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IDEXX: Contributing to something bigger

He is called “the dog whisperer,” but as it turns out—somewhat famously—I called him “the dog screamer.” And I was not shy about it.

What Cesar Millan was doing was hardly as subtle as a whisper. His TV shows often highlighted aversive training techniques, and I was not the only one exasperated by Millan’s methods—so were members of the American College of Veterinary Behaviorists (ACBC), who happen to like the humane and science-based notion of positive reinforcement.

However, as Millan’s programs enjoyed success, more dog trainers began marketing themselves as whisperers or hanging a shingle on their doors and websites, calling themselves behaviorists (which, unless they are boarded diplomates of the American College of Veterinary Behaviorists, they decidedly are not).

Enough was enough. In 2014, the ACBC authored a book with the hopes of setting the record straight regarding dog training and enhancing awareness of diplomates. The book is called 

, and I was honored to write the introduction (and gladly promoted the book as if it were my own, though I was a coeditor).

 addresses common misconceptions about feline behavior.

Because of sky-high sales (which are continuing) and favorable reviews, the same publisher had no issue with allowing the ACBC to create a sequel, suitably called 

, coedited by Meghan Herron, DVM, DACVB; Debra Horwitz, DVM, DACVB; and Carlo Siracusa, DVM, PhD, DECAWBM. Again, I was honored to pen the introduction. The book is primarily geared for pet parents in hopes of dispelling the many myths and misconceptions surrounding cats.

“[When] cats wave a flag, there’s something wrong,” says one of the book’s contributors, Amy Pike, DVM, DACVB, IAABC-CABC. “Well, that is the cat’s perspective, [that] they’re waving the flag, but many times pet parents don’t notice the change in behavior because cats can be subtle. If the owners do seek help, where are they going?”

Pet parents seem to suggest, more so with cats than dogs, that their pet is out to get them or is being spiteful. “Dogs have changed dramatically from their original ancestors,” adds Herron. I have a French bulldog myself—talk about neoteny (retention of juvenile features in the adult animal).

“However, domestic cats physically haven’t changed a whole lot,” she says. “So that means the behavioral repertoire is quite similar too. A strong hunting instinct, a desire to scratch and climb all over things and, perhaps, to do anything to feel safe. Perfectly normal behaviors for cats but problematic for some families. When it comes to cats, our [clients’] expectations are too often not what cats truly are.”

While felines tend to be more popular than their canine counterparts and are considered lower maintenance (eg, don’t bark or require walks), sometimes their owners don’t fully comprehend their enrichment needs.

“We don’t write about damaging cat training as we did damaging dog training,” says contributing author Julie Albright, DVM, DACVB, associate professor of veterinary behavior at University of Tennessee College of Veterinary Medicine, Knoxville. “Although cats are way more self-sufficient than dogs, we’re often not fair to cats, not giving them what they need.”

Albright is referring to enrichment. “I actually prescribe enrichment all the time. I have a handout; I circle what’s right for that individual cat,” says Albright. “We talk about what that individual client can do and meet them where they [pet owners] are at. I tell clients to set times and have reminders to ensure that they do it. I talk about how cats can be taught to play fetch. I think there should seriously be an equivalent of canine nose work for cats. I have moose scent and put that on a paper towel.”

Although moose scent is not for all cats, contributor Kelly Ballantyne, DVM, DACVB, says, “Enrichment is no longer considered an important idea; today it’s a necessary idea for all indoor cats.” Enrichment is about meeting cats’ hardwired needs. Albright brings up a new area of study, “Enrichment releases the neurochemical brain-derived neurotrophic factor (BDNF).”

At least that’s the case in rodents, humans, and very limited studies in dogs. BDNF serves as a sort of natural antidepressant.

Another important objective consistent throughout the book is to help clients be more aware that a change in behavior may be a result of a medical issue. “Every day when I was in general practice, people said, ‘Give me the Prozac,’” Herron says. She adds that clients want a magic pill that doesn’t exist, and because the internet says the problem is behavioral, it must be. So, they add litter boxes for the cat with kidney disease; that’s fine, except that the cat still has kidney disease.

A lot of clients get embarrassed to even bring up a behavioral problem, or they don’t think it’s important or don’t think a veterinarian would have any interest in a behavioral problem. “I suggest private practitioners always ask, not if there’s a behavior problem, but if there’s been any change in your cat’s behavior,” says Pike. “Sometimes people may not even think about it until you ask. Or they may think a change, like an older cat no longer jumping on a counter, is to be expected. Of course, that tells us the cat may be in pain, right? And we can do something for that cat.”

