Choosing an In-House Veterinary Chemistry Analyzer

Serum chemistry analysis is something most veterinarians use at least daily, and often many times throughout their workday.

These tests can be used for well-patient health checks, for pre-surgical bloodwork, and to assess an ill patient.

Having accurate results and a system for obtaining them is important. So, when choosing the best method or machine for your practice’s needs, it makes sense to put research and time into that decision. Here are some things to consider…

Should You Use an In-House Chemistry Analyzer, or Send Samples to an Outside Lab?

Each veterinarian has their own preference. And many veterinary practices use a combination of both—in-house analyzers for when results are needed immediately (such as for guiding the treatment plan for an ill or injured patient), and an outside laboratory for more routine testing.

Depending on the pricing structure, an in-house machine might also allow the practice to keep a higher percentage of the profits with each test performed—although this will probably depend on volume and other factors such as contracts and maintenance. Either way, there is some freedom to create your own system for your practice flow.

What Should a Veterinarian Consider When Choosing an In-House Chemistry Analyzer?

Here are a few important considerations before making a purchase…

• Brand preference. Sometimes, a veterinarian or their team members prefer a particular brand due to previous experience or their relationship with the company or sales representative. Certain companies may offer discounts on other services or tests (such as snap tests, hematology analyzers, or consults with specialists) as a perk of using their equipment, which may make financial sense for a practice.

• Contracts. Sometimes, particularly when equipment is heavily discounted, there may be “strings” attached, such as a requirement to perform a certain number of tests per month (and a penalty for not doing so). It’s always important to check the contract closely when making a purchase or signing an equipment lease.

• Costs. Obviously, the cost of the chem analyzer itself should be considered. But remember to also factor in the costs of supplies (rotors, etc.) and the cost of each test relative to the cost to the client. 

• Machine specifics. Which specific tests are available (chem panels vary in size and comprehensiveness), and for which species? Are single tests available, for when you only need to retest one specific value (and how much do supplies for these tests cost versus the larger panels)? How fast are the results? How much blood is needed to run each test—and does the blood need to be spun down first? 

• Ease of operation. Is the machine simple and intuitive to use? Is training provided by the company that sells the machine? And, how are results added to a patient’s medical record? 

• Warranty and maintenance. Ask if there is a warranty included, what it covers, how long it’s good for, and if there’s an option to renew it once it runs out. Also, ask about routine maintenance costs, if there’s a helpline available if you have questions, and how fast an issue with the machine can be repaired/resolved.

• “Real-world” performance. Ask around and see if any colleagues in your area use the equipment, and see what their experience has been. Or, see if the company will let you use the equipment on a short trial period before buying.

IDEXX, Abaxis, and Heska

These three companies are popular choices for veterinary practices. Here are the stated advantages of highlighted chem analyzers from each company…

IDEXX Catalyst One Chemistry Analyzer

IDEXX’s machine offers up to 34 parameters for chemistry, electrolytes, and immunoassay profiles in a single run. They note the practitioner has flexibility in terms of test comprehensiveness, including individual tests and preloaded CLIPs (pre-programmed chem profiles, or the option to create custom testing profiles). Results are available in minutes, and they advertise high accuracy from proprietary technologies. The machine is supposed to be simple to use (“load-and-go” with whole blood, serum, or plasma), for easy workflow. The IDEXX Catalyst One also features 24/7 auto-monitoring and maintenance.

Abaxis VETSCAN VS2 Chemistry Analyzer

The Abaxis analyzer is a small, portable option. It allows a practitioner many options for analyzing chemistry, electrolyte, acid-base, and immunoassay tests, with 12 testing profiles available. The machine is advertised to be easy to use (only a few steps to use, and minimal maintenance), with the capability of connecting to practice management software. The VETSCAN VS2 operates on as little as 2 drops of whole blood, serum, or plasma, with results in 12 minutes. It features its own intelligent Quality Control (iQC) system, which contributes to accuracy.

Heska Element DC5X Chemistry Analyzer

Heska advertises that their analyzer offers ease of use, high performance/volume capabilities, and “gold standard” technology. Ease of use means a fully automated process (“load and go”), an intuitive touchscreen, and easy integration with practice management software (with bi-directional communication). High performance means up to five samples per operation, and up to 190 tests per hour, with the option to preload up to 50 pipettes at once to save time. Veterinarians can choose from a broad, pre-programmed panel or customize to run only the tests needed. Only 10mL of sample is needed per test. Heska also advertises a free warranty.

Keep in mind that there are different analyzer models available from each company that have varying specifications and that details may change over time. So always confirm the specifics before making a purchase.

There are many options available, so it’s important to do some research and see what’s the best fit for an individual practice and if any special deals can be obtained when purchasing or leasing. It’s worth the time since the machine will probably be used frequently to serve the needs of your patients and clients.

Written by: Dr. Tammy Powell, DVM

Choosing an In-House Hematology Analyzer

Complete blood cell counts and qualitative analysis of blood cells are some of the most common diagnostic tests used by veterinarians.

Just a few of the many uses for hematology include diagnosing and monitoring anemia and looking for signs of inflammation, infection, cancers such as leukemia, and many other ailments.

Since blood tests are so crucial to the diagnostic plan for many ill patients and are often included in baseline testing for well patients, choosing the right machine for your practice’s needs is an important decision.

Why Choose an In-House Hematology Analyzer?

When it comes to blood cell analysis, veterinarians have the option of doing tests in-house or sending samples out to a lab. Each method offers its own advantages, and some vets even use a combination of both. 

For example, when a sample is sent to an outside lab, there is usually the advantage of a specialist doing the qualitative/differential analysis. With in-house analyzers, it’s a good idea to include blood smears for increased accuracy and to look at cell morphology.

A veterinarian or their nurses can gain this skill through practice. However, a specialist may be able to detect subtle changes to blood cells that a general practitioner might not notice since the specialist looks at blood cells all day long. And, they can often confidently differentiate between artifacts and pathology when looking at cells on a blood smear.

On the other hand, the in-house analysis offers a lot of conveniences.

Sometimes, a veterinarian needs an answer quickly in order to start treating an ill patient right away. And worried pet owners might want answers as soon as possible.

Plus, depending on the specific contract the veterinarian has entered into, an in-house machine might allow the practice to keep a higher percentage of the profits with each lab test performed.

What Should a Veterinarian Consider When Choosing an In-House Hematology Analyzer?

Here are a few important considerations before making a purchase…

• Brand preference. Maybe a veterinarian or their team has had a good experience with a particular brand. Or, if the company has any additional equipment or tests (such as snap tests) the practice is also interested in, maybe it would be possible to negotiate a better deal for everything together.

• Contracts. Sometimes, particularly when equipment is heavily discounted, there may be “strings” attached, such as a requirement to perform a certain number of tests per month (and a penalty for not doing so). It’s always important to check the contract closely when making a purchase. 

• Costs. Obviously, the cost of the analyzer itself should be considered. But remember to also factor in the costs of supplies (rotors, reagents, etc.) and the cost of each test relative to the cost to the client.

• Machine specifics. How fast are the results? How much blood is needed to run each test? Which species can be tested? And how are results added to a patient’s medical record?

• Ease of operation. Is the machine simple and intuitive to use? Is training provided by the company that sells the machine?

• Warranty and maintenance. Ask if there is a warranty included, what it covers, how long it’s good for, and if there’s an option to renew it once it runs out. Also, find out about routine maintenance costs, if there’s a helpline available if you have questions, and how fast an issue with the machine can be repaired/resolved.

• “Real world” performance. Ask around and see if any colleagues in your area use the equipment, and see what their experience has been. Or, see if the company will let you use the equipment on a short trial period before buying.

IDEXX, Abaxis, and Heska

These three companies are popular choices for veterinary practices. Here are the stated advantages of highlighted analyzers from each company…

IDEXX ProCyte Dx Hematology Analyzer

IDEXX claims to have the industry’s most comprehensive CBCs (27 whole blood parameters plus fluid analysis options, with 17 species capabilities), with reference lab-quality results. They advertise dot plots with each in-house CBC report and extra help such as differential diagnoses and access to board-certified consultants at no charge. Results take two minutes.

Noted special capabilities include detecting band neutrophils and nucleated red blood cells, and including a reticulocyte count.

