When faced with renovating the West Kendall Animal Hospital in Miami, Florida, which is a more than 25-year-old practice that had a distinctly 1980s look and small 2,100 square foot space, the architects at Rauhaus Freedenfeld & Associates focused on making the most out of their available footprint. The dvm360 team spoke with Eric Nelson, AIA, associate at Rauhaus Freedenfeld & Associates about the small touches that made a big difference for the Under 8,000 square foot Hospital of the Year winning hospital in the 2019 dvm360 Hospital Design Competition.

West Kendall Animal Hospital was resourceful in where they placed their cabinetry to maximize storage space. “It was a very tight project in terms of overall space available, but we mined every inch of it for storage,” Nelson says. The kinds of storage needed were broken down into very accessible, less accessible and long term. Cabinets are intelligently placed, from below the countertops to lining the ceilings down the staff corridor and accessed only by a rolling ladder. “This is the most highly engineered project in terms of storage that we've been involved with to date.”   

Using their surroundings in Miami as inspiration, the finishings in the lobby bring to mind ocean views.Located within an unremarkable strip mall, the West Kendall Animal Hospital shines as an urban, sophisticated space that evokes thoughts of the ocean. “The wood variety was selected to mimic driftwood, and the glass tiles connote the sense of light on water. The blue background reinforces that,” says Nelson. A 

 ceiling treatment creates a focal point, running across the ceiling and down the wall behind the reception area, and the soft colors of the laminate cabinet adds a calming vibe.

By expanding their leasehold, the clinic was able to add a third examination room.The West Kendall Animal Hospital was able to expand their leasehold to take over half the adjacent space, increasing their square footage by approximately 500 square feet. “This gave us just enough space so that inpatient areas had sufficient depth,” Nelson says. “We wanted the functionality to revolve around the center of the hospital,” and the expansion gave them room to do that. They also kept up the quality of the finishes into the back of the hospital, maintaining a warm feel throughout.

Articles

When building or renovating your veterinary practice in a small space, take notes from the 2019 under 8,000 square foot Hospital of the Year.

Storage wars: Animal hospital edition

When it comes to work-life balance, our Fetch dvm360 conference speakers walk the walk, not just talk the talk. They are busy people, just like you-striving to have fulfilling professional lives while nurturing their personal lives. There's veterinary behaviorist Dr. Lisa Radosta, who runs hours at a time to 

. There's practice management speaker Dr. Sarah Wooten, who 

. There's veterinary endocrinologist Dr. David Bruyette, who takes on 

And then there's veterinary behaviorist Dr. John Ciribassi, who loves riding motorcycles so much that he has created a motorcycle touring company to share his passion with experienced riders. Dr. Ciribassi and his business partner, Clecio Sousa, recently launched 

Dr. Ciribassi says their goal is for riders to experience the same rewards that they do every time they ride-“the sense of exploration, seeing new sights and, most of all, meeting new people and developing friendships.”

Dr. Ciribassi began riding in seventh grade on a pull-start mini-bike and has been riding motorcycles ever since, except for a break in college and veterinary school. He currently rides either a KTM 1090 Adventure R or a KTM EXC 350F-adventure bikes that can handle both highway and off-road travel. “Most MotoRide trips will be mainly off road,” he says.

Dr. Ciribassi says that riding motorcycles, especially off road, “takes you to places you would ordinarily not get to see-remote areas of Colorado and Utah, the Mojave Desert outside Las Vegas, Death Valley, the forests up the eastern seaboard from Virginia to New York, the Maritime Provinces of Canada and the Alps.”

Veterinary behaviorist Dr. John Ciribassi will be presenting behavior sessions at the Fetch dvm360 conference in 

To learn more details about his motorcycle tours, visit 

. The tours during Fetch are for intermediate riders, and you don't have to bring your bike (unless you want to); rentals will be available.

