Learn how IDEXX is enhancing the lives of animals, people, and the planet.

IDEXX: Contributing to something bigger

Hemangiosarcoma is often the first thing that comes to mind when a splenic mass is found in a dog. Although it is the most common malignant splenic tumor, it is not the only differential. Unfortunately, obtaining a definitive diagnosis and prognosis for the patient requires histopathology, which must be obtained surgically. The decision to go forward with surgery in the face of a potentially poor prognosis can be a difficult one for clients, especially in an emergency situation when the tumor has ruptured and is actively hemorrhaging.

During a session at the American Veterinary Medical Association Virtual Convention, Sue Ettinger, DVM, DACVIM (oncology), a veterinary oncologist at the VCA Veterinary Referral and Emergency Center in Norwalk, Connecticut, discussed key facts that practitioners need to know about hemangiosarcoma to help their clients make the best decision for their pet and family.

Clinical signs of hemangiosarcoma vary greatly depending on tumor location and how advanced the disease is at diagnosis. Tumor location can vary from the skin to subcutaneous tissue to visceral organs. The most common primary visceral sites are the spleen, heart, and liver. Because it is a cancer of blood vessels, it metastasizes quickly, with the liver and lungs being the most common targets.

Some patients with splenic hemangiosarcoma present with nonspecific signs such as decreased appetite, lethargy, or gastrointestinal distress, and other patients present in hypovolemic shock after an acute collapse. It is also possible for patients to have no clinical signs, with the mass being found by accident.

Ettinger reminded clinicians that although large breed dogs are generally at increased risk, any dog can present with hemangiosarcoma. Golden retrievers, German shepherds, and Labrador retrievers are thought to be at highest risk, and a genetic predisposition is suspected.

Ettinger noted that only approximately 45% of splenic masses are hemangiosarcoma, based on what she referred to as the “double two-thirds rule”: Two-thirds of patients presenting with a splenic mass have a malignant tumor, and of these malignancies, two-thirds are hemangiosarcoma. According to Dr Ettinger, published literature reports between 45% to 65% of splenic masses in dogs to be hemangiosarcoma.

Differentials for the one-third of dogs with benign masses include nonneoplastic masses like hematomas, abscesses or nodular hyperplasia, or a benign hemangioma. Differentials for the remaining malignancies include lymphoma, histiocytic sarcoma, and osteosarcoma.

In Ettinger’s experience, emergency clinicians have a higher suspicion of hemangiosarcoma when a splenic mass is identified, despite the double two-thirds rule. This is likely because patients presenting with a splenic mass in the emergency setting often have ruptured tumors and hemoabdomen, which both increase the index of suspicion for malignancy. In one study that evaluated dogs presenting with nontraumatic hemoabdomens, 80% of the splenic masses were neoplastic, with 88% of those diagnosed as hemangiosarcoma.

Another exception to this rule is that nonruptured splenic masses found incidentally, which Ettinger nicknamed “incidentalomas,” are less likely to be malignant. In a 2016 study, only 30% of these masses were malignant.

Ultimately, the definitive diagnosis of any splenic mass is through histopathology. However, several diagnostics should be performed prior to surgery to assess patient risk and stability.

Blood work is an essential part of the preoperative work-up and should include, at a minimum, a complete blood count (CBC) and a chemistry panel. CBC results may raise the suspicion of malignancy if anemia, nucleated red blood cells, abnormal red blood cell morphology, or thrombocytopenia are present. CBC results can also help assess risk of perioperative mortality. Patients with marked preoperative thrombocytopenia or anemia (hematocrit levels<30%) have an increased risk of death.

Coagulation status should be assessed with a prothrombin time or partial thromboplastin time blood test, in house if available. If these tests are not available in house, perform a buccal mucosal bleeding time evaluation or toenail clip to assess clotting. Half of patients with hemangiosarcoma will present with a coagulopathy.