Abaxis VetScan HM5 Hematology Analyzer

This Abaxis machine reports 22 parameters in less than four minutes, including histograms. The company advertises compatibility with select practice management systems, ease of use, and minimal, quick maintenance with automated cleaning reminders.

Another benefit may be the small sample size requirement of just two drops of whole blood. It has capabilities for 15 species, as well as fluid analysis options. One noted special capability is a direct eosinophil count.

Heska HemaTrue Hematology Analyzer

Heska notes this machine can deliver accurate, reproducible results in 55 seconds, using just 20uL (about one drop) of blood. Results include 17 parameters and histograms. The color touchscreen interface is noted to be simple to navigate, with several species options.

The HemaTrue has daily automatic cleaning and quality control. The company states veterinarians have options such as a free analyzer use, low test prices compared to competitors and a free warranty. One additional advantage is a built-in blood tube mixer.

Keep in mind that there are different analyzer models available from each company that have varying specifications and that details may change over time. So always confirm the specifics before making a purchase.

There’s no one right machine that’s a fit for every veterinary practice. Instead, look at your practice’s individual needs and budget to find the hematology analyzer that’s the best fit for your team and for meeting the needs of your patients and clients.

Written by: Dr. Tammy Powell, DVM

5 Tips to Improve Proficiency With Ultrasound

By becoming proficient at ultrasound studies, a veterinarian can elevate patient care at their practice while also boosting profits.

Whether you’re evaluating the abdomen, the heart, or something else, an ultrasound study can be a very valuable tool.

Here are five ways for a practitioner to improve their ultrasound skills and offer more of this valuable service to pet owners…

The Right Equipment Can Make a Vet’s Job Easier

Having good, well-functioning equipment can really make life easier for a veterinarian and their team. 

This could include a variety of factors, such as…

• Does all of the ultrasound equipment—probe, machine and monitor, and any programs for saving videos and information—work? Does any component (or the whole system) need to be repaired or replaced?

• Is the equipment of a good quality? Maybe it’s technically working, but do the images you produce have enough detail and clarity to see what you need to see? Is any part of the process cumbersome, which can make it less likely that the ultrasound will be used to its full capacity and potential?

• Would routine maintenance or an upgrade improve efficiency and make it easier to offer this service to clients and their pets?

This is all-important because even as you learn, practice, and improve your skills, inefficient or subpar equipment may make it challenging to fully implement your new training and may lead to frustration.

Standard Protocols and Techniques Can Improve Efficiency

If an ultrasound is only performed once in a while, it may feel like a hassle or lead to confusion or inefficiency when trying to schedule and perform an ultrasound study.

To improve efficiency and make it easier to offer ultrasound services at your practice, consider all stages of the process, including…

• Has the veterinary team been trained and empowered in all aspects of scheduling an ultrasound study? For example, is there a specific day of the week, especially if there is only one doctor at the practice who performs ultrasounds? Has enough time been scheduled, especially if sedation is needed? Having a standard set of instructions or protocols can help the team and make things run smoother for everyone.

• If the patient needs any special instructions to prepare for their ultrasound study (such as fasting from the previous evening), is there a clear process for communicating this to the client?

• Does the veterinary team know all the tools you would prefer to have available during an ultrasound study? This may include everything from a v-trough, towel, and clippers, to syringes and microscope slides in case an FNA is indicated. Having a kit or list prepared ahead of time will help save time so no one has to run to the other room and grab supplies mid-study.

• If a patient is sedated or under anesthesia, is there a standard format/form for monitoring?

• Is there a report prepared for the client? Can video clips or still images be saved as part of the medical record? Will the client be present during the ultrasound in some cases? Make sure the whole team knows what should be done.

Take Advantage of All the Resources You Find Helpful

This may include textbooks and other references for what is normal on each ultrasound study and what is not. 

Access to a second opinion can also be helpful. Consider discussing your findings with colleagues within the practice, subscribing to an online forum such as the Veterinary Information Network (VIN), or even using a specialist consultation service for an expert, second set of eyes on your ultrasound images or videos.

Practice Makes Perfect

Any new skill can be challenging at the beginning. But ultrasound proficiency will improve over time, with practice. So even if fitting more ultrasounds into a busy schedule feels time-consuming at first, it will probably get to be second nature over time. 

In addition to training and courses, it may help to ultrasound healthy patients for practice, to gain a thorough understanding of all the different ways normal anatomy can look in different sizes and breeds of veterinary patients. This could be done with the pets of veterinary team members, or possibly offered to clients at a discounted price in the early stages.

Communicate Effectively With Clients

If pet owners are unsure about proceeding with ultrasound for any reason or experiencing sticker shock, the conversation can take up a lot of time for veterinarians and their team members. By planning what to say and gaining comfort with these conversations, time can be saved while providing patients with the care they need. 

Efficient conversations about pet ultrasounds may include general principles for good communication (active listening, empathy, non-verbal communication, etc.), as well as explaining the excellent value that clients are receiving for the cost. For example, explain just how much information can be gathered from an abdominal ultrasound study. In addition to looking at suspected abnormalities, it’s a thorough look at many important organs. Occasionally, unexpected issues are caught early, or if the dog or cat is normal then the owner can have peace of mind.

Putting all these principles together, a veterinary team may find the whole ultrasound process becomes more efficient. This is good for team morale, as it helps to keep the day running as smoothly as possible. It can also increase a practice’s bottom line while providing excellent care for patients.

For all these reasons, it may be well worth it for a veterinary team to invest time and effort in adding ultrasound to their practice!

Written by: Dr. Tammy Powell, DVM

5 Tips to Improve Efficiency With Radiographs

Efficiency can increase a veterinary practice’s income by allowing more patients to be seen or more procedures such as radiographs to be performed.

Additionally, it may lead to an increased average charge per patient—which can improve a practice’s bottom line while delivering excellent patient care.

When it comes to radiographs, here are five ways to increase efficiency…

Start With the Best Equipment for Your Practice’s Needs

Having good, well-functioning equipment can really make life easier for a veterinarian and their team. After all, slower machines and image processors can increase the time per shot. And equipment that’s not operating at its best may lead to frustrating retakes—or even to rescheduling a procedure.

To maximize the usefulness of radiography equipment at a veterinary practice, start by taking an inventory of which equipment is there, including: generator, table, plate or cassette, film processor or digital image software, etc.

Next, evaluate each piece of equipment with the following questions:

• How is the equipment functioning right now?

• If not working well, can repairs or maintenance solve the issue—and what is the cost?

• Is there any routine maintenance due to be performed?

• Does anything need to be replaced—and is it the whole system, or just one specific component?

• Would an upgrade improve efficiency? For example, upgrading from film to digital x-rays can save a lot of time that would otherwise be spent processing films.
  

  Develop Standard Protocols and Techniques

If certain procedures are performed infrequently or don’t have a standard set of protocols to follow, this may lead to confusion, inconsistency, or errors—all of which can waste time and cause frustration.

To make things more efficient, it helps to have standard protocols for team members to follow, which have been properly explained to them. Protocols may include:

• Specific instructions for patient positioning for different radiographic views, such as thorax, hip, spine, etc.

• Guidelines for effective patient restraint while minimizing the staff’s exposure to radiation. For example, be sure the team knows how to properly use positioning aids such as sandbags and tape. 

• If patients are sedated, be sure to have a minimum standard for patient monitoring, with prepared monitoring sheets a team member can easily pick up and use for their monitoring notes.

• Have a standard technique chart, or make sure the team knows how to properly set up an x-ray study using a digital program that automatically sets technique. This includes explaining how to measure a patient in the position in which they will be radiographed.

  Have the Right Resources Available for Radiographic Interpretation

This may include textbooks and other references for what is normal on each radiographic view and what is not. 

Access to a second opinion can also be very valuable. Try to create a collaborative environment where veterinary colleagues within the practice can help each other discuss and interpret radiographs. Consider subscribing to an online forum such as the Veterinary Information Network (VIN), where a vet can post their radiographs for a second opinion. Or, consider using a teleradiology consultation service with veterinary radiologists.

Practice Makes Perfect

Efficiency in taking and interpreting radiographs will improve over time, with practice. So even if fitting more radiographs into a busy schedule feels time-consuming at the beginning, it will get to be second nature over time. 