Dr. Ciribassi's favorite rides have included one through the Alps (Belgium, Switzerland, Italy and France), which he took with his wife and some friends, riding double. His other favorite: the Colorado Backcountry Discovery Route, a ride he, Clecio and two other friends did last July. “It was mostly an off-road ride through Colorado, starting at the Colorado-Wyoming border and finishing at the Four Corners area in southwestern Colorado,” On this week-long trip, he says, “We had a few bumps in the road, in terms of some bike issues-broken foot pegs, a stuck starter switch and flat tires.” On one of the bikes, a bolt securing the axle came loose. They also came upon a mountain pass that was a challenge to navigate with their larger adventure-style motorcycles; they had to maneuver the bikes down a steep rocky section without going over the side. Dr. Ciribassi concludes, “The coolest thing was the way the four of us pulled together at every turn to support each other so that we could continue the journey and get to the end of the ride together.” True, the tours that Dr. Ciribassi guides won't be as difficult as that ride wound up being, but this is where the real adventure lies: getting the most out of what is inside you and sharing the experience with friends.

Dr. Ciribassi says, “There used to be an old Honda commercial with the tagline, ‘You meet the nicest people on a Honda.' I would generalize that line by saying that you meet the nicest people on motorcycles.”

John J. Ciribassi, DVM, DACVB, earned his DVM degree from the University of Illinois in 1984. He received his board specialization from the American College of Veterinary Behaviorists in 2006. He sees behavior cases at Chicagoland Veterinary Behavior Consultants (CVBC) and is co-editor of 

Decoding Your Dog: Explaining Common Dog Behaviors and How to Prevent or Change Unwanted Ones

. Dr. Ciribassi lives in Carol Stream, Ill., with his wife and daughters. He (obviously) enjoys motorcycling in his spare time.

You meet the nicest people on a ...um motorcycle. So, let the good times roll  because its not the destination, its the journey. 

Born to ride: Veterinary behaviorist John Ciribassi launches a motorcycle tour company

dvm360's 2018 Firstline Career Path Study surveyed the salaries of credentialed veterinary technicians, veterinary hospital managers, veterinary assistants and receptionists. 

Out of 399 respondents, nearly 32 percent reported making $10 to $15.99 an hour, while 41 percent reported an hourly wage of $16 to $20.99. 

With years of training and potential mounds of student debt, we wanted to see how the compensation of veterinary team members compares to jobs that require little to no formal education, so we checked PayScale. This is what we found: 

Source: 2018 Firstline Career Path Study, PayScale.com.

These jobs provide a similar pay rate to those in the veterinary industrythey also require little to no formal education.

Should you have been a plumber? Comparing vet team pay to other jobs

Never have I ever ... driven myself too hard as a veterinary professional and lost sight of my health, my family, my sanity ... ?

If you've never played ‘Never Have I Ever …,” it's simple. A question is asked, and participants raise a two-sided paddle, showing one side to the audience: “I have” or “I have never.” To our amazement, when we used this game in Women's Veterinary Leadership Development Initiative sessions at 

, attendees admitted all sorts of things-tasting pyrantel pamoate, asking clients on dates, peeing in pools and secretly wishing they were wizards at Hogwarts. (As an aside, I think veterinary professionals possess the courage of Gryffindors and the knowledge of Ravenclaws, and where is my letter?)

Apart from being fun and hilarious, the game was revealing. Almost everybody admitted to telling lies to avoid conflict with co-workers, wishing they could leave work on time and cussing out clients behind their backs. Many people admitted to staying in toxic jobs because they were afraid. Mostly, the game taught us that we aren't facing the challenges of life in vet med alone and that it's safe to talk about the things that haunt us in this profession-namely, conflict, fear and poor self-care …

Never have I ever… been stressed by conflict with a coworker or client

We've all been there. When you're in conflict with another person, it's hard to know whether to die on that hill or keep quiet. According to Dr. Thierren, conflict avoidance is when a person does not deal with the conflict at hand-instead, they use other tactics, such as ignoring the problem, changing the subject, complaining to someone else or shutting down.

Conflict avoidance is easy, because it deludes our brain into thinking we're safe from the conflict. The feeling of relief you get reinforces the avoidance behavior, making it more likely that you'll avoid conflict again in the future. The problem is that conflict avoidance can silently rot an organization and your emotional health from the inside out. Suppressed emotions, anyone?

Avoid getting bogged down in the stories you tell yourself about why people do things-stick to facts.

Dr. Therrien (who knows what she's talking about, BTW, as she manages more than 100 hospitals and spent a decade working for Canada's own border patrol) says that if we don't deal with conflict, we stunt our own personal growth. Instead of avoiding, we can choose to view conflict as an opportunity to change and grow. In her professional career, Dr. Therrien found 

The premise is simple: Anytime you find yourself stuck, there's a crucial conversation you're either not holding or not holding well. Above all, these crucial conversations must be safe.