Chest radiographs should be performed prior to surgery to assess for gross metastatic disease. Taking 3 views of the chest is essential to maximize the chances of detecting a lung nodule if one is present.

If available, abdominal ultrasound can be a helpful tool because it is less affected by effusion than radiographs. It allows the clinician to confirm the presence of any splenic tumors and assess the degree of effusion and for gross metastasis to other abdominal organs. Additionally, the architecture of the mass can be evaluated, which guides the decision to perform fine needle aspiration (FNA). FNAs are not recommended on cavitated splenic masses. Generally, cytology is low yield and inaccurate for hemangiosarcoma, and obtaining the sample has a high risk of hemorrhage due to the friable nature of the mass. If a solid splenic mass is visualized, an aspirate may be helpful to aid in the diagnosis.

Although some textbooks recommend echocardiography prior to surgery to screen for right atrial masses, it is not necessary in most cases, according to Ettinger. A better use of the client’s money is an electrocardiogram, monitoring during and after surgery because arrhythmias are common in patients regardless of whether the mass is benign or malignant. The presence of intraoperative ventricular arrhythmias doubles the risk of perioperative mortality.

Hemangiosarcoma is a treatable cancer, and when treated, dogs do live longer. However, according to Ettinger, the 1-year survival is less than 10% no matter how aggressive treatment is. The best prognosis is seen with non-ruptured, low-grade splenic tumors.

Surgery is the first-line treatment for splenic masses. During surgery, the abdomen should be fully explored. The gross appearance and size of the primary mass at the time of surgery does not correlate with malignancy. Suspected metastatic lesions on other abdominal organs, such as the liver, may actually be hematomas, extramedullary hematopoiesis, or another benign process. Thus, all suspicious lesions should be biopsied and submitted for histopathology along with the entire spleen. Surgeons must remember that hemangiosarcoma can only be diagnosed definitively by histopathology and should not make intraoperative assumptions about malignancy.

Ettinger cautioned that iatrogenic spread of neoplastic cells is possible due to the highly friable nature of the tissue. To minimize seeding of neoplastic cells during surgery, the abdomen should be thoroughly lavaged prior to closure, and fresh gloves and instruments should be used for closure.

Surgery alone is considered a palliative treatment, which controls local disease and reduces risks of acute hemorrhage in the future. Average survival time following palliative surgery is 1 to 3 months.

Average survival time can be extended to 6 months when surgery is followed by systemic chemotherapy.

Doxorubicin-based protocols are the most common, but the number of treatments that a patient can receive are limited by the accumulated cardiotoxicity. Other protocols, including the use of metronomic chemotherapy, are being investigated to maximize survival times and quality of life following surgery.

There is also new, ongoing research into therapeutic options for hemangiosarcoma, but limited data are available at this time. Ettinger said that a new drug called eBAT is being studied at the University of Minnesota as both a treatment and preventative option, but it is not commercially available. Losartan, an angiotensin subtype II receptor blocker in dogs, is also being studied as a possible palliative option due to its antitumor effects. Ettinger expressed excitement about the possibility of new therapies but noted that more research is needed.

Ettinger also discussed the use of supplements as a part of both palliative and curative-intent treatment protocols. Polysaccharopeptides are derived from Asian mushrooms and are thought to have antitumor activities through several different mechanisms of action. Several blends are available, but many are proprietary, which makes comparing brands difficult. Ettinger recommended I’m-Yunity, the product used in a small study of 15 dogs that showed a slight increase in survival times beyond surgery alone, though the study lacked a placebo group.

 However, because this product can be expensive, she offered K9 Immunity Plus as an alternative

 with the reminder that this blend has not been studied.

Yunnan Baiyao, a Chinese herbal mixture commonly used in patients with hemorrhage, may also be helpful for patients with hemangiosarcoma. Ettinger suggested this product as a palliative measure for patients with metastatic nodules that could rupture and bleed or for patients with a splenic tumor that has ruptured and the client declines surgery.

