The VETgirl beat is a quarterly publication available to all subscribed members of VETgirl. The digital emagazine features highlighted webinars (small animal, large animal, veterinary technician, leadership), tech tips, provider spotlights, and recent happenings.
BEAT ISSUE 29 VETERINARY eMAGAZINE
04 FORGET THE BOX AND FOCUS ON THE FELINES – FELINE INAPPROPRIATE ELIMINATION 26 TO POKE OR NOT TO POKE: ULTRASOUND GUIDED NEEDLE SAMPLING OF ABDOMINAL ORGANS (PART 2) 12 ZOONOTIC DISEASES IN VETERINARY MEDICINE: 08 FIP IN REAL PRACTICE – UPDATED CLINICAL CUES AND DIAGNOSTICS 18 TO POKE OR NOT TO POKE: ULTRASOUND GUIDED NEEDLE SAMPLING OF ABDOMINAL ORGANS (PART 1)
SHIFTING THE FOCUS FROM TREATMENT TO PREVENTION
40 TECH TIPS 43 UPCOMING WEBINARS 34 MIND MASSAGE
JULY 2026
QUARTERLY BEAT
JULY 2026
ISSUE 29 –JULY 2026
WEBINAR HIGHLIGHTS FORGET THE BOX AND FOCUS ON THE FELINES – FELINE INAPPROPRIATE ELIMINATION 04 FIP IN REAL PRACTICE – UPDATED CLINICAL CUES AND DIAGNOSTICS BLOG HIGHLIGHTS 08 WEBINAR HIGHLIGHTS TO POKE OR NOT TO POKE: ULTRASOUND GUIDED NEEDLE SAMPLING OF ABDOMINAL ORGANS (PART 1) 18 ZOONOTIC DISEASES IN VETERINARY MEDICINE: SHIFTING THE FOCUS FROM TREATMENT TO PREVENTION 12 WEBINAR HIGHLIGHTS
WEBINAR HIGHLIGHTS TO POKE OR NOT TO POKE: ULTRASOUND GUIDED NEEDLE SAMPLING OF ABDOMINAL ORGANS (PART 2) 26 34 MIND MASSAGE 40 TECH TIPS 43 UPCOMING WEBINARS
2 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
QUARTERLY BEAT
JULY 2026
EARLY BIRD PRICING ENDS 123126. CE YOU THERE!
GRAND HYATT SCOTTSDALE RESORT • VETGIRLONTHERUN.COM
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 3
QUARTERLY BEAT
JULY 2026
FORGET THE BOX AND FOCUS ON THE FELINES – FELINE INAPPROPRIATE ELIMINATION Dr. Amy L. Pike, DACVB WEBINAR HIGHLIGHTS
What do you do when a cat starts thinking outside the box, literally? In this VETgirl webinar on May 29, 2025, Forget the Box and Focus on the Felines – Feline Inappropriate Elimination , Dr. Amy Pike, DACVB, walks us through a systematic approach to feline inappropriate urination, from identifying the culprit and ruling out medical causes to distinguishing marking from elimination behaviors, and finally, building a multimodal treatment plan. In case you missed the webinar, watch it again HERE or read the cliff notes below!
Recommended Diagnostic Workup • Complete blood count (CBC) and serum biochemistry • Urinalysis +/- culture • Total T4 and free T4 (by equilibrium dialysis) • Comprehensive physical exam • Orthopedic and neurologic evaluation • Imaging (radiographs +/- abdominal ultrasound as indicated) Common Medical Differentials • Conditions affecting frequency, urgency, or volume (e.g., cystitis, renal disease, endocrinopathies) ◦ Also includes feline idiopathic cystitis (FIC) • Disorders affecting mobility or access (e.g., osteoarthritis, obesity) Treatment for medical disorders is imperative. Even after resolution, negative conditioned emotional responses may persist and require behavioral intervention. Behavioral therapy must then be implemented for full resolution.
Inappropriate urination is among the most common behavioral complaints in small animal practice and is a leading cause of relinquishment. These cases are frequently multi-factorial, requiring a systematic approach that integrates medical assessment and treatment, environmental modification, and behavioral assessment and treatment.
STEP 1: IDENTIFYING THE CULPRIT
Accurate identification of the offending cat is critical in multi-cat households. Misidentification can result in inappropriate treatment and worsening inter-cat dynamics. Objective tools such as motion- activated video monitoring can improve diagnostic accuracy since isolation/confinement can be stressful and not always help to determine the offender.
STEP 2: RULE OUT MEDICAL CAUSES
With any behavior change, a thorough medical evaluation is mandatory. Medical conditions must always be ruled out before attributing the issue to behavior.
4 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
QUARTERLY BEAT
JULY 2026
STEP 3: CHARACTERIZING THE BEHAVIOR
STEP 5: ENVIRONMENTAL MODIFICATION AND ENRICHMENT Environmental stress can play a significant role in feline behavioral disorders and lower urinary tract disease. In 2013, the AAFP and ISFM introduced the concept of the “Five Pillars of a Healthy Feline Environment” to ensure the best possible environment for our feline patients.
Differentiating urine marking from inappropriate elimination is essential for diagnosis and treatment planning. A critical distinction must be made between urine marking and inappropriate elimination, as the underlying motivations, and therefore treatments, can differ.
