We talked to 3 veterinarians about what it feels like to be working in the veterinary industry right now, what might be driving the perceived shortage, and whether this era of veterinary medicine is sustainable.

It’s a difficult thing to get your arms around. I'm not sure shortage is even really the right word. There's not necessarily a lack of people with the proper training. It's just that they're not willing to do the job right now for a variety of reasons. A lot of people are retiring. A lot of people are working part time. If you choose to have a child, you are out of the workforce to some extent for a period. Because most veterinarians are women, that is a real issue for our workforce. It’s not a bad thing, but it is something that we contend with.

In my opinion, a lot of practices think they need more doctors, when they actually need more support staff. They need a different type of scheduling. Some of the issues are more about efficiency and empowering your support staff. Our support staff have an incredible amount of talent and training and communication skills, but often they're limited to restraining and drawing blood. And that's not engaging as a career. I think if we did a better job leveraging that talent, we might be better off.

I guess I'm not convinced the entirety of the problem is a veterinarian shortage per se. A lot of issues that have been present in the industry for a long time came to the fore with COVID. It became more obvious where we had some shortcomings. I think that sped up the burnout for a lot of different people in the field. When I left full-time practice, I was the fourth of six doctors to leave. A couple of weeks ago, the fifth doctor also put in notice.

We interviewed for veterinarians and the corporate practice offered very high starting salaries. But the number of patients we were asked to see in a day… I was working 16 hours a day for a 10-hour shift. No one's going to do that. There's a point at which, no matter how much you pay somebody, the workload is too much. The managing doctor told me, “At this point, I'll take a warm body.” And I said, “I think that's the problem. If you don't want turnover, if you want us to stay, you need to have a mission-driven practice. Those things are not about money.”

I have been in practice for almost 15 years, and I've been in the field for almost 30 years. I recently transitioned into a different role as a clinical mentor veterinarian. My job is to provide new graduates with balanced curriculum as they move from the classroom into practice. I do hands-on surgical training, case discussions, and then some financial education. It’s been so wonderful to work with new graduates who are still so joyful about the profession and medicine itself, which is important to me. 

My new role is very exciting, but I still have some sort of ethical guilt about the shortage. So I also continue to pull both GP and emergency relief shifts. I have the luxury of doing so though, because I have a husband who doesn't mind, and he also works a lot, and I don't have kids. I do think that makes a difference when you're making those decisions.

I feel like years ago, there would be busy days and there would be less busy days. It seems like ever since COVID, it's constantly been busy and it just hasn't stopped. I think the reasons for that are complex and I don't know that we've quite figured them out yet. Some vets retired and that played a big role, but there's just so much more demand for our services now than I feel like there was when I graduated in 2009.

I read one article more recently that portrayed female veterinarians as trying to prioritize family life over working long hours. I guess they were trying to say that people want a work-life balance, but it kind of sounded like, “newer vets don’t want to work.” And I don't think that's the case at all. 

In our society the fact is that women still carry more of the burden of childcare. It all falls on our shoulders. I've got two kids and my husband and I both work. I can't be on call all the time. So when some of the media makes it seem like we’re not wanting to work, that's just not the case.

I personally know several veterinarians who have left clinical practice to do other things in the industry. I think a lot of that was just burnout. I was very close to that before I took the relief job. I considered doing something totally different. I was like, could I teach? Could I do something else? I felt like I couldn't do it anymore. The stress was so much.

As a relief veterinarian, I see how different practices set client expectations. The clinics that try to continually take on everything end up getting more burnout, getting more staff turnover, which doesn't end up helping the animals. You can't say yes to everything. There's only so many hours in a day. There's only so much you can do with the staff that you have.

Practices that prioritize the mental health of the people who work there and give them the ability to say no tend to do better. Practices that realize that someone can only do so much, that they might not have enough staff to be able to see some cases, are able to set realistic expectations for clients. 

My hope is that it's temporary, but unfortunately, it's a pipeline. It is a highly trained field. It takes four years to pump out the next line of veterinarians, so it's not an instant fix. My hope is that it's temporary. But we're probably talking years as opposed to a couple of months.

It's funny, because for a long time, people have talked about a veterinary shortage, even pre-pandemic. What I would hear in informal discussions of this coverage of the veterinary shortage is these people are crazy. There's not a veterinary shortage. There's plenty of veterinarians with a shortage of veterinarians who want to work for low pay.

So we ended up with plenty of veterinarians who are fully qualified and maybe even want to be in clinical practice in certain specialties, like large animal, food animal, or even in general small animal, but they don't want to work for what they perceive to be unacceptably low pay. And so they go into other jobs. I mean, they are still veterinarians, right?