When discussing hemangiosarcoma with clients, Ettinger described it as an “aggressive and malignant cancer of blood vessels” that can occur in many locations in the body. She stresses to clients that noninvasive tests will not tell us if a splenic mass is hemangiosarcoma and that we must wait for biopsy results to give accurate diagnosis and prognosis. Treatment of hemangiosarcoma is fought on 2 battlefronts: locally and distantly. Locally is where the cancer is growing, and distantly is to control metastatic disease.

Despite the poor long-term prognosis, Ettinger noted that “a lot of my clients who treat are very happy they did, even with surgery alone, because the quality of life they get is good.”

Kate Boatright, VMD, a 2013 graduate of the University of Pennsylvania, is an associate veterinarian and freelance speaker and author in western Pennsylvania. She is actively involved in organized veterinary medicine at the local, state, and national levels and is a former national officer of the Veterinary Business Management Association.

Pintar J, Breitschwerdt EB, Hardie EM, Spaulding KA. Acute nontraumatic hemoabdomen in the dog: a retrospective analysis of 39 cases (1987-2001). 

Cleveland MJ, Casale S. Incidence of malignancy and outcomes for dogs undergoing splenectomy for incidentally detected nonruptured splenic nodules of 105 cases (2009-2013). 

 2016;248(11):1267-1273. doi:10.2460/javma.248.11.1267

Wendelburg KM, O'Toole TE, McCobb E, Price LL, Lyons JA, Berg J. Risk factors for perioperative death in dogs undergoing splenectomy for splenic masses: 539 cases (2001-2012). 

2014;245(12):1382-1390. doi:10.2460/javma.245.12.1382

Wendelburg KM, Price LL, Burgess KE, Lyons JA, Lew FH, Berg K. Survival time of dogs with splenic hemangiosarcoma treated by splenectomy with or without adjuvant chemotherapy: 208 cases (2001-2012). 2015;247(4):393-403. 

Clinical Veterinary Advisor Dogs and Cats

. 2nd ed. St. Louis, MO: Elsevier Mosby;2017:483-486.

Brown DC, Reetz J. Single agent polysaccharopeptide delays metastases and improves survival in naturally occurring hemangiosarcoma. 

. 2012;2012:384301. doi:10.1155/2012/384301

Articles

During a session at an AVMA Virtual Convention, a veterinary cancer specialist discusses key facts about the disease to help clients make the best decision for their pet. 

Essential information for veterinary practitioners about hemangiosarcoma

Natural canine and feline joint health supplement

Antinol is a joint supplement that helps to maintain healthy joints and mobility in cats and dogs. This product works quickly and is safe for long-term use. This concentrated formula contains a natural blend of 6 marine lipid groups including Omega-3, ETA, EPA, DHA, DPA OTA, and it contains over 90 essential fatty acids and has no serious side effects. Antinol’s organic blend is designed to support a canine or feline’s natural inflammatory response and aid in their joint, skin, and cardiovascular function while reducing joint discomfort linked to pet aging and activity. Antinol is easy to swallow as it comes in a 0.4-in long softgel. It can be tableted or used in conjunction with a pill pocket or wrap. For best results, store this product at 75°F or below. In hotter climates, keep it refrigerated and remove it from the container before use.

This veterinarian-formulated, triple-tested CBD oil is extracted from premium American-grown hemp and made with extra virgin olive oil. Specially developed for equines, VETCBD Hemp Tincture helps support normal brain function and joint mobility and promotes calmness. This product contains 3000 mg of CBD oil and comes in a 2-fl oz bottle. It also includes a pet-safe syringe for accurate dosing. Though available on VETCBD’s website, laws in Idaho, Kansas, Nebraska, and South Dakota prohibit the shipment of this product to these locations. Additionally, because of state regulations, it’s currently not for sale in California.