The same is true with x-ray image interpretation—many vets become faster and more proficient with practice. Also, be sure to study the radiographs of normal patients, to gain a thorough understanding of all the different ways normal anatomy can look in different sizes and breeds of veterinary patients.

Plan for Conversations With Clients

If pet owners are unsure about proceeding with radiographs—especially when sedation is required—the conversation can take up a lot of time for veterinarians and their team members. By planning what to say and gaining comfort with these conversations, time can be saved while providing patients with the care they need. Also, clients may feel more comfortable if everything is explained in just the right way.

Efficient x-ray conversation techniques may include general principles for good communication (active listening, empathy, non-verbal communication, etc.), as well as proactively discussing the answers to commonly asked questions and concerns. For example, explain how sedation not only makes the radiographs more detailed and accurate—it also makes the procedure less scary and more comfortable for a dog or cat.

Putting all these principles together, a veterinary team may find the whole x-ray process becomes more efficient. This is good for team morale, as it helps to keep the day running as smoothly as possible. It can also increase a practice’s bottom line over time while providing excellent care for patients. For all these reasons, it’s usually well worth it for a veterinary practice to invest in radiographic efficiency!

Written by: Dr. Tammy Powell, DVM

The Ultimate Guide to Veterinary Dental Cleaning Stations

A comprehensive oral health assessment and treatment (COHAT), also known as a veterinary dental procedure, is an important consideration for any pet’s long-term health.

Keeping the mouth healthy helps protect a dog or cat’s teeth and contributes to a pet’s overall wellbeing. And, it can be a source of revenue for the veterinary practice.

Here are some of the common components of a dental cleaning station, and the roles they play during a COHAT.

The Equipment Needed for Scaling and Polishing

Even for pets who need significant extractions, the dental procedure typically also involves scaling and polishing the remaining teeth, to clean them, keep them in good health for as long as possible, and avoid further tooth loss. 

So, it’s safe to say that scaling and polishing are an important part of any dental procedure.

Dental scaling and polishing are often delegated to skilled veterinary technicians and nurses. So, when it comes time to invest in a new dental cleaning station, it’s a good idea for veterinarians and practice managers to review the equipment available and see what is required to meet their practice’s needs.

These common tools on a dental cleaning unit play a role in scaling and polishing:

• Ultrasonic scaler. Hand scalers are still used, too, especially for tight spots that need extra attention. And curettes are needed for subgingival cleaning. However, it’s hard to beat an ultrasonic scaler for speed and efficiency when removing large amounts of dental calculus above the gumline. Many include a built-in LED light for easy visualization of the area being cleaned.

• Polisher/Low-speed handpiece. This tool is crucial for smoothing over any small defects or microabrasions in the tooth enamel caused during scaling. In other words, polishing should ALWAYS follow scaling. Recent AAHA dental guidelines recommend using disposable prophy angles and individually packaged, fine-grit prophy paste with a polisher.

• Air/Water syringe. This tool is useful for flushing away bits of tartar and other debris as you’re working, for drying a tooth prior to applying a sealant, or for irrigation and inspection of any visible subgingival areas after cleaning.

• Suction tool. Weak suction can be a convenient way to remove excess water and saliva during a procedure.

Equipment for Drilling and Extractions

Many extractions require drilling into alveolar bone to expose the tooth root or divide the tooth into segments. This allows for safe and efficient extractions, with less risk of leaving root tips or fragments behind.

For this reason, a high-speed drill is an essential component of any veterinary dental cleaning station. The drill should have several burs to choose from, too, since veterinarians see patients of all different sizes and since different bur shapes (rounded or tapered, for example) serve different purposes.

In addition to the drill, hand tools—such as elevators, luxators, extraction forceps, and suture kits—will be used. 

Other Factors to Consider In a Dental Cleaning Station

In addition to the tools available on the dental station, here are some considerations that may affect a veterinarian or practice owner’s decision to make a purchase…

• The size of the unit. Practices with small spaces may prefer a compact cleaning station, while others might not have a size restriction.

• Easy storage and access to tools. No matter the size of the station, it should be easy to store and access the tools right when you need to. No veterinary team member wants to fumble while reaching for a tool or accidentally drop something because it’s difficult to put back.

• Water reservoirs. No one wants to run out of water (which is used for many of the tools, including drilling and ultrasonic scaling) during the middle of a procedure, then put things on hold as the reservoir is refilled. For that reason, it may be beneficial to look for a station with a larger distilled water reservoir capacity.

• Service, maintenance, and warranty. It’s important to protect any equipment investment and to make sure it’s easy to keep the machine running so a veterinary practice can avoid canceling procedures due to equipment issues.

Also, remember to invest in high-quality complementary equipment. In addition to the dental cleaning station and other dental tools, a complete dental procedure also involves dental x-rays, appropriate anesthetic protocols and equipment, personal protection equipment, and anything else needed to perform a COHAT safely and effectively.

Veterinary dentistry can be a rewarding way to provide excellent patient care and generate income for a veterinary practice—a win-win scenario. To make sure these procedures run as smoothly as possible, it’s important to choose the equipment that’s the best fit for your practice’s needs.

Additional resources:

2019 AAHA Dental Care Guidelines for Dogs and Cats: https://www.aaha.org/globalassets/02-guidelines/dental/aaha_dental_guidelines.pdf 

Editor’s Note:

Currently, we offer a complete veterinary dental cleaning station at an affordable price including shipping, delivery, and a 3-year warranty. 

The space-saving machine is designed for high-volume use. 

It features key tools that are crucial to any veterinary dental procedure—plus, a few exciting special features like advanced cooling for the high-speed drill, a scaler with an endodontics feature, an LED light on the polisher, and more!

Learn more, and contact us with any questions, here: https://newvetequipment.com/cleaning-station 

Written by: Dr. Tammy Powell, DVM

Mastering Small Mammal X-Rays: Techniques and Tips

Small mammals can be rewarding to work with, although they can also present some unique challenges.

When radiographing these pets, it’s important to understand species differences and plan accordingly. 

Here are some tips and starting points for radiographing these unique pets…

Considerations for Small Mammal X-Ray Studies

While often lumped together as one group—commonly called “small mammals,” “exotic small mammals,” or even “pocket pets” for smaller species—this group of pets actually covers a range of diverse species. 

This can include everything from ferrets to guinea pigs and rabbits to small rodents like hamsters and mice—and even marsupials like sugar gliders.

It’s important to understand what’s normal and what’s not for each species. For example, hindgut fermenters (rabbits, guinea pigs, and chinchillas) often have notable gas in their GI tract, whereas that amount of gas would be abnormal for a ferret.

To gain an understanding as to what’s normal for each species, it helps to not only study texts and references but also to practice looking at radiographs of healthy pets for comparison.

In addition to understanding species differences in anatomy, it’s also important to consider each patient’s needs when preparing for an x-ray study. For example, certain small mammals may face health consequences with fasting prior to x-rays. For others, a short period of fasting (especially if anesthesia is used) might be appropriate.

Due to the small size of most patients, highly detailed images are needed. Many experts recommend using mammography films for this reason, with tabletop technique. For very small patients, or for extremity views, dental x-ray machines and films may provide good results.

Positioning and Restraint of Small Mammals

Since many small mammals are prey species, they may be prone to excess stress with strong manual restraint, especially if they are already ill. For critical, dyspneic, and otherwise in poor condition patients, it’s usually best to stabilize them prior to pursuing diagnostics.

For patients who are stable, it may make sense to use manual restraint for short studies. Chemical restraint is often favored over manual restraint, though, for reducing patient stress and patient movement. Chemical restraint may include injectable sedative drugs, or inhalant anesthetic delivered via intubation. If intubation isn’t possible, inhalant delivery via mask may also be an option for some patients. Check for appropriate drug doses for each species.

The use of positioning aids and props depends on the size of the patient. Due to their small size, heavy sandbags are not typically used for these patients. Taping a patient’s limbs to the cassette may be a better strategy. And a small trough may be helpful for obtaining a VD view.

Key Radiographic Views

As with any other species, it’s important to obtain a minimum of two orthogonal views (a lateral and VD/DV) with proper patient positioning. Then, additional views such as obliques can be added if relevant. 