“I’m so glad that cats are finally receiving the attention they deserve—and hope 

 clears up the long list of misconceptions and misunderstandings people have about cats,” Albright concludes.

Jha S, Dong BE, Xue Y, Delotterie DF, Vail MG, Sakata K. Antidepressive and BDNF effects of enriched environment treatment across ages in mice lacking BDNF expression through promoter IV. 

Articles

An animal behavioralist sets the record straight on where pet parents get their information and sheds light on the many misconceptions surrounding feline behavior.

Demystifying the many myths about cats

Cannabidiol (CBD) and tetrahydrocannabinol (THC) are fairly hot-button topics in veterinary medicine that are difficult to unpack, with no distinguishable gray area—or so I thought. Historically, I always seem to encounter either the die-hard “holistic” believers or their antipode, the “gold standard Western medicine practitioners.” However, in recent years I have learned there are many “closet supporters” of CBD who find it difficult to openly endorse as a legitimate treatment modality because of either lack of clinical understanding or fear of legal ramifications.

As a CBD user who has experienced quantifiable results, I firmly believe there is a place for CBD in veterinary medicine that does not have to be limited to holistic practices. After all, anyone working in emergency medicine is likely familiar with Yunnan Baiyao, a traditional Chinese medicine used in hemorrhagic cases for its presumed hemostatic qualities. All that being said, this is my attempt at addressing the CBD debate.

To understand when and why CBD is appropriate to discuss or use in veterinary medicine, we must first understand what it is. This requires a general understanding of the cannabis plant. CBD and THC are phytocannabinoid derivatives of the cannabis species.

 Cannabis is an umbrella term for any hemp or marijuana plant with a THC concentration that has not been quantified; marijuana is cannabis with a determined THC concentration greater than 0.3%; and hemp is cannabis or any part of the plant with a determined THC concentration less than 0.3%.

 family can be broken down into the species 

Although the cannabis community has created a perception that one species is known for higher concentrations of THC over CBD and vice versa, concentrations of either can vary by species and the chemical makeup is greatly affected by how the particular strain is grown. In actuality, the differences between the species largely come down to where the plant originated and the general appearance (eg, plant size and leaf shape).

As mentioned, CBD is a phytocannabinoid, which acts on the endocannabinoid system (ECS). The ECS exists within humans and animals, vertebrates and invertebrates alike, and regulates functions in nearly every organ system throughout the body. It consists of G protein-coupled cell-membrane receptors and endogenous cannabinoid ligands, commonly referred to as endocannabinoids.

 The receptors most important in understanding the use of cannabis in medicine are cannabinoid receptors 1 and 2 (CB1R and CB2R). CB1R is found mainly within the central and peripheral nervous systems with some general distribution throughout the body, whereas CB2R is found mainly within the immune system.

Canines specifically have been found to have a greatly increased number of CB1R within the cerebellum and brain stem compared with humans, which due to the preferential binding of THC to these receptors accounts for the pronounced clinical signs that we see with marijuana toxicosis.

 CBD interacts with receptors quite differently than THC does.

CBD has a weak affinity for receptors but can cause some antagonist activity at CB1R and inverse agonist activity at CB2R.

 In humans, this inverse agonist activity has been shown to reduce some of the psychoactive adverse effects (AEs) of THC when used in conjunction with CBD, and is known as the entourage effect.

 In veterinary medicine, THC is not a treatment option, but that does not mean CBD cannot be.

We know what CBD does on a chemical level, but what is important is the quantifiable response to consistent use. The FDA has only approved 1 cannabis-derived CBD product for use in human medicine. Epidiolex is used to control seizure episodes associated with Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex.

 In clinical trials, it showed an average reduction of seizure activity across the 3 syndromes by 39% to 48% over 14- to 16-week periods.

 Outside of prescription use, CBD users tout it for its benefits in controlling pain, appetite and nausea, anxiety and depression, and insomnia, just to name a few. I personally have experienced benefits in controlling chronic pain, anxiety, and shift work-related insomnia. With all of the clinical and anecdotal evidence available in human CBD use and the knowledge that animals have an endocannabinoid system akin to humans, it is fairly reasonable to assume that the benefits of use in veterinary medicine would be similar to those we experience. However, exploration of CBD in veterinary medicine did not gain popularity until very recently.

There have only been a handful of CBD studies in animals, with most of the focus on epilepsy and osteoarthritis. Two notable studies are those conducted by Colorado State University (CSU) and Cornell University. The study conducted by CSU involved the use of CBD to treat canine epilepsy. Although it was a small-scale study, the results were promising with 90% of participants experiencing a decrease in seizure activity

 and a median reduction in seizure activity of 33%.

