A tumor is an abnormal mass of tissue that is not inflammatory, does not have physiological function, and arises with no obvious cause from cells of preexistent tissue. A tumor may also be called a neoplasm or neoplastic mass. Oral tumors are the fourth most common tumors seen in dogs, accounting for 6% of all canine tumors and up to 12% of tumors in cats.

 Oral tumors can originate from several sites in the oral cavity, including the tongue, mucosa, gingiva, lips, maxillary, and mandibular bone,

 and they may spread to adjacent cartilaginous tissues and bone. Metastasis can occur within the lungs and regional lymph nodes.

Signs of oral tumors in cats and dogs include halitosis, loss of teeth, anorexia, dysphagia, facial swelling, hemorrhage, sneezing, hypersalivation, oral pain, pawing at the face, lymph node enlargement, weight loss, and swelling or thickening of the maxilla or mandible.

 The oral mass may be visible upon oral examination, but oral tumors often go unnoticed by the pet owner until clinical signs are advanced.

 The normal oral anatomy of the dog and cat mouth should be considered when trying to identify an oral mass. Anatomic structures—such as the normal papillae of the tongue, the incisive papilla (located palatal to the maxillary incisors,) the salivary papillae, the sublingual caruncles, and the molar salivary gland in cats that is located lingual to the first mandibular molars—should not be confused with oral tumors.

Malignant oral tumors are locally invasive and may metastasize.

 A veterinary dentist and/or oncologist should be considered for treatment that may include surgical excision, chemotherapy, and/or radiation.

A complete history, general physical examination, and thorough oral examination should be performed. General anesthesia may be required for a comprehensive oral evaluation, including palpation of the mass, description of size, location, presence of necrosis, ulceration, pigmentation, firmness, etc.

Diagnostic testing may include a complete blood count, chemistry panel, urinalysis, lymph node cytology, 3-view thoracic radiographs, dental radiographs, CT scans, and MRIs.

 An excisional or incisional biopsy is needed to confirm the histopathological diagnosis.

The most common malignant oral tumors found in dogs are malignant melanoma, squamous cell carcinoma, osteosarcoma, and fibrosarcoma. The most common malignant oral tumors found in cats are squamous cell carcinoma and fibrosarcoma.

Oral malignant melanoma (OMM) is reported to be the most common malignant neoplasm found in dogs but is rare in cats.

 An OMM may appear grayish or brownish-black, ulcerated or necrotic, and firm to friable.

 Although OMM lesions are usually pigmented, 40% may be amelanotic and therefore are pink or red.

 Malignant melanomas occur most commonly on the mucosa and gingiva but may occur anywhere in the oral cavity.

OMMs occur more often in older, pigmented, male dogs. Miniature poodles, cocker spaniels, and chow chows may be predisposed.

 OMMs are highly invasive to the jawbones and have a high potential for metastasis to the lungs and regional lymph nodes.

 Treatment options for OMM include aggressive and wide surgical resection to prevent recurrence, and adjunctive therapies include radiation therapy and immunotherapy (melanoma vaccine).

The most common malignant oral tumor found in cats and the first or second most common malignant oral tumor found in dogs is squamous cell carcinoma (SCC).

 It usually affects older cats and dogs, with no sex predilection.

SCC is commonly located in the premolar or molar regions of the maxilla; premolar region of the mandible; or rostral mandible, palate, or sublingual region at the base of the tongue.

 SCC has a pink to red ulcerated, cauliflower-like appearance and bleeds easily or may appear as ulceration with no overt mass.

 It is a rapidly growing, locally invasive tumor.

In dogs, SCC is often divided into tonsillar and nontonsillar.

Higher metastasis and shorter survival time are associated with tonsillar and lingual tumors vs SCC in a more rostral location.

 Cats with SCC often present to the veterinarian for a decreased appetite, decreased grooming, halitosis, ptyalism, and/or weight loss.

 Treatment options for cats are wide surgical excision and/ or radiation or chemotherapy.