I love being a veterinarian and I wouldn’t want to do something else. If my personal financial situation were different, I might feel differently. I'm super, super lucky that I don't have crippling student debt. I don't have to support my family. I obviously prefer to be fairly compensated for what I do. But I have wiggle room. And not everyone does.

It's frustrating right now. I feel like I can't accommodate my patients’ needs. I think everyone is frustrated that we can't provide every patient with the level of care we would like to provide, or any care in some circumstances. It makes us feel like we're not meeting our end of the deal. If every time I called my doctor, he said, “I'm sorry, I'm too busy. I can't see you until next month,” I'd be pissed.

Sometimes people joke about saying to the client, “Okay, sure, I will see you today at 2:30, but you need to pick from this list of 5 other people that I'm supposed to be see at that time and tell them I gave their slot to you."

We’re too busy and I feel we're sort of throwing up our hands in despair. I feel like everyone is facing burnout every day in this profession. We do what we can to support each other. But what can really be done with this problem of not being able to do what you're trained to do? These problems are outside my control and I just keep reminding myself, I'm only one person, and I can only do what I can do. And I only have so many hours in the day.

And I still show up for work because I love my job. I really do. I love being a veterinarian. It's what I've always wanted to do. It's exactly what I always dreamed of. I think my first job was in the sixth grade, working for a vet. It's depressing when you're doing everything you can to help an animal and the animal's owner doesn't recognize that you are working within certain limitations that are out of your control. But even if some owners are assholes, I love taking care of animals. It's not the animal's fault.

A recent wellness exam (with a client who has been coming to our practice for years!) got awkward when she asked for a diet recommendation for her healthy, 2-year-old mixed-breed dog. I suggested a chicken-based adult maintenance kibble made by a well-known pet food company.

At first, she was quiet. But then she said that she had been doing research online, and that she no longer wants to feed commercial food made by any of the big pet food manufacturers because it’s all “garbage” and that veterinarians must only recommend those foods because we’ve been “brainwashed.” Instead, she is going to feed a homemade raw diet because it’s “natural,” and she thinks it will protect her pets from diseases that they would likely develop if they stayed on a commercial diet like the one I had recommended. Not wanting to upset her or potentially lose a good client, who has referred several other clients to our practice, I responded with something neutral and continued my exam.

Later, we talked about other topics including vaccines and heartworm prevention (which she keeps up to date) and she seemed to be OK with the visit, but I can’t stop thinking about it. 

How could I have handled this better? I don’t want to lose a client, but I do want to be able to confidently convey my medical opinion over Dr. Google.

—Can't Compete with Dr. Google

Dear Can't Compete,

I have definitely been in that position! Sometimes a client says things I don’t agree with and I’m left wondering how to share my knowledge without creating barriers. You are definitely on the right track of being respectful, not wanting to lose a good client, and engaging in objective analysis of the situation.

A couple of ideas on what NOT to do in these situations:

A few ideas on what TO do in these situations:

Lastly, let it go. You showed up and did your best to be respectful and informative. Good job! That is all that matters. Now on to the next case.

Warmly, 

Sarah Wooten

Multiple techniques for enucleation are available. It is important to consider the underlying disease process when choosing an approach. 

The most common technique is the subconjunctival approach, in which the globe is reached via dissection through the conjunctiva. The eyelid margins, conjunctiva, and third eyelid are then resected. This approach should not be used if there is obvious infection of the conjunctiva, neoplasia of the extraocular surface, or corneal perforation.

With the transpalpebral approach, initial dissection is made through the eyelids, allowing removal of the globe and associated supportive and secretory tissues as one unit. This approach minimizes the risk for leaving residual conjunctival tissue (which can cause draining fistulas from the orbit) and is recommended for neoplasia or infection (as there is less risk for spread of ocular surface contaminants throughout the orbit). The transpalpebral approach is discussed in this article.

Place the patient in lateral recumbency with the surgical eye facing upward. Shave the eyelids (A), and prepare the periocular and ocular surface tissues with dilute povidone iodine (add povidone iodine [4 mL] to sodium chloride [1,000 mL]; B). Contact time for irrigation of the globe and associated structures is ≈2 to 3 minutes. Position and support the head with a vacuum pillow (C). Perioperative cefazolin can be administered intravenously at this time.

Reirrigate the eyelids with dilute povidone iodine, and drape the surgical site.

Suture the eyelids closed with an absorbable or nonabsorbable suture in a continuous suture pattern.

Using a #10 scalpel blade, make 2 elliptical skin incisions into the eyelids ≈2 mm from the lid margin, completely encircling and including the medial and lateral canthus.

Use Allis tissue forceps to grasp the eyelid margins (only grasp tissue intended to be excised), creating mild traction to aid with initial dissection (A). Transect the canthal ligaments, and dissect the superficial eyelid fascia with light sweeps of the scalpel blade until just posterior to the limbus (B, C).

