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 28 VETERINARY eMAGAZINE
04 ORAL TUMORS: WHAT TO DO
22 NOT ONLY FOR THE BIRDS: IMPLICATIONS OF HIGHLY PATHOGENIC AVIAN INFLUENZA FOR POULTRY AND OTHER ANIMALS 12 PSYCHOPHARMACOLOGY IN CANINES 32 TECH TIPS 35 UPCOMING WEBINARS 08 DENTAL PROCEDURES: TO TURN OR NOT TO TURN? 27 MIND MASSAGE 16 FIP DIAGNOSTICS UPDATES FROM 2025
APRIL 2026
QUARTERLY BEAT
APRIL 2026
ISSUE 28 – APRIL 2026
WEBINAR HIGHLIGHTS ORAL TUMORS: WHAT TO DO 04 DENTAL PROCEDURES: TO TURN OR NOT TO TURN? BLOG HIGHLIGHTS 08 PSYCHOPHARMACOLOGY IN CANINES BLOG HIGHLIGHTS 12
WEBINAR HIGHLIGHTS NOT ONLY FOR THE BIRDS: IMPLICATIONS OF HIGHLY PATHOGENIC AVIAN INFLUENZA FOR POULTRY AND OTHER ANIMALS 22 27 MIND MASSAGE 32 TECH TIPS 35 UPCOMING WEBINARS
16
BLOG HIGHLIGHTS
FIP DIAGNOSTICS UPDATES FROM 2025
2 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
QUARTERLY BEAT
APRIL 2026
REGISTER NOW Grow your expertise in specialty medicine at the 2026 ACVIM Forum. Whether you’re attending in person or virtually, the ACVIM Forum delivers world-class education, meaningful connection, and innovative research-supporting your career growth at every stage. Join us virtually or in Seattle, June 11–13! CELEBRATING EXCELLENCE IN EDUCATION Seattle, Washington June 11-13 Specialty Symposium June 10 + VIRTUAL ACCESS
ACVIMForum.org
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 3
QUARTERLY BEAT
APRIL 2026
ORAL TUMORS: WHAT TO DO Dr. Michael Balke, DAVDC, F-OMFS Arizona Veterinary Dental Specialists WEBINAR HIGHLIGHTS In this VETgirl Webinar Oral Tumors: What to Do on October 14, 2025, Dr. Michael Balke, DAVDC, F-OMFS walks you through a practical, step-by-step approach to working up canine and feline oral tumors. Starting from asking key history questions that matter, all the way to documenting lesion characteristics like a pro, read on for a clear roadmap to navigating patients with oral tumors. Missed the live session? Catch the replay on demand HERE or read the cliff notes below!
Malignant tumors tend to appear suddenly, get big quickly and can cause clinical signs such as difficulty eating and drinking, drooling with possible blood and the pet being sensitive around its mouth. Benign tumors tend to stay the same size or gradually increase in size over time and cause minimal clinical signs. These are not hard-set rules but merely guidelines as benign and malignant tumors can sometimes share similar features.
INTRODUCTION
An oral tumor can involve the gingiva, lip, oral mucosa, tongue, bone, or a combination of any of these tissues. They are a relatively common finding in small animal practice. Their presentation, biological behavior and therapeutic outcomes vary widely depending on tumor type and location. Early recognition, accurate diagnosis, and a multidisciplinary treatment approach are essential for optimal outcomes. This first article in a two-article series will help the primary care veterinarian focus on how to systematically approach and diagnose oral tumors in canine and feline patients.
PHYSICAL EXAMINATION
HISTORY
The initial step in working up an oral tumor is obtaining a good history and performing a complete physical examination. The following questions can give the veterinarian insight into the biological behavior of the tumor (additional questions may be warranted based on answers):
• When was the tumor first noted? • Is it changing in size/color? • Have you noticed drooling? Is there blood in it?
• Has the client noticed any changes in their pet’s behavior (eating, drinking, upper respiratory sounds, playing with toys, pawing at mouth, being head shy)?
Perform a thorough general and oral examination, sedation is often required to get good oral visualization and tumor evaluation. Closely examine all the oral structures as other significant pathology could be present such as a large tonsil. Referral to a board-certified veterinary
4 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
QUARTERLY BEAT
APRIL 2026
dentist/oral surgeon and oncologist is recommended for many oral tumors so be as descriptive as possible about the size, location and appearance of the tumor in the medical record. Use a metric ruler or calipers to get measurements of the tumor (length, width, height), if that is not possible use your best guess or reference something similar in size, example: peanut, grape, lime. If teeth are involved list which teeth and if they are displaced, mobile, discolored. Describe the color and surface texture (smooth, lobulated, ulcerated). The best way to document the tumor is with high-quality pictures. Ideally, pictures should be attached to the medical record and taken with good lighting, the mass and surrounding anatomy fully visible at different angles and with a ruler to reference size (see Figure 1). Be alert for facial asymmetry, exophthalmos, nasal discharge or regional lymphadenopathy, which may indicate a deeper or more invasive disease.
Ideally, an incisional biopsy should be performed in which a representative section of the tumor is sampled. The biopsy should be taken within the tumor itself and not through skin or healthy tissue as this may “seed” cancer cells outside the tumor. Be sure to try and get to a biopsy from the surface to the core of the tumor as superficial samples may only diagnose inflammatory tissue that is surrounding the tumor. Punch biopsies are very useful for non-bony tumors; crosscut fissure burs, such as the 701L, work well to cut samples from tumors involving bone. When submitting a biopsy, give detailed information about the history, appearance and provide pictures along with dental imaging. This information is valuable to the pathologist in addition to a good biopsy sample. Excisional biopsies are the attempted complete removal of the tumor prior to a diagnosis and should only be considered for smaller, soft tissue tumors. Taking a clear post-biopsy picture of the tumor site and surrounding anatomy is recommended, especially with excisional biopsies, as margins may not be clean and planning future surgical revision can be difficult if there is no macroscopic evidence of the tumor (Figure 3).