 Without clean surgical margins, long-term prognosis for cats with SCC is generally poor.

 It is often difficult or impossible to obtain surgical margins in cats and small dogs, and palliative local irradiation in cats may be considered.

 Dogs tend to adapt better following glossectomy.

 Risk factors in cats may include eating canned cat food or canned tuna, use of flea collars, and exposure to environmental tobacco smoke.

 Papillary SCC is a less aggressive variant found in both young and old dogs and may present as a gingival mass with a verrucous pink surface.

Fibrosarcoma (FSA) is the second most common malignant oral tumor in cats and the third most common in dogs.

 FSAs often present as slow growing, firm, flat, diffuse, broad based, and locally invasive.

 Masses usually occur on the maxilla, growing on the palate or lateral muzzle; however, they can also occur elsewhere, such as the mandible.

 In dogs, FSA is more common in large breeds with a possible breed predilection for retrievers.

 The treatment of choice is wide surgical excision; however, because FSAs have a high rate of recurrence and that surgery is usually palliative, ancillary radiation is recommended.

Osteosarcoma (OSA) may involve the mandible or maxilla; appear as soft or hard, fleshy, red, and friable; and bleeds easily.

 OSA is locally aggressive, and the metastasis rate of oral OSA is lower than appendicular OSA.

 The preferred treatment for oral OSA is radical or wide excision.

Regardless of the type of oral malignant tumor, early detection and treatment are important for a more positive outcome. The smaller the tumor, the smaller the surgery.

Smith M. Oral tumors. Presented at: 2017 Veterinary Dental Forum; September 14-17, 2017; Nashville, TN.

Perrone JR, March PA. Common dental conditions and treatments/oral tumors /malignant oral tumors and treatments. In: Perrone JR, ed. Small Animal Dental Procedures for Veterinary Technicians and Nurses, 2nd ed. Wiley-Blackwell; 2020:134-139.

Niemiec BA, Dhaliwal RS. Malignant oral neoplasia. In: Niemiec BA, ed. Small Animal Dental, Oral & Maxillofacial Disease: A Color Handbook. Manson Publishing Ltd; 2011:225-235.

Wingo K. Histopathologic diagnoses from biopsies of the oral cavity in 403 dogs and 73 cats. J Vet Dent. 2018;35(1):7-17. doi:10.1177/0898756418759760

Reiter AM, Gracis M, Romanelli G, Lewis JR. Management of oral and maxillofacial neoplasia. In: Reiter AM, Gracis M, eds. BSAVA Manual of Canine and Feline Dentistry and Oral Surgery, 4th ed. British Small Animal Veterinary Association; 2018:279-285.

Articles

Cancerous growths originating in the mouth region may require treatment with a veterinary dentist or oncologist

Identifying malignant oral tumors

April is the beginning of the second quarter, and it is a nice feeling. I have always felt that the first quarter of the year is the toughest, as it tends to drag a little. But now that the clocks have sprung forward, and we see glimmers of springtime approaching in various parts of our country, it makes us feel energized, rejuvenated, and ready to spend some time outdoors with our families and pets. I was chatting with my fantastic neighbor, telling him how nice it is to see him and the family outside and enjoying the weather here in the Northeast. He so eloquently stated, “I wish I could enjoy it, but my headspace is with my family in Ukraine.”

As the war continues, many animals have been stranded in the rush for safety along with the millions of refugees. According to the Associated Press (AP), a German organization has set up a shelter at the Ukraine-Poland border to help. All the animals are “very traumatized and very stressed coming from a war zone,” Sonja Mortensen-Dissing, a volunteer from Denmark, told the AP. Many animals are huddled and some are street dogs being grouped with lost pets. The Humane Society International is providing necessary support, including emergency funds, to groups that are helping the Ukrainian people and the animals in their care who have been devasted by Russia’s military invasion.

