VETgirl Q2 2021 Beat e-Magazine

beat ISSUE 10 | JULY 2021

QUARTERLY BEAT / JULY 2021 ///

CONTENTS July 2021

ARTICLES

06 Dilution May Be the Optimal Solution for Cats With Lower Urinary Tract Disease 10 5-FU Toxicity in Dogs 12 Emotional Wellness: Why Dark Emotions are Just as Important as Warm & Fuzzy Ones 14 Making Sense of Common Muscle and Tendon Injuries in Dogs

16 UPCOMING CONTENT 18 TECH TIPS 21 PROVIDER SPOTLIGHT WHAT’S NEW

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A NOTE FROM VETgirl

Garret and I are excited to bring you the newest edition of our VETgirl BEAT E-magazine! And with it, we have some big news… so keep reading...

Back in 2012, I had the amazing opportunity to lecture in India. While visiting, I helped some veterinarians perform a thoracocentesis on a HBC dog. One of the veterinarians said to me that they thought it was one of the first thoracocentesis procedures done in the country. While I’m sure that wasn’t true, it made me feel fortunate to have the opportunity to elevate the quality of emergency critical care globally. That same year, I reached out to fellow tech-savvy PennVet ECC resident, Dr. Garret Pachtinger, with a crazy idea that I had been simmering for almost a decade… being able to provide education in a format never used before – online continuing education (CE) . Little did I know, we’d be one of the first online veterinary CE providers out there. Our goal and passion? To deliver clinically relevant, practical CE. Because we wanted our veterinary colleagues to take away 2-3 “learning points” per lecture that was going to directly help save that patient’s life. That way you could learn anywhere, regardless of where you were. Like in India. Through the help of fellow resident mates and colleagues, along with our continued passion for delivering clinically relevant, practical CE, it’s been an honor to see VETgirl continue to grow. And grow, we did. Over the past 8 years, we’ve expanded from just small animal to add more opportunities to learn: large animal, veterinary technician, leadership, practice management, nutrition, certificates, LIVE conferences and so much more. That’s why we decided to team up with BluePearl and become part of Mars Veterinary Health. This partnership will help us take VETgirl to the next level. Please know that this won’t fundamentally change anything about what we do and love here at VETgirl. Garret and I will still be at the helm, ensuring our content stays clinically relevant. Practical. Lifesaving. And unbiased.

Globally.

Let’s elevate the quality of veterinary medicine worldwide. It took us almost a decade to grow it in North America, and we still have a long way to go. But, reflecting back on my veterinary visit to India, I wanted to help bring VETgirl’s CE to a more international level. And we wouldn’t be able to take it global without them. Our view? Why not expand to help save HBC’s needing that thoracocentesis around even the most remote corners of the world? Because our patients deserve better. By partnering with BluePearl and Mars Veterinary Health, it’ll allow us to provide unprecedented opportunities, support, and access to high quality education to all veterinary professionals, national and international. We’ll be able to raise the level of education and expand our community globally. We firmly believe that joining the Mars Veterinary Health family brings only positive changes for the veterinary community. It will certainly make the company stronger and the increased resources will ensure that we are more capable of providing quality, clinically relevant, practical, unbiased, and convenient education as well as an improved user experience - not just better technology, but more content offered in different languages, with closed captioning and transcriptions to make it even easier to learn. We have always been passionate about giving back to our veterinary community - with free, sponsored CE, with decade-long support for several Diversity, Equity & Inclusion scholarships at veterinary schools, with stress-relieving social media humor, with our boutique veterinary conference for our most loyal, with our first ever-hire being prioritized as our Chief Happiness Officer and licensed social worker. Because we truly love our veterinary community.

Thank you for all that you do. Thank you for loving to learn and for always striving to save that patient’s life. We’re not going anywhere. Thank you for trusting us to continue to learn with us.

Deepest regards, Justine & Garret

GARRET PACHTINGER VMD, DACVECC COO, VETgirl

JUSTINE A. LEE DVM, DACVECC, DABT CEO, VETgirl

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QUARTERLY BEAT / JULY 2021 ///

SPONSORED ARTICLE

CAMILLE TORRES-HENDERSON , DVM, DABVP (Canine and Feline) Dilution May Be the Optimal Solution for Cats With Lower Urinary Tract Disease

Managing cats with lower urinary tract disease (LUTD) can be one of the more vexing problems you encounter as a veterinarian. But here’s the good news: We’re learning more about some of the potential causes of LUTD and, in some cases, are able to employ less-invasive ways to manage cats with this issue.