Screening for metastasis in tumors that are likely to be malignant is recommended.
Thoracic radiographs (3-view) or thoracic computed tomography and fine needle aspirate or biopsy of regional lymph nodes can be performed at the time of biopsy or after diagnosis.
Figure 1. Providing pictures of oral tumors at different angels with a ruler is a great way to document the size and appearance of the tumor in the medical record. (Photos courtesy of Dr. Michael Balke, DAVDC, F-OMFS)
DIAGNOSTICS
Based on the history and exam findings, a differential diagnosis list can be formulated, but to determine what the tumor is, a biopsy must be performed. Once you have a minimum diagnostic database (CBC, Chem, UA) biopsy is your next step. It is best to avoid needle aspirates of oral tumors as they may not exfoliate well into the needle, resulting in minimal cells available for the pathologist to evaluate, making diagnosis difficult to impossible. Obtaining a good quality biopsy is very important as the diagnosis, prognosis and treatment options are dependent on its results. Biopsy collection must be performed under sedation or anesthesia with regional nerve blocks for the safety and comfort of the patient and veterinarian. Prior to obtaining a biopsy, dental radiographs, or, if available, computed tomography, should be performed to assess the tissues involved with the tumor. If bone is involved with the tumor, then including abnormal bone, in addition to soft tissue, with the biopsy is important for a representative sample (see Figure 2).
FOLLOW UP
Once a diagnosis has been made and, if performed, staging completed, an open conversation can be had with the client to discuss treatment options and prognosis specific to the type and stage of oral tumor affecting their pet. It is imperative when talking to the client about how to move forward to listen, show empathy, acknowledge their concerns and
Figure 3. Taking pictures after obtaining a biopsy can be critical
in planning future surgical margins as the biopsy site
can be indistinguishable from surrounding tissue after it heals. The sutures marking the previous biopsy site in this picture helped determine surgical margins for a lip melanoma, as the case was referred after the site had healed. (Photo courtesy of Dr. Michael Balke, DAVDC, F-OMFS)
ask questions to understand their goals. Smaller benign tumors may be amendable to removal with the primary care veterinarian if they are comfortable with the procedure. Consultation or referral to a board- certified veterinary dentist/oral surgeon and oncologist is recommended for patients with most oral tumors in order to provide the most progressive care. If referral is not an option due to geographic or financial restrictions, primary care veterinarians may have access to specialists via email or virtual options to discuss the best course of action. For clients that elect not to pursue treatment for their pet, monitoring quality of life and supportive care should be the goal.
Figure 2. This case helps show the importance of taking dental radiographs to assess bone involvement with the tumor. An incisional biopsy was performed by removing portions of gingiva, alveolar bone and teeth involved with the tumor, and the site was closed with absorbable suture. (Photos courtesy of Dr. Michael Balke, DAVDC, F-OMFS)
WEBINAR HIGHLIGHTS
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 5
QUARTERLY BEAT
APRIL 2026
carcinoma is often locally invasive but has a lower metastatic potential than oral melanoma. In dogs, aggressive surgical resection of the tumor can be curative if clean margins can be achieved (Figure 6). 6
Malignant oral melanoma is the most common malignant oral tumor found in dogs but is rarely diagnosed in cats. 1 These tumors are highly invasive and have a high metastatic potential, mostly to the regional lymph nodes and lungs. Wide surgical removal is the treatment of choice to obtain local control. Radiation therapy can be used in addition to surgery if clean margins are not achieved or as a primary mode of treatment if surgery is not an option. When combined with surgery or radiation therapy, a melanoma vaccine has been shown to increase the median survival time in some studies. Chemotherapy has not been shown to offer a significant survival benefit. 2 Cases in which the melanoma is identified and treated early, while the tumor is relatively small in size and prior to metastasis, can have a favorable prognosis (Figure 4). 3
Figure 5. Canine oral malignant melanoma attached to the buccal mucosa. This tumor was surgically resected with clean margins, but the dog eventually developed metastasis to the lungs 8 months after surgery. (Photo courtesy of Dr. Michael Balke, DAVDC, F-OMFS)
Figure 6. Very large and invasive mandibular squamous cell carcinoma on a dog that had been present for 9 months prior to surgical removal. The tumor was able to be completely removed with clean margins. The owners reported an increase in overall quality of life after tumor removal. (a: Pre op, b: Post op). (Photo courtesy of Dr. Michael Balke, DAVDC, F-OMFS) Similar to oral melanoma, if surgery is not an option or clean margins were not achieved, radiation therapy can be used to attempt local control. Chemotherapy has not been shown to be an effective treatment modality, but can be used for palliative care in dogs with SCC. 7 Prognosis is fair to good. Like dogs, aggressive surgical resection can be curative in cats. Unfortunately, it is often not an option as these tumors are typically too large and invasive at the time of diagnosis (Figure 7).
