VETgirl July 2023 Beat e-Magazine

/// QUARTERLY BEAT / JULY 2023 BEAT

ISSUE 17 | JULY 2023

EMAGAZINE

WHAT’S ON THE CALENDAR

TECH TIPS ONE CLICK... THAT’S IT.

UROLITHIASIS IN SMALL ANIMALS

The current state of cyber security in veterinary medicine CYBER SECURITY

FELINE HEARTWORM INFECTION 8 Are YOU Looking for it?

Counseling Clients with Over- weight Pets: Is There a “Recipe?” FEATURED STORY

mind massage webinar recap

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BEAT EMAG Contents

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FEATURED STORY: Counseling Clients with Overweight Pets: Is There a “Recipe?” 8-9 FEATURED STORY: Feline Heartworm Infection: Are YOU Looking for it? 10-14 WEBINAR HIGHLIGHTS: Urolithiasis in Small Animals

TRANSFORM HIS METABOLISM AND PROMOTE MOBILITY

15 Associate Spotlight

16-19

WEBINAR HIGHLIGHTS: Cyber Security: The Current State of Cyber Security in Veterinary Medicine

New OM Metabolic Response + Joint Mobility uses a unique 3:1 protein-to-starch ratio and was shown to reduce body fat while minimizing loss of lean body mass in a 6-month weight loss study. * New OM Metabolic Response while minimizing loss of lean body mass in a 6-month weight loss study

20-22

WEBINAR HIGHLIGHTS: Cardiovascular Emergencies - The Beat Goes On 25 TECH TIPS: 1 Click ... That’s It.

Shown to reduce select pro-inammatory cytokines after 6 months of weight loss * after 6 months of weight los

Helps improve select metabolic health indicators

High level of omega-3 fatty acids (EPA) to help nutritionally manage dogs with joint conditions

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Mind Massage - Webinar Highlights

WHAT’S ON THE CALENDAR: Upcoming Webinars

*Caloric restriction @25% MER for months 1-4 and @40% MER for months 5-6; on - package feeding instructions reect 40% restriction. Nestlé Purina Petcare Internal Data (2022).

1-800-222-8387 (8:00 AM - 6:00 PM CST M-F) | Talk to your Purina Veterinary Consultant. Learn more at PurinaProPlanVets.com/MetabolicResponse. 1-800-222-8387 (8:00 AM - 6:00 PM CST M-F)

Purina trademarks are owned by Société des Produits Nestlé S.A.

Live size: 7.5” x 10” Bleed size: 7.75” x 10.25”

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The way we communicate with clients who have overweight or obese animals—and who may be overweight or obese themselves—both through our words and our body language, is critical. Deal with clients compassionately and empathetically, talk with them about the challenges they may have with their pet and look for common goals like alleviating osteoarthritis (OA) pain in order to improve their pet’s quality of life. Make a Proven Feeding Recommendation In addition to empathetic client communication, recommending an appropriate therapeutic weight management diet is critical. These diets are formulated to achieve calorie reduction without restricting nutrients. Some of the critical nutritional modifications include:

loss without creating a nutrient deficit. Therapeutic weight management diets are formulated to accomplish this, while over-the-counter weight management diets aren’t necessarily formulated to effectively restrict calories without also restricting nutrients. High protein levels: Protein is especially important because it helps dogs maintain lean body mass. The majority of an animal’s metabolic energy requirements come from lean body mass and the goal is to minimize its loss as the pet loses body fat. Satiety: It’s important for an animal that is on a weight management program to feel full and satisfied—otherwise, they might exhibit begging behaviors that could prompt clients to provide added food and treats. Nutrients that can promote satiety include protein and fiber.

involves both owner- and pet-related elements. Weight bias—a negative attitude or stereotype aimed at an individual because of their weight—is a topic that’s being talked about quite a bit in human medicine. Weight bias is the tendency to focus on willpower and personal responsibility over environmental and biological factors as reasons for an individual being overweight or obese. 2 It can even cause compromised patient care in human settings. 3 In veterinary medicine, the area of weight bias is just starting to be explored. One recent study found that veterinarians and veterinary students may also exhibit weight bias. These groups reported negative feelings, such as blame and frustration, toward dogs with obesity and their owners versus lean dogs and their owners. They were also pessimistic about the weight management compliance they would receive from owners of dogs with obesity. 4 Clearly, we have a long way to go in dealing with this issue.