In the United States, many of us are doing what we can to support Ukrainian refugees and pets in solidarity. Marty Becker, DVM, founder of the Fear Free movement, dvm360® Advisory Board member, has gone further than most veterinarians. He has traveled to the Ukraine-Romania border and is working with the World Vets nonprofit organization to provide free veterinary services to animals from Ukraine in need of medical care. Visit 

We are better connected than ever. Social media, Zoom calls, and other telemedicine like apps have promoted the term “metafriends.” We have more international friends because of the pandemic, and that has made us check on our friends in Ukraine. We are a diverse, loving, and compassionate veterinary community. We know the importance of kindness and what it takes to be a good human being. In times of seeing humanity questioned, we as a veterinary community learn how to stay strong and support one another. Veterinarians are here not just for the animals but also for the people.

On behalf of dvm360® and MJH Life Sciences®, we stand with the people and the pets of Ukraine. We are here to support them in any way we can, because we know we are stronger together, regardless of borders and boundaries.

Stronger Together

With the onslaught of cloud—based veterinary practice management software (PMS) programs that have hit the veterinary marketplace over the past 5 to 7 years, are you starting to feel your in-house clinic-based PMS system has become obsolete? And that perhaps you’re getting left in the dust? Are you worried that without going to a cloud system it will be hard for your practice to reach its full potential? Recent technology has had a major impact on veterinary medicine practice. Fifteen to 20 years ago, you may have been asked if your practice was computerized vs operating off paper charts. Today, nearly all practices utilize a PMS system, and you are more likely to be asked if your practice software runs off an in-house server (local area network) vs a cloud-based server.

The move to software delivered via the cloud has been slow but sure, and over time, it is almost certain to become the status quo. Practices that are satisfied with their current in-house clinic-based server software often question what they will gain by moving to a cloud server. Is there something unique to this software that will propel their practice(s) to the next level? Certainly, some view the move as an unnecessary expense, and there is often trepidation associated with the data conversion process. Another concern is whether a new provider will have staying power and still be in business 5 to 10 years down the road.

A trend occurring with cloud software providers is that distributors and group practices are buying them out. Some practitioners are concerned that when these companies are no longer independently owned that they may not cater to a practice’s needs as well and that customer service may suffer. A share of clinics making the jump to the cloud now do so because their current software has become obsolete and their current provider is not investing in software upgrades.

The brick-and-mortar PMS companies that dominate the market continue to enhance their products so that they interface adequately with new third-party services and technology, especially related to laboratory and imaging equipment. Practices have not left in droves to join cloud-based PMS providers to date because these main players are meeting most of the needs of their clientele.

Yes, hospital management is often intrigued with cloud based software because it is new, sexy, and appears to be the wave of the future. On close inspection, however, some discover that aside from remote access, the features are not very different from their current software. From a functionality perspective, new software may be clunkier and not run as smoothly as the current software. Reasons for this stem from how well the data from the previous program converted into the new system, programmers still working out bugs in the software, and issues with spotty internet connections.

If moving to the cloud is in your near-term plans, then take time to do your due diligence. Consider having a committee complete this process. Ideally, test drive the top 3 cloud programs that you have an interest in and compare their features and functionality to your current system.

As a starting point, cloud platforms have a few key advantages: remote access, no need to maintain your own server and local area network, and no need to stress about doing your own backups. These are not insignificant, but how important are they to your clinic? And are you willing to make a change if the features and functionality are not as good as what your current program provides?

Be careful with items that are “in the works,” such as bidirectional connectivity with reference laboratories and storage of imaging. You may be told that it is on the near completion or it is a top priority; however, many of these items can take a long time to complete because they often are dependent on cooperation from independent vendors.

In the end, is there a system that wows you, gives a good bang for the buck, and improves practice efficiency? You may find that your current system is fine and that you are better off focusing on utilizing the features your provider has developed over decades in the veterinary space.