Figure 4. Canine oral malignant melanoma on the left mandibular gingiva that was able to be successfully treated with wide surgical removal of the tumor. (a: Pre op, b: Post op). (Photos courtesy of Dr. Michael Balke, DAVDC, F-OMFS) Unfortunately, melanomas that are not discovered until they are larger in size make local control more difficult and the chance of metastasis much higher, giving them a guarded to poor prognosis (Figure 5). Squamous cell carcinoma (SCC) is the second most common malignant oral tumor found in dogs 4 and the most common in cats 5 . There are various subtypes of oral squamous cell carcinomas, but broadly speaking, we will discuss tonsillar vs non tonsillar. Non tonsillar squamous cell
6 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
QUARTERLY BEAT
APRIL 2026
REFERENCES
1. Murphy BG, Bell CM, Soukup JW. Veterinary oral and maxillofacial pathology. Wiley-Blackwell, 2020, p. 130. 2. Pazzi P, Steenkamp G, Rixon AJ. Treatment of Canine Oral Melanomas: A Critical Review of the Literature. Vet Sci. 2022;9(5):196. 3. Carroll KA, Kuntz CA, Heller J, et. al. Tumor size as a predictor of lymphatic invasion in oral melanomas of dogs. J Am Vet Med Assoc. 2020;256(10):1123-1128. 4. Evans SM, Shofer F. Canine oral nontonsillar squamous cell carcinoma: prognostic factors for
Figure 7. Picture (a) and intraoral radiograph (b) of a 12-year-old cat diagnosed with squamous cell carcinoma of the left mandible. The mass was occupying most of the left mandible resulting in diffuse bony destruction and soft tissue swelling. Unfortunately, due to the advanced nature of the tumor and the cat’s declining condition, humane euthanasia was elected shortly after diagnosis. (Photo courtesy of Dr. Michael Balke, DAVDC, F-OMFS) Treatment is often palliative and can include radiation therapy, non- steroidal anti-inflammatory drugs (NSAIDs) and opioids. Prognosis is poor with median typical survival times of less than three months. 8 Tonsillar squamous cell carcinoma is primarily diagnosed in dogs and is a very aggressive tumor with a high metastatic potential. Unless diagnosed and treated early, multimodal treatment with surgery, radiation therapy and chemotherapy may extend life but is rarely curative. Prognosis is considered poor to guarded, with median survival often less than one year. 9
recurrence and survival following orthovoltage radiation therapy. Vet Rad. 1988;29(3):133-137.
5. Murphy BG, Bell CM, Soukup JW. Veterinary oral and maxillofacial pathology. Wiley-Blackwell, 2020, p.143. 6. Fulton AJ, Nemec A, Murphy BG, et. al. Risk factors associated with survival in dogs with nontonsillar oral squamous cell carcinoma 31 cases (1990-2010). J Am Vet Med Assoc. 2013;243(5):696-702. 7. Boria PA, Murry DJ, Bennett PF, et. al. Evaluation of cisplatin combined with piroxicam for the treatment of oral malignant melanoma and oral squamous cell carcinoma in dogs. J Am Vet Med Assoc. 2004;224(3):388-94. 8. Bilgic O, Duda L, Sánchez MD, et. al. Feline Oral Squamous Cell Carcinoma: Clinical Manifestations and Literature Review. J Vet Dent. 2015;32(1):30-40. 9. Mas A, Blackwood L, Cripps P, et.al. Canine tonsillar squamous cell carcinoma -- a multi-centre retrospective review of 44 clinical cases. J Small Anim Pract. 2011;52(7):359-64. 10. Martano M, Iussich S, Morello E, et. al. Canine oral fibrosarcoma: Changes in prognosis over the last 30 years?. Vet J. 2018;241:1-7.
Fibrosarcoma is the third most common malignant oral tumor in dogs and is less common in cats. They are a highly aggressive tumor locally that rarely metastasize. Early detection and wide surgical management can improve outcome and possibly be curative. If complete wide removal is not achieved or surgery is not a possibility, radiation therapy can be used to help with local control. Chemotherapy has not been shown to be effective against fibrosarcoma. Because of the tumor’s invasive nature and high recurrence rate, it is considered to have a guarded to poor prognosis. 10 The best opportunity for a successful outcome of oral tumors in dogs and cats typically occurs with early detection, accurate diagnosis and collaboration with oral surgical and oncological specialists. When possible, a combination of surgery, radiation and adjunctive therapies offers the best chance for long-term control. For animals that are not able to undergo curative treatment, supportive and palliative care with pain management and nutritional support should be provided.
WEBINAR HIGHLIGHTS
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 7
QUARTERLY BEAT
APRIL 2026
BLOG HIGHLIGHTS
DENTAL PROCEDURES: TO TURN OR NOT TO TURN? Stepfanie Perry , CVT, VTS (Dentistry) Should your dental patients be in sternal, lateral, or dorsal recumbency? In this VETgirl article , Stefanie Perry, CVT, VTS (Dentistry) breaks down why positioning isn’t just a “clinic preference” — it’s a patient safety and workflow decision. From airway protection to smoother monitoring, and easier intraoral visualization, read on to learn some practical real-world tips on head/neck angle, packing pitfalls, and whole-body positioning so your dentistry days run smoother, faster, and safer.
Figure 1. Photo courtesy of Stefanie Perry, CVT, VTS (Dentistry)
When teams adopt dorsal recumbency, they often find that procedures run more smoothly and with fewer safety concerns. The change benefits both patients and the staff caring for them. Among the available positions, dorsal recumbency offers significant advantages in three key areas: patient safety, workflow efficiency, and intraoral examination. Patient Safety Patient safety is the priority of veterinary medicine, and dentistry is no exception. While every practice has its own routines, safety protocols must be consistent and practical to uphold the standard of care. Anesthesia itself carries inherent risks such as hypotension, arrhythmias, or other physiologic changes. Aspiration is an additional consideration in dental procedures. Ultrasonic scalers, high-speed drills, and irrigation fluids used to cool instruments can all contribute. Even with a properly placed endotracheal tube, aspiration is possible. Positioning is a critical factor in minimizing this risk. Securing the Airway Every anesthetized dental patient should have an appropriately sized, cuffed endotracheal tube. Inflate the cuff gradually until no leak is detected at 20 cmH 2 O inspiratory pressure. This approach ensures an effective seal while reducing the chance of tracheal irritation or pressure necrosis. A secure airway is the final safeguard against aspiration.