STEP 4: LITTER BOX MANAGEMENT
Litter box management remains the foundation of behavior treatment. The Feline Veterinary Medical Association (FVMA; formerly American Association of Feline Practitioners) and the International Society of Feline Medicine (ISFM) recommend the following litterbox guidelines: • One litterbox per cat in the household plus one extra (Note: This may underestimate the number of boxes required
if there is inter-cat conflict, multiple stories in the home, or specific feline preferences)
STEP 6: BEHAVIOR MODIFICATION
• Multiple, accessible locations (i.e., litter boxes should be spread throughout the home, not co-located together in one area, and located in areas that have multiple entrances and exits whenever possible) • Unscented, feline-preferred substrates (Note: Most cats prefer clay clumping litter, but some individuals may prefer pellets, wood chips, or a towel or rug. A litter substrate preference test may be needed to determine individual choice) • Daily to multiple times daily scooping of waste and full litter box cleaning and replacement of litter at least monthly
Behavioral training interventions will be case-specific and should target the underlying motivations. Referral to a certified cat behavior consultant/trainer or veterinary behaviorist may be warranted for appropriate behavior modification implementation.
WEBINAR HIGHLIGHTS
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 5
QUARTERLY BEAT
JULY 2026
STEP 7: PHEROMONES AND NUTRACEUTICALS
STEP 11: MANAGING CLIENT EXPECTATIONS
Clear communication and client education are critical to maintaining compliance and preventing frustration. • Improvement is often gradual, not immediate • Relapses can occur, particularly with environmental changes • Appropriately treated feline elimination disorders and inter- cat conflict cases can show improvement, though complete resolution is not guaranteed. Setting realistic expectations improves adherence and preserves the veterinarian-client relationship.
Pheromone and supplement products can help reduce stress- related behaviors: • Facial pheromone analogs (F3 fraction) can support environmental familiarity and reduce stress • Maternal appeasing pheromones have been shown to reduce inter-cat conflict • Nutraceutical supplements can help reduce stress associated with environmental stressors ◦ Alpha-casozepine ◦ L-theanine ◦ Bifidobacterium longum These products may provide adjunctive support for stress reduction, though evidence varies. These should not replace primary interventions or pharmacologic management when necessary.
CONCLUSION
Feline elimination disorders require a comprehensive, multimodal approach grounded in medical rule-outs, litter box and environmental management, behavioral treatment, and client education. Success depends not only on identifying the cause but also on implementing sustainable, individualized treatment plans. By approaching these cases systematically, veterinarians can significantly improve outcomes while strengthening the human-animal bond.
STEP 8: DIET AND NUTRITION
Dietary therapy with prescription nutritional formulas plays a supportive role in both medical and behavioral cases.
STEP 9: PHARMACOLOGIC INTERVENTION
ABBREVIATIONS
Pharmacologic therapy is indicated in cases involving significant anxiety, inter-cat conflict, or refractory elimination disorders. Medication should always be combined with environmental and behavioral modification for optimal outcomes.
• AAFP: American Association of Feline Practitioners • CBC: complete blood count • FVMA: Feline Veterinary Medical Association (formerly the American Association of Feline Practitioners) • FIC: feline idiopathic cystitis • ISFM: International Society of Feline Medicine • T4: thyroxine
STEP 10: MONITOR AND MODIFY
Treatment of feline elimination disorders is dynamic. Regular follow-up is essential to: • Assess response • Adjust interventions • Address new or evolving stressors Clients should be prepared for iterative changes to the plan. Treatment plans should be adjusted based on response, compliance, and changes in the environment.
6 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
QUARTERLY BEAT
JULY 2026
RESOURCES
• Buffington CA, Westropp JL, Chew DJ, et al. Clinical evaluation of multimodal environmental modification (MEMO) in the management of cats with idiopathic cystitis. J Feline Med Surg. 2006;8(4):261-8. • Buffington CA. Idiopathic cystitis in domestic cats--beyond the lower urinary tract. J Vet Intern Med. 2011;25(4):784-96. • Ellis SL, Rodan I, Carney HC, et al. AAFP and ISFM feline environmental needs guidelines. J Feline Med Surg. 2013;15(3):219-30. • Horwitz DF, Mills DS. BSAVA Manual of Canine and Feline Behavioural Medicine. 2nd ed. Brittish Small Animal Veterinary Association; 2009. • Landsberg G, Radosta L, Ackerman L, eds. Behavior Problems of the Dog and Cat. Elsevier Health Sciences; 2023. • Mills DS, Redgate SE, Landsberg GM. A meta-analysis of studies of treatments for feline urine spraying. PLoS One. 2011;6(4):e18448. • Feline VMA. Accessed April 16, 2026. https://catvets.com/ • International Society of Feline Medicine. ISFM resources. Accessed April 16, 2026. https://fabclinicians.org/isfm-resources/
WEBINAR HIGHLIGHTS
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 7
QUARTERLY BEAT
JULY 2026
remdesivir is still advisable with the goal of transitioning to oral GS-441524 once able. While data on oral absorption (especially when complicated by various gastrointestinal conditions) is lacking, current recommendations are to give oral GS-441524 on an empty stomach and wait 30 minutes before a full meal - but hiding a crushed tablet in a small treat is still considered ok! Update #2: Treatment Duration may be Effective in a Shorter (6 week) Course in SOME Cats Most FIP protocols still include a 12-week treatment plan, often with once daily GS-441524 administration for 84 days (or split q12h if neuro/ocular disease is in the mix). That said, newer data looking at cats with ‘wet’ FIP show that many did well with a 6-week course without incurring a higher relapse risk. The catch? This shorter course was studied only in cats that presented mostly with an effusive FIP form, had been diagnosed early in their disease, were treated early as a result, and were hospitalized for their first week of treatment. The study used oral GS-441524 at 15 mg/kg q24h and found most of these cats had a fast response to treatment with resolution of lab work abnormalities and elevated alpha-1 acid glycoprotein (AGP) levels, often within the first 28 days. But before shortening your patients’ treatment, be sure to prioritize a response-driven approach.