Combination parasite preventative for dogs

Simparica Trio (sarolaner, moxidectin, and pyrantel) is the first monthly chewable tablet in the United States to provide all-in-one protection against heartworm disease, ticks, fleas, roundworms, and hookworms. This FDA-approved medication prevents flea infestation by killing fleas before they can lay eggs within 4 hours of administration. Additionally, it has been demonstrated to achieve 100% effectiveness in 8 hours. One clinical study revealed that 1 monthly tablet provided 100% protection. Simparica Trio is proven safe for puppies as young as 8 weeks old, weighing at least 2.8 pounds. Each package contains 6 liver-flavored tablets.

Canine Tooth Gel with eco-friendly bamboo toothbrush

This cruelty- and toxic-free dental kit is Leaping Bunny Certified and features an eco-friendly bamboo toothbrush coated in soybean wax and USDA-Certified Organic canine gel. The tooth gel contains natural ingredients such as coconut oil, olive leaf extract, fennel extract, sweet potato, cinnamon powder, and kelp extract to tackle plaque and tartar. The product is available in sizes small and large.

Here's our regular rundown of new and notable veterinary products.



dvm360 product report: Equine hemp oil, plus a natural pet joint health supplement and more 

Diabetes mellitus, a disease affecting an estimated 1 in 300 adult dogs and 1 in 230 cats in the United States, is on the rise.

 In fact, recent studies have revealed that diabetes diagnosis has been increasing by 79.7% in dogs and 18.1% in cats since 2006.

To help combat these alarming and disheartening statistics, Merck Animal Health, Purina, and Zoetis have announced that they will continue their now 7-year partnership with the 

 to help provide free educational materials and diagnostic tools for participating veterinary practices during Pet Diabetes Month. The main goal of the Diabetes PetCare Alliance program, formed in 2014, is to raise awareness of pet diabetes and facilitate the screening of at least 2,000 pets during Pet Diabetes Month (November).

In addition to awareness and screening tools, the Diabetes PetCare Alliance will provide every client whose pet is diagnosed between November 1, 2021, to December 31, 2021, with a free disease management kit. Each kit will include:

One AlphaTRAK® 2 Blood Glucose Monitoring System from Zoetis

One 6-pound bag of Purina® Pro Plan® Veterinary Diets DM Dietetic Management® Feline Formula for cats or Purina® Pro Plan® Veterinary Diets EN Gastroenteric Fiber Balance® Dry Formula for dogs

One 10 mL vial of Vetsulin® (porcine insulin zinc suspension) from Merck Animal Health

Veterinary practices can start enrolling on September 1, 2021. Enrollment ends on October 31, 2021. To enroll or learn more, go 

Feline diabetes mellitus in the UK: The prevalence within an insured cat population and a questionnaire-based putative risk factor analysis. McCann TM, Simpson KE, Shaw DJ, et al. 

Canine diabetes mellitus; can old dogs teach us new tricks? Catchpole B, Ristic JM, Fleeman LM, Davison LJ. 

Banfield Pet Hospital. State of Pet Health: 2016 Report. Accessed on August 5, 2021. 

https://www.banfield.com/pet-health/State-of-pet-health

Aptekmann, KP, et al. J Am Anim Hosp Assoc, 2014. (v1.0) - Owner Experiences in Treating Dogs and Cats Diagnosed with Diabetes.

In advance of National Pet Diabetes Month in November, the Diabetes PetCare Alliance program will start accepting enrollment on September 1, 2021.

Enrollment opens next month for the 2021 Diabetes PetCare Alliance Program 

When managing “spinal” disease, the first step is ruling out an imposter such as a cruciate tear, immune-mediated polyarthritis (IMPA), and metabolic and vascular issues that produce weakness (ie, internal bleeding). “When something can’t walk, we need to first ask whether it is truly neurological and then, number two, if it is like this because of a problem in the brain or in the spine or if it is neuromuscular,” explained Michelle Carnes, DVM, MS, DACVIM, medical director at Specialists in Companion Animal Neurology in Naples, Florida.