Perform deep dissection through the periorbital tissue with Stevens tenotomy scissors (A). Dissect toward the globe until the sclera is visualized, then extend the pocket around the globe with a combination of blunt dissection and cutting (B). Transect the extraocular muscles close to their scleral insertion, allowing the globe to be mobilized. Use caution in the dorsomedial location near the orbital rim to avoid transecting the medial angularis oculi vein. If this is transected, ligate the vessel.

Place slight traction, reach behind the globe with the scissors held open, and cut the optic nerve.

Remove the globe, pack the orbit with gauze sponges, and apply firm digital pressure for 2 to 3 minutes to control hemorrhage. Once hemorrhage is controlled, remove the gauze and irrigate the orbit with sterile saline.

Soak a sterile absorbable gelatin sponge with bupivacaine (optional) and place in the orbit.

Close the deep fascial layers and subcutaneous tissues with 4‐0 absorbable suture material in a simple continuous pattern.

Close the skin with simple continuous or interrupted sutures using 6-0 nonabsorbable monofilament suture.

Gabapentin is FDA-approved in humans for use as an anticonvulsant, treatment of pain associated with postherpetic neuralgia and fibromyalgia, and treatment of neuropathic pain associated with diabetes and spinal cord injuries.³ Gabapentin is the seventh most frequently prescribed drug in the United States; use has increased significantly in human medicine and is often (>80%) extra-label.^4,5

A survey of clinicians found that gabapentin use in veterinary medicine is similar to use in human medicine; 69% of respondents indicated they prescribe gabapentin on a daily or weekly basis, most commonly for acute and chronic pain (extra-label).¹ 

Following are the author’s top 5 recommended uses for gabapentin based on mechanism of action and physiology of pain.

At-home administration of oral sedatives/anxiolytics before visiting the clinic can reduce patient anxiety and fearful behaviors by allowing drugs to take effect before the patient encounters stressors. Gabapentin is used extra-label as an antianxiety medication in humans^6-8; administration in cats (50-100 mg/cat PO) can decrease stress scores.^9,10 

The Chill Protocol (ie, combination drug protocol that includes gabapentin, melatonin, and oral transmucosal acepromazine) is an option for preclinic sedation developed at the Cummings School of Veterinary Medicine at Tufts University to manage fearful and aggressive dogs and cats.¹¹ Dose-dependent sedation is a common adverse effect of gabapentin administration in veterinary patients^12,13; high doses of gabapentin (ie, 20-25 mg/kg PO the evening before the appointment and 20-25 mg/kg PO at least 1-2 hours before the appointment) are incorporated in the Chill Protocol to induce preclinic sedation.¹¹

Neuropathic pain (eg, intervertebral disk herniation, plexus avulsions, nerve root impingement) is caused or initiated by a primary lesion in the CNS or peripheral nervous system, including damage or injury to nerves that transfer information from the skin, muscles, and/or other parts of the body to the brain and spinal cord.^14,15 Imbalances between excitatory and inhibitory pain signaling, as well as modulation of pain messages in the CNS, contribute to development of neuropathic pain.¹⁵ 

Gabapentin inhibits presynaptic calcium channels, thus decreasing release of excitatory neurotransmitters (eg, substance P, glutamate, glycine) that amplify pain signals by binding to postsynaptic neurokinin-1 (ie, NK-1), N-methyl-D-aspartate (ie, NMDA), and alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (ie, AMPA) receptors.

Neuropathic pain is a complex pain state, and several drug classes are often required to reduce inciting nociceptive afferent impulses.¹⁴ Gabapentin can be included in a multimodal treatment plan in conjunction with other analgesic drugs (eg, NSAIDs, opioids, N-methyl-D-aspartate–receptor antagonists).¹⁴

Pain transmission involves conversion of a noxious stimulus to an electrical signal transmitted by peripheral sensory fibers to the dorsal horn of the spinal cord.¹⁴ Pain signals are either amplified or suppressed by endogenous neurotransmitters or analgesic drugs in the dorsal horn and progress to the brain, where the signal is consciously perceived. Untreated amplification of pain signals in the dorsal horn can lead to maladaptive or chronic pain states.¹⁴ 

Gabapentin can be added to an analgesic regimen to manage heightened pain states if first-line analgesics are insufficient. Inhibition of presynaptic calcium channels can help reduce excitatory pain signaling, thus improving analgesia. Gabapentin may also act synergistically in combination with other analgesics, reducing required doses and minimizing adverse effects (eg, dysphoria, sedation). Heightened pain states that may require adjunct analgesics (eg, gabapentin) include polytrauma, pathologic fractures, thrombosis, and extensive inflammation (eg, peritonitis, fasciitis).¹⁴

Osteoarthritis is a chronic inflammatory condition involving joint pain that results in decreased mobility and muscle weakness¹⁴; however, there may also be a neuropathic component.¹⁶ Inflammation of the affected joint activates peripheral nociceptors innervating the synovial capsule, periarticular ligaments, periosteum, and subchondral bone. Repetitive activation results in peripheral sensitization and abnormally excitable pain pathways in the peripheral nervous system and CNS.¹⁶ 

Osteoarthritis treatment can be complex, and recommendations include baseline analgesics (eg, NSAIDs) and nonpharmacologic treatments (eg, exercise, weight management).¹⁴ Gabapentin is an adjunct analgesic that can be incorporated if first-line treatments are insufficient.