Should dental procedures be performed in sternal, lateral, or dorsal recumbency? Every clinic has established routines that shape patient care, and change can feel daunting, especially when team members are hesitant to try new things. But evolving our methods is often the key to improving safety, efficiency, and patient outcomes. Successful workflow changes are best introduced during team meetings or training, with clear explanations of the “how” and the “why.” When the entire staff understands the benefits to patients, veterinarians, and technicians, it will smooth the transition and avoid mistakes. The Benefits of Dorsal Recumbency Performing dentistry in dorsal recumbency offers clear advantages: • Neck extended, limiting irrigation from reaching the airway • Enhanced visualization of oral anatomy without repeated repositioning • Reduced risk of vagal stimulation, regurgitation, or other complications linked to frequent movement • Less strain on patients with orthopedic pain or arthritis • Fewer interruptions to vital sign monitoring and heat support (Fig 1.)
Substances requiring airway protection in dentistry include: • Irrigation from power instruments • Blood • Mucus • Debris such as tartar or calculus
• Minimized manipulation of the endotracheal tube • Improved efficiency by eliminating time-consuming position changes
8 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
QUARTERLY BEAT
APRIL 2026
Whole-Body Monitoring Dental procedures may focus on the head, but prolonged positioning affects the entire body. A patient’s comfort and safety must be considered from nose to tail.
My approach: After induction and intubation, I begin with the patient in sternal recumbency to capture maxillary intraoral radiographs. I then rotate to dorsal recumbency, where most of the procedure takes place. As needed, I make small adjustments with partial head or chest rotations to access specific areas—without repositioning the entire patient. (Fig 2.)
Figure 2. Photos courtesy of Stefanie Perry, CVT, VTS (Dentistry)
• Head & Neck: Avoid overextension, cushion against hard or cold surfaces, and take care with patients who have cervical disc disease. • Eyes: Prevent contact with surfaces, lubricate at least every 30 minutes, and protect from debris or irrigation. • Thorax: Ensure patients with respiratory disease, obesity, or reduced lung function have room for chest wall expansion. • Spine: Limit twisting or torque in patients with intervertebral disc disease. Use bean bags or surgical positioners to support their body weight and prevent twisting. • Pelvis: Avoid full “frog-leg” positioning, which worsens hip arthritis and causes pain. Support on either side of the pelvis with positioners will prevent that. (Fig 4) • Stifles: Minimize tension, particularly in patients with osteoarthritis or a history of surgery. Avoid prolonged flexion of the knee if possible.
Other Positioning Points Gauze or absorbent packs: Any material used to block irrigation from the throat must be changed regularly when soaked or when debris collects. These cause a hazard by trapping fluid when they’ve absorbed too much, and the material could be mistakenly left after recovery. Any material should be tied to the endotracheal tube as a double check that it is removed. Head and neck positioning can replace this with diligent attention to positioning. Head and neck angle: The patient’s nose should be pointed toward the floor to keep irrigation flowing out of the mouth. Towels or other material to support the neck and help keep the nose down will make the neck more comfortable and prevent the position from accidentally changing. (Fig 3)
Workflow Efficiency If patient safety isn’t reason enough, consider efficiency. A comprehensive oral health assessment and treatment (COHAT) is time-intensive, and every minute counts. Each time a patient is rotated laterally, equipment must be adjusted, monitors repositioned, and anesthesia re-stabilized—all of which add up to lost time. With dorsal recumbency, radiographs can still be performed by rotating only the head and neck. This not only spares patients unnecessary full-body movement but also allows staff to maintain consistency in monitoring and heat support. On busy days, those saved minutes per procedure quickly accumulate.
Figure 4. This patient has additional special needs as a forelimb amputee and additional positioning equipment prevents undue stress to his spinal column, shoulders, and pelvis. Photo courtesy of Stefanie Perry, CVT, VTS (Dentistry).
Figure 3. Photo courtesy of Stefanie Perry
BLOG HIGHLIGHTS
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 9
QUARTERLY BEAT
APRIL 2026
Workflow during a COHAT can make or break a schedule. By simplifying positioning, teams can reduce frustration, maintain anesthetic stability, and keep the day running on track. Intraoral Exams Made Easier Finally, dorsal recumbency makes intraoral exams more efficient. Nearly all oral surfaces including buccal, lingual, palatal, and caudal tissues are easily visualized in this position. This means more thorough evaluations with less repositioning and less risk of missing subtle pathology. From a technician’s perspective, this efficiency is invaluable. It allows more time to focus on cleaning, scaling, and extractions rather than repositioning, while ensuring the veterinarian has the clearest possible view during the assessment.
Final Thoughts Shifting to dorsal recumbency for dentistry may feel like a significant change, especially in practices accustomed to sternal or lateral positioning. But the benefits are hard to ignore. From improved patient safety to greater efficiency and more complete exams, this approach elevates the standard of care while reducing stress for the veterinary team. The key to success lies in communication and training. When a team understands the reasoning behind a new approach and sees the benefits firsthand, implementation becomes far easier. By embracing thoughtful positioning strategies with the patient’s safety and comfort in mind, we not only safeguard our patients but also streamline our workflow and strengthen the bond within our teams.
Please note that the opinions in this blog are expressed by the author, and not directly endorsed by VETgirl.
BLOG HIGHLIGHTS
10 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
QUARTERLY BEAT
APRIL 2026
summer ce in salt lake JUNE 19-21, 2026 | THE GRAND AMERICA HOTEL This summer, Salt Lake City is where education meets elevation! From June 19-21, 2026, we’re taking over the Grand America Hotel downtown. Get ready for a weekend of education, networking, and just enough fun to call it "work." Who says learning can’t be fabulous? Snag your seat now!