The next step is localizing the lesion into one of the 3 main anatomic districts: cervical; T3-L3; and L4>caudad. This neurologic examination also assesses motor function, proprioception, spinal reflexes, and deep pain perception.

The lesion is likely high cervical if the motor and/or proprioception are abnormal and withdrawal reflex is normal in all 4 limbs. However, if the withdrawal reflex is decreased/absent in the front limbs but normal in the hind limbs, the lesion is likely low cervical. For T3-L3 and lower lumbar lesions, the thoracic limbs are unaffected but the hind limbs have abnormal withdrawal reflexes. If withdrawal reflexes are decreased or absent in all 4 limbs, the problem is neuromuscular, Carnes explained: “Make sure it’s spinal, because neuromuscular takes us on a very different pathway from a spinal cord problem.”

The presence of spinal pain leads down a different path than its absence. For example, if pain is present, think spinal fracture, extradural neoplasia, or acute intervertebral disc disease (IVDD). A nonpainful dog, on the other hand, could be experiencing chronic IVDD, intradural neoplasia, fibrocartilaginous embolism (FCE), or degenerative myelopathy.

IVDD is the most common cause of myelopathy and back pain in dogs. Chondrodystrophic breeds are predisposed, often presenting between 3 and 6 years of age.

 – acute extrusion of the nucleus pulposus from the annulus fibrosus

 – chronic bulging of the annulus fibrosus

 – acute, high-velocity, noncompressive extrusion of the nucleus pulposus

secondary to sudden tear in the annulus fibrosus resulting from spinal trauma

The clinical signs—which vary with the spinal level of the lesion—are back pain, proprioceptive deficits, and paresis/paralysis. The absence of deep pain (assessed by compressing the digits) is the primary negative prognostic factor and signals the need to act fast. “The sooner the better,” Carnes said. “You’re getting secondary injury the longer that compression is there.”

To relieve compression and prevent spinal cord necrosis—which, in 10% of patients lacking deep pain, can culminate in the irreversible liquefactive condition known as myelomalacia—surgery may be necessary. Besides the absence of deep pain, the chief indications for surgery are nonambulatory paraplegia or paresis, recurring paresis, unrelenting spinal pain, or medical treatment failure.

Most IVDD cases can be medically managed. This hinges on at least 2 weeks of strict cage rest, followed by a month or so of restricted activity. Effective drugs include diazepam, gabapentin, and nonsteroidal anti-inflammatory drugs (NSAIDs) or, alternatively, prednisone as short-course therapy.

According to Carnes, a 2007 study of medical management for thoracolumbar/cervical herniations in 200 ambulatory dogs, approximately 54/49% recovered with no recurrence, 30/33% recovered withrecurrence and 14/18% did not recover.

An FCE occurs when a fibrocartilaginous fragment breaks from the disc and injects itself into the spinal cord vasculature. The neurologic fallout from this is determined by the extent of circulation occluded. “It’s like a stroke in the spinal cord,” Carnes said.

Canines with an accelerated risk for FCE are usually either young or adult miniature schnauzers and giant breed dogs. The typical presentation is sudden vocalization amidst vigorous activity, followed by an inability to walk. Deficits are asymmetrical and signs are nonprogressive. Affected dogs are usually anxious with no apparent pain.

FCE improves with supportive care and rehabilitation but not with corticosteroids. Manual bladder expression is usually necessary until function returns. “If they can’t move their legs, they can’t urinate,” said Carnes. Most patients regain function, although some have residual deficits. In one study cited by Carnes, 73% of canine survivors recovered within a few weeks.

The more serious cases are signaled by several negative prognostic indicators, including symmetrical clinical signs, decreased spinal reflexes, absent/reduced deep pain sensation, spinal cord swelling (on MRI), lower cervical/lower lumbar localization (spinal intumescences), and elevated CSF leukocytes.