WHAT CATS ARE MOST AT RISK? Factors as diverse as neuter status, stress and weight can figure prominently into whether or not a cat develops LUTD. A study examined the risk factors for LUTD in cats and found that the proportional morbidity rates of cats developing LUTD, irrespective of cause, was 8 in 100 cats. 1 Here’s what this and other studies have revealed: • It’s a weighty matter. Cats with feline idiopathic cystitis (FIC)—inflammation of the urinary bladder with no identifiable cause—were significantly more likely to be overweight compared to both healthy cats in the same household and a control population of clinically healthy cats. 2 • Neutering is associated with the development of LUTD. Castrated males are at increased risk for each cause of LUTD except urinary tract infection (UTI) and incontinence, while spayed females had increased risk for urocystolithiasis, UTI and neoplasia. 1 • Lack of exercise and low moisture intake are also culprits. Inactivity and foods with low moisture content may also increase the risk of urolith development. 3 Urolith formation may be the end result of several combined disorders, not all of which can be corrected even if they are identified. 4 Here’s an example: A cat has an elevated level of calcium in his or her urine. Add a stress factor such as environmental stress or lack of enrichment, then add obesity. Taken alone, these individual factors might not be directly linked to urolith formation. Combined, they could result in a stone forming. However, it’s often difficult to make connections between those contributing factors.

TYPES OF LUTD AND MANAGEMENT Two of the most common forms of LUTD are urolithiasis and FIC. While both can be managed, they have different causes and can require different courses of action. Urolithiasis The overarching goal in managing cats with urolithiasis is to use the least-invasive strategy possible. Therapeutic dissolution diets are formulated to dissolve struvite uroliths. Veterinarians are often concerned about taking time to dissolve stones through diet because of the risk of obstruction. I used to feel that way myself. However, the 2016 ACVIM consensus statement on the treatment and prevention of uroliths in both dogs and cats supports adopting a more conservative approach to determine if stones can be dissolved through diet as opposed to surgical removal. 5 Postponing surgery for several weeks to first try a diet formulated to dissolve struvite uroliths (in conjunction with pain management and antibiotic therapy, if appropriate) can potentially lead to a more positive outcome. We may be able to avoid unnecessarily anesthetizing the patient or traumatizing the bladder through surgery. Calcium oxalate stones cannot be dissolved, regardless of diet. Regardless of stone type, one of the most beneficial approaches practitioners can take in managing cats with a history of urolithiasis is to increase urine volume. Increasing the volume of urine in the bladder decreases the concentration of calculogenic (stone-forming) minerals and increases voiding frequency. Increasing urine volume is usually accomplished by boosting moisture intake.

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cats with FIC, feeding a canned diet and/or increasing liquid intake is the optimal way to achieve a lower urine specific gravity. If a patient accepts it, a hydration supplement can be a good way to help decrease a patient’s urine specific gravity. For example, there are nutrient-enriched water supplements available that promote healthy feline hydration and aid in the absorption of water at a cellular level. Given how common urinary conditions are in cats, it may be a good idea to encourage owners to offer their cats foods with a variety of textures when they’re young, as opposed to when they are older and may be conditioned to only eat dry foods. That’s not to say that rotating diets throughout a cat’s lifetime is necessary, only that exposing them to different textures at a young age is a good way to get them comfortable and hopefully promote acceptance. CHOOSING A THERAPEUTIC DISSOLUTION DIET The first step in choosing a therapeutic dissolution diet is to ascertain what type of stone has formed in the patient. Struvite stones can often be dissolved with diet, thereby avoiding the costs and risks associated with surgery and anesthesia. Sterile struvite uroliths in cats may dissolve as early as one to two weeks after transitioning to a therapeutic dissolution diet.