The Cornell study addressed canine osteoarthritis and results showed a reduction of pain and improved mobility in over 80% of the participants, suggesting CBD to be an appropriate adjunct therapy in the treatment and management of osteoarthritis.

 In both these studies, minimal AEs were noted with the most significant being an increase in serum alkaline phosphatase.

A safety study conducted by Canopy Animal Health also indicated that CBD oil is well tolerated in canines, with over 94% of AEs scored as mild and mainly involving gastrointestinal signs and elevated serum alkaline phosphatase.

Unfortunately, there is limited study data available on the safety and efficacy of CBD use in felines.

As proven in multiple studies, CBD can be an effective, safe therapy for many animals, which begs the question of why more veterinarians are not recommending it. Until very recently, CBD was classified as a Schedule I drug under the Controlled Substances Act (CSA) and therefore federally illegal. The passing of the Agricultural Improvement Act of 2018, known popularly as the 2018 farm bill, removed hemp and hemp-derived products from the definition of marijuana, thereby declassifying it as a scheduled substance under the CSA so long as the plant and products contain less than 0.3% THC.

 However, the hemp bill preserved the United States Food and Drug Administration’s right to regulate any cannabis and cannabis derivatives under the Food, Drug, and Cosmetic Act,

meaning veterinarians cannot legally prescribe CBD as a treatment protocol and must use diligence when discussing its use with clients.

Additionally, although CBD is now legal at the federal level, there are still 8 states with restrictions regarding sales and use,

 which adds another layer of complexity when considering its use in veterinary medicine. The only way to safely discuss CBD with a client is to refrain from stating that it is a drug that can treat or cure any particular illness. As with any other unregulated supplement or nutraceutical, the loophole exists wherein we can discuss how it can “support” a particular bodily system or function.

As part of my own research, I recently polled peers, veterinarians, technicians, and assistants to learn their opinions regarding CBD. I asked 2 questions: Do you believe CBD has a future in veterinary medicine, and why or why not? The responses were overwhelmingly in favor of CBD, feeling that “it can’t hurt and might help.” Some of my peers already use CBD for their own animals mostly for its anxiolytic effects and to support mobility and appetite; a few had experience with successful use in epileptic cases in animals whose seizures were poorly managed with multiple anticonvulsant medications. One person had no opinion in either direction due to lack of experience with it. One was firmly against its use, citing a study suggesting no legitimate benefit in patients with epilepsy and concern about misuse at the hands of owners.

Despite the opinions that CBD does have a future, the support comes with stipulations. The primary concern is that there needs to be appropriate training provided to veterinary professionals and equivalent education to owners to prevent misuse; for example, an owner intentionally using a product containing THC, causing a toxicity case. Having seen a large increase in marijuana ingestion cases following the legalization of recreational use in my state, I tend to agree that the risk increases without proper education. The other concerns surround the potential for owners to put all their hope on CBD as a replacement for Western medicine, the fear of legal repercussions for veterinarians, and the stark lack of supporting clinical evidence.

Considering all the current information on CBD use in human medicine, the beginnings of research in veterinary medicine, and the changes in legality, I strongly believe it has a future in our field. I did not previously subscribe to the hype and I would refuse to discuss the topic with clients or owners who were seeking support and approval for their decisions to experiment with CBD. But like the field, I have evolved and transitioned from my previously adamant no to a willingness to discuss without making recommendations. Now, I can safely say I am ready to openly advocate for its use if it can improve the quality of life for our patients.

I have found that most clients interested in the properties of CBD are pursuing it as a last-ditch effort, frequently as an adjunct therapy in hospice care or to mitigate the AEs of chemotherapy treatment. These owners have nothing left to lose but their animal companions. They, as well as all pet owners, deserve the opportunity to discuss other options. We exist in this profession for the betterment of our patients and their owners; we have an obligation to seek new and better therapies and right now that means we need to focus more attention on CBD research. For me, there is no debate. I am “Team CBD” all the way.

Janelle Overholser, CVT, is an ICU veterinary technician for BluePearl Specialty and Emergency Pet Hospital. She is a graduate of Penn Foster College and recently returned to school to obtain her BAS degree in veterinary technology. She is passionate about emergency medicine and is pursuing her VTS in ECC.

Compound summary: cannabidiol. National Center for Biotechnology Information. Updated June 19, 2021. Accessed May 6, 2021. 

https://pubchem.ncbi.nlm.nih.gov/compound/Cannabidiol

American Veterinary Medical Association. Cannabis in veterinary medicine. August 2020. Accessed May 6, 2021. 

https://www.avma.org/sites/default/files/2021-03/APH-CannabisResources-Report-20201207.pdf

Indica vs. sativa: understanding the differences between weed types. Leafly. September 20, 2018. Accessed May 5, 2021. 

https://www.leafly.com/news/cannabis-101/sativa-indica-and-hybrid-differences-between-cannabis-types

Silver RJ. The endocannabinoid system of animals. 