BLOG HIGHLIGHTS
In 2026, nucleoside analogues remain the backbone of FIP therapy, and treatment protocols continue to evolve with clinical experience, emerging studies, and (in some regions) improved access to quality-assured drugs. In areas where legal access is limited, some veterinarians and cat owners have turned to unregulated products — often out of necessity. VETgirl echoes International Cat Care’s caution: black-market antivirals may have inconsistent active drug content, no quality assurance, and have been associated with adverse events, including reports of severe injection-site injuries linked to highly acidic formulations. And while none of us want to play “antiviral roulette,” if limited access guides your antiviral selection, just remember the goal is to treat thoughtfully, monitor patient’s closely, and give that cat a fighting chance. With that context in mind, the current backbone of FIP treatment are the nucleoside analogue antivirals, which work by interfering with feline coronavirus RNA replication. This group includes GS-441524, remdesivir, molnupiravir, and EIDD-1931 (with legal access varying by country and, in some regions, requiring a compounding pharmacy). Molnupiravir and its parent drug EIDD-1931 carry additional safety considerations such as reported neutropenia, potential viral mutation concerns, and teratogenic risk, so they’re typically reserved as backup options for treatment failures or relapses, or for regions where access to GS-441524 and/or remdesivir is limited. Beyond nucleoside analogues, there are emerging successful reports using nirmatrelvir with ritonavir (Paxlovid™) in refractory or neurologic cases. Lastly, GC-376, a 3CL protease inhibitor, has gained attention from anecdotal reports, but its restricted access puts it in the “watch for now” category. Next, we break down some of the major highlights and pearls we’ve learned so far in our treatment battle against FIP. Update #1: Oral GS-441524 can be First-line Therapy From Day 1 We no longer need to start with injectable antivirals (i.e., remdesivir), unless the patient is severely dehydrated, cannot swallow, or otherwise cannot receive oral medications. But for critically ill or clinically dehydrated patients, hospitalization for ~48 hours for IV fluid therapy and injectable Wondering what’s changed in FIP treatment? This VETgirl article , article walks through the current antiviral lineup, emphasizes thoughtful monitoring (and fast pivots when cats aren’t improving), and reviews dosing considerations for the tricky ocular/neuro patients. Read on for practical guidance on what drugs to reach for, how long to treat, and what responses should we expect to see throughout treatment. And if you’d prefer instead to listen about FIP diagnostic updates, you can also tune into our FIP in Real Practice- Updated Clinical Cues and Diagnostics podcast HERE ! FIP IN REAL PRACTICE – UPDATED CLINICAL CUES AND DIAGNOSTICS Dr. Amy Kaplan-Zattler , cVMA, DACVECC, MRCVS CE Program Manager, VETgirl
Practical rule of thumb: Treat at least 2 weeks past normalization of biochemistry abnormalities and AGP levels, as well as resolution of effusion/ocular/neuro signs. We don’t want our haste to be the reason a cat relapses!
Update #3: Follow a Streamlined Dosing Framework by FIP “Type” (with Special Attention to Eyes and Brains)
Ocular and neurologic presentations generally warrant dose adjustments to improve penetration across the blood-brain/blood-CSF and blood- ocular barriers. Dose increases may improve penetration, and dividing the total dose into twice-daily administration may maintain steadier blood concentrations throughout the day. Below are suggested antiviral doses by clinical signs, and extrapolated from icatcare.org.
8 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
QUARTERLY BEAT
JULY 2026
BLOG HIGHLIGHTS
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 9
QUARTERLY BEAT
JULY 2026
Update #4: Expect Early Improvements; Otherwise, Consider Changing the Plan!
Update #7: When can FIP Cats get Back to Routine Veterinary Care? • Spay/neuter: Ideally, wait >1 month after finishing antivirals. If surgery has to happen during treatment (life happens!), it’s likely OK - just continue antivirals 2–4 weeks post-op to keep treatment momentum on your side. • Parasite prevention: Deworming and flea/tick meds can continue during treatment - no need to pause the basics. • Vaccines: We still need prospective data, but current thinking is: if the cat is clinically well, killed/non-live vaccines are probably reasonable during antiviral therapy. Live vaccines, are still a question mark, so it’s recommended to save those for >1 month after treatment ends. Do cats with FIP relapse after treatment? The first month after stopping antivirals is the prime relapse-risk window. Thankfully, relapse is uncommon (often quoted at <10%) and becomes rare once a cat cruises past the 4-week mark. That said, prep cat owners that relapses can happen, and they don’t always look like the cat’s original FIP presentation. Some cats throw new curveballs, including new neurologic, ocular, or even gastrointestinal signs despite originally presenting with effusion. That’s why a recheck exam around 4 weeks off meds is typically recommended. And if you have it, a normal post-treatment AGP is a nice little confidence boost that things are really staying on track. Conclusion When in doubt, for the newly diagnosed cat with FIP the gameplan should be: start treatment early, dose according to the cat’s clinical signs, and know when to tweak the plan/ Build in early check-ins so you can pivot fast if the cat isn’t responding quickly to treatment. As our knowledge (and collective clinical experience) with FIP therapy grows, expect these recommendations to evolve right along with it. And the best update of all? We’re no longer asking whether to treat FIP - we’re fine-tuning how to treat it. That’s a pretty fantastic problem to have…because it means more cats are surviving long enough for us to fine-tune the details.
Coach owners to be your at-home “FIP vital signs team”: track resting respiratory rate/effort, appetite, and overall behavior. Cats should start looking better quickly, so if they’re not trending upward, or if cat owners observe faster/labored breathing, inappetence, erythematous/painful eyes, or new/worsening neurologic signs (e.g., depression, ataxia, seizures), the cat should be evaluated ASAP for a possible dose adjustment. Before calling the failed response a “drug failure”, start with the basics: confirm the medication is actually getting into the cat and being given on schedule, because “I gave it” doesn’t always mean the cat got it! Also remember that in the first 48 hours (while drug levels are building) it’s possible to see worsening or new onset of clinical signs. Update #5: Therapeutic Drug Monitoring (TDM) is Entering the Chat (in Some Regions) TDM isn’t mainstream (yet), but it’s likely where we’re headed. More personalized dosing - especially for cats who aren’t improving on schedule - may eventually let us fine-tune therapy for the tricky cats, especially those with questionable GI absorption (hello, IBD cats!)..