Dr. Therrien recommends starting with empathy and positive intent, managing your emotions and mindset, maintaining a place of mutual respect and avoid getting bogged down in the stories you tell yourself about why people do things-stick to facts and own your contribution to the conflict. Ego is not allowed in crucial conversations. Following these recommendations could get you to a place where you can brainstorm new strategies to find mutual solutions.

Never have I ever ... chosen to care for others over myself

, the word is out: Vets are more likely to die by suicide than many others. Dr. DeWilde redirected some of her own energy as a veterinarian towards correcting some bad self-care habits that infect our industry. More often than not, vets are working more than 40 hours a week and spend six to seven days a week in the clinic.

For Dr. DeWilde, the moment of reckoning came when she realized she'd been devoting her life to a clinic that didn't appreciate her, and because she left for work so early in the morning, she didn't even know what her 1-year-old son ate for breakfast. During the session, Dr. DeWilde shared several tools that helped her course-correct, including establishing and sticking to boundaries and taking time for herself.

It's amazing how many veterinarians have unused vacation hours accruing … for what? Take it now.

When asked if they worked through lunch, almost every attendee raised the “I have” paddle. While it might not seem important, scheduling and actually taking breaks (and leaving the building!) is a must. Fifteen-minute breaks? Take them. Go outside. Walk. Breathe. Appreciate the birds or the sky or the lack of barking dogs. The work will still get done. How about your vacation time? It's amazing how many veterinarians have unused vacation hours accruing … for what? That magic time in the future when they'll have permission to take time for themselves? Take it now.

From experience, I know that you cannot pour from an empty cup, and if you continue to do so, your body, your mental health, your emotional health and your relationships will suffer. Take one step now to improve your self-care. It doesn't have to be huge to make a big impact.

Never have I ever ... wanted to tackle a new challenge but was too afraid of failure

I spent years imprisoned by fear. I stayed in jobs that sucked me dry, because I was afraid I wouldn't find anything else. I tiptoed through life, hoping to make it safely to death. The saddest part was that I didn't even know I was afraid. It felt like I'd been conditioned since birth to avoid risks, be a good employee, follow all the rules and never make mistakes.

What I didn't realize was that my fear of failure was greater than my faith in myself. Then one day, I woke up. Even though fear still had power over me, I realized that at its root, fear was a 

 and I could choose whether I listened to fear or not.

So I cut the crap. I geeked out on books about fear and mindsets. I went to neurofeedback and talk therapy. I started meditating. I cut my excuses and started doing things that were 

 outside my comfort zone, like public speaking, diving with sharks and half-Ironmans. I stopped watching the news, I took Facebook off my phone, and I 

 to engage with scary thoughts at night. I confronted my fear of failure head on, and books like 

We are in charge of the life we design. Taming conflict and fear and engaging in self-care like a MOFO are all ways to get out of victim mode and take control of how we spend our days on this planet. How are you spending yours?

Some of our more fun choices for the game

This article is real talk about tough situations, but our “Never Have I Ever …” game also had some fun (and funnier) choices. Here are a few. Have you ever …	

Gone shopping with blood splatter on your skin/clothes?

 Grossed out your significant other by talking about a cool case during dinner?

Worn the same underwear two days in a row?

Not presented the gold standard because you thought the client wouldn't pay for it?

Wished you could tell a client where to shove it?

Dr. Sarah Wooten graduated from UC Davis School of Veterinary Medicine in 2002. A member of the American Society of Veterinary Journalists, Dr. Wooten divides her professional time between small animal practice in Greeley, Colorado, public speaking on associate issues, leadership, and client communication, and writing.  

At Fetch dvm360 conference, we're the support system you need. With every conference this year, we intend to nurture your mind (meaning quality CE for days) while also encouraging you to take stock of your physical and emotional health. 

Ever noticed that people tend to be a lot more honest about their life choices when asked to tell the truth in a game? This phenomenon is exactly what Drs. Caitlin DeWilde and Kimberly-Ann Therrien and I experienced when we used a popular party game to teach life lessons in Women's Veterinary Leadership Development Initiative sessions at Fetch dvm360.