Cancer pain can range in severity, depending on the location and type of cancer. Patients may experience inflammatory pain due to tumor necrosis or pain caused by direct pressure of the tumor on nerves or muscles. Metastatic involvement of bone is also a frequent cause of cancer pain and can be associated with clinical signs related to neuropathic pain.¹⁴

A multimodal approach using several classes of drugs is most effective. Therapies that decrease tumor activity, reduce inflammation, or target neuropathic pain can help treat cancer pain. First-line agents often include NSAIDs with the addition of opioids and adjunctive drugs (eg, gabapentin) as indicated.¹⁴

Gabapentin has a narrow indication for use in veterinary patients, but administration is common. Caution should be used when prescribing gabapentin, particularly for use as a sole analgesic for conditions with little evidence for efficacy (eg, acute postoperative pain).¹

Gabapentin can be abused in humans, and prescriptions for veterinary patients can be diverted for human recreational use (see Drug of Abuse). Gabapentin should thus not be prescribed when it is unlikely to be effective (see Inappropriate Uses for Gabapentin), the quantity should be limited, and restrictions should be placed on refill authorizations.

Impression smear and tape-strip preparations are traditional and validated skin cytology methods for diagnosis and monitoring of suspected bacterial or Malassezia spp overgrowth. 

This study compared slurry preparation, a novel cytologic sampling method, with traditional methods to detect bacteria and Malassezia spp in 30 dogs presented with atopic dermatitis that had lesions consistent with superficial bacterial pyoderma and/or Malassezia spp dermatitis. Samples were collected using impression smear, tape-strip, and slurry preparation methods and stained with modified Wright-Giemsa stains. 

For slurry preparation, a microspatula with a flat-ended blade was used to scrape the surface of a lesion; debris (including scale and crust) was collected on a glass slide. One drop of sterile water was placed on the slide and gently mixed via rocking. The slide was then briefly heated on a hot plate, after which the slurry was mixed and larger debris macerated with a wooden applicator stick, yielding an opaque liquid. Larger, unmacerated debris was removed from the sample, and the preparation was again briefly heated to dry remaining water. This preparation method took 2 to 3 minutes.

Slurry preparation identified significantly higher numbers of bacteria compared with other techniques; however, tape-strip cytology detected more yeast than slurry preparation. 

Slurry preparation is a reasonable alternative to impression smears and tape-strip preparation for crusted and scaly lesions to improve chances of identifying bacterial infection. The authors recommend sampling pustules with impression smears instead of the slurry method, as pustules need to be ruptured prior to sampling.

Key pearls to put into practice:

Skin cytology is recommended at both initial and follow-up examinations in patients presented for itching, scaling, crusts, or skin debris.^1,2 A combination of sampling methods can be used, depending on lesion appearance. For example, tape-strip cytology may be used on inflamed and scaly feet, impression smears may be used for a pustule on the ventral abdomen, and slurry preparation may be used for crusting on the dorsum during a single examination of a dog.

It may be easier for less experienced examiners to review impression smears and slurry preparations for bacteria, Malassezia spp, and inflammatory cells; tape-strip cytology preparations can appear more crowded to the untrained eye.³

Skin cytology allows for judicious oral antimicrobial use, as patients may have scaling or crust caused by Malassezia spp infection alone.³ Routine use of skin cytology at follow-up examinations can also help guide timing of bacterial culture and enable correlation between culture results and morphologic characteristics of bacteria on cytology.¹

Feline recurrent urethral obstruction (rUO) affects 11% to 58% of cats.¹ Prazosin, an alpha-1–adrenoceptor antagonist, is commonly used to prevent rUO despite lack of supporting veterinary clinical studies.^2,3 Prazosin has been recommended to reduce risk for recurrence because of its potential action as a urethral smooth muscle relaxant²; however, administration following urethral obstruction may cause increased patient stress from pill administration and adverse effects (eg, hypotension, lethargy, GI upset, ptyalism).