Because most of these patients are small in size, whole-body radiographs are common. Then, additional close-up views of areas of interest (like limbs or the skull, for example) can be included, too. For patients who are large enough, it may be ideal to do separate thoracic and abdominal studies.

If needed, standard contrast agents such as barium and iodinated contrasts may be used. Keep in mind that GI transit time is variable depending on the species. In general, carnivores (like ferrets) have the fastest transit times, while hindgut fermenters have the slowest.

Skull radiographs are common in small mammals for evaluating dental issues. A complete set of skull radiographs usually includes DV/VD, lateral, right and left oblique, and “skyline” (rostrocaudal) views.

Conclusion

With the right knowledge, practice, and a few adaptations, radiographs can be used to help diagnose and treat small mammals. Owners of these unique pets often appreciate finding a veterinarian who is able to perform such procedures and deliver a high quality of care to these small patients. 

Written by: Dr. Tammy Powell, DVM

Radiographing Reptiles: Helpful Key Tips and Techniques

If you work with lizards, snakes, tortoises, or other reptiles, x-rays are an important diagnostic tool for these patients.

So, how does the process of radiographing reptiles differ from dogs and cats? Here are some helpful tips for reptile x-rays…

Considerations for Reptile Radiographs

Many reptiles are small in size compared to the average dog or cat. Thus, good quality radiographs with sufficient detail are required for images to be diagnostic. High detail films such as those used for mammography can be beneficial here.

At the same time, many reptiles have highly keratinized scales, or, in the case of chelonians (turtles and tortoises), a shell. These coverings can mean a higher power beam is required, which can also mean loss of detail for internal body structures. Fortunately, motion blur is not a common issue, though.

As with other species of pets, good general rules of radiography apply. This means taking a minimum of two orthogonal views to get a complete picture of the part(s) of the body being radiographed.

Indications for Reptile Radiography 

With reptiles, clinical symptoms are often subtle, and exam findings are often non-specific. So, diagnostic tools such as radiographs are important for figuring out what’s going on and providing the best treatment.

With this in mind, full-body radiographs are beneficial for any reptile who is showing symptoms of illness.

Additional common indications may include evaluating…

• Bone lesions, such as osteomyelitis, traumatic injuries, or metabolic bone disease such as nutritional secondary hyperparathyroidism.

• The digestive tract, including looking for ingested foreign bodies or other digestive ailments.

• Reproductive issues, such as dystocia, egg binding, or yolk coelomitis.

• Abscesses and other soft tissue swellings.

• Lung disease.

• Urinary issues such as bladder stones.

• Problems with other organs such as the heart or liver, although these organs may be difficult to evaluate in detail for many types of reptiles.

• Assessing if intraosseous catheters are placed correctly.

Restraint for Reptile X-Rays

Fortunately, many reptiles hold still without restraint, or with limited restraint, for certain x-ray views. But it’s still important to have a plan in place to ensure quality, diagnostic images are obtained.

A few examples of restraint for different reptile species may include…

• For snakes, allowing them to crawl inside a plastic tube. This also prevents coiling (which may interfere with radiographic interpretation) and ensures the snake is evenly extended for their radiographs.

• Cardboard boxes or other radiolucent containers for smaller species, especially small lizards. Note that this may result in a minor reduction in details/image quality.

• Vagal response in large lizards, which means placing pressure over the eyeballs when the lizard’s eyes are closed. This stimulates the vagus nerve, resulting in a lower heart rate and a calmer lizard. A vagal response could be accomplished with gentle digital pressure, or by placing cotton balls over the eyes and holding them in place with VetWrap wrapped around the head. Dimming the lights and avoiding any noise stimulation will also help.

• Chemical restraint if indicated. This could mean sedation or general anesthesia, depending on how challenging the patient is to work with, what information needs to be obtained from radiographs, and the health status of the patient. Be sure to check the best sedative drugs and doses for the particular reptile species you are working with.

Common Radiographic Views for Reptiles

As mentioned above, it’s important to obtain orthogonal x-ray views. Often, due to the smaller size of many reptiles, this means orthogonal views (a lateral and a DV) of the entire body. 

It’s important to remember that reptiles don’t have a diaphragm. They have a coelomic cavity, rather than separate abdominal and thoracic cavities like mammals have. Because of this difference, placing a reptile (except for snakes) in lateral recumbency may result in coelomic contents shifting, which can confound radiographic interpretation.

To prevent this issue and view organs in their natural position, many veterinarians obtain lateral radiographs of reptiles using a horizontal beam while the animal is standing. 

For chelonians, it helps to place them on some type of stand by balancing the plastron on a block, overturned bucket, etc. This facilitates the horizontal beam view and encourages the patient to hold still and extend their limbs and head from their shell.

Additionally, the horizontal beam can be used to obtain a craniocaudal view in chelonians. This allows comparison of the right and left lung fields.

Contrast agents, such as barium or iodine-based contrast, may be used, especially when evaluating the GI tract. However, it’s important to keep in mind that digestive transit times are highly variable (within a day at the shortest, and weeks at the longest) depending on the species, their nutritional status, and environmental conditions such as temperature and season.

If more detailed radiographs of the skull or extremities must be obtained, it’s important to collimate. For some species, veterinary dental films may provide better detail. Anesthesia may be needed for chelonians to fully view the skull or extremities outside of the shell.

Conclusion

Radiographs are a key tool when assessing reptiles for disease or injuries. But it’s important to understand the wide range of species variations in anatomy and become familiar with what’s normal and what’s not for each type of patient. This could mean having a good reference text, obtaining additional CE, or radiographing a healthy patient of the same species for comparison.

Once the best strategies and techniques are incorporated, diagnostic images can help a practitioner evaluate these unique pets and form an appropriate treatment plan. 

Written by: Dr. Tammy Powell, DVM

Radiographing Exotic Pets: avian patients

When it comes to avian patients, many general principles of radiology still apply, just as they would for a dog or a cat.

For example, proper technique and a systemic method for looking at the entire image are important.

However, birds also present unique challenges. For example, their small size means that fine details must be visible on radiographic images. And a bird’s rapid breathing rate can create motion artifact and blurriness, which can compromise radiographic details.

Here are a few strategies and tips for radiographing an avian patient…

Restraint of Birds for Radiographs

Appropriate positioning and stillness of the patient are both crucial for obtaining x-ray images with enough detail to be diagnostic. Because of this, sedation or anesthesia are usually necessary, with appropriate patient monitoring.

Of course, the decision to administer anesthesia depends on the stability of the patient and whether they can handle anesthesia. But even with ill birds, light sedation may still be beneficial to reduce stress, discomfort, or injuries that could be caused by physical restraint. 

When administering sedation or anesthesia, be sure to check the best medications and doses for birds, as these may vary from those used for dogs and cats.

Radiographic Technique for Avian Patients

It’s ideal to use the shortest possible exposure time. This helps minimize motion blur due to a bird’s fast respiration rate.

For small patients, tabletop technique is used. A grid is not needed, thanks to a bird’s air sacs which don’t cause significant x-ray beam attenuation or scatter radiation. However, a grid may be considered when radiographing an area wider than 10 cm.

Also, appropriate collimation should be used.

Positioning Avian Patients for Radiographs

Whether a patient is canine, feline, or avian, orthogonal x-ray images are more useful and accurate than single-view x-ray studies. So, whenever possible, try to obtain both a lateral and VD view.

A common view for studies is a “whole bird” radiograph for small or medium-sized birds, which means a head-to-tail view including the coelom, pectoral limbs, and pelvic limbs. However, it’s beneficial to focus on areas of interest, too—whether that’s examining organs in the coelom, evaluating a fractured limb, etc.

To visualize the coelom, it’s best to pull the wings and legs away from the body. That way, there’s nothing overlying the coelomic cavity that could complicate interpretation or cover up important details.

When positioning, it’s best to be gentle, especially with small birds that can be fragile. Pulling the wings too much can cause pain or injury, or lead to over-rotation and improper patient alignment. Tape may be used, but it should have minimal adhesive in order to avoid pulling feathers. Other positioning aids made from clear plastic can also be very useful.