Update #6: For Adjunct Drugs, ‘Less’ is Often ‘More’
Corticosteroids: Try to avoid, but don’t shy away if they’re needed! Yes, FIP cats can come with comorbidities that may benefit from steroids (e.g., IMHA, IBD). For uveitis, a short course of topical corticosteroids is reasonable for comfort during the first 1–2 weeks of FIP treatment. If clinical signs still require corticosteroids beyond 2 weeks, that’s more suggestive of undertreated FIP, so the antiviral dose may need a bump. Immune-mediated hemolytic anemia has been rarely reported along with FIP, and the good news is we have weak evidence suggesting 0.5-2 mg/ kg/day prednisolone does not negatively impact survival. So if you needsteroids for a true immune-mediated problem, or to dampen inflammation, they’re not automatically off-limits!
ABBREVIATIONS: • A:G: albumin-to-globulin ratio • AGP: alpha1-acid glycoprotein • ALT: alanine aminotransferase
Immunostimulants: As tempting as these may sound, the evidence isn’t quite there (yet). Current guidelines don’t recommend routine immunostimulant use with FIP, largely because we’re already seeing excellent response rates with antiviral therapy alone. So for most cats, this is one more add-on we can skip.
• CSF: cerebrospinal fluid • FCoV: feline coronavirus • FIP: feline infectious peritonitis • IBD: irritable bowel disease • IMHA: immune-mediated hemolytic anemia
• RNA: ribonucleic acid • SAA: serum amyloid-A • TDM: therapeutic drug monitoring
10 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
QUARTERLY BEAT
JULY 2026
RSOURCES : • Kamiyoshi T, Kamiyoshi N, Jintake C. High-dose induction therapy and treatment termination criteria for feline infectious peritonitis with remdesivir, GS-441524 and adjunctive mefloquine: 46 cases (2023). J Small Anim Pract. 2025;66(9):617-626. doi: 10.1111/ jsap.13869. • Andrews ALMM, Izaguirre E, Green J, et al. Treatment With Remdesivir Alone or in Combination With GS-441524 in Cats With Ocular Involvement of Feline Infectious Peritonitis: An Observational Case Series. J Vet Intern Med. 2025;39(6):e70253. • Roman N. Feline infectious peritonitis. Merck Veterinary Manual. Updated November 2025. Accessed January 26, 2026. • Thayer V, Gogolski S, Felten S, et al. 2022 AAFP/EveryCat Feline Infectious Peritonitis Diagnosis Guidelines. J Feline Med Surg. 2022;24(9):905-933. doi: 10.1177/1098612X221118761.
REFERENCES : 1. Taylor S, Tasker S, Barker E, et al. An update on the treatment of feline infectious peritonitis (July 2025). International Cat Care; Accessed January 26, 2026. https://icatcare.org 2. Barua S, Kaltenboeck B, Juan YC, et al. Comparative Evaluation of GS-441524, Teriflunomide, Ruxolitinib, Molnupiravir, Ritonavir, and Nirmatrelvir for In Vitro Antiviral Activity against Feline Infectious Peritonitis Virus. Vet Sci. 2023;10(8):513. doi:10.3390/vetsci10080513. 3. Mulligan AJ, Browning ME. Quality assessment and characterization of unregulated antiviral drugs for feline infectious peritonitis: implications for treatment, safety, and efficacy. Am J Vet Res. 2024;1- 9. doi: 10.2460/ajvr.23.10.0221.
BLOG HIGHLIGHTS
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 11
QUARTERLY BEAT
JULY 2026
What happens when PPE is treated as the whole plan instead of the last line of defense? In this VETgirl article based on her December 9, 2025 webinar, Zoonotic Diseases in Veterinary Medicine: Shifting the Focus from Treatment to Prevention Dr. Katherine Brannick, MS, DACLAM, reframes infection control through a risk-based approach that helps the entire veterinary team reduce biological, chemical, and physical hazards before they reach the PPE stage. Want to learn more? Check out the on-demand webinar HERE ! ZOONOTIC DISEASES IN VETERINARY MEDICINE: SHIFTING THE FOCUS FROM TREATMENT TO PREVENTION Dr. Katherine Brannick, MS, DACLAM WEBINAR HIGHLIGHTS
As veterinary professionals, we carry a higher occupational risk for zoonotic diseases than the general public. We manage that risk every day, often without thinking about it, from putting on gloves before examining an open wound to grabbing a gown on the way to a messy case, or using a mop to clean up that accident in the lobby. These actions are routine, almost reflexive. That familiarity should be reassuring, but here's the thing about familiarity: it breeds complacency. When personal protective equipment (PPE) and sanitation practices become a checkbox, something we do on autopilot rather than as a deliberate risk management strategy, the level of protection quietly diminishes. Most infection control failures in veterinary medicine are not rare or dramatic. They come from common cases handled just slightly incorrectly, over and over again, until something finally slips through. In most cases, those failures are predictable and preventable. Infection prevention and control strategies can be implemented in any setting, small animal, equine, livestock, shelter, or academic, and they are designed to protect everyone: patients, clients, staff, and the broader community. PPE is a critical part of that system, but it is only one part. Effective infection control depends on how we recognize risk, how we structure our workflows, and how consistently we apply standard precautions in everyday practice. This VETgirl article focuses on practical infection prevention with an emphasis on PPE, but the goal is broader than gloves, gowns and masks. Together we will build a framework for risk-based thinking that
supports better decision-making across all aspects of clinical care. This content is written for the entire veterinary team, including credentialed technicians, assistants, kennel staff, client service representatives, and veterinarians, because infection control does not belong to one role. It belongs to all of them.