START YOUR ADVENTURE AT VETGIRLONTHERUN.COM
Pending RACE Approval | 08072025
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 11
QUARTERLY BEAT
APRIL 2026
These medications should be tested prior to the actual stressful event. Dogs may have an adverse response to the medication, such as agitation or gastrointestinal (GI) upset that you do not want to discover at the time of the stressful event. Furthermore, it can be difficult to distinguish between an agitated response to a medication during a stressful event vs. a drug dose that was inadequate for that stressor, if prior testing was not performed. Testing ahead of time helps the owner observe any adverse effects and helps them determine which dose is appropriate for that dog. Dose does not necessarily relate to severity of issue. A highly aggressive dog may not require as high a dose for veterinary care as a very shy but not aggressive dog, depending on their individual response. This means you should generally start low-dose in trials and have the owner increase the dose at subsequent trials if they are not seeing a difference. Testing on a routine day gives the owner an idea of how the medication affects their baseline. If the dog shows minimal stress during the day, they can test the medication and drive to the parking lot of the vet clinic or go for a walk and see if the dog appears somewhat “subdued” or unbothered. Likewise, if multiple fast-acting medications are prescribed for a stressful event, they should ideally be trialed individually. This helps differentiate each drug’s effect. EXAMPLE: A 1-year-old male neutered German Shepherd shakes with fear during an annual veterinary exam and hides in the corner when it is time to collect blood. Talk with this owner about rescheduling a day to come back for lab work, so as to not relay to this pet that his polite attempts at avoiding interaction are useless. This can lead to a dog that will very likely “speak louder” the next time he is in a similar situation. Sileo® (dexmedetomidine oromucosal gel; Zoetis) may be a good option for this scared dog and help him avoid becoming a “sedate on the way in the door” dog a few years from now.
BLOG HIGHLIGHTS
PSYCHOPHARMACOLOGY IN CANINES Dr. Maggie O’Brian, DACVB Virtual Veterinary Behavior Medicine, Managing Partner Not sure when to reach for fast-acting vs. long-lasting behavior medications in dogs? This VETgirl article breaks down what to use before predictable stressors, how to bridge the gap before longer acting medications take effects, and how to avoid the dreaded sedation “see-saw.” Read on for common medication options, smart trialing tips, and when to loop in a behaviorist (spoiler alert: earlier is better!).
Introduction Treatment of significant behavioral disorders in dogs requires a robust plan. Medications often play an important role in this plan. We will discuss the two broad groups of medications to consider — short-acting medications (e.g., trazodone) and long-lasting medications (e.g., fluoxetine). We will also discuss additional considerations when prescribing medication for dogs. Fast-Acting Medications Fast-acting medication can be used in one of three ways: 1. as-needed use 2. bridging medication where you are initiating a long term medication or switching between long-lasting medications and need support during onboarding, or 3. long term use, typically in conjunction with a long-lasting medication. FAST-ACTING MEDICATION FOR AS-NEEDED USE Short-acting/fast-acting medications are commonly used in anticipation of a stressor, such as fireworks or veterinary care. In these cases, they are typically administered 30 minutes to 2 hours prior to the stressful event, depending on the medication. Their effects last anywhere from 2 to 12 hours.
12 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
QUARTERLY BEAT
APRIL 2026
FAST-ACTING MEDICATION AS A BRIDGE The onboarding time for the long-lasting medication (typically 4-6 weeks) may feel too long for a dog with an urgent issue — whether because their behavior is dangerous to others or themselves or because there are significant welfare concerns due to fear and anxiety. In this case, a short- acting medication can act as a bridge to help the dog while you are waiting to see what the long-lasting medication is going to do for them. A common question is, "How will I know which medication is helping, the fast-acting medication or the long-lasting medication?" If both drugs end up working well, you will typically see obvious timing of clinical response associated with the fast-acting medication — the owner can tell when they are due for the fast-acting medication and can tell if they have missed a dose. After a few weeks, and especially getting towards the 4 to 6-week mark of initiating long-lasting medication, the owner no longer typically sees these big swings in relation to the fast-acting medication timing. They also may be late to administer or forget a dose and not realize it. At this point, it is reasonable to start weaning the fast-acting medication.
EXAMPLE: A 4-year-old dachshund with global fear significantly improved with a combination of sertraline 2 mg/kg twice daily and lorazepam 0.2 mg/kg every 8 hours.
Dosing should similarly start low and typically start twice daily for a bridge. Further adjustments in dosing and timing depend on the pet’s response.
FAST-ACTING MEDICATION LONG TERM, IN CONJUNCTION WITH LONG-LASTING MEDICATION Some dogs benefit from long-term polytherapy - meaning the long-lasting daily medication the dog takes is helping but not enough to maintain adequate control over the anxiety. In these cases, even once the long- lasting medication has taken full effect, you still have the dog on one or more fast-acting medications. The goal with this daily use of fast-acting medication is to help further reduce anxiety and fear without causing sedation. In this case, weaning the fast-acting medication results in increased behavioral concerns, but you still want the baseline medication doing most of the heavy lifting. You do not want to see wild swings of behavior associated with the fast-acting medication’s timing — this likely indicates that the baseline medication is not doing enough. USING A FAST-ACTING MEDICATION LONG TERM WITHOUT THE PRESENCE OF A LONG-LASTING MEDICATION In some cases, fast-acting medications are used daily on a longer-term basis without any long-lasting medication. This is a common practice for recovery from an orthopedic surgery (e.g., giving a dog gabapentin every 8 hours during a multi-week recovery window). Another scenario would be if a dog had a temporary stressor spanning more than one day (e.g., a dog may benefit from a calming medication for the first week or two following a move or following the death of a close housemate). However, if a dog has generalized anxiety or suffers from long-term fear or hyper-arousal that warrants long-term medical management, using a fast- acting medication in the absence of a long-lasting medication is not ideal for the following reasons: 1. You can have a dog whose behavior seesaws throughout the day depending on the timing of the medication. 2. If you miss a dose or are late on a dose, it is typically obvious. 3. Repeated use can lead to less significant efficacy (i.e., the effects may wear off after time). 4. These medications can cause sedation, especially at higher doses. Pet parents (and we!) do not want dogs sedated daily.