A percentage of veterinary practices may have compelling reasons to make a change. Group practices that want to manage one software and have remote access to all locations fit into this category. Additionally, new facilities, those with unsupported PMS software, and those with early-adapter management philosophy are also good candidates. On the other hand, clinics that are happy with their PMS system and have an “if it’s not broken, don’t fix it” mentality may want to leave well enough alone for the time being. In line with that, some will find it hard to ditch the management system they invested $10,000 or more into to now inherit an ongoing perpetual monthly fee that becomes another fixed cost.

More important than switching software is to have a key person or 2 on your team who knows your software system inside and out and monitors all updates. These are team members that you can send to seminars on your software and that are involved with group forums.

There is a lot of gold in most of these management systems, and most hospitals only use a fraction of the features. Maximizing the potential of your PMS system—be it clinic or cloud based—is the secret to pushing your clinic to the next level of success.

If you’re planning a change in technology, do your due diligence and compare
programs you’re interested in with your current system

Practice management software: is your head in the clouds?

They told us somewhere, in some class, in veterinary school that we all had a reason we wanted to practice veterinary medicine, that it was different for each of us, and that it would change as we matured in our career. They also said that by the end of our career, it would be obvious, as we looked back over the years, just what it was that we used as a motif.

They said for some of us it would be money, for others fame, or the challenge of medicine and surgery, or compassion for animals, or the effect on owners whose animals we care for. But for most of us, it would be a combination of all these things with an emphasis on one or two.

I have watched 27 years of practice pass by and wondered several times where I fit into this list. Most veterinarians have a compassion for animals—so I think that one is a given—but what has kept me going for all that time? One case best describes why I love this job so much.

Benny was an 80-year-old man that I had never met before. He stood before me with a 20-year-old gelding that had a seriously damaged left hock. All the skin was gone over the dorsal side of that area of the leg and the joint was open and contaminated. The gentle old gelding stood on the other 3 legs with both ears hanging low and a sad expression in his eyes.

“That is a terrible injury, sir. I am afraid that joint is badly infected, and it looks like it has been injured a few days already. There is dirt in the joint and no living skin left to suture. I am not sure how effective treatment is going to be, and it could sure run into a lot of money and still not save your horse,” I said with as much compassion and realism as I could muster.

One of the things you might not consider unless you are a veterinarian is the dilemma we face every time we are confronted with a situation like this. I had no idea if this man had the finances available for an undertaking like this, and I didn’t want to see the horse suffer if the client could not pursue the aggressive treatment that was going to be necessary to even have a chance of fixing this mess. If I place too much emphasis on the money, I look like I am just in it for the financial gain and not the best interest of the animal.

“What are you saying veterinary man? I drove 100 miles to get this horse here to you and I didn’t come all that way for a pessimist to tell me it can’t be fixed. I was hoping I had come to a place that had a staff with some confidence and know-how, but it appears I was wrong. I am an old man, and that horse is my best friend. Now fix him and I’ll be back to get him in a couple of weeks when he is well,” the man said in a tone that was somewhere between hateful and angry.

I stood with the intern as Benny glared at us for a minute from underneath the brim of his cowboy hat, ambled to his truck, got in, and drove away. I wondered if that guy had ever smiled even once in his life, as the truck disappeared down the road.

“Do you think there is any chance of fixing this horse?” the intern asked.

“It is bad. I have never seen a joint that messed up get happy, but let’s give it a try,” I replied.

“That old dude has no idea how messed up that leg is,” the intern said. “He seems to think it will just be a couple of weeks of hydrotherapy and then he is going to be rounding up cattle again. You know how much medicine, bandages, pain killers, lab tests, joint lavages, limb perfusions, surgeries, and time it is going to take to even have a 10% chance that that horse will be ridden again? That will cost the clinic thousands of dollars’ worth of just material, not to mention all the time and help it is going to require. You didn’t even tell him how much it will cost, and he never even asked. Usually when people don’t ask, it means they don’t intend on paying…. You gonna do it?”

“I bet he’ll pay,” I replied. “Get started on it. I don’t think he is as grumpy as he puts on.”