No one gets this right 100 percent of the time. But getting it right more often starts with understanding what "right" actually looks like.
. PUT PPE BACK WHERE IT BELONGS
If I ask a room full of veterinary professionals, "What's your first line of defense against infection?" the answer I hear most often is some form of PPE. Gloves. Gowns. Masks. It feels intuitive. PPE is tangible, visible, and within our control. But this instinct is where intuition leads us astray. The National Institute for Occupational Safety and Health (NIOSH) hierarchy of controls is widely considered the gold standard for risk management and places PPE as the last line of defense. The controls at the top reduce risk before exposure ever occurs. A strong infection control program does not rely on one layer. It uses multiple layers across the hierarchy so that if one fails, others are still in place. Think of this as the "Swiss cheese model." Every layer has holes, but when you stack them together, those gaps are far less likely to line up and allow something to pass through.
12 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
QUARTERLY BEAT
JULY 2026
WEBINAR HIGHLIGHTS
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 13
QUARTERLY BEAT
JULY 2026
Looking at all potential hazards does more than improve general safety. It changes how we think about infection control. For this article, we are primarily focused on biological hazards, but those risks do not exist in isolation. A patient that poses an infectious disease risk may also present a bite risk requiring chemical restraint, or involve environmental contamination. Identifying all relevant hazards is what allows you to choose the right layers of control.
WHAT DOES THIS LOOK LIKE IN PRACTICE?
Consider an aggressive dog that needs a detailed oral exam. It is difficult to visualize through a muzzle, so you could rely on restraint and hope your reflexes are fast enough, or you could sedate the patient and eliminate the bite risk before your hands are ever near the mouth. That is an upstream control. You may still need a muzzle or bite-resistant gloves during recovery, but the highest-risk step, the oral exam, has already been controlled. If you rely on PPE alone in this scenario, you are removing stronger layers of protection and depending on a single, less reliable barrier. In terms of the Swiss cheese model, you are taking away layers instead of stacking them, which increases the chance something will pass through the gaps. Now consider the shelter puppy adopted two days ago and scheduled for work up of vomiting and diarrhea. You could use a standard exam room and rely on additional PPE and clean up afterward, or you could route that patient directly into isolation. Controlling that animal's movement is far more protective than allowing it through shared traffic areas and trying to manage contamination afterward. Upstream controls do the real work. Ventilation, clean-to-dirty workflows, and facility design reduce exposure before it happens. PPE is the safety net, not the scaffolding. When we treat it as both, we overestimate our protection and underestimate our exposure.
You cannot select the right protection if you have not first identified what you are protecting against.
QUESTION 2: HOW DOES IT SPREAD?
For biological hazards, the route of transmission should guide the barrier we choose. Get this wrong, and your PPE is just for show. • Contact transmission: is the most common route in veterinary settings, and the most underestimated. Think about everything you or your patient touches in a single visit: the exam table, the scale, your stethoscope, the keyboard, and the door handle on the way out. Your scrubs become fomites the moment a patient sneezes on them or a contaminated surface brushes your sleeve. Cages, leashes, and muzzles all act as potential fomites. • Respiratory transmission: includes both droplet and airborne spread. Droplet transmission occurs with the sneezing cat with feline herpesvirus or the coughing dog in the lobby. These particles are larger and typically travel short distances, so proximity and time both matter. • Airborne transmission: is less common but higher consequence. Coxiella burnetii during ruminant birthing and Mycobacterium tuberculosis are classic examples. These pathogens remain suspended in the air and can travel beyond typical droplet range. In these situations, an N95 respirator, properly fit-tested, becomes essential. • Vector-borne transmission: is less common in the clinic setting, but still relevant. Ticks, fleas, and other pests can introduce pathogens into the clinic environment and transfer them to other patients, staff, or equipment. • Oral exposure: deserves its own mention. I have watched a veterinary student eat lunch without washing their hands after handling a Cryptosporidium-positive patient. That student was one bite away from a very unpleasant weekend. Infection requires three things: an infectious source, a susceptible host, and a route of transmission. We often have limited control over the patient and only partial control over host susceptibility. The route of transmission should dictate the barrier we choose, every time. If you block the route, you break the chain of transmission.
START WITH RISK, NOT EQUIPMENT
Understanding where PPE fits in our risk assessment is only part of the equation. We also have to decide what protection is actually needed in the moment. I've watched technicians put on N95 respirators to clean a kennel and then walk bare-handed into a room with a leptospirosis suspect. The issue isn't laziness. It's that no one ever gave them a framework for matching controls to the level of risk. Risk assessment is the foundation of infection control. At its core, it is a simple process: identify the hazard, understand how it spreads, and decide what happens if you are wrong.
QUESTION 1: WHAT IS THE HAZARD?
In veterinary medicine, biological hazards dominate: bacteria, viruses, fungi, and parasites, but they are only part of the picture. A comprehensive approach to safety considers multiple categories of risk. Chemical hazards include chemotherapeutics, disinfectants, anesthetic gases, and euthanasia solutions. Physical hazards include sharps, slippery floors, and animal-related injuries such as bites and scratches. Radiation hazards come from imaging equipment and therapeutic exposures. Ergonomic hazards, like restraining a thrashing 90-pound dog, are injury risks we often overlook. Noise and psychosocial stressors also contribute to overall workplace risk.