EXAMPLE #1: An owner looks at you with deep exhaustion as you explain that the Clomicalm® (clomipramine hydrochloride; Virbac) will take 4-6 weeks to take effect to help his Doodle, who is currently doing a mixture of pacing, barking and destroying your exam floor 30 minutes into the appointment. Give this owner the option of a bridging medication, such as clonidine twice daily. Help him today.
EXAMPLE #2: A 6-year-old female spayed Australian Shepherd was started on fluoxetine two years ago. You have slowly increased the dose to 2 mg/ kg. The medication has been very helpful for generalized anxiety, but her appetite has taken progressive hits with dose increases and has not rebounded after 1 full month at the current dose. Previous dosing of 1.5 mg/kg daily was not enough to maintain adequate control of anxiety. In this case, transitioning to a new medication is indicated since she does not tolerate 2 mg/kg and 1.5 mg/kg is not effective enough. This transition will likely be somewhat bumpy due to fluoxetine’s positive influence on her overall anxiety, so utilizing a fast-acting medication such as trazodone during the swap from fluoxetine and a new long- lasting medication would be beneficial.
BLOG HIGHLIGHTS
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 13
QUARTERLY BEAT
APRIL 2026
SHORT-ACTING MEDICATION EXAMPLES • Clonidine: Clonidine is an alpha-2 agonist used 2 hours prior to stressful events, and repeated up to every 8 hours. • Trazodone: Trazodone is a serotonin antagonist and reuptake inhibitor (SARI) used 2 hours prior to stressful events, and repeated up to every 8 hours. • Gabapentin/pregabalin: These are gabapentenoids used to treat anxiety and neuropathic pain, as well as seizures. These medications have a wide dose range and are used 2 hours prior to stressful events, and repeated up to every 8 hours. • Sileo ® (dexmedetomidine) oromucosal gel: This is an alpha- 2-agonist medication labelled for noise aversions. It is typically applied 30 minutes prior to stressful events or at the onset of a sudden stressor. It can be re-dosed every 2 hours, up to 5 times in a single day. Sileo can be used off-label for other stressors, such as fear of veterinary handling, to lower fear and provide better focus during behavior modification training, or travel. Owners should be educated on application and safety of administration should be considered for dogs with any owner- directed aggression. • Benzodiazepines: This is a large drug class that works by potentiating the effects of GABA in the brain. There are multiple different medications that may be chosen based on duration of action needed, clinician preference, or trial and error testing. Benzodiazepines can cause disinhibition of aggression and are not typically first-line choices in a case involving aggression. Long-Lasting Medications Long-lasting medications are pulled from the anti-depressants developed in people. These medications are intended for longer-term use and take 4 to 6 weeks to take effect. Long-lasting medication can be utilized for a wide variety of behavior concerns including, but not limited to aggression, generalized anxiety, noise fears, separation related problems, compulsive disorders, urinary marking, and global fear. It is a common misconception that daily long-lasting medications are contraindicated in aggression. In fact, long-lasting medications, such as selective serotonin reuptake inhibitors (SSRIs), are often a cornerstone of treatment to help dogs with aggression. Any behavior medication can cause agitation, which can lead to increased aggression. However, this is rare, and the proportion of pets that can improve with these medications is significant. It is important to have a conversation about possible side effects and provide follow-up for continued management. Early implementation of a long-lasting medication can help supplement a behavior modification plan and lead to best outcomes. Long-lasting medication should not be considered a last resort option. The goal of long-lasting medication is to reduce anxiety, fear, and improve impulse control without causing sedation or other long term side effects. Transient, mild side effects (e.g., reduced appetite or sedation) may be tolerated for 1 to 2 weeks. However, if side effects are persistent, even if mild, medication should be discontinued and another option should be trialed. If medication causes significant side effects (e.g., profound sedation, agitation, significant GI upset), it should be discontinued right away. The goal is a happier and safer dog, not to have a lump in the corner. It is very helpful to proactively go through these expectations with the owners when discussing medication, as many owners hesitate to start long-lasting medication because they don’t want their dog sedated.
Dosing should start at half of the typical starting dose for 1 to 2 weeks to watch for any side effects before moving to the standard starting dose at the low end of the dose range. Increases can be considered once a pet is on the standard dose for 4 to 6 weeks.
EXAMPLE #1: A 6-month-old female spayed mixed breed dog presents for starting to growl at strangers on walks. You’ve had to start restraining carefully during vaccines. This dog is a good candidate to combine a long-lasting medication with a comprehensive behavior modification plan. Six months of age is an earlier than typical onset for fear-related aggression and should be treated urgently.
EXAMPLE #2: A 5-year-old newly adopted Newfoundland is destructive, having accidents and vocal when home alone. This was reported in the previous home and was the reason for relinquishment. The owner works out of the house 3 days per week and has an active social life out of the home. This dog is a good candidate for long-lasting medications to help treat a long-standing problem of separation-related problems and help provide some potential independence from – or, at minimum, amplification with - the use of fast- acting medications used for departure, which are also likely indicated in this case. LONG-LASTING MEDICATION EXAMPLES • Selective Serotonin Reuptake Inhibitors (SSRIs): This drug class blocks the reuptake of serotonin and includes medications such as fluoxetine (generic or Reconcile®), sertraline, paroxetine and escitalopram. There are mild differences in each medication that may point us towards one versus another, such as fluoxetine being more likely to reduce appetite. • Serotonin-norepinephrine reuptake inhibitors (SNRIs): This drug class blocks reuptake of serotonin and norepinephrine. Venlafaxine is the main medication used in dogs within this category. • Tricyclic antidepressants (TCAs): TThese medications block
reuptake of serotonin, norepinephrine and dopamine. They also are antihistaminergic and anticholinergic. The most common medication used in this category is clomipramine (generic or Clomicalm®).