We went to work. It was a tough case with many places for failure to occur. We were about 4 days into treatment when the old man’s adult grandson showed up at the clinic. He was a kind man with a sincere expression and had seen the injury prior to the old man bringing the horse and realized how bad it was.

He told us all about it. Not the injury, but the story of the old man. The old cowboy had cancer. It was diagnosed about 3 months ago and it was not a good kind. That horse was his best friend, and he rode it ever day to check cattle in his pastures. It was the only horse he trusted enough to ride, and at age 80, getting pitched off could be deadly. Everyone in the county had offered to let him have a gentle gelding to substitute, but he told them that if he couldn’t ride his horse, he wasn’t going to ride at all.

The grandson went on to say that Benny was going to be in cancer therapy and surgery for the next 3 months. If we could get that horse fixed and ready to ride by the time they released Benny, it would be better therapy than all the medicine every hospital in the world had to offer.

Luck was on our side. We worked hard and that horse was a great patient. In 3 months, the leg had progressed to a point of healing that was far beyond what I had even hoped for. But we had not heard a word from the old cowboy. He would not answer his phone, and we didn’t have the grandson’s number. I wanted to tell him the good news and maybe give him a little hope, but I had no way of getting in touch with him.

One morning I got to work, and the grandson was in the parking lot with a trailer. I hadn’t heard from these people in 3 months and, for all they knew, the horse had died or gotten worse. And for all we knew, the old man had gotten sicker (or even worse). But here the grandson was, walking across the parking lot with a halter, ready to take ole’ grey home.

Two days later, I got a message on Facebook from the grandson. It was a photo of Benny with a glowing smile, gathering a pasture of cows on that horse. The caption was simple: “Thank you doc. You made one old man happy again! First time he has smiled in half a year.”

After 27 years, I know the reason I do this every day. Yes, it is to help that horse and every one like him that comes in. Yes, it is to make money and take care of the people who work with me and my family. Yes, it is to have some notoriety and face the challenges of hard cases. But, that story may be my true motif. There is just nothing better than watching people smile because some horse, dog, cat or other critter is still in their life, and we had something to do with keeping it that way.

How a cowboy with cancer and his horse with a leg injury made me realize why I became a vet

The 80 year-old man 

A lot has happened since 2018 when published results of the first clinically relevant peer-reviewed study showed safety and efficacy of cannabidiol (CBD) in reducing pain in dogs with osteoarthritis.

Despite being used for thousands of years in both humans and animals, cannabinoids—the therapeutic molecules found in 

Linnaeus—have been stigmatized or considered an illegitimate or illegal therapeutic tool for veterinary patients since the 1930s. This largely stemmed from legal prohibition at the federal level, which still exists today.

 There is much to be done to educate clinicians about the therapeutic indications for cannabinoids, as well as dosing ranges and harm reduction. 

For clinical application, data from preclinical studies and veterinary specific clinical trials show the legitimacy and usefulness of these compounds in veterinary populations. This is especially true when comparing cannabinoid use with other novel or integrative techniques already well adopted by veterinary practitioners despite limited or conflicting evidence. However, the data on how these compounds work still need further research and dissemination to practitioners, in addition to larger powered studies and diversity in clinical use. 

Although there is no FDA-approved veterinary CBD product currently available, at least 10 pharmacokinetic (PK) studies on CBD in dogs have been published, in addition to 3 safety studies evaluating clinical presentation of CBD-dominant products at various doses.

 For cats, there are 2 PK studies and 2 safety studies at various doses.

In addition, there have been 2 published PK studies on horses, and 1 PK study on dairy calves, and multiple PK studies are underway on various species.

 It should be noted, given the vastly different formulations and ratios of various cannabinoids (there are more than 120 described so far), that it cannot be assumed all products will have the same bioavailability or efficacy when compared with those used in the published studies. Despite alkaline phosphatase elevations in a small percentage of dogs and a transient alanine aminotransferase elevation in 1 cat in 1 of the studies, the therapeutic index appears to be very high, meaning these products are safe when properly manufactured and tested. 

