and equipment in your practice.

During your cleaning efforts, don’t forget about a powerful piece of sterilization equipment you probably use frequently…

Maximize your use of this key piece of veterinary equipment…

If your own or work at a veterinary practice, there’s a good chance you have at least one autoclave available for use.

Autoclaves use steam under pressure to kill microbes and are one of the most powerful disinfecting tools you have in your arsenal.

Surgical equipment—and beyond!

An autoclave is a tried and true method of sterilization for surgical packs, drapes, and tools.

But, maybe there are a few more items you don’t always think of that could be put into an autoclave for quick, thorough disinfection.

Things your autoclave can be used for include…

• Gowns for surgery, isolation, or general use as an extra layer of protection.

• Cloth caps.

• Cloth face masks.

• Surgery light handles.

• Nitrile exam gloves or surgical gloves (ideally these would be single-use, but there are procedures described to maximize the lifespan of your PPE during shortages).

• Dentistry tools.

• Wound care items such as Penrose drains.

• Cones/specula for otoscopes.

• Pipette tips.

• Certain muzzles.

• Certain nail clippers.

• Biological waste—in case you suspect viral contamination and want to sterilize waste prior to disposal.

There may be other items you can sterilize, too—so get creative! 

Just be sure to check the manufacturer’s guidelines before you sterilize a new item—they’ll guide you on what’s safe or not safe to go in your autoclave.

But, once you get into the habit, this will save you time and do a more thorough job of eliminating microbes than most hand cleanings could ever do.

Why invest in a top-of-the-line autoclave?

In modern times, we can’t help but think of an autoclave as a potent killer of coronavirus!

But really, a good autoclave is useful to you all the time, pandemic or no pandemic. It ensures your equipment is properly sterilized from all microbes prior to use.

A good quality autoclave is dependable and makes your life easier via the simplicity of use. Here’s what we recommend you look for…

• Several setting options including solid or liquid items, and wrapped or unwrapped items.

• The option to choose a preset that suits your needs.

• Large water reservoir so you don’t have to refill as often.

• A tabletop model with a large chamber capacity so you can fit more items per cycle.

• Locking mechanisms for safety.

• A strong warranty and excellent customer service.

Our pick is this Full-Size Veterinary Autoclave because it meets all of these criteria, and has an industry-leading 3-year warranty (which includes a loaner autoclave if yours ever needs to be serviced).

How to keep your autoclave healthy

It’s always important to protect your investments by caring for your equipment—and that’s even more true during times when the business may be slower due to social distancing.

Here are a few tips to keep your autoclave in tip-top shape…

• Use distilled water, not tap water.

• Post guidelines for routine maintenance (otherwise, it’s easy to forget!).

• Look for debris when the autoclave is cool, and clean it as needed.

• Wipe the trays clean weekly.

• Note any water or steam leaks.

• Listen for any unusual sounds.

• Observe the tape indicator each time, to ensure the autoclave is functioning as it should.

With a little attention and care, your autoclave will stay healthy—and in turn, it can help keep your equipment pathogen-free!

Clave 23+ Steam Sterilizer With Drying Compressor

Full-Size Veterinary Autoclave

Click here to see the one we sell