For patients in poor condition, it may make sense to first do a “screening” x-ray via a horizontal beam. For this shot, the bird could be standing on a perch on the x-ray table. Sometimes, this gives enough information to rule out certain conditions (such as egg binding or heavy metal ingestion) and develop a preliminary treatment plan. Then, if needed, more detailed imaging could be pursued once the patient is more stable.

A Few Tips for Bird X-Rays

Here are a few more things to keep in mind when it comes to bird radiographs…

• If possible, it’s helpful to fast a patient prior to radiographs of the GI tract. This allows better visualization, and it reduces the risk of regurgitation and aspiration pneumonia. However, keep in mind a bird’s fast metabolism. For very small patients, fasting beyond two hours may be detrimental.

• Have a good reference guide available to use as a point of comparison for your patient’s images. This will help not only with distinguishing what’s normal and what’s not for an individual bird, but also for anatomic variations between species.

• Consider a referral or consult as needed. There’s nothing wrong with referring a patient to an avian and exotics specialist. Or, if you take the radiographs yourself, consider sending the images for a teleradiology consult.

X-rays can be a very important part of the diagnostic plan for birds. With knowledge and some practice, bird radiographs may become faster and easier for the team, leading to prompt diagnosis and treatment of ailments and excellent avian care. 

Written by: Dr. Tammy Powell, DVM

Dental Disease and Heart Disease: What’s the Correlation?

Dental disease is one of the most common health conditions affecting dogs and cats, even though much of it is preventable.

Estimates of dental disease prevalence vary, but many experts say that most (more than half of) dogs and cats over three years of age have some form of periodontal disease.

How Dental Disease Progresses to Periodontal Disease

The process begins with plaque, a thin, bacteria-containing film that forms on the teeth. Plaque can be removed by brushing. But if plaque is not removed, minerals in the saliva harden the plaque, which creates tartar (calculus). Tartar is much more difficult to remove, and it can build up to look like “concrete” deposits on the side of a dog or cat’s tooth.

Pet owners may or may not notice tartar on the crown of their pet’s teeth. But the biggest problem comes from the part they can’t see—the tartar that grows below the gumline.

This leads to periodontal disease, a condition that affects the structures that hold teeth in place. 

Consequences of Periodontal Disease

The early stage of periodontal disease is gingivitis, inflammation or infection of the gums that is often noticeable as red, swollen, or bleeding gingiva. Gingivitis is reversible if treated in a timely fashion. 

After that, further damages from periodontal disease are NOT reversible. This may include damage to the periodontal ligament, cementum, and alveolar bone. These three structures, together with the gingiva, are collectively called the ‘periodontium’.

As periodontal disease progresses, a pet may suffer from gingival recession, tooth loss, alveolar bone loss, and even jaw fractures in severe cases. And one ‘bad’ tooth may affect neighboring teeth, thanks to infection and damage to bone and other surrounding structures.

Bacteremia From Periodontal Disease

Tartar harbors a lot of bacteria, and a mouth affected by periodontal disease carries infections.

These bacteria may enter the bloodstream via areas of the mouth affected by periodontal disease, which may lead to negative health consequences for an affected pet. 

Studies demonstrate conflicting conclusions, so the association between bacteremia from periodontal disease and pathology of certain organs (especially the heart, liver, and kidneys) is not as clear-cut as it was once thought to be. 

For example, the common condition of MMVD (myxomatous mitral valve degeneration) in small dogs is no longer thought to be caused by periodontal disease. Instead, both are conditions that occur commonly in older, small breed dogs. 

The link between periodontal disease and heart disease is more firmly established in human beings. And in pets, there have been associations noted between periodontal disease and pathologic changes to the heart, liver, and kidneys on necropsy. 

Because of these associations with organ disease in other parts of the body, and since bacteremia can and does happen in dogs with periodontal disease, it makes sense to take extra precautions for pets with a condition that would make them more at risk from bacteremia. 

For example, immunocompromised patients, or patients with certain types of heart conditions may benefit from an injectable dose of prophylactic antibiotics during a dental procedure, whereas it might not be necessary for an otherwise healthy pet.

There’s some speculation that chronic inflammation is responsible for pathology to other organs just as much as (or more than) bacteremia. Maintaining good oral health is the best way to decrease the risks of both infections and inflammation from periodontal disease.

Preventing Dental Issues Is Good for a Pet’s Overall Health

So, what’s the conclusion to draw from all of this information, some of which is conflicting?

Of course, that’s up to each practitioner. But in general, maintaining a healthy mouth will always be a good thing. 

Having a chronic disease (such as periodontal disease) anywhere in the body can be a strain on a pet’s health. So appropriate dental care can only serve to improve the overall health of the pet and reduce any risks associated with bacteremia and chronic inflammation.

Additionally, good dental care can also improve quality of life by decreasing oral pain, preventing tooth loss, and decreasing halitosis that could interfere with the human-animal bond. So, preventive dental care is an important part of any pet’s health plan.

Written by: Dr. Tammy Powell, DVM

Ultrasound of the Duodenum and Jejunum in Dogs and Cats

There are many reasons why a veterinarian may perform an ultrasound of the duodenum and jejunum sections of the small intestines in a dog or a cat.

For example, the vet may suspect a GI foreign body, inflammatory disease, or neoplasia. 

Here are a few key checkpoints to remember when scanning the duodenum and jejunum.

Setting Up the Gastrointestinal Ultrasound Study

If a patient can be fasted, that’s ideal.

An empty gastrointestinal tract may be easier to visualize, whereas food or digestive content may cause artifacts such as beam attenuation. However, this won’t be possible for all patients, especially in an emergency situation.

Patients are often placed in dorsal recumbency, although lateral recumbency may also be used. The patient can also be repositioned mid-study if needed for better visualization. 

Performing a Thorough Evaluation

Often, a GI ultrasound study is part of an entire abdominal study. In some cases, the GI tract may be visualized on its own. Either way, to ensure nothing is missed, it’s important to perform the study the same way each time. Many experts recommend keeping it simple by following the GI tract in its normal order of digestion, i.e. starting with the stomach, then moving on to the small intestines (duodenum, jejunum, ileum), cecum, and colon. Examine each segment in both longitudinal and transverse views.

Evaluation should include wall thickness (and whether that thickness remains uniform within each GI section), wall layers, luminal contents, signs of obstruction, the presence of a GI mass or multiple masses, infiltrative disease, and whether there’s normal motility/peristalsis.

The Duodenum

The duodenum is located along the right lateral abdominal wall in dogs. It can be found near (ventral to or ventrolateral to) the right kidney. The cranial portion may be challenging to see and may require viewing via an intercostal approach.

In cats, the duodenum may be closer to midline, or just right of midline.

The wall of the duodenum is up to 5mm thick in dogs, and 2-2.5mm thick in cats.

Jejunum

It’s often difficult to trace the long jejunum loop by loop. So, most veterinarians evaluate the jejunum by sweeping the transducer from side to side across the abdomen, in a cranial to caudal direction. Slightly overlapping each sweep will ensure that nothing is missed.

The wall of the jejunum is 2-5mm in dogs, and 2-2.5mm in cats. 

Evaluating the Layers of the Intestinal Walls

The walls of the intestinal tract have 5 specific layers, in this order: the luminal-mucosal interface (most interior layer), mucosa, submucosa, muscularis, and serosa (outermost layer). 

In longitudinal view, these layers are easily distinguished from one another (in a normal patient), thanks to their alternating pattern of hyper- and hypoechogenicity. The inner and outermost layers, and the submucosa, are hyperechoic. The mucosa and muscularis are hypoechoic. 

If these 5 layers are not distinctly visible throughout the intestines, it could indicate a problem. For example, focal wall thickening with obliteration of the layers could indicate focal neoplasia.

Make notes of any wall thickenings, whether they’re focal or diffuse, and whether the 5 layers are still distinguishable or not.

One normal finding that could be mistaken for abnormal is Peyer’s patches (pseudoulcers) in dogs, which appear as focal, hyperechoic indentations within the hypoechoic mucosal layer.

Signs of Obstruction

Sometimes, the obstructing foreign body may be visualized directly. However, this is often not possible. So, a foreign body obstruction may be detected due to differences in intestinal dilation proximal and distal to the point of obstruction. The intestinal tract proximal to the obstruction would tend to be dilated with fluid and gas, while the distal intestinal tract is normal or even empty.