Studies on pain management with cannabinoids such as CBD have not addressed effectiveness on acute pain, although anecdotes suggest effectiveness. However, 5 peer-reviewed studies show moderate to good efficacy in decreasing pain scores in dogs with chronic pain from osteoarthritis.

 Another possible use of cannabinoids is for epilepsy. One published study showed an approximate 33% decrease in seizure frequency and severity with the addition of what is considered a low dose of a CBD-dominant product for dogs with intractable idiopathic epilepsy when comparing dosing of CBD for epilepsy in people.

 A longer-term study using a higher dose is underway. 

Results of a randomized PK study showed that administering phenobarbital with a CBD product led to no major concerns for drug-to-drug interaction.

 In addition, anxiety and behavior modification warrant better-designed clinical studies. Two published studies show some or no change in the temperament of shelter dogs given CBD when exposed to loud auditory triggers and animal caretakers.

 Other studies are investigating CBD use for conditions such as atopic dermatitis in dogs, stomatitis in cats, epilepsy in dogs, quality of life in canine patients with cancer, acute pain in dogs, and anxiety in cats. 

Products derived from hemp—defined as any cannabis plant with less than 0.3% Δ-9-tetrahydrocannabinol (THC)—remain legal at the federal level, whereas the legality of products derived from marijuana (defined as any cannabis plant with more than 0.3% THC) varies from state to state. Even in states where all forms and uses of cannabis have been decriminalized, guidance from state boards of veterinary medicine ranges from no guidance to legislation and regulations around veterinarians’ ability to recommend or even discuss the use of cannabis in their patients. In Nebraska and Idaho, any cannabis-derived product is illegal, regardless of whether it comes from marijuana or hemp. 

The authors reached out to 48 states’ veterinary medicine boards and received responses from 19 (

). The authors believe that products derived from hemp belong in the same category as other nutraceuticals or supplements that veterinarians recommend every day, often with less scientific backing and data than what exists for cannabinoid-containing products. To that end, CBD has a monograph in 

Research on this cannabinoid is limited but growing.

 CBG is a precursor molecule for many of the cannabinoids produced by the cannabis plant, including both CBD and TCH. It is noninebriating and demonstrates effects on the neurological system, making it a potential therapeutic in epilepsy and other neurological conditions. Human studies are underway for its use in Huntington disease, Parkinson disease, irritable bowel syndrome, and inflammatory bowel disease. It has high affinity for both α2 and serotonin receptors. 

This cannabinoid is a product of oxidation or aging of THC and is often found in products that have been stored for long periods or those exposed to heat during storage. It binds to CB1 receptors in the endocannabinoid system, just as THC does, but is approximately 75% less potent at these receptors than THC. In historic studies, CBN has shown sedative and anticonvulsant effects, which has led to its use as a sleep aid in humans. Recent human-based research has not demonstrated clear evidence of CBN as a sleep aid, though it may work in this way as part of the entourage effect when combined with other cannabinoids and terpenes in full- and broad-spectrum products.

This terpene has been isolated as the primary active ingredient in catnip and silvervine and is 1 of the hundreds of terpenes found in cannabis. At least 1 veterinary cannabis company is looking to develop nepetalactone in feline products to harness its therapeutic effects of mild sedation and euphoria. 

The “new kid” on the block, ∆-8 THC is a molecule that can be synthesized from CBD, including CBD that is derived from hemp. In this way, it is marketed as legal THC. It is completely unregulated and requires the heavy use of industrial solvents and other chemicals to force the conversion of CBD to ∆-8 THC, some of which may remain in any final product. ProVerde Laboratories has tested hundreds of such products with a wide variation in cannabinoids and other molecules found, some of which have no safety data whatsoever. ∆-8 THC is reported to be anywhere from 20% to 80% less potent than ∆-9 THC (the naturally occurring isomer of THC found in cannabis), requiring much higher doses for similar effects. There is no veterinary indication for its use, and safety concerns, as well as lack of consistency, make it questionable for human use as well.