Infection of intervertebral disc(s) with lytic invasion of adjacent endplates, diskospondylitis produces severe spinal pain, proprioceptive deficits, and fever +/- systemic illness. Large-breed dogs are at increased risk for this aggressive infection, which results most frequently from translocation of skin pathogens like 

. It can also be caused by hematogenous bacterial spread, migrating foreign bodies, and other penetrating wounds.

Though bacteria are typically implicated in diskospondylitis, 

 spp. can also precipitate it, particularly in German shepherds.

Although blood or urine cultures can support treatment choices, most cases are best addressed with broad-spectrum antibiotics like Clavamox or Simplicef, presenting a response within 5 days of treatment. NSAIDs and cage rest are key to a good outcome.

X-rays that track bone healing should be obtained every 2 to 3 months. “Where those lytic lesions were, I want to see smoothing of the bone of the vertebral bodies,” said Carnes, adding that antibiotics should be continued for about a month past radiographic resolution.

This slowly progressive decay of spinal cord white matter is considered the canine analogue for the human amyotrophic lateral sclerosis (ALS). A mutation in the 

 gene and in most cases, underlies this chronic, nonpainful myelopathy that manifests as gradual weakness in the older (>8 years) dog. Usually seen in large-breed dogs—notably German shepherds, boxers, Bernese mountain dogs, Chesapeake Bay and golden retrievers, standard poodles, and Siberian huskies. Degenerative myelopathy (DM) does not spare smaller breeds, particularly pugs, miniature poodles, and Cardigan Welsh corgis.

The T3-L3 region, which corresponds to the pelvic limbs, is affected first, followed by the thoracic limbs. A diagnosis of rule-out, DM looks like IVDD on clinical presentation—wobbly gait, proprioceptive deficits, and loss of motor function, but for its sparing of the withdrawal reflex and its nonresponse to corticosteroids. MRI can exclude IVDD and neoplasia.

Though there is no established treatment for DM, intense physical therapy has been shown to slow deterioration and lengthen survival times. Further support may come from adjunct treatments, including NSAIDs, thyroid supplementation, and weight loss, in the case of corresponding comorbidities.

Joan Capuzzi, VMD, is a small animal veterinarian and journalist based in the Philadelphia area.

Although the spinal cord choreographs everything a dog does, it is a delicate neural pipeline and vulnerable to common issues that can be mechanical, vascular, infectious, or degenerative.  

Common canine spinal disease simplified 

The American Association of Feline Practitioners’ (AAFP) Cat Friendly Certificate Program continues to earn recognition and praise from industry associations, receiving the 2021 Best In Business Award from Veterinary Medical Association Executives (VMAE). The award is an indication of how the Cat Friendly Certificate Program truly shined and was a stand-out during the awards ceremony, which took place July 20. The VMAE Awards Committee presented the award to the AAFP’s Cat Friendly Certificate Program for exhibiting originality in content, creativity, and usefulness to veterinary professionals. 

The AAFP is honored and thrilled by the ongoing recognition of the Cat Friendly Certificate Program. The impact of this feline-specific training and education program enables all veterinary professionals to advance the standards of feline care. In May 2021, the Cat Friendly Certificate Program received the 2021 Gold Circle Award from the American Society of Association Executives (ASAE). Both awards recognized the importance of this feline-specific educational program and the exemplary work being done in the field. 

“We know that it is stressful to bring cats to the veterinary practice and not enough cats come in for regular routine care. This Program ensures the veterinary team will receive specialized training solely focused on cats to reduce stress associated with the visit and to create a much better experience," said Heather O’Steen, CAE, AAFP Chief Executive Officer. “We are proud these awards showcase our ability to provide valuable educational opportunities to everyone in the veterinary community who seeks to expand their feline expertise." 