'Never have I ever ... ': Veterinary edition

For a better boarding experience, this cat needs to be separated from dogs, out of sight of other animals and given a place to hide inside its enclosure. It's easy to assume that a boarding environment in your veterinary hospital can't ever 

 be comfortable for the residents, because it isn't home. This actually need not be the case. 

 and the growing body of data supporting low-stress techniques to enhance patients' experiences in your facility.

Creating a Fear Free boarding environment does not mean a complete facility makeover. Far from it! Attention to detail, some imagination and an understanding of Fear Free principles-coupled with the willingness to look at the boarding experience from your patients' perspective-can transform simple overnight care to true tender loving care.

This may seem self-evident, but I've been in facilities that still house cats and dogs in the same wards. Even in a small physical plant, your patients' emotional well-being is best served by keeping dog and cat spaces separate.

Adjust sight lines: Provide visual barriers

Fear Free boarding means creating visual barriers between occupants. One example is making all the cages in a ward face a single direction to eliminate any aggressive posturing or the stress of feeling pursued or dominated by patients across the way. Some pets may appreciate a privacy curtain at the front of their spaces.

Adjust sight lines: Cats like to hide and go vertical

If possible, install cat-specific condos. These provide great flexibility in housing, and most have built-in shelves for cats to climb onto. There are also made-for-cats cubbies that can be placed in an existing cage to provide privacy and offer a raised surface for perching.

Change your protocols: Pheromones, pheromones, pheromones

 Classic diffusers in the cat spaces. Adaptil reminds dogs of time with their mommas, and Feliway leverages the way cats mark objects with their chins and faces. Another option for dogs is an Adaptil collar, which creates a “zen zone” around their head. You can also spray dog bedding with Adaptil and cat bedding with Feliway about 10 to 15 minutes before a patient arrives. Ask team members to spray their tops or jackets with Feliway and pants with Adaptil at the beginning of their shifts and halfway through the day. This reassures the residents.

Change your protocols: No harsh chemicals, please

Quaternary ammonia and bleach products are effective at killing bugs, but equally effective at rendering cats and dogs “nose blind.” Cats and dogs rely heavily on their sense of smell, so it's incredibly disorienting for them to lose that sense. It's time to use the same accelerated hydrogen peroxide products that are used in most human hospitals. (Virox makes 

) These products kill all the bugs, but break down into water and oxygen-no odors and no residue.

Touch up your interior design: What's on 

Paint is an inexpensive way to make big visual changes. For years, bold colors were “in.” But when we look at the boarding experience from the pets' perspective, we need to consider 

 emotional well-being. Pastels and pale colors 

. Avoid reds and oranges, and allow the color focus to include towels, scrubs and bedding. Consider this easy redo.

Touch up your interior design: Lights, lights, lights

Pets don't enjoy traditional fluorescent lights. They can hear the constant hum of the fixtures, and the conventional fluorescent spectrum is harsh. 

 with a color temperature of 4000K or higher. Another benefit is, these lights last a long time. Consider adding recessed “can” lights in the ceiling with rheostats for adjusting the brightness. These can provide softer overnight lighting, allowing patients to see the environment but remaining dimly comfortable to support good sleep.

Audiology research has revealed that certain pitches and rhythms induce a physiologic relaxation response in cats and dogs (different for each-no surprise). There are music players available from 

 that offer hours of music on an endless loop. The music can also be streamed online through another device.

Change your protocols: Don't wait-medicate

Finally, be aware of the various nutraceuticals that have been shown to decrease anxiety. This may be an important component of creating a Fear Free boarding experience. Be sure to gain pet owner consent before providing these options.

As you can see, with a bit of forethought, a relatively small monetary investment and a little imagination, you can transform a so-so or stressful boarding experience into a fabulous “Fear Free resort” experience.

Dr. Robin Downing, who holds a master's degree in clinical bioethics, is a diplomate of the Academy of Integrative Pain Management, a diplomate of the American College of Veterinary Sports Medicine and Rehabilitation, a certified veterinary pain practitioner, a certified canine rehabilitation practitioner, and hospital director at the Downing Center for Animal Pain Management in Windsor, Colorado.

You cant guarantee that every patient or pet staying in your veterinary hospitals boarding wont get scared, but you can make some small tweaks to make their stay less stressful and more comforting.

Bring down the stress in boarding

Safety is always a concern, but for cats, so is obesity. 

 is designed to improve felines' physical and mental health without having them go outside. The wheel is designed for cats that do not exceed 25 lbs. According to One Fast Cat's website, this product is best fit for trainable cats with moderate to high energy levels.