For information on the legal status of all forms of cannabis in your state, visit 

Liz Hughston, MEd, RVT, CVT, LVT, LMVT, VTS (SAIM) (ECC); and Stephen Cital, RVT, SRA, RLAT, CVPP, VTS-LAM, co-authored the textbook 

Cannabis Therapy in Veterinary Medicine: A Complete Guide

, with fellow co-authors Katherine Kramer and James S. Gaynor. The book was released in 2021.

Gamble LJ, Boesch JM, Frye CW, et al. Pharmacokinetics, safety, and clinical efficacy of cannabidiol treatment in osteoarthritic dogs. 

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Canines need to be transported for a multitude of reasons, including recreational travel, moving to a new home, exhibition in a show, relocations from homeless shelters, and mass evacuations during catastrophes. As veterinarians, we should ensure all these patients reach their destination as safely as possible. But what if those same patients are heartworm positive? 

Although heartworm disease brings additional complications to all forms of transport, the following guidelines can be used to successfully get a canine with heartworm disease from point A to point B. 

Evaluate your transporatation candidates carefully

All dogs should be assessed before travel. Categorize each patient that is heartworm positive (HW+) and assign a risk assessment. A low-risk patient may be a dog that is 12 months old with no clinical signs; a moderate-risk patient may be older with mild symptoms, and a high-risk patient could be a canine that is aged 7 years with breathing issues and syncope. 

These designations can alert transporters and point personnel along the way and can provide clarity so that handlers know which dogs need monitored the most, especially in group situations of HW+ transfers. All dogs with HW+ status will carry risk for travel, even in the lowestrisk group. If possible, travel should be delayed or abandoned in the high-risk group. 

In a perfect world, each HW+ patient would receive the proper American Heartworm Society guideline treatments and be allowed to fully recover before any travel is attempted, but this ideal is not always the reality, especially in shelter removals and mass-evacuation procedures. Initial steps in the process should be completed as soon as possible after positive diagnosis. All treatments will need timed correctly based on travel dates provided, and time should be allotted to allow monitoring for the first heartworm prevention dosage. Dogs can also be started on doxycycline and prednisone before they are sent off to travel. 

Adequate supplies of all medications should be sent with each dog so that treatment can continue seamlessly during travel and in the immediate arrival period. Again, dogs that are clinically sick from heartworm disease should have travel plans aborted until they can receive proper care. 

It is extremely important to have all documentation travel with the HW+ dog. This would include type of testing (microfilaria, antigen, etc), tests used (Accuplex, 4Dx, etc), and dates of testing; heartworm prevention treatment manufacturer, type, and date(s) of dosing; and any other medications started as well as the dosages and dates given. If the dog has already received melarsomine injection(s), include the dates and sites administered. In situations where multiple HW+ dogs are traveling together, each should have their own separate paperwork. Every person along the route of these patients’ journey needs access to this paperwork so they understand where this patient is in the treatment process and so the information is readily available with that patient in case of a medical emergency. 

Travel can be very stressful to canines not acclimated to it, and heartworm disease compounds this problem. We can mitigate some of these issues with a little preplanning. 

Plan out the shortest travel times in advance, and be sure not to overcrowd travel vehicles. Use appropriately sized travel crates. Crates also should have a waterproof bottom and adequate ventilation, and crate coverings can add more comfort. Use blankets with pheromone treatments and antianxiety medications to keep patients calm, and play white noise or calming music. 

HW+ dogs need severe exercise restrictions; this should be a required communication to all personnel transporting and receiving these canines. It is not uncommon during heartworm disease treatment to have 8 to 10 weeks of exercise restriction. Leash control is a must for these dogs. Daily activity must be kept to a minimum to keep heart rate and blood pressures as low as possible. It is important that every point-ofcontact person realizes this to ensure the best possible trip and the fewest emergency situations. 

Treatment, travel, and receiving are challenging but achievable
with a coordinated, detailed plan

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