14 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
QUARTERLY BEAT
JULY 2026
QUESTION 3: WHAT IF I'M WRONG?
This is where most infection control programs succeed or fail, not because these steps are complicated, but because they are easy to skip. Standard precautions are what protect you in the cases you do not recognize. They are the default when certainty is not available, which is most of the time.
This is the question we skip most often, and it is the most important one. Standard precautions exist because we cannot reliably identify every infectious risk in every scenario. The apparently healthy shelter kitten? Shedding Microsporum canis. The bouncy puppy with normal vitals? PCR-positive for Leptospira . The cat boarding for the weekend? MRSA carrier. "What if I'm wrong?" is not paranoia. It is preventative medicine. Over time, this mindset becomes habit, a quick mental check before each interaction.
PUTTING IT ALL TOGETHER: ONE ROUTINE VISIT, MULTIPLE POINTS OF FAILURE
The Case: A 2-year-old Labrador Retriever presents for acute vomiting and lethargy. No additional history is collected at intake. During check-in, the dog urinates on the reception floor. A technician lifts him onto the scale and gets urine on the front of her scrubs, places him in an exam room, then returns to clean the area using a mop bucket from the morning cleaning. During the exam, the dog becomes increasingly stressed and difficult to restrain. As the technician attempts a blood draw, her hands are full and she uncaps the needle with her teeth. After a near-bite, the veterinarian requests sedation. The patient is moved to the procedure area, where his barking triggers a chain reaction of noise among other hospitalized animals. By this point, the technician is in the tenth hour of an understaffed shift. She strains her back during restraint and does not report the near-bite incident. She later runs to the break room for a quick snack without washing her hands.
STANDARD PRECAUTIONS: THE NON-NEGOTIABLE BASELINE
Standard precautions exist for a simple reason: we are often wrong about risk. These practices are outlined in the NASPHV Compendium of Veterinary Standard Precautions and reinforced by the AAHA Infection Control, Prevention, and Biosecurity Guidelines, and they form the foundation of infection prevention in veterinary settings. They are a set of core practices designed to reduce risk that apply to every patient, every time, regardless of what you think is going on. They are not "extra." They are the baseline. The floor, not the ceiling.
The Diagnosis: Leptospirosis
Breaking Down the Risks: This case probably does not sound unusual, and that is exactly the point. A single routine visit now involves biological, physical, chemical, ergonomic, psychosocial, sharps, noise, and oral hazards. None of these risks occurred in isolation. They compounded. Remember our chain of transmission? There were multiple opportunities to break that chain in this scenario. A more complete history might have revealed that this patient spent the previous weekend at a family cabin with access to natural water sources and wildlife exposure. Using a disposable material instead of a shared mop during urine cleanup would have reduced fomite exposure. Safer sharps handling and earlier sedation would have reduced physical risk. Hand hygiene before eating would have removed another potential route of exposure. Even something as simple as a disinfectant with a clearly defined concentration and contact time could have reduced uncertainty in the moment.
WEBINAR HIGHLIGHTS
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 15
QUARTERLY BEAT
JULY 2026
RESOURCES
This case is not about blame. It is about recognizing how quickly routine work can become high risk when systems are weak or shortcuts become normalized. Infection control cannot be separated from the rest of workplace safety. It has to be built into the way we think, the way we move, and the way we work. Take Home Message: This is what infection control looks like in real life. It is not one dramatic failure. It is a series of small decisions, each of which makes the next problem more likely. When it works well, it is not a checklist. It is a system. PPE matters, but it only works when it is part of a broader system built on risk recognition, layered controls, and standard precautions that hold even when the day gets busy.
• Williams CJ, Scheftel JM, Elchos BL, et al. Compendium of veterinary standard precautions for zoonotic disease prevention in veterinary personnel: National Association of State Public Health Veterinarians Veterinary Infection Control Committee 2015. J Am Vet Med Assoc. 2015;247(11):1252-1277. doi:10.2460/ javma.247.11.1252. • Stull JW, Bjorvik E, Bub J, et al. 2018 AAHA infection control, prevention, and biosecurity guidelines. J Am Anim Hosp Assoc. 2018;54(6):297-326. doi:10.5326/JAAHA-MS-6903. • Occupational Safety and Health Administration. Personal Protective Equipment. OSHA 3151-02R; 2023. U.S. Department of Labor. • National Institute for Occupational Safety and Health. Hierarchy of Controls. Centers for Disease Control and Prevention. Updated April 10, 2024. • Tomas ME, Kundrapu S, Thota P, et al. Contamination of health care personnel during removal of personal protective equipment. JAMA Intern Med. 2015;175(12):1904-1910. doi:10.1001/jamainternmed.2015.4535. • Brannick K. Zoonotic Agents in Veterinary Medicine: Practical Risk Awareness for the Modern Clinician. VETgirl CE Webinar. September 9, 2025. • Brannick K. Zoonotic Diseases in Veterinary Medicine: Shifting the Focus from Treatment to Prevention. VETgirl CE Webinar. December 9, 2025.
KEY TAKEAWAYS
Infection control is a team effort: every role matters, from the front desk to the surgeon. • PPE is the last line of defense: always start with the hierarchy of controls and work downstream • Use a simple risk assessment: What is the hazard? How does it spread? What if I'm wrong? • Standard precautions apply to every patient, every time: you cannot identify carriers by clinical appearance alone • Build systems that make compliance easier: good infection control should be the path of least resistance, not the path of most paperwork
ABBREVIATIONS
Please note that the opinions in this blog are expressed by the speaker and not directly endorsed by VETgirl.
• NASPHV: National Association of State Public Health Veterinarians • NIOSH: National Institute for Occupational Safety and Health • PPE: personal protective equipment
WEBINAR HIGHLIGHTS
16 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
QUARTERLY BEAT
JULY 2026
Better Collaboration. Better Patient Care.