The objective of this study was to determine whether prazosin administration decreased the rate of feline rUO both prior to and within 14 days of discharge. Observational surveys were completed by clinicians who self-reported that they always or never prescribe prazosin. Development of rUO was compared in 302 (78%) cats administered and 86 (22%) cats not administered prazosin. There was no significant association between prazosin administration and risk for rUO prior to discharge; however, within 14 days following discharge, the cumulative rate of reobstruction was significantly higher in cats treated with prazosin (73 [24%]) compared with cats not treated with prazosin (11 [13%]). 

Data from this study combined with data from selected prior prospective studies showed that cats given prazosin (24%) were more likely to develop rUO than cats not given prazosin (13%).^2,3 The only significant associations identified with risk for rUO were subjective difficulty performing catheterization and perception of a gritty urethra during catheterization.

The cause of prazosin’s lack of efficacy is likely multifactorial. The distal 63% to 72% of the feline urethra is composed of striated muscle, which is not relaxed by alpha-1–adrenoceptor blockade.⁴ Most urethral obstructions occur in the distal urethra where prazosin has no pharmacologic effect. Evidence that urethral spasms contribute to rUO in cats is lacking; treatment with urethral muscle relaxants may thus be ineffective. 

The results of this study suggest that routine use of prazosin for prevention of rUO should be discouraged.

Key pearls to put into practice:

Prazosin is ineffective at decreasing risk for rUO and may increase risk for recurrence.

Prazosin may increase patient stress, increase treatment costs, and cause adverse effects.

Study results suggest prazosin should not routinely be administered to prevent rUO in cats.

Hemangiosarcoma is a malignancy that originates from vascular endothelial cells. The spleen is the most commonly affected primary organ in dogs, but additional sites have also been reported.¹ Other splenic sarcomas (eg, fibrosarcoma, leiomyosarcoma, extraskeletal osteosarcoma, undifferentiated sarcomas) are nonangiomatous, nonlymphoid tumors of connective tissue. 

Several prognostic factors (eg, hemoabdomen, multiple splenic lesions, imaging findings, anemia, thrombocytopenia) have been evaluated in dogs with splenic hemangiosarcoma, with clinical stage of disease consistently correlated with overall survival time. Dogs with advanced clinical stage have poor outcomes compared with dogs with stage I disease.^2,3

This retrospective study evaluated the clinical significance of sternal lymphadenopathy in 195 dogs undergoing splenectomy (most due to hemoabdomen), as well as prognostic significance in malignant splenic disease. Of these dogs, 102 (52.3%) were diagnosed with benign lesions, 74 (37.9%) were diagnosed with hemangiosarcoma, and 19 (10%) were diagnosed with malignancies other than hemangiosarcoma. 

Incidence of sternal lymphadenopathy was 12.8% overall, 16.2% in the hemangiosarcoma group, 15.8% in the nonhemangiosarcoma malignancy group, and 9.8% in the benign process group. 

Although sternal lymphadenopathy was not a predictor for malignancy in dogs with hemoperitoneum, dogs diagnosed with both hemangiosarcoma and sternal lymphadenopathy had shorter survival compared with dogs with hemangiosarcoma without sternal lymphadenopathy. Sternal lymphadenopathy may therefore have predictive value for survival of dogs with splenic malignancy.

Key pearls to put into practice:

Sternal lymphadenopathy is not a predictor of malignancy in dogs with splenic masses, with or without hemoperitoneum.

Etiology of sternal lymphadenopathy is unknown. Microscopic evaluation is needed to rule out reactive versus metastatic disease processes.

Dogs diagnosed with both splenic hemangiosarcoma and sternal lymphadenopathy on thoracic radiographs had shorter survival compared with dogs without radiographic evidence of sternal lymphadenopathy.

Propofol (premedicated dogs, 1-4 mg/kg; nonpremedicated dogs, 6.5 mg/kg; IV over 10-40 seconds and titrated to effect) is commonly administered for smooth, rapid induction of general anesthesia.¹ Benefits include rapid onset, short duration of action, quick redistribution, and short elimination half-life.² Adverse effects are dose dependent, with postinduction apnea and hypotension being most common.^3,4 Slow administration rate may decrease incidence of apnea.

This randomized, blinded clinical trial sought to determine the optimal propofol infusion rate for rapid tracheal intubation and reduction of postinduction apnea in healthy dogs. Dogs were randomly assigned into 5 groups. All dogs were premedicated with methadone (0.5 mg/kg IM) and dexmedetomidine (5 μg/kg IM). Thirty minutes after premedication, dogs were preoxygenated via facemask for 5 minutes. Each group was administered a different propofol infusion rate (0.5, 1, 2, 3, or 4 mg/kg/minute IV) for induction via syringe pump; infusions were discontinued once a dog was ready for intubation. After intubation, dogs were monitored until spontaneous breathing occurred. Time to intubation and duration of apnea were recorded. Cardiopulmonary variables (eg, heart and respiratory rates, oxygen saturation, blood pressure) were measured.