With a linear foreign body, plication of the intestines may be seen via ultrasound. The foreign body itself may or may not be well visualized.

In case of an intussusception, the affected section of intestines will have a characteristic “bullseye” appearance in transverse view. If this is noted in an older pet, be sure to search for signs of neoplasia that could explain why the intussusception occurred.

Intestines may be hypermotile with a recent obstruction, but possibly hypomotile with a more chronic condition.

GI Neoplasia and Inflammatory Conditions

Neoplasia in the digestive tract may occur as a solitary mass, multiple masses, or diffusely as an infiltrative disease.

As mentioned above, discreet masses are often identified because of their focal thickness relative to the rest of the intestines and disruption of the wall layers.

Infiltrative disease, however, can be more difficult to pinpoint. There may be wall thickening with or without disruption of the wall layers. In particular, it can be challenging or impossible to differentiate between small cell lymphoma and inflammatory bowel disease in cats without further testing.

Regional lymph nodes should be evaluated, too.

Conclusion

The duodenum and jejunum are an important part of any GI evaluation. It’s helpful to get an idea of what’s normal and what’s not for these sections of the small intestines, as they’re commonly evaluated for a variety of conditions, including those listed above. 

Written by: Dr. Tammy Powell, DVM

Evaluating the Urinary Bladder on Ultrasound

An ultrasound of the urinary bladder can be recommended for a number of reasons, including suspected uroliths, cystitis, and neoplasia—to name a few.

Often, the evaluation includes the entire abdomen and any other parts of the urinary tract that can be visualized.

Given all the conditions that can affect the bladder, as well as important information from an ultrasound study to help guide the treatment plan, it’s beneficial to gain proficiency in evaluating the bladder via ultrasound.

Use a Systemic Approach to Evaluating the Bladder

A systemic approach to the whole abdomen is good, and a bladder evaluation is usually just one part of an abdominal ultrasound study. So while it may be tempting to jump to the bladder right away if the patient is having urinary symptoms, it’s best to complete your abdominal ultrasound study in the same order that you usually do it.

Once you reach the urinary bladder, a systemic approach is again useful, to ensure nothing is missed. Here is one method for a stepwise evaluation…

• Is the overall bladder shape normal and as expected? Through practice, a veterinarian can get a good feel for what shape is normal for canine and feline patients, and how it may change if the bladder is full versus empty or nearly empty.

• How does the lumen of the bladder look? If urine is present, is the urine is anechoic? Is there sludge, sediment, crystalline material, a polyp, or anything else that is abnormal?

• If there are uroliths present, they generally appear as hyperechoic structures inside the lumen of the bladder. There may be acoustic shadowing, and the calculi may move freely depending on how large they are. 

• Is the bladder wall smooth, a normal thickness, and well-defined? Be sure to evaluate the entire bladder. If cystitis is present the wall may be focally or generally thickened or have irregularities in the mucosa, depending on the severity and duration of the cystitis. Keep an eye out for polyps or masses/tumors, too. Also, look for deviations in the wall that could indicate a urinary bladder diverticulum.

• If a mass is present, make note of the size, appearance, and location. Transitional cell carcinoma, the most common neoplasia of the bladder, tends to occur in the bladder wall near the neck and trigone. Commonly, these masses are hyperechoic or mixed echoic and have been compared to cauliflower in appearance. Evaluate nearby blood vessels and regional lymph nodes, too. Avoid cystocentesis or aspiration for samples, because of the risk of seeding the neoplasia into the abdominal cavity when the needle is withdrawn. Sometimes, it’s easy to confuse blood clots with masses, so keep this in mind and re-evaluate as needed.

• Be sure to evaluate other urogenital structures, including the kidneys and ureters (the latter are often not visible unless there’s an abnormality), as well as blood vessels and lymph nodes in the region. Remember to look for the uterus/ovaries in intact females and the prostate in males, although it might not be possible to visualize these structures in all patients, especially if they are normal.

Whenever abnormalities are noticed, describe them in detail and take measurements. Include all of this in the notes. Even if things look normal, it’s still a good idea to take some measurements (such as bladder wall thickness) and describe what you’re seeing, as a baseline for comparison in case anything changes in the future.

A Few Tips

A full bladder can help with visualizing certain lesions (such as hyperechoic uroliths) by providing “contrast” or a backdrop to help make abnormalities stand out. Also, a full bladder smooths out the bladder wall, whereas an empty bladder may lead to false readings of wall thickening or masses. Additionally, a large bladder allows for an easier ultrasound-guided cystocentesis. So whenever possible, try to ultrasound with a full, or at least partly full, bladder. In some cases, it may be appropriate to give the patient water or IV/SQ fluids and wait for the bladder to fill prior to the study.

Pressure from the transducer can alter the bladder’s shape.

So be sure to practice with various pressures and become familiar with how the appearance of the bladder might change.

Repositioning the patient can also be helpful.

This may give you a better viewing angle and position for certain structures. Having the patient stand up may put gravity in your favor by decreasing the distance between the bladder and the probe. Also, patient movement may cause sludge/sediment to move around or disperse so that it’s not mistaken for a urolith.

Have appropriately sized needles, syringes, and collection materials available.

In case an aspiration/cystocentesis is needed, it’s best to have supplies ready to go.

Ultrasound of the urinary bladder is a very valuable skill, and it works well in conjunction with information gained from x-ray studies. Training and practice in ultrasound of the urinary bladder are often well worth it for patient care and for additional income from ultrasound studies. 

Written by: Dr. Tammy Powell, DVM

Finding the Adrenal Glands in Large Dogs using Ultrasound

A thorough abdominal ultrasound includes evaluating the adrenal glands.

Common reasons to look at the adrenals include searching for signs of neoplasia, Cushing’s, or Addison’s disease. And even in animals where adrenal disease isn’t suspected, sometimes growths or other changes to the gland(s) are discovered incidentally.

Unfortunately, sometimes adrenals can play “hide and seek” and be tough to find. That’s true for any dog—but especially for large dogs with deep abdomens, since the abdomen may be too thick for the ultrasound waves to penetrate well. 

Having a repeatable system for where to look can help. Here are some steps for finding those tiny glands inside of a big dog…

Perform an Abdominal Ultrasound in the Same Order Every Time

Just like reading an x-ray or performing a physical exam, a systemic approach helps ensure that nothing is missed. 

Each veterinarian may have their own preference for how to go through a scan in a stepwise fashion. For example, some may scan cranially to caudally. Others may scan clockwise, or have some other system. Any system is fine, so long as it covers everything you need to see and is easy to repeat on each patient. So choose what works best for you.

In addition to revealing unexpected abnormalities of the adrenal gland(s) sometimes, systemically examining the entire abdomen will also help a veterinarian gain experience. Then, when it’s time to locate the glands on a patient with suspected adrenal disease, you’ll have plenty of practice to fall back on and may feel less pressure.

Where to Find the LEFT Adrenal Gland

• To narrow the search, first, find the left kidney by scanning the left dorsal mid-abdomen.

• Next, narrow the search even further by finding the vascular landmarks: the aorta (in long view) and the left renal artery. 

• Look for the spot where the left renal artery branches off from the aorta. The left adrenal gland should be just cranial to this junction.

Where to Find the RIGHT Adrenal Gland

• First, locate the right kidney by scanning the right cranial abdomen.

• Next, locate the vascular landmarks: the caudal vena cava (in long view) and the cranial mesenteric artery.

• Apply some pressure, which will cause compression of the caudal vena cava and allow better visualization of the adrenal gland. The gland is dorsolateral to the vena cava and just cranial to the cranial mesenteric artery.

A Few Tips

It may be tempting to use the kidneys as a primary landmark since the adrenal glands are located near each kidney. However, the kidneys may overshadow the small glands. So while the kidneys are a good starting point, it’s also important to use vascular landmarks.

Color Doppler can be a big help, too. It often makes it easier to find and view vascular landmarks.

Minimize the distance between the probe and the adrenal glands as much as possible. This can be done by moving the probe as needed, and by applying gentle pressure if the patient allows.