We went ahead and asked three veterinarians to watch the video above (from One Fast Cat's website) and share their thoughts on the product's design, as well as the potential pros and cons. Here's what they said:

The videos of the cats that I've seen using exercise wheels show cats doing it voluntarily and happily. As for whether or not they are well designed, that's going to vary by wheel. The one that you sent me looks pretty sturdy. If the cat is trained with positive reinforcement and chooses to perform this activity, it could be a great way to fight obesity and enrich the cat's life.

They seem safe enough, and not as bad as some of the knuckle-headed stuff cats will just do on their own. [Dr. Petty said he is considering purchasing an exercise wheel since one of his daughter's 10-month-old cats is already out of shape.]

I wish I'd been the one to have the creative insight to invent this amazing cat exercise equipment! Here we have, in one device, mental and physical stimulation for a species that is often overlooked for such things.

We know that in order for cats to be as safe as possible, and to live as long as possible, they really need to live indoors. We also know that cats are extremely intelligent and that they do best when they have a rich environment in which to live-lots of mental stimulation. Hence, the interest in environmental enrichment that my behaviorist colleagues continue to unravel, address and guide us 

Indoor cats don't receive the natural exercise that cats who live outdoors obtain. So, in addition to the mental doldrums in which cats may find themselves, they don't burn calories. Obesity remains the single most important preventable disease we deal with in feline patients. Fat cats will become diabetic, if left to their own devices. In addition, we can't treat obese cats like we do overweight dogs-remember the book, 

, that's not going to work with cats! I love the idea of helping cats learn how to burn calories and build muscle by utilizing a game/toy like this one.

There is one potential problem that we have to be aware of and to speak to our clients about if we recommend a cat wheel to them.

 is a potential two-edged sword. Some cats will become very OCD when they are taught to chase a laser pointer. It is important for people training cats to use an exercise wheel to utilize different enticements in order to minimize the risk of creating an obsessive “monster.”

Hamster wheels, but for cats. We asked three experts for their thoughts on One Fast Cat exercise wheels.

Entertaining to watch, but is it safe for cats? Veterinarians weigh in on cat running wheels

 What's the one thing you wish pet owners understood about cannabidiol (CBD) in dog treats?

If I had a magic wand, I'd teach everyone in the world about the numerous therapeutic effects of cannabinoids when used safely and under the direction of a cannabis-trained veterinary practitioner. In addition, I'd tell them that CBD is only one of hundreds of phytocannabinoids available.

What pet conditions or concerns do CBD dog treats address?

, I would refer to the recent study published out of Cornell University that shows a wide safety profile and great success in pain reduction related to osteoarthritis in dogs.1 But that is only the tip of the iceberg. Dogs with conditions such as epileptic seizures, anxiety, acute pain, poor appetite and nausea could also experience benefits from cannabinoid-infused treats. Preliminary results from an in vitro study looking at the cancer killing ability of ElleVet in four different canine cell lines were also recently released.2 In addition, 

 from Dr. Stephanie McGrawth's lab at Colorado State University reportedly showed 89% of canines that received CBD in a clinical trial had a reduced frequency of seizures compared to 43% in the control group. While we don't have studies for specific conditions other than OA in dogs published so far for companion animals, we do have numerous studies in lab animal models and humans on the efficacy of cannabis products for several conditions such as epilepsy, anxiety, inappetence and nausea.

What particular role can veterinary technicians play in educating pet parents about CBD?

In the words of Dr. Casara Andre, founder of 

Veterinary Cannabis Education and Consulting

, we must teach harm reduction to veterinary staff and pet owners. There are too many bogus products flooding the market. The only way for our patients to be safe is if veterinary personnel take the initiative to educate themselves on cannabis products, despite federal or state laws on the topic of prescribing, recommending, discussing or dispensing cannabis products.

Technicians can act as liaisons between DVMs and clients' questions and concerns. Veterinary Cannabis also offers a program for technicians to become certified consultants. 

 What would you recommend to other vet team members when they discuss CBD in dog treats?

 If team members are asked about CBD or cannabis products, I would encourage them to pass the question off to someone who is well-versed on the endocannabinoid system, potential drug interactions, the pros and cons of cannabis therapy and how to choose the right product for the patient.