Propofol infusion rate had significant effects on both time to intubation and duration of apnea. Of the 60 dogs that completed the study, those that received propofol at 0.5 mg/kg/minute or 1 mg/kg/minute had a significantly shorter duration of apnea. None of the 60 dogs desaturated during the study. Between these 2 groups, intubation time was shorter in dogs that received propofol at 1 mg/kg/minute. Effect on blood pressure was not significantly different among groups.

Based on results of this study, the optimal rate of propofol infusion for induction of general anesthesia is 1 mg/kg/minute. Slow titration is recommended so propofol concentrations can equilibrate between the blood and the brain to achieve loss of consciousness with minimal adverse effects. Faster infusion rates lead to higher plasma concentration that exceeds the minimum dose to achieve unconsciousness, increasing the likelihood of apnea and hypotension.

This study only evaluated healthy dogs premedicated with methadone and dexmedetomidine. The cardiovascular effect of dexmedetomidine-induced vasoconstriction may have helped minimize the hypotensive effect of propofol. The effect of a priming bolus to help reduce total propofol induction dose was not evaluated.

Key pearls to put into practice:

Propofol should be administered slowly IV and titrated to effect during induction; premedicated dogs require a lower dose.

Slow administration allows for a time delay between drug administration and loss of consciousness, as propofol concentrations need to equilibrate between the blood and brain.

Rapid administration can cause postinduction apnea, which can result in desaturation if patients are not preoxygenated prior to induction.

Feline onychectomy (ie, declawing) is controversial and presents an ethical dilemma. Pet owners may request declawing to prevent or manage destructive scratching behaviors, but patient welfare with elective amputation of digits should be considered. Refusal to perform the procedure and instead attempting to manage unwanted behaviors can result in frustrated owners choosing to euthanize or relinquish destructive cats. As more municipalities prohibit onychectomy, it is critical to understand and acknowledge the implications. 

This study compared rates of and reasons for relinquishment and owner-requested euthanasia at multiple shelters in a single province in Canada 3 years before and 3 years after a legislative ban on onychectomy. The study aimed to determine whether the rate of relinquishment and euthanasia increased, as well as whether relinquishment increased due to destructive behavior.

Results demonstrated no significant difference in relinquishment or owner-requested euthanasia. Destructive behavior was an uncommon primary reason for surrender, comprising only 0.18% of surrendered cats over the study period; there was no significant increase after the ban. This may suggest most owners are able to manage or accept scratching behaviors, and withholding the option to declaw is unlikely to increase relinquishment or euthanasia; however, the study did not include cats that may have been declawed illegally, rehomed privately or through alternative welfare organizations, or released outside by owners because of unwanted scratching behaviors. 

Future research should investigate whether owners who surrendered or euthanized cats due to destructive scratching would have pursued onychectomy if available, as owners of these cats may not have been committed to declawing, lessening justification of the procedure.

Key pearls to put into practice:

Scratching is natural behavior in cats. New cat owners should be educated to expect this behavior and understand early management interventions. 

There are short- and long-term welfare concerns with onychectomy, regardless of method or pain medication administered. Recently graduated clinicians are unlikely to be confident and able to perform this procedure as it continues to be removed from veterinary curricula. Hospitals will likely rely on experienced clinicians to perform the procedure or teach new practitioners willing to learn.

Relinquishment is usually related to owner concerns (eg, housing, financial challenges). Access to veterinary care and pet friendly housing are critical for preventing unnecessary relinquishment and euthanasia.

This study evaluated the effect of 2 types of music (ie, cat-specific, classical) compared with no music (control) on stress in hospitalized cats. Cat-specific songs used frequencies similar to cat vocal ranges and were composed to create an affiliative effect using pulses related to purring (1380 bpm) and suckling (250 bpm).¹ 

Client-owned cats (n = 35) were randomly divided into 3 groups. Cat stress score, respiratory rate, and social interaction were measured at 5 specified times over 31 hours of hospitalization. Saliva for salivary cortisol measurement was collected during the first and fourth assessments. 

Cat stress scores did not differ among the groups at any time point. A higher percentage of social interactions was noted in the cat-specific music group compared with the other groups at the first evaluation, and average respiratory rate was lower in the classical music group than in the control group on the fourth evaluation. Statistical analysis of salivary cortisol was not possible due to the small number of viable samples obtained. The authors concluded that both cat-specific and classical music appear to offer some benefit to hospitalized cats.