The entourage effect: How CBD and THC work together. Healthline. Accessed May 7, 2021. 

https://www.healthline.com/health/the-entourage-effect

Epidiolex. Greenwich Biosciences. Accessed May 13, 2021. 

https://www.epidiolex.com/about-epidiolex

McReynolds T. New study: CBD shows promise for treating canine epilepsy. NEWStat. May 30, 2019. Accessed May 13, 2021. 

https://www.aaha.org/publications/newstat/articles/2019-05/new-study-cbd-shows-promise-for-treating-canine-epilepsy/

McGrath S, Bartner LR, Rao S, Packer RA, Gustafson DL. Randomized blinded controlled clinical trial to assess the effect of oral cannabidiol administration in addition to conventional antiepileptic treatment on seizure frequency in dogs with intractable idiopathic epilepsy. 

 2019;254(11):1301-1308. doi:10.2460/javma.254.11.1301

Smith D. Cornell University study says hemp oil works for dogs in pain. Cannabis.net. February 14, 2018. Accessed May 12, 2021. 

https://cannabis.net/blog/medical/cornell-university-study-says-hemp-oil-works-for-dogs-in-pain

Vaughn D, Kulpa J, Paulionis L. Preliminary investigation of the safety of escalating cannabinoid doses in healthy dogs. 

FDA regulation of cannabis and cannabis-derived products, including cannabidiol (CBD). FDA. Updated January 22, 2021. Retrieved May 1, 2021. 

https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd#farmbill

Keehn J. CBD laws by state 2020 - just the facts [is CBD legal in 2020?]. CBD School. Updated February 23, 2021. Accessed May 12, 2021. 

https://www.cbdschool.com/cbd-laws-by-state-2020/

Learn about the background and properties of cannabidiol, the controversy it is facing, and how it can improve quality of life for human and animal patients. 

When and why: The CBD debate	

The Veterinary Hospitals Association (VHA) has entered into a partnership agreement with 

—an industry leader in veterinary client engagement software—to provide all VHA members with unique access to improved, simplified client communication solutions.

, the intuitive, user-friendly platform will help simplify daily tasks and save time for both pet owners and veterinary teams to ensure patient care remains the top priority.

"PetDesk is a strong solutions provider for veterinary clinics," says Jeff Benson, VHA executive director in the release. "In a time when veterinary clinics need processes streamlined and client communication simplified, PetDesk is a trusted partner in meeting those needs while offering superior customer service and pricing to our members."

PetDesk also offers veterinary practices a powerful suite of tools to enhance communication flow, reminders, appointment requests, and more while mitigating stress for the front office staff. Additionally, the digital platform renders a 5-star rated mobile app that connects pet owners with their pet care providers to stay updated on their pet’s current health.

"As many clinics are now reopening or exploring hybrid models of operation post-pandemic, the key to unlocking the right care for our pets is to ensure that both the relationship and therefore communication between pet parents and clinics, is the best it can be,” says Taylor Cavanah, CEO and cofounder of PetDesk in the release.

“PetDesk is excited to partner with VHA, and we look forward to all the great things we can accomplish together," adds Cavanah.

All VHA members new to PetDesk will receive exclusive sign-on offers, and members who currently utilize PetDesk’s client communication solutions will also receive additional incentives.

This collaboration will grant all VHA members with exclusive access to improved client communication solutions, simplify daily tasks, and beyond. 


VHA announces partnership with PetDesk 

Many clients remain unaware of the hallmark signs surrounding feline heartworm disease such as rapid and difficult breathing, intermittent vomiting, and lethargy. To help keep you updated and informed on this challenging condition, we've selected 3 articles that provide various tips and tricks for detecting, diagnosing, and treating infected cats. 

From tips for educating clients about the proven measures and methods of treating feline heart disease to why the condition is overlooked in feline patients compared to canine patients—there's something for everyone. Happy reading! 

Matters of the heart: Educating clients about feline heartworm disease prevention

: Learn the methods for detecting and diagnosing feline heartworm disease, plus a few communication pearls to help educate your clients about the perils of this condition and the many proven preventatives and solutions available. 

Embracing routine testing for heartworm in cats

: Though the risk of developing heartworm disease runs high in both dogs and cats, it's often overlooked in felines. Discover why and explore the prevalence of feline heartworm disease, the importance of testing cats, and beyond.