FIC In studies that have evaluated risk factors for cats with FIC, most report that feline patients that are male, approximately 2 to 7 years of age and/or overweight are at increased risk. 6 A variety of husbandry/environmental risk factors, such as indoor housing and increased stress, were also consistently found. 6 Because so many pets in the U.S. are spayed or neutered, and the number of overweight or obese pets increases every year, LUTD in cats may be on the rise. However, we’re also more aware of how to diagnose these conditions and manage these patients. So whether prevalence is increasing or we are now more proactive in diagnosing LUTD is an open question. UPPING DIETARY MOISTURE LEVELS Cats have a lower physiological thirst drive than dogs, so identifying other strategies to boost fluid intake is key. Increasing dietary moisture can increase urine volume and promote a more-dilute urine, which decreases the opportunity for crystals to form. The 2016 ACVIM consensus statement suggests that urine dilution is probably one of the best ways to help reduce the risk of urolith formation. 5 We can help owners boost cats’ moisture intake in a variety of ways, such as by recommending use of water fountains, adding water to dry food and feeding a canned diet, introduced gradually to help avoid gastrointestinal upset. For

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If there are no contraindications to trying a urinary diet, I recommend placing the cat on a two- to four-week trial with a diet that’s indicated for dissolution in addition to reducing the risk of struvite urolith formation. Veterinarians can initiate pain management for discomfort, treat with antibiotics if indicated based on urinalysis and culture, start the patient on a urinary diet, monitor progress, and then determine next steps based on radiographs and abdominal ultrasound. If the stones do not appear to be dissolving, surgical or minimally invasive removal options should be explored. Some therapeutic diets have undergone relative supersaturation (RSS) testing to ensure they promote a urinary environment that is unfavorable to the development of struvite and calcium oxalate crystals. However, many of these diets are not indicated for dissolution of struvite uroliths. There are diets available that 1) help dissolve struvite uroliths, 2) promote a urinary environment that is unfavorable to the development of both struvite uroliths and calcium oxalate uroliths, and 3) can be fed for maintenance of adult cats. Urine dilution may be an effective solution for many cats with LUTD. However, each patient’s clinical, behavioral and dietary history should be carefully evaluated to determine the best management plan. References 1. Lekcharoensuk C, Osborne CA, Lulich JP. Epidemiologic study of risk factors for lower urinary tract diseases in cats. J Am Vet Med Assoc . 2001;218:9:1429–1435. https://doi.org/10.2460/javma.2001.218.1429.

2. Cameron ME, Casey, RA, Bradshaw, JWS, et al. A study of environmental and behavioural factors that may be associated with feline idiopathic cystitis. J Small Anim Pract . 2004 Mar;45(3):144–7. https://doi.org/10.1111/j.1748-5827.2004.tb00216.x. 3. Jones BR, Sanson RL, Morris RS. Elucidating the risk factors of feline lower urinary tract disease. NZ Vet J . 1997;45:100–108. https://doi.org/10.1080/00480169.1997.36003 4. Bartges J, Callens A. Urolithiasis. Vet Clin North Am Small Anim Pract. 2015 Jul;45(4):747-68. doi: 10.1016/j.cvsm.2015.03.001. 5. Lulich JP, Berent AC, Adams LG, et al. ACVIM Small Animal Consensus Recommendations on the Treatment and Prevention of Uroliths in Dogs and Cats. J Vet Intern Med 2016;30:1564–1574. https://doi.org/10.1111/jvim.14559. 6. Forrester SD, Towell TL. Feline Idiopathic Cystitis. Vet Clin Small Anim 2015;45:783–806. http://dx.doi.org/10.1016/j.cvsm.2015.02.007 Camille Torres-Henderson, DVM, DABVP (Canine and Feline) is an assistant professor of small animal nutrition at Colorado State University Veterinary Teaching Hospital.

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®

®

WHAT IF… WE COULD DISSOLVE STRUVITE STONES AS EARLY AS TWOWEEKS?

When it comes to urinary stones, every day matters. In a Purina study, Purina ® Pro Plan ® Veterinary Diets UR Urinary ® St/Ox ® dry appeared to dissolve presumed struvite cystoliths within two weeks. *

Wet variety pack also available

Helps dissolve struvite uroliths

Promotes a urinary environment unfavorable to the development of both struvite uroliths (undersaturated, RSS