14 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
QUARTERLY BEAT
APRIL 2026
Fast-Acting Medications • Medication is a valuable tool in treating a dog with behavioral concerns and should not be considered a last resort. • Fast-acting medication can help reduce anxiety and fear prior to stressful events, during the onboarding of a new long-lasting medication, or long term in conjunction with a long-lasting medication.
• Azapirones: The primary medication used in this category for dogs is buspirone. Buspirone acts as a partial serotonin agonist. It is thought to help with bravery. It is typically avoided in dogs with aggression.
Medication Should Never be the Only Part of the Conversation TRAINING It is extremely important to discuss training methodology (not just a yes/no on whether the client is working with a trainer) when discussing behavior problems and implementing medications. Many patients are started on fluoxetine while concurrently working with a shock collar trainer who is punishing the dog every time it growls at a dog across the street. Punishing a dog for outward signs of fear or anxiety can lower warning signals and increase the risk of explosive aggression. Aversive training also has a high risk of negative impact on patient welfare. Prescribing medication without pointing the client towards appropriate help is an incongruous approach; it is implementing medication to reduce stress while the concurrent training may be running a massive risk of increasing stress. I would equate this to a patient coming in with fleas — the pet is treated with steroids and antibiotics to address the itch and subsequent skin infection, but when the owner states they don’t need preventatives because they are applying garlic at home, we say “Sounds great! Let us know if the steroids and antibiotics don’t work.” Have a network of local trainers that use science-based training methods to refer to in your area. It’s helpful to provide a list of appropriate local trainers during behavior consults, as well as for newly adopted dogs or puppies (or any dog!). OTHER MANAGEMENT It is also very important to discuss management as part of medication implementation. For instance, aggression towards owners needs a full plan to reduce motivation, address aggression in the moment and discuss overall management and safety. Separation-related problems should involve a discussion of environmental set up for departure, enrichment during departure and other management strategies. All behavior concerns require a management discussion. REFERRAL Early referral to a veterinary behaviorist is an important option to provide to clients. Veterinary behavior appointments are typically an hour or longer and provide a thorough review of behavioral history and medical history, and a comprehensive treatment plan of medication, environmental management and behavior modification. Early referral can help the pet reach the best outcome for that patient and pet. When we delay referral until a dog fails multiple medications, or when the owner is considering euthanasia or rehoming, we are intervening later than ideal, which may affect prognosis considerably. Not every client is going to pursue referral, but they should all understand their full range of options from the onset of the discussion for best outcome. This is similar to referring for an echocardiogram when you hear a new murmur, not only when the dog is in heart failure.
• Long-lasting medications can help treat a wide variety of behavioral concerns, from aggression to compulsive disorders. The goal is to have a safer and happier pet, and if there are unwanted side effects - even mild - the medication should be adjusted or changed. • Medication should not be used in a vacuum. Behavior plans should involve discussion of management, appropriate training techniques, environmental management and the option of early referral.
BLOG HIGHLIGHTS
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 15
QUARTERLY BEAT
APRIL 2026
BLOG HIGHLIGHTS
FIP DIAGNOSTICS UPDATES FROM 2025 Dr. Amy Kaplan-Zattler, cVMA, DACVECC, MRCVS CE Program Manager, VETgirl Now that antivirals have made FIP treatment a real option, how do we confidently diagnose FIP? This VETgirl article breaks down which cats are at risk, what FIP looks like “in the wild,” and how to stack supportive diagnostics so you can start therapy sooner. 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!
Image courtesy of Dr. Dave Gordon.
In a small number of cats infected with FeCV (around 10%), the virus can mutate and begin replicating within macrophages and monocytes. At this stage, the newly mutated virus is called the feline infectious peritonitis virus (FIPV) and it essentially “hitchhikes” inside these white blood cells throughout the body, triggering an over-the-top inflammatory response centered around blood vessels (i.e., vasculitis), which is what ultimately drives the clinical symptoms of FIP. We still don’t fully understand how or why this mutation occurs in some cats but not in their siblings or in other cats living in the same environment. FIP is more often thought as a “young cat” disease (< 2 years of age), but don’t cross it off your differential list in adult cats; a small percentage are first diagnosed later in life. Intact males are overrepresented compared to females, and breed may also play a role as purebred cats have been overrepresented in some reports. Other risk factors include coinfection with feline immunodeficiency virus (FIV) or feline leukemia virus (FeLV), other concurrent disease, immunosuppression, and stress.
For years, feline infectious peritonitis (FIP) had been a diagnosis that made everyone’s stomach drop — the kind of case that felt as grim as the big “C” (cancer) diagnosis. But in the last few years, extra-label use of select antivirals has flipped the script, with reported response rates around 85–90%. With treatment now truly on the table, the priority shifts to rapid, confident diagnosis so cats can start therapy as early as possible for the best outcomes. In Part 1 of this 2-part blog, we focus on recognizing FIP in real life and how to build the strongest supportive diagnostic case. Check back next week for Part 2, where we dive into updated treatment strategies, including dosing, monitoring, and with a refreshed antiviral “cheat sheet” chart. Which Cats get FIP? Most young cats will pick up a feline enteric coronavirus (FeCV) at some point - often early in life - especially when living in close proximity of other cats such as in multi-cat households, catteries, or shelters. FeCV replicates within the apical columnar epithelial cells of the small intestine which can cause gastrointestinal signs such as diarrhea, some cats develop upper respiratory signs, and some remain asymptomatic. The virus is shed as early as 2-3 days after infection and cats may continue shedding for up to several weeks; a small handful of cats have been documented to shed lifelong. The diarrhea is usually short-lived, but if you have a kitten presenting with a history of persistent diarrhea for weeks to months, FeCV should definitely be among your differential diagnoses.