What to Include In the Medical Record

Be sure to describe any abnormalities. Additionally, rather than just noting ‘normal’ or ‘abnormal’, it’s good to provide specific details in case a comparison is needed in the future. Here are some things to note, even if the glands look normal…

• Measure and record the size of each gland. Measurements are typically taken from the cranial to caudal pole, as well as a measurement of the thickness of each pole.

• Note if the glands are hypoechoic to surrounding fat or if their appearance is different than expected.

• Classic adrenal gland shape has been compared to a ‘peanut’, or sometimes an ‘arrowhead’ for the right adrenal. Note if the shape is as expected or if it’s abnormal.

• If any abnormalities are noted, list the most likely rule-outs and a recommendation for follow-up/monitoring or further diagnostics if indicated.

With practice, locating the adrenal glands will become second nature. It may still be challenging on some patients, but having a repeatable system and gaining experience will help.

Written by: Dr. Tammy Powell, DVM

Veterinary X-Ray Options: Naomi and CareRay Explained

Comparing X-Ray Panels: Naomi and CareRay

Digital radiography equipment continues to evolve, with several types of x-ray detectors or sensors available to veterinarians.

So, which is right for your practice? Do you need the latest technology to provide the best care, or is it best to get the most mileage you can out of previous generations of technology?

The Evolution of Digital X-Ray Detectors

Just like our cell phones and tablets, maybe it feels like there’s always a new type of x-ray technology available, whether you’re looking for small or large animal x-ray equipment, or for general, mobile, or dental radiography.

When trying to research the technology and all the lingo, maybe the choice feels a bit overwhelming.

To start with the basics, here’s a quick overview of the most common digital radiography plates on the market right now…

• CR (computed radiography). CR cassettes are also known as phosphor plates. In terms of practical application, the biggest difference between CR and DR is probably the fact that CR requires an extra step—rather than the image being transferred directly from the plates to a computer, the sensors must be read by the CR plate reader.

• DR (direct [capture] radiography). DR technology allows images to be read directly from the plate and then show up on a computer screen, which is usually a rapid process. Within DR, there are two main types of plate technologies: 

  • CCD panels. Charge-coupled device (CCD) detectors are generally built into or attached directly to the x-ray table. This technology has been compared to a digital camera in the way it detects and records light. 

  • Flat-panel detectors. Here, the x-rays are converted into an electrical signal (either directly, or indirectly by first converting x-rays into light and then into an electrical signal). The panel is separate from the x-ray table and can be removed in case a horizontal beam is needed. 

The advantages of flat panels include lower x-ray doses and better detail and clarity in the images (although opinions on image quality vary amongst practitioners). On the other hand, flat panels tend to cost more than CCD panels.

Note: The abbreviation DR is also used for “digital radiography” in general, in addition to direct capture panels.

Additional X-Ray Equipment Considerations

In addition to the detector that picks up the x-ray beam, successful radiographs also require…

• An x-ray generator, which produces the x-ray beam. This may be purchased as part of a new digital x-ray system. Or, older generators and tables may be retrofitted to be compatible with a new digital sensor.

• Software. This is what shows the x-ray image that was picked up by the sensor so that a veterinarian can see and read the image. It’s also where images are stored as part of the medical record, or shared electronically with clients, other veterinary clinics, or specialists as needed.

• Wired or wireless technology. So far as the sensor or plate goes, some have wire connections while others are wireless.

In addition to considering which sensor technology is a good fit for your practice, it’s important to think about whether or not any other equipment needs to be upgraded, and how compatible the whole system will be together.

When Is It Time to Upgrade?

This depends a bit on a veterinary practice’s needs. Typically, it’s not necessary to replace equipment for the latest model every time new technology is available, and it may be possible to keep older equipment in good working order for many years.

Using the Naomi CCD panels and CareRay Cesium (DR) panels as an example, here are some considerations…

• If a clinic is using older Naomi CCD panels that are still producing great, diagnostic images, then it’s typically not necessary to upgrade to a flat panel detector.

The veterinarian is not missing out by hanging onto older technology that still gets the job done.

• What if the plates work fine but there’s a software problem—say, the software is no longer supported? Or, what if there’s no longer any technical support or a warranty available for the plates, which sometimes happens with older technology? 

Here, the decision to upgrade may come down to personal preference, budget, risk tolerance, and how much time and effort it takes to get readable images from the software. 

• Of course, if the panels are no longer producing diagnostic images, then it’s probably time to upgrade. 

You can always check on your warranty if it’s still in place or ask about the cost of repairs, but sometimes veterinarians find that repairs are costly on older technology and their investment may be better spent on an upgrade. But this strategy will vary depending on each individual business and situation.

No matter which equipment you are currently using (or considering purchasing), remember to also think about things such as availability and cost of technical support, whether a loaner plate is available during repairs, and how the software integrates with your practice software.

Also, see if you can sell your used equipment (or make a trade-in, if your vendor allows) to offset the costs of new equipment.

All of these factors will aid in the decision of whether or not it’s time for an upgrade. 

Written by: Dr. Tammy Powell, DVM

Portable Equine X-Ray Generators: What’s Better, Plug In Or Battery Powered?

Plug-In Or Battery Powered?

As an equine practitioner, many of your daily practice needs are different from those of your small animal colleagues. 

Maybe you meet your patients where they are, in a barn or on a farm call. Or, even if you have a facility that allows for equine visits and hospitalization, you may still need portable equipment to bring with you into a stall.

So, which type of portable generator is best for you: plug-in or battery-powered? Here are some things to consider…

Benefits of Battery Powered Portable Equine Generators

One obvious advantage is that a battery-powered generator may be easier to use out in the field, for the simple fact that you’re “wireless” and thus not dependent on a power outlet. This may be especially helpful in situations where power outlets are not immediately accessible, during power outages in inclement weather, or in some barns or other locations where the power supply may be less consistent.

The lack of a cord also allows for simpler mobility during use. There’s no need to untangle a cord and no possibility of tripping over the wire at any point during the procedure.

Benefits of Plug-In Portable Equine Generators

The most common reason for equine practitioners to choose a plug-in generator is probably this: They don’t want the battery to run out!

Nowadays, there are battery-powered generators available that have long battery life. However, depending on how many hours you’re out, a battery may or may not meet your needs. Or, a team member may forget to charge it between shifts. Also, some practitioners note that battery life may decrease over time—and that the batteries of an x-ray generator can be very expensive to replace.

Additional considerations mentioned by some veterinarians are that plug-in generators may weigh less than battery-powered units. Also, plug-in units may cost less on average. There are variations in weight and equipment cost from model to model, though.

Other Considerations

Different brands and models may offer different price points, battery/equipment expected lifespan and other important differences. Doing research before a purchase is crucial.

This includes talking to the company, as well as speaking to colleagues for recommendations (ask companies for referrals to other practitioners in your area who use the equipment or ask around in online forums or in-person events).

In addition to the equipment itself, you’ll also want to consider things like warranty, ongoing costs (repair and service costs, and image storage costs for digital), integration with any of your current equipment (for example, if you already have a plate), ease of use, durability in rugged conditions or temperature extremes, and whether 24/7 live technical support is available.

With all this in mind, different veterinarians may have different preferences—there’s no one size fits all in terms of plug-in versus battery-powered portable equine generators, or in terms of a particular brand and model that are best for everyone.

So be sure to do your research and gather feedback from colleagues, but also think about what will work best for your own preferences and individual practice needs.

Written by: Dr. Tammy Powell, DVM

Ultrasound-Guided Cystocentesis: Pros & Cons for Veterinary

A cystocentesis offers advantages over other urine collection methods

If you work in a small animal veterinary practice, there’s a good chance you’ve performed, assisted with, ordered, or overseen a cystocentesis in many of your patients.

A cystocentesis offers advantages over other urine collection methods in that it provides a sterile sample, as opposed to free catch or even catheter methods that may contain contamination with pathogens or cells from the skin or urethra.

But how does an ultrasound-guided cystocentesis compare to a blind cystocentesis obtained via palpation or anatomical landmarks?

Your preference may depend on your practice style, experience, and patient needs. But here are a few things to consider…

Which Patients Are Good Candidates for Ultrasound-Guided Cystocentesis?