With its debut in late 2020, the AAFP Cat Friendly Certificate Program continues to grow and gain the support of veterinary practices, communities, organizational partners, and industry partners. The AAFP is working with numerous sponsors and partners who recognize the value of the Cat Friendly Certificate, and are developing large-scale initiatives to raise awareness and access to the Program. These initiatives bring new opportunities to those eager to improve the veterinary experience for cats in an accessible, easy-to-digest program.

The impact of this feline-specific training and education program enables all veterinary professionals to advance the standards of feline care. 

AAFP's Feline-Focused Certificate program named 'best in business'

At 6:30 in the morning, Dr Kay received a phone call that she first thought was from a client whose dog had been having significant issues. However, the message on the phone proved to be rather disturbing. It was from one of Dr Kay’s early-arriving staff members who had just discovered that the clinic had been robbed!

Upon the team members' arrival, they noticed one of the front glass doors had been shattered. Further investigation showed petty cash was missing as well as some cell phones (which became a safety measure during the COVID-19 pandemic). The total loss was an estimated $1,500.

The police responded quickly and checked out the clinic’s internal surveillance cameras, which revealed a couple of men in sweatshirts and hoodies who were essentially unidentifiable. The police were attentive but recommended immediately reporting the incident to the insurance carrier as the stolen items were not going to be recovered.

Fortunately, the controlled substances were locked up and pharmacy drugs were untouched. There was also very little vandalism. The only loss was some cash and the cost of replacing the shattered glass at the point of entry. As expected, some staff members were upset. They feared for their safety when walking to their cars after work. Everyone’s suggestions were dutifully heard. A meeting of the management team was scheduled to evaluate what happened and to plan precautions that can help prevent a future robbery.

At the meeting, the management team agreed they should be concerned about the clinic’s relaxed approach to security. Although they had surveillance and a secure safe for controlled substances, there was no burglar alarm system, petty cash was not securely locked up overnight, and exterior lighting and theft protection signage were not adequate.

It was also noted that unless there is substantial monetary or equipment loss, the insurance company advised against advised against making a claim due to the risk of significantly increased post theft premiums. In addition to improving the existing security measures, the staff had to be reassured that they were working in a safe environment.

Ultimately, it was decided that the clinic would retain a security consultant to recommend a comprehensive security protection plan. This would take the protection of the clinic out of the hands of well-meaning staff and place it in the care of professionals. The next step was scheduling a staff meeting where the team would be reassured that the significant steps were being taken to prevent an intrusion of this nature in the future.

The final management team meeting covered an uncomfortable subject. They had to discuss the possibility that one of the 41 staff members may have been involved in the break-in. It was one of the first questions the police asked when investigating the robbery. They would of course ask their security consultant to assist in this area even though the thought of staff involvement was unthinkable.

Overall, the general staff meeting was well-received. The team was informed of the event that occurred, how a future incursion would be prevented, and finally, that staff safety was the primary concern. One team member’s comment summed it up by saying, “I love my workplace, and respect my coworkers, but an ounce of prevention is worth a pound of cure.”

Most veterinary professionals worry about difficult clients, staff shortages, and missed appointments. Incidents involving robberies and vandalism barely warrant any thought at all—that is until you are the victim. Unfortunately, many clinics learn the hard way. This is a perfect example where being proactive rather than reactive is the answer. First, abandon any thoughts of, “it can’t happen to me.” Second, don’t get lulled into being casual when it comes to securing your clinic’s pharmacy drugs and money. Finally, invest in a professional security evaluation and listen to their recommendations. Following these steps can help you avoid that early morning call from your local gendarmes.

Marc Rosenberg, VMD, is director of Voorhees Veterinary Center in Voorhees, New Jersey. Although many of the scenarios Rosenberg describes in his column are based on real-life events, the veterinary practices, doctors, and employees described are fictional.

A robbery is something you hope to never experience at your hospital, but being prepared is crucial for ensuring your staff's safety and preventing significant loss of cash, equipment, and more.