: Brian Calabro, DVM, covers the clinical differences of heartworm disease in both cats and dogs, plus the common difficulties associated with diagnosing and treating felines suffering from this condition. 

Hone your skillset by brushing up on the latest methods for detecting, diagnosing, and treating felines presenting with heartworm disease. 

3 must-reads on feline heartworm disease

Rescue Disinfectants decrease the risk of an outbreak and the non-toxic solution is safe for animals, staff, and clients (Photo courtesy of Virox Technologies).

American Society for the Prevention of Cruelty to Animals

 (ASPCA), approximately 6.5 million companion animals entering the United States animal shelters are exposed to high-risk outbreaks caused by pathogens like canine parvovirus.

To help prevent these conditions, Shelters United has collaborated with Virox Technologies—the creator of Rescue

Disinfectants—to grant thousands of US animal welfare organizations access to these responsible, effective cleaning and disinfection solutions. 

Additionally, this partnership also offers Shelters United members discounted access to Rescue Disinfectants and its educational resources to ultimately help prevent animals from developing illnesses within these facilities.

“We are excited to be a new partner of Shelters United. Shelters, rescues, and S/N clinics do such vital work for the communities they serve. We want to help them keep animals healthy and safe.” says Lee Nesbitt, executive vice president of commercial markets at Virox Technologies, in a company 

“Rescue Disinfectants’ ability to disinfect up to 10x faster than other disinfectants along with its non‐irritating formulation means that staff and volunteers can focus more of their attention on treating the animals in their care,” adds Nesbitt.

According to the release, Rescue Disinfectants is powered by patented Accelerated Hydrogen Peroxide® technology and provides a one-step, efficient process for disinfecting in less than half the contact time of other disinfectants. This innovative, non-toxic solution is also safe for animals, staff, and clients by proactively reducing the chance of an outbreak, thus preserving the integrity of animal health facilities.

“It is companies like Virox that Shelters United is proud to partner with,“ says Mal Schwartz, founder of Shelters United and president of the Institute for Nonprofit Excellence. “Partners like Virox who align with the mission of Shelters United and in turn, the missions of our 900+ member nonprofit animal welfare organizations who are on the front lines of saving lives and adopting out healthy, happy pets.”

To learn more about Virox Technologies’ sanitary solutions, go 

This partnership provides all Shelters United animal welfare organizations with discounted access to the elite cleaning and disinfection solutions, Rescue DisinfectantsTM, which will help reduce the chance of outbreaks and more. 

Shelters United and Virox Technologies team up to offer discounts on safe disinfectants

During these hotter months, more veterinary clinics are treating pets for heatstroke. Clients are flocking outdoors and carrying their animal companions with them on spontaneous beach trips and long picnics. When exposed to prolonged heat, a pet's body temperature can rise to dangerous levels.

To curtail this threat and to help educate owners about the serious consequences of overheating Covetrus—a global animal-health technology, and service company, provided dvm360

 with 3 safeguards for keeping your patients, cool, safe, and comfortable during the warmer months.

Encourage clients to monitor the daily forecast, heat index, temperatures both inside buildings and outside the home, and the temperatures inside vehicles. If they have second thoughts about whether they should bring their animal outside, advise them to always play it safe and keep them inside.

2. Different pets have individual temperature needs

The heat affects pets differently. It’s important to remind your clients that animals come in a variety of breeds, shapes, sizes, and of course, fur. Not only do you need to be wary of temperature levels, but you must also teach them about conditions that work best for their pet's breed and individual needs. Here are some important heat-related facts to share with your clients:

Darker-coated animals absorb more heat than those with lighter coats.

Animals with double coats have a natural layer of insulation to protect them against heat.

Animals with matted double coats struggle to stay cool. Do not cut the mats away or shave their coat; instead, comb them out as much as possible.

Remind your clients that it’s OK to sacrifice a little fun for their pet’s safety. In addition, provide them with a few tips and tricks for keeping their pets hydrated and cool indoors during the summer including:

Using fans, misters, air conditioning, etc. 

Warn your clients that hot pavement could be potentially painful for their pets. As a rule of thumb, if the pavement is too hot for their hand, it's definitely too hot for their paw pads. 

Odds are, animals are not going to want to run around when the air is hot and humid. Advise clients to opt for indoor activities to keep the pet entertained and completely cool.

Following these measures not only guarantees the pet's utmost well-being but keeps the stress off both the owner and the veterinary team as well. 

Check out these tips for educating your clients about the dangers of overheated pets, plus strategies for keeping furry companions cool during warmer months.

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IDEXX: Contributing to something bigger