The Triad of Care Insider is the American College of Veterinary Internal Medicine’s (ACVIM) free newsletter for DVMs, delivering specialist insights, referral resources, and practical tips to support better collaboration and patient care. SUBSCRIBE
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 17
QUARTERLY BEAT
JULY 2026
WEBINAR HIGHLIGHTS
What happens when the ultrasound probe says, “There’s something there,” and now you need to collect cells to tell the whole story? In Part 1 of this 2-part VETgirl article series based on his February 24, 2026 webinar, To Poke or Not to Poke: Ultrasound Guided Needle Sampling of Abdominal Organs Dr. Marc Seitz, DACVR, DABVP (Canine and Feline Practice), reviews the practical foundations of ultrasound-guided abdominal fine-needle aspiration, including patient preparation, equipment selection, sampling technique, and key safety considerations to help improve diagnostic yield while minimizing complications. Missed the webinar? Check it out HERE on-demand! TO POKE OR NOT TO POKE: ULTRASOUND GUIDED NEEDLE SAMPLING OF ABDOMINAL ORGANS (PART 1) Dr. Marc Seitz, DACVR, DABVP (Canine and Feline Practice)
. INTRODUCTION
Ultrasonographic changes to abdominal viscera are often non-specific and necessitate tissue sampling. Some tissues may appear normal on ultrasound despite the presence of focal or diffuse disease. Fine needle aspirates are a clinically useful, minimally invasive means of achieving a definitive or categorical diagnosis. This session will focus on updates in the literature that will help clinicians hone their technique to maximize diagnostic yield and minimize complications. Organ specific considerations will be reviewed next in Part 2. Some knowledge and experience performing ultrasound-guided needle procedures is recommended.
GENERAL CONSIDERATIONS
Figure 1. Abdomen prepped for ultrasound-guided FNA. Photo courtesy of Tom Thompson, MSU-CVM photographer.
Ultrasound-guided fine needle aspirates typically follow a complete diagnostic ultrasound, or similar evaluation with some other imaging modality. Ultrasound confers a significant advantage over blind techniques in that it ensures accurate needle placement, increasing diagnostic yield while minimizing complications. Although general anesthesia is rarely needed, patients should be adequately sedated to minimize patient movement and provide some form of analgesia. The author commonly uses dexmedetomidine with butorphanol, alfaxalone, or propofol in healthy patients. For debilitated patients, midazolam with butorphanol works well. Other drug combinations are appropriate, but agents that induce panting, ileus, or significant splenic enlargement are less ideal. While some sources (Launay 2023) describe performing the technique without sedation, this is not recommended by the author due to each patient having a unique response to pain and the increased risk for complications and lower diagnostic yield that comes with patient movement.
The skin should already be clipped of fur from the ultrasound exam, wiped free of external gross debris, and sterilely prepped (Figure 1.). Care must be taken to remove all ultrasound gel (even if sterile) as it can interfere with cytologic interpretation by causing cell swelling or
lysis and by mimicking necrotic material or mast cell granules. Although virtually any transducer may be used, microconvex probes are most common (Figure 2.). The author prefers a linear probe for superficially located or smaller lesions due to its superior spatial resolution, especially in the near field.
18 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
QUARTERLY BEAT
JULY 2026
Numerous prior veterinary and human studies have found conflicting literature favoring both larger and smaller gauge needle sizes or finding equivocal results.
Figure 2. Linear probe (left), microconvex probe (right). Photo courtesy of Tom Thompson, MSU-CVM photographer.
The decision to hold the needle with the dominant or nondominant hand is inconsequential and should be based on the operator’s preference. Most individuals insert the needle along the probe marker side of the transducer, but the opposite side may be needed due to anatomic considerations. An appropriate window is one where the needle may be advanced the shortest distance possible, ideally without entering another body cavity or organ. Any imaging plane may be used to achieve this goal and surrounding tissue should be evaluated to know what is adjacent to the planned needle path. The focal zone should be placed at the lesion of interest. Needle visualization is easy and rapid with most modern ultrasound machines. In cases where visualization is challenging, fanning/rocking the transducer and/or turning off compound imaging usually helps. Slow advancing or retracting the needle may be performed next but done so cautiously to avoid tissue damage or vessel laceration. Although discussed in some texts, aspirating a small volume of saline or air can interfere with visualization of the target or dilute the diagnostic sample.
Figure 3. Prepare your disinfectant and equipment needed for ultrasound- guided FNA. Photo courtesy of Tom Thompson, MSU-CVM photographer.
The results of three large, well designed, recent veterinary studies (Arai 2019, Llanos 2023, and Launay 2023) concluded that there is not a significant difference in diagnostic quality between larger gauge (22G or 23G) and smaller gauge (25 or 27G) needles. Arai et al. prospectively looked at results of 50 masses from cutaneous, subcutaneous, and intracavitary locations and found 25G needles resulted in less blood contamination but increased cell trauma. Similarly, Llanos et al. prospectively evaluated 282 splenic aspirates from 94 dogs and 348 aspirates from 116 dogs and also did not find significant differences in diagnostic quality. Curiously, more blood contamination was noted with hepatic aspirates when using a 22G needle as compared to a 25G needle, but no differences were seen with the spleen. Finally, Launay et al. also found no difference in the final cytology diagnosis between 23G, 25G, and 27G needles when obtaining splenic aspirates but did observe that 23G needles were of significantly higher cellularity. It is possible that diagnostic yield could vary among other organs or even disease etiology, but more studies would be needed to investigate this concern. For example, results of a preliminary investigation (Blacklock 2018) on five canine malignant tumors suggested that an aspiration technique (i.e., pulling back on the syringe during sampling, discussed further below) with a 25G needle and a 10 mL syringe yielded more cells for melanoma, lymphoma, and anal gland adenocarcinoma as compared to an advance/withdraw technique, a needle only technique, using 21G or 23G needles, or while aspirating with 2 or 5 mL syringes. However, this study had several limitations. The tumors were aspirated outside the patient after surgical removal and appeared to be cutaneous/ subcutaneous, the sample size was low, and the tumors were aspirated
EQUIPMENT
By definition, a “fine needle aspirate” is the use of a needle less than 20-guage (G), with anything larger considered a needle core biopsy (Liffman 2017). A 21G - 25G, 1.0 – 1.5-inch needle is most commonly used. Longer needles (e.g., 2.5 – 8 inch) with a stylet may be used for deeper lesions but are technically more challenging to place into the lesion accurately due
to the increased travel distance. Needle size has been extensively studied in both human and veterinary medicine. In theory, a larger gauge needle is easier to see with ultrasound, less likely to bend, can collect more cells, and is less likely to damage
cells; however, it could cause more blood contamination in the sample (Liffman 2017). All of the above would be opposite for a smaller gauge needle.