What Does FIP Look Like Clinically in Our Feline Patients? FIP is not a one-size-fits all disease – in fact it’s
quite the shape-shifter. Many times FIP presents as an “ADR” cat, producing
only nonspecific signs (e.g., lethargy, anorexia, weight
16 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
QUARTERLY BEAT
APRIL 2026
loss or failure to gain weight, waxing/waning fever). Check out a list of various clinical signs in the figure at the end of this article!
Broadly, we talk about two categorizations of FIP: the ‘wet form’ and the ‘dry form.’ • Effusive, or ‘wet’, FIP might look like the pot-bellied cat, or the cat working harder to breathe due to large-volume abdominal
fluid compressing/restricting the diaphragm. FIP effusion most commonly accumulates in the abdomen or chest, and
occasionally in the pericardial sac or scrotal sac. • Non-effusive, or ‘dry’, FIP tends to show up as
pyogranulomatous lesions in organs like the kidneys, liver, lymph nodes (including mesenteric lymph nodes), and in the eyes and brain.
Bullous keratopathy in an FIP positive cat. While this cat’s bullous keratopathy may have been idiopathic in origin or linked to other factors, it’s possible this was caused from progression of severe anterior uveitis and corneal edema secondary to FIPV. (Image courtesy of Dr. Amy Kaplan, cVMA, DACVECC, MRCVS) manifestations include pruritic nodules or papules and other dermatologic changes, as well as glomerulonephritis due to immune-complex deposition. For these reasons, separating FIP into ‘wet’ and ‘dry’ forms is not particularly useful, because they do not represent distinct disease entities. However, the patient’s clinical signs can help guide our selection of diagnostic tools, and can help identify which treatment protocols to follow.
BLOG HIGHLIGHTS
Neurologic signs reflect the neuroanatomic distribution of disease, which may be focal, multifocal, or diffuse and can be seen as clinical signs of: And because FIP doesn’t follow the book, cats can present with mixed-form FIP showing clinical features attributed to both ‘wet’ and ‘dry’ forms. Regardless of the form, cats may also develop jaundice, lymphadenopathy, or pale mucous membranes. Less common
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 17
QUARTERLY BEAT
APRIL 2026
Diagnostic Dilemma – Support vs. Confirmation Diagnosing FIP can be frustrating, especially in dry (non-effusive) cases where you don’t have biopsy results or the benefit of an accessible and diagnostically useful effusion sample. The clinical signs of FIP are often nonspecific and many readily available tests in practice provide diagnostic support rather than confirmation of FIP. The gold standard for confirmation remains immunohistochemistry (IHC) demonstrating FIP viral antigen
within macrophages, typically performed on tissue samples obtained via laparoscopy, laparotomy, or post-mortem examination. If ocular involvement
is present, aqueous humor can also be submitted for IHC. In
18 VETGIRL BEAT EMAGAZINE
VETGIRLONTHERUN.COM
QUARTERLY BEAT
APRIL 2026
real life, however, IHC isn’t always feasible in a timely manner, so clinicians commonly rely on a layered approach of stacking supportive findings until the overall clinical picture is compelling enough to justify treatment. When FIP is on the differential list, it’s best to start with baseline diagnostics: a complete blood count (CBC), serum biochemistry, urinalysis (to assess for possible renal involvement), and FeLV/FIV testing.
Viscus, “stringy” fluid sampled from a kitten’s abdomen with suspected FIP based on clinicopathologic support. (Image courtesy of Dr. Amy Kaplan- Zattler, cVMA, DACVECC, MRCVS). RT-qPCR on effusion is often treated as a “heavy hitter” because published performance can be excellent, and it’s fast enough to fit into clinical workflows, but it’s limited by cost, equipment, and technical expertise, which can make routine access variable. Rivalta’s test is a simple, low-cost bedside assay performed on effusion fluid that can be a helpful piece of the diagnostic puzzle for FIP. It evaluates whether the effusion contains a high concentration of protein and inflammatory macromolecules (classically including fibrin/fibrinogen), which will precipitate when exposed to dilute acetic acid. To perform the test, prepare a dilute acetic acid solution by adding 20–30 uL of 98% acetic acid to 7–8 mL of distilled water in a plain, sterile test tube (no additives), then gently place a single drop of effusion onto the surface of the solution in the tube.
The albumin-to-globulin (A:G) ratio is calculated from measured albumin and globulin concentrations in serum/plasma or effusion. In cats with FIP, a low A:G ratio reflects the classic combination of polyclonal hyperglobulinemia (chronic immune stimulation/inflammation) and hypoalbuminemia (negative acute-phase response, decreased production during inflammation, and/or redistribution). Clinically, this is supportive but not diagnostic , because other inflammatory, infectious, and neoplastic diseases can produce a similar pattern.
Next, if an effusion is identified, the diagnostic workup should “pivot” toward effusion characterization and targeted effusion tests, because FIP effusions often carry higher-yield clues. While variability of the clinical features exists (and concurrent disease can muddy the waters), FIP-associated effusions commonly share these features:
• Color: yellow/amber/straw; transparent to cloudy • Texture: viscous (“sticky”) • Protein: typically >3.5 g/dL (>35 g/L)
• Cellularity: often low, but variable (approximately 2–6 × 10³/uL, sometimes higher); commonly non- degenerate neutrophils and macrophages with fewer lymphocytes and a granular proteinaceous background • Effusion A:G ratio: often <0.4
Video courtesy of Dr. Dave Gordon.
VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE 19
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 40Made with FlippingBook - Online Brochure Maker