Here are a few factors that may determine if an ultrasound-guided cystocentesis is a good option for any particular patient…

• Large or overweight patients. A blind (or non-ultrasound assisted) cystocentesis may be straightforward on cats, and even small dogs, who are not overweight. In these patients, it is often possible to palpate the urinary bladder and to easily reach the bladder with a standard-length needle. 

However, difficulties arise in patients who are overweight, which makes it more challenging to feel and reach the bladder. Additionally, an ultrasound can help guide your needle with large dogs.

• Patients with “hard to stick” bladders. Maybe your patient’s bladder is thickened due to chronic cystitis or another condition. Or, maybe the patient’s bladder is small. 

Either way, an ultrasound provides additional direction (and visualization) of partially-full or otherwise difficult-to-obtain-a-sample-from bladders.

• Patients whose bladders could use a visual evaluation. If you’re obtaining a cystocentesis because the patient has urinary symptoms, a quick scan can provide more information about any obvious lesions. 

Use this for your own peace of mind (i.e., there’s no bladder tumor present at the time of the cysto), or create a charge for urinary ultrasound evaluation packaged together with other diagnostics.

Which Patients Are NOT Good Candidates for Ultrasound-Guided Cystocentesis?

• Thin cats with big bladders. Depending on your practice style and preference, you may find it’s easier to do a blind cystocentesis on a cat with an easily palpable bladder, especially for routine health checks. 

Although it may still be worth doing an ultrasound if the cat presented for urinary symptoms, so you can look at the bladder.

• Patients with bladder masses or tumors. If a patient has transitional cell carcinoma, placing a needle into the bladder may “seed” tumor cells into the abdomen as the needle is withdrawn. 

So any time a mass is present or suspected, it’s good to be cautious and skip the cysto (with or without ultrasound).

• Fractious or wiggly patients. These patients may not be good candidates for either ultrasound-guided or blind cystocentesis, since it wouldn’t be good for them to move around while the needle is inserted.

However, sedation may make the procedure possible for these dogs and cats.

PROS of Ultrasound-Guided Cystocentesis Versus Blind Cystocentesis 

Advantages include…

• Quick and easy. If you’re new to ultrasound-guided cystocentesis, it may take some practice. But soon it becomes a habit and may even be faster than a blind cysto.

• Visualization of the bladder. You know exactly where the needle is heading, and therefore you have an improved likelihood of getting a sample from a small or partially-full bladder. 

Plus, you may want to do a quick bladder evaluation to look for things like uroliths, sludge, or bladder masses, as this could change your recommended course of treatment.

• Safety. Supporters of ultrasound-guided cystocentesis point out that if you can see where the needle is going, there’s less risk of accidental puncture of other organs or blood vessels. 

CONS of Ultrasound-Guided Cystocentesis Versus Blind Cystocentesis 

• Training and practice are needed. It may take a little time for your team to become comfortable with this new method. Fortunately, it’s simple and straightforward to learn.

• Creating a charge for the service. This isn’t necessarily a bad thing—after all, you should be paid for your time and expertise when you provide a service.

However, there are differing opinions from practice to practice as to when and how to charge.

• For example, will you charge for all ultrasound-guided cystocentesis?

• Or only charge as part of a package with other diagnostics (urine analysis, urine culture and sensitivity, and quick ultrasound evaluation of the bladder, for example) in patients who are symptomatic?

• And how much will you charge?

• Small risk of side effects. The most common side effect is hematuria, which is mild and transient. Other risks do exist, such as bladder rupture or injury, organ or blood vessel puncture, urine leakage into the abdomen, the spread of bladder cancer, or vagal reactions (retching, panting, hypersalivation, collapse). 

While these effects are quite rare, it’s always worth considering the risks of any procedure before performing it, especially in patients who may be at higher risk due to underlying health conditions.

Investing in Ultrasound Training

In addition to teaching your team members to do an ultrasound-guided cystocentesis, it’s worth considering training in ultrasound examinations for you or one of your DVM associates.

There are plenty of other uses, including but not limited to abdominal evaluation for organs, masses, ascites, or even pregnancy, and cardiac or pericardial evaluations.

By maximizing your ultrasound usage, you can offer more diagnostics to your patients, while also getting the best ROI on your equipment investment—a win-win.

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

10 Marketing Ideas for Your New Veterinary Practice

Even in the beginning stages of planning your veterinary practice, it helps to think about marketing alongside all the practical considerations like financing, equipment, and staffing.

Marketing is how you let potential clients know who you are, and what sets you apart from the competition. It’s what helps you bring in more and more clients as your practice grows.

With that in mind, today we have a list of marketing ideas for veterinary practices. 

We’ll have in-depth articles on some of these topics down the line, so you can learn more. But for now, here are 10 ideas to inspire your plan for your very own practice…

1. Make Sure Your Website is Mobile-Friendly

Today, the largest pet-owning population in the US is Millennials. As you may have guessed, Millennials spend a lot of time online, especially on devices like smartphones.

So, it’s important to make sure your website shows up clearly and quickly not just on a computer screen, but also on a small, vertical smartphone screen. If you’re not sure whether or not your practice’s website is optimized for mobile, talk to your website host or manager.

2. Claim Your “Google My Business” Listing

This online listing is connected to Google Maps, and optimizing it can improve your rankings in online search results.

3. Content Marketing

This broad category includes things such as…

• Blog posts and articles.

• Email newsletters.

• Client handouts and educational materials.

• Testimonials or case studies (success stories of some of your patients, published with their owner’s permission).

Content marketing works like this…

Clients read informative content from you. Then, when the time comes for their pet to receive care, they won’t even look anywhere else… They’ll want to bring their pet to you, because they already feel like they’ve gotten to know you—and that they can trust you—after reading your blog posts or newsletter.

So, this is a long-term strategy. The good news is, the work you put in can help to develop long-term client relationships and promote client retention.

Plus, this is a convenient way to update current clients on new services you’ve added to your practice, as well as any specials or promotions.

If you’re not sure where to start—or, if you don’t enjoy writing—consider working with a professional veterinary copywriter, who can guide you and help you create content.

4. Online Reviews

Don’t leave your online reviews to chance, or in the hands of difficult-to-please clients (who are often the only ones who remember to take the time to leave a review).

We’ll have a more in-depth article later, but some simple strategies to encourage good reviews are simply asking happy clients if they would mind leaving a review (but don’t place pressure, or tell them what to say), and making it easy with a “Review us now” button on your website or in a post-visit email.

5. Use Social Media

Your social media platforms can be great places to engage with your clients (and thus reinforce their bond to your practice). It’s also great for announcing updates to your practice, and sharing specials and promotions.

The occasional fun contest or giveaway (such as having a small prize for captioning a cute pet photo) can also encourage clients to interact with you, and strengthen your client relationships.

6. Create Videos

Next to Google, YouTube is the most used search engine.

So, creating useful or cute videos for pet owners can help your practice show up higher in online search results and nurture a client’s bond to your practice.

Fortunately, nowadays you don’t have to be a tech whiz or own an expensive camera to produce a reasonable quality video. Most modern smartphones have a great camera that can be used for this purpose.

Video ideas include a tour of your facilities, introductions to staff members, short educational content for pet owners, and “how-to” videos such as a demonstration on how to properly clean a pet’s ears or give a pet medicine.

Post the videos on your website and social media, and ideally on YouTube, too.

7. Start a Rewards Program

Consider punch cards for products such as parasite prevention or pet food, to encourage pet owners to return to you for purchasing these supplies.

8. Start a Referral Program

Create an incentive—such as a small discount on the next visit—for current clients to refer friends to you.

9. Build Relationships With Other Community Businesses

For example, offer a first free exam to pets adopted from the local shelter or rescue organization, so that these businesses will refer new clients to you.

Or, develop a relationship with a local grooming or boarding facility. They can refer to you, and vice versa.

10. Hold Classes at Your Practice

This could mean puppy or kitten, socialization classes.

Or, it could mean an educational evening for pet parents on nutrition, first aid, or other topics of interest.

Consider holding these classes a couple of times per month to create a positive perception of your clinic, and to find new clients who are interested in providing a high level of care to their pets.

There are many other marketing techniques out there, but this should give you a great place to start—and hopefully, it’s sparked some ideas for seeing your veterinary practice grow and thrive!

Written by: Dr. Tammy Powell, DVM

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

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

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

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