Once again, a great tool for educating oneself about cannabis is

 or the Veterinary Cannabis Academy on Facebook.

What would you recommend to a vet team member who's interested in discussing these products with a skeptical practice owner or manager in order to provide them as a retail option to clients? What tips would you give?

 If a team member wanted to discuss cannabis as a modality within the hospital and is being met with resistance, I'd encourage them to ask why the practice owner or manager has reservations. If concerns are about the legal climate, that's fair. I suggest checking with their state board. I would also encourage them to read the revised Farm Act of 2018 and its specific language surrounding hemp and its derivatives. If they are concerned about the “evidence”, I would remind skeptics that there are over 23,000 scientific papers on cannabinoids in humans, lab animals and companion animals in 24 different species that have been published. I'd also encourage them to get CE on the topic from a qualified cannabis educator that has practical experience.

Gamble LJ, Boesch JM, Frye CW, et al. Pharmacokinetics, safety, and clinical efficacy of cannabidiol treatment in osteoarthritic dogs. Front Vet Sci Jul 23;2018:165.

Levine CB, Bayle J, Biourge V, et al. Effects and synergy of feed ingredients on canine neoplastic cell proliferation. BMC Vet Res 2016;12:159.

Stephen Cital, RVT, RLAT, SRA, VCCS and VTS-LAM, is the Academic Liaison for the Society of Laboratory Animal Veterinary Technicians, Executive Director at the Academy of Laboratory Veterinary Technicians and Nurses, Chief Operating Officer of the Veterinary Anesthesia Nerds and co-founder of the Veterinary Cannabis Academy.

Get the lowdown on what conditions CBD has shown efficacy for, where to learn more about it, what supporting role you can play, and more. 

5 quick Q&As on cannabidiol use in veterinary practice

Here's a scenario: A 9-year-old, 25-lb (11.3-kg), fixed, mixed-breed male dog is brought to your clinic because, as the owner says, “Something is off with Marley.” The owner reports that Marley hasn't been eating much and is lethargic.

Is gastrointestinal (GI) bleeding on your differential diagnosis list? According to Jonathan Lidbury, BVMS, MRCVS, PhD, DACVIM, DECVIM, it should be.

, Dr. Lidbury explained that although GI bleeding can be obvious with clear GI signs, this isn't always the case. Sometimes the only noticeable clinical sign is a behavioral change or anorexia. Luckily, Dr. Lidbury outlined a step-by-step approach for diagnosing obscure (cause is identified by using endoscopy) or occult (cause can't be determined by using endoscopy) GI bleeding.

Check vitals, stabilize the patient, complete a physical exam

Dr. Lidbury emphasizes checking for petechiae; looking for blood in all orifices (e.g. nose, eyes); performing a rectal examination to check for blood, masses and other foreign bodies; and, finally, palpating the abdomen.

Question owners about access to drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, antithrombotic drugs and heparin and if the pet could've been exposed to coumarin rodenticides. A description of recent bowel movements is also needed.

Order a complete blood count and serum chemistry profile

Results may reveal anemia, hypoproteinemia, an increased blood urea nitrogen (BUN)-creatinine ratio or variable platelet counts. However, Dr. Lidbury says that normal blood results don't automatically rule out GI bleeding. Other lab tests, such as a coagulation test or a fecal direct smear, can be useful for identifying or ruling out potential causes of bleeding.

GI ulceration is difficult to capture with abdominal ultrasonography, but Dr. Lidbury says you may see mucosal thickening, a mass effect, thickening around an ulcer or a crater. Ultrasonography isn't a definitive diagnostic tool, but it can detect abdominal masses and lesions of other organs that may help you rule out GI ulceration, Dr. Lidbury says. Abdominal radiography is not a good way to detect GI ulceration but is useful for identifying foreign bodies, masses or free fluid.

Visualize the GI tract with endoscopy or surgery

If you still suspect GI bleeding but haven't been able to confirm it, endoscopy or exploratory laparotomy is the next step. Dr. Lidbury recommends endoscopy over surgery since it allows you to look for a lesion from the inside rather than looking for it from the outside. However, both methods have pros and cons. For example, endoscopy allows you to biopsy lesions but doesn't allow you to resect them.