Ocular trauma is common in dogs, and all ocular structures are vulnerable to injury after trauma to the eye. Some injuries (eg, iris rupture) may cause few effects, but more extensive lesions (eg, glaucoma, retinal detachment) can result in a nonfunctional eye. Uveitis is common with ocular trauma and should be aggressively managed to prevent complications.¹ Limited studies have reported eye injuries (eg, retinal detachment, hyphema) secondary to blunt and penetrating forces (eg, gunshots, cat clawing, bomb explosions).^2-4 

This retrospective study described prognostic indicators and visual outcomes of dogs with sports ball projectile ocular injuries. Closed-globe injuries (n = 12) were more common than open-globe injuries (n = 6); were commonly presented with traumatic uveitis, hyphema, and subconjunctival hemorrhage; and were medically managed. Vision was maintained in 67% of cases. Open-globe injuries included corneal lacerations and scleral rupture, and all affected eyes required enucleation except one, which was managed with corneal laceration repair and third eyelid flap placement prior to referral (vision was maintained).

Injuries from small, dense sports balls (eg, golf balls, baseballs) were associated with a guarded prognosis and required more aggressive medical management compared with injuries from lighter balls (eg, tennis balls, toy balls). Traumatic uveitis was the most common initial ocular lesion and had varying visual outcomes. Hyphema was the second most common initial ocular injury and carried a poorer visual prognosis than traumatic uveitis.

Key pearls to put into practice:

Compared with trauma from lighter sports balls, ocular trauma from small, dense sports balls typically results in more extensive injury and more frequent initial presence of hyphema and is often associated with enucleation or a poor visual prognosis.

Open-globe injuries have a poor visual prognosis and often result in enucleation.

Ocular ultrasound and CT scans can help identify vitreal hemorrhage, retinal detachment, retinal hemorrhage, scleral rupture, and orbital wall fractures that may not be clinically evident.

• Neoplastic
  • Lymphoproliferative
    • Lymphoma
    • Chronic lymphocytic leukemia
    • Acute lymphoblastic leukemia
  • Metastatic neoplasia (common causes)
    • Carcinoma (eg, mammary gland carcinoma, thyroid carcinoma, oral squamous cell carcinoma) 
    • Sarcoma (eg, soft tissue sarcoma, histiocytic sarcoma)
    • Mast cell tumor
    • Melanoma (oral or digit)
• Reactive
  • Infectious 
    • Systemic fungal infection
      • Blastomycosis (ie, Blastomyces dermatitidis)
      • Histoplasmosis (ie, Histoplasma capuslatum)
      • Coccidioidomycosis (ie, Coccidioides immitis)
      • Sporotrichosis (ie, Sporothrix schenckii)
      • Aspergillosis (eg, Aspergillus fumigatus, A flavus)
      • Pythiosis (ie, Pythium insidiosum)
    • Bacterial infection
      • Brucellosis (ie, Brucella canis) 
      • Nocardiosis (ie, Nocardia spp)
      • Plague (ie, Yersinia pestis)
    • Vector-borne disease (coinfection is common)
      • Ehrlichiosis (eg, Ehrlichia canis, E chaffeensis, E ewingi, E equi)
      • Anaplasmosis (ie, Anaplasma phagocytophilum) 
      • Neorickettsiosis (ie, Neorickettsia risticii)
      • Salmon poisoning disease (ie, Neorickettsia helminthoeca)
      • Bartonellosis (eg, Bartonella henselae,¹ B clarridgeiae, B vinsonii) 
      • Rocky Mountain spotted fever (ie, Rickettsia rickettsii) 
      • Leishmaniasis (eg, Leishmania infantum, L donovani)
      • Babesiosis (ie, Babesia canis)
      • Hepatozoonosis (ie, Hepatozoon americanum)
  • Severe generalized pyoderma
    • Primary bacterial pyoderma
    • Secondary bacterial pyoderma
      • Atopy
      • Demodectic mange
      • Sarcoptic mange
      • Sebaceous adenitis
• Inflammatory, noninfectious 
  • Cutaneous lupus erythematosus²  
  • Juvenile sterile granulomatous dermatitis and lymphadenitis (ie, juvenile cellulitis, puppy strangles)    
  • Adult-onset sterile granulomatous dermatitis and lymphadenitis (ie, juvenile cellulitis)³
• Other
  • Phenobarbital-induced pseudolymphoma⁴

Escherichia coli is a gram-negative bacterium in the Enterobacterales order and is commonly found in the GI tract and the environment. Strains are mostly nonpathogenic but can be opportunistic. Pathogenicity is largely related to a range of virulence genes, including those that influence the ability of the bacterium to adhere to tissue or produce toxins. E coli can be classified into groups (including enteropathogenic, enterotoxigenic, enterohemorrhagic, adherent invasive, and uropathogenic) based on the presence of various virulence mechanisms. Similar to other gram-negative bacteria, cell walls of E coli contain endotoxin, a pyrogenic toxin that can be associated with severe disease (eg, septic shock). 

Although many genetic lineages and strains of E coli can be found in dogs and cats,^1,2 some strains are shared among dogs, cats, and humans.^1,3 Clinically relevant transmission between species should thus not be ignored.