WEBINAR HIGHLIGHTS
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 19
QUARTERLY BEAT
JULY 2026
numerous times with 9 different techniques among several clinicians with no means to control intratumoral trauma from multiple aspirations. Finally, absolute cell quantity should not be equated to diagnostic yield, which was not evaluated. In other words, more cells may not be advantageous if a lower number of cells of a highly exfoliative tumor provides a diagnosis. Recall that Launay et al. found no differences in final cytologic diagnosis among needle sizes despite larger needles yielding more cellularity. One final consideration is the impact of needle size on pain. In the study by Launay et al., a 27G needle produced the least adverse reactions in non-sedated patients during splenic aspiration. Although non-sedated techniques are reported, the author strongly recommends sedation or analgesia unless there is a medical reason not to do so, which is quite uncommon, even in debilitated patients. In addition to the obvious patient welfare considerations, sedation anecdotally results in a faster sample acquisition time due to patient compliance. For now, it appears any needle size between 22-25G should yield similar diagnostic quality results with a theoretical: a larger gauge may obtain more cells and damage them less, but a smaller gauge may confer less blood contamination in some but not all organs. At this time, the author uses 22G, 1.0 – 1.5 needles as long as the patient is adequately sedated. Other radiologists (Mattoon 2021) report similar success with 25G needles as their standard and only use a larger gauge if the initial results are non-diagnostic.
In light of the evidence, clinicians should feel empowered to adapt to individual circumstances. For example, at the author’s institution, a FN- NA technique is always used initially to obtain 3 samples from each site. If the initial samples are perceived to be of low cellularity, 2-3 more are obtained using the FNA technique. Anecdotally, follow-up FNA appears to improve diagnostic yield in some lesions that do not initially exfoliate well with FN-NA. If an FNA technique is used, the size of the syringe should be considered. Most operators report improved dexterity when using a small syringe (Liffman 2017). In addition, a small syringe (3-5 mL) may provide adequate suction while minimizing cell trauma and blood contamination. In contrast, a larger syringe will provide more suction but risks damaging or hemodilution of the sample. For small lesions or in locations with vital surrounding structures, attaching the needle and syringe to an extension set allows the operator finer motor control while another individual applies suction with the syringe. The author finds this particularly helpful when obtaining samples from gallbladders, small pockets of effusion, or even small nodules or tissues. If a FN-NA technique is used, multiple passes should be used to increase the odds of a diagnostic yield. Limited evidence and common sense suggest the rate of a definitive diagnosis increases with each needle pass, but likely declines after a certain number. At this time, it appears that 4-5 passes are required to optimize diagnostic yield. Regardless of if the FNA or FN-NA technique is used, each lesion or tissue should be sampled multiple times as cells or diseases can be heterogeneously distributed throughout. Although the optimal number of samples is not well studied, the author’s institution usually obtains a minimum of three, but increases for poorly exfoliative tissues.
TECHNIQUE
Although the phrase “fine needle aspiration” is used in general terms for ultrasound-guided needle sampling, two distinct techniques exist that differ in their use of suction: fine needle aspiration (FNA) and fine needle non-aspiration (FN-NA, also referred to as the pincushion, advance- withdraw, or woodpecker technique). True FNA involves the use of a syringe of varying size, commonly between 1- 20 mL, to generate suction that pulls cells into the needle and hub. In contrast, FN-NA relies on the cutting action of the needle to pack cells inside with 3-5 passes, which are then trapped with capillary tension. The majority of human studies on various abdominal tissues have demonstrated the FN-NA obtain samples of superior quality), especially for the spleen and lymph nodes (LeBlanc 2009, Liffman 2017, and Flemming 2019). However, poorly exfoliative tissues such as the pancreas and kidneys may benefit from an aspiration technique (Liffman 2017). Although veterinary studies are less numerous, one (LeBlanc 2009) looking at splenic aspirates and one looking at hepatic aspirates (Fleming 2019) both found that a FN-NA technique resulted in more diagnostic quality samples with improved cellularity and cell preservation as well as reduced blood contamination. In addition, rotation of the needle during sampling may also increase diagnostic yield (Mattoon 2021). The same findings may not be true for non-abdominal samples of certain tumor types (Blacklock 2018), but for now, FN-NA appears to be superior when sampling abdominal viscera such as the liver and spleen.
. Figure 4. Demonstration of the FN-NA technique. Photo courtesy of Tom Thompson, MSU- CVM photographer.
Finally, while review of slide preparation and staining is beyond the scope of this presentation, techniques include the squash prep, blood smear, line smear,
20 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48Made with FlippingBook - Online Brochure Maker