Endoscopy is a definitive tool in diagnosing GI ulceration in most of the GI tract. Unfortunately, it isn't possible to assess the entire GI tract with conventional endoscopy; there is a section in the middle of the tract that is inaccessible. Dr. Lidbury suggests endoscopy combined with exploratory laparotomy if you can't find a lesion by using conventional endoscopy. With this method, the surgeon pulls the intestine over the endoscope, guiding it further into the GI tract than a conventional endoscopy could do alone. While this is time-consuming, Dr. Lidbury says it allows you to visualize the entire GI tract.

Another option is capsule endoscopy, where the dog swallows the capsule (

.) The capsule travels the entire GI tract, taking 360-degree images along the way. The images are stored in the capsule itself, so once the capsule is recovered, the images are available for download. Dr. Lidbury performs capsule endoscopy in tricky, occult cases. This method may also be helpful in practices that don't have an endoscope. One downside is that you can't get a biopsy, and it should only be performed in patients over 13 lb (6 kg).

Ideally, you treat the underlying cause of the bleeding, Dr. Lidbury says. For example, you would resect a tumor if it's the cause or administer vitamin K if there's vitamin K antagonism. Occasionally, resection of gastroduodenal ulcers is recommended. However, for GI ulceration, medical treatment is standard.

Sucralfate, proton pump inhibitor (PPI [omeprazole, pantoprazole]) or famotidine therapy (although this is less effective than PPIs) is the generally recommended medical treatment. Dr. Lidbury's treatment of choice is usually sucralfate combined with PPI. There does not appear to be an advantage to combining PPIs with famotidine.

Although it seems like a fecal occult blood test would be an important diagnostic tool in regards to GI bleeding, Dr. Lidbury rarely performs it. He says that it results in a lot of false-positives, most likely because of a patient's diet. Dr. Lidbury does note that there are sensitive and specific tests used in human medicine, and he is hopeful that a similarly effective assay will be developed for veterinary medicine.

(Disclosure: Dr. Lidbury has acted as a paid speaker for and received funding in support of research from Infiniti Medical.)

Gastrointestinal bleeding in dogs is not uncommon. Unfortunately, the signs can be subtle. Follow this approach from Dr. Jonathan Lidbury when presented with patients with suspected GI bleeding.

Suspect GI bleeding? What to do when you don't see red

Forget arachnophobia. Think entonophobia, the fear of ticks. A phobia that might be good to instill in pet owners because of all the diseases ticks can transmit to their pets-as well as to owners themselves. But there are so many different species of these small arachnids to be familiar with. Here is an overview of four common ticks to help scare your clients into realizing the importance of monthly preventives in their pets.

 and Ticks: Have mouth parts, will travel	 

 their hosts. Most lone star ticks quest, or wait on low shrubs, bushes and blades of grass-some run toward their host instead of passively waiting for an opportunity.

 Historically southern U.S. but now considered present in most of the eastern two-thirds of the U.S.

 Ehrlichiosis, Rocky Mountain spotted fever, cytauxzoonosis, rickettsiosis, tularemia, coxiellosis (Q fever), heartland virus, bourbon virus, southern tick-associated rash illness (STARI)

These large, aggressive ticks like to hang out at the top of grass blades and other vegetation, catch hold of whatever walks by and start feeding as quickly as possible.

 The south, by the Gulf Coast, of course, but moving north to include the central East coast and states such as Kansas, Missouri and Ohio

 American canine hepatozoonosis, most prominently (transmitted by ingestion)	 

This tick may have “dog” in its name, but that doesn't matter much when it's looking for a blood meal. The American dog tick infests cats and urban wildlife, such as opossums, raccoons, rabbits and squirrels-which means these ticks are probably in your backyard.

 Most of North America except higher elevation areas (Rocky Mountains and extreme Southwest)

 Rocky Mountain spotted fever (primary vector), tularemia, tick paralysis, cytauxzoonosis 

This species of tick is the only one that prefers to feed off of dogs through all of its life stages. It can also survive at a much lower humidity than other ticks and is the only tick species in North America that can infest buildings, including our homes.

 Year-round since they live inside in homes and kennels-they love carpet and upholstery

 Anywhere dogs are, thus, everywhere-even Canada and Alaska!

 Ehrlichiosis, Rocky Mountain spotted fever, anaplasmosis (in Hawaii and the Caribbean), hepatozoonosis, babesiosis

A pictorial guide to these sickening suckers to help advise your veterinary clients.

Vetted March 2019