E coli can cause opportunistic infections in any body system (see Table 1) but is most commonly involved in urinary tract and skin/soft tissue infections.

Diagnosis requires detection of E coli at an infected site, primarily via culture. Definitive diagnosis is likely in cases in which E coli is isolated from a normally sterile site (eg, blood) or E coli is found at sites where it is not normally present and there are supportive clinical and cytologic findings (eg, isolation from the lower airways in a patient with septic changes on bronchoalveolar lavage cytology). Although E coli is the leading cause of bacterial cystitis, this bacterium can also be found in patients without classical clinical signs of lower urinary tract disease (ie, subclinical bacteriuria), making interpretation of culture and susceptibility results challenging.^4-9 Clinical signs and other urinalysis results are important for determining the clinical relevance of E coli isolation. 

Enteric disease is the most challenging to diagnose, as E coli is a common enteric organism found in many healthy dogs. Detecting specific virulence factors may be useful, but the range of potential virulence factors and diseases is not adequately understood, and E coli with disease-associated virulence genes can be found in healthy patients. Diagnosis of histiocytic ulcerative colitis (ie, granulomatous colitis) typically relies on identification of intracellular E coli via fluorescent in situ hybridization.¹⁰

E coli is intrinsically susceptible to a wide range of antimicrobials (Table 2), but acquired resistance and resistance from narrow spectrum beta-lactamase production are common.^11,12 Extended spectrum beta-lactamase (ESBL)–producing strains are increasingly common and confer resistance to cephalosporins; however, these strains often acquire numerous additional resistance genes, making them resistant to most available antimicrobials.^13,14 Fluoroquinolone resistance is also increasingly common. Clinical observation suggests ESBL-producing E coli are typically susceptible to a limited range of drugs, particularly amikacin and meropenem. Fosfomycin (dogs only) and nitrofurantoin can be used to treat bacterial cystitis caused by multidrug-resistant E coli. Further development of resistance is a concern with E coli. In human medicine, E coli is increasingly resistant to most antimicrobials, including carbapenems.

Treatment should ideally be based on culture and susceptibility results; however, empirical treatment may be indicated in lieu of or while waiting for culture and susceptibility results. Systemic antimicrobials can be withheld until culture results are available in some cases (eg, disease is very mild; anti-inflammatory drugs [eg, NSAIDs], topical treatment, or other supportive care might be effective). Culture importance depends on confidence in the diagnosis (ie, E coli is the likely pathogen), likelihood of antimicrobial resistance (potential for treatment failure), and implications of failed initial treatment (eg, prolonged mild disease vs life-threatening progression). Factors associated with increased risk for resistance include prior antimicrobial treatment, hospitalization, and feeding raw diets, including raw animal-based treats.^15-19

There are no specific preventive measures for E coli, but some syndromes (eg, bacterial cystitis) are often associated with predisposing factors, treatment of which may reduce the risk for recurrent infection.

Although E coli is a common cause of infection in humans, zoonotic risks from companion animals are poorly understood. Overlap of strains in humans and companion animals is possible,^20-22 and presence of the same strain in humans and their pets has been reported.^23,24 Whether these overlaps reflect animal to human, human to animal, or common source infection is not well understood. Use of basic hygiene practices (eg, hand washing, avoiding contact with feces and infected sites) is prudent when handling infected patients.

Rosie, a 4-year-old, 11-lb (5-kg) spayed Yorkshire terrier, is presented 12 hours after an episode of hematemesis followed by hemorrhagic diarrhea. She is hyporexic and increasingly lethargic. There is no known history of toxin exposure or dietary changes. Vaccinations, heartworm, and flea and tick preventives are current. 

On presentation, Rosie is dull, tachycardic (180 bpm), and tachypneic (80 breaths per minute) with weak femoral pulses, pale pink mucous membranes, and a prolonged capillary refill time of 3 seconds. She is estimated to be 7% dehydrated. Rectal temperature is 99.1°F (37.2°C), and frank blood is present on the thermometer. 

Physical examination findings suggest hypovolemic shock, and immediate stabilization measures are initiated. An IV catheter is placed, and a bolus of lactated Ringer’s solution (LRS; 400 mL/hour [20 mL/kg IV over 15 minutes]) is administered with a fluid pump. The remainder of the physical examination is unremarkable except for mild abdominal discomfort without distension. Cardiothoracic auscultation is normal. 

Abdominal radiograph and thoracic point-of-care ultrasound results are normal. Blood pressure measured via Doppler is 75 mm Hg. A blood gas and electrolyte panel reveal moderate metabolic acidosis with respiratory compensation and severe hyperlactatemia (Table 1). Packed cell volume (PCV) and total solids (TS) are 65% and 5.5 g/dL, respectively. Electrocardiogram reveals sinus tachycardia.