Story

COUNSELING CLIENTS WITH OVERWEIGHT PETS: IS THERE A “RECIPE?”

In this VETgirl feature article sponsored* by Purina, Martha Cline, DVM, DACVIM (Nutrition) discusses how to counsel clients with overweight pets. As it’s such a sensitive topic, how can we ensure that we work with pet owners to ensure compliance with treatment of obesity?

•

High nutrient-to-calorie ratio: We must create a calorie deficit to promote weight

*Please note the opinions of this article are the expressed opinion of the author and not directly endorsed by VETgirl.

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What do we think when an overweight or obese dog enters our clinic? That the odds of achieving healthy, successful weight loss are high? That the pet owner will be reluctant to talk about the sensitive topic of weight management? That we’ve created a weight management plan for this patient in the past and the necessary follow- through obviously didn’t occur? As veterinary professionals, we can help clients understand the risks of excess weight to both their pets’ health and quality of life. But while it’s possible to successfully manage overweight and obese dogs, it takes time and patience. We also need to focus on the factors we can control as opposed to the ones we can’t. And what we can control is 1) how we communicate with clients and 2) how we recommend that our clients feed their pets. Let’s look at these individually. Rethinking How We Talk About Weight What we say, how we say it and how clients perceive our words are critical factors when

discussing pet weight management. Weight loss success hinges on performing an effective nutritional assessment for each patient, which includes open-ended questions about the pet’s current diet, home environment, treats, supplements, food given with medications and activity level. A detailed assessment provides the foundation for a productive conversation with the client about weight management. Here are some tips to help optimize those discussions.

dog’s eating habits. For example, rather than asking Lee, “What diet are you feeding?” ask, “Can you tell me everything Shadow eats throughout the day?”

PUT THE PATIENT’S HEALTH IN CONTEXT.

Pet owners are interested in doing what they can to help ensure the best quality of life for their pets. In a study involving 84 dog owners and 36 cat owners, survey statements based on pet health were the most effective for owners to consider changing their pet’s diet. 1 In a weight management scenario, the health benefits that could be derived from getting the pet to a healthier weight and body condition should be emphasized. For example, “If Shadow could lose ‘X’ pounds, it would make going on walks with you much easier for him.”

ASK FOR PERMISSION TO DISCUSS THE PET’S WEIGHT AND BODY CONDITION. Starting this way shows the client respect and lets you assess where they are in terms of wanting to take action. For example, “Lee, I’d like to talk with you about Shadow’s diet and body weight—would you be open to that?” If Lee says no, write it in the record and move on. However, clients are usually receptive to at least broaching the topic. POSE OPEN-ENDED QUESTIONS. Ask questions that are geared to generate information-rich responses regarding a

STEPS TO SUCCESSFUL Weight Management

4. RECOGNIZE AND MANAGE YOUR WEIGHT BIASES. Obesity is a multifactorial disease that

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Steps to Successful Weight Management

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Anti-inflammatory properties: Omega-3 fatty acids help manage inflammation and reduce the clinical signs associated with OA, which is often a weight-related condition.

Integrating effective client communication and nutritional management to facilitate canine weight loss requires the commitment and engagement of the entire veterinary team. The 2021 American Animal Hospital Association (AAHA) Weight Management Guidelines for Dogs and Cats 6 provide a deep dive into a variety of topics from effective client communication strategies to creating nutritional recommendations. A focus on optimizing pet health and building trust between clients and clinic will help promote the health of both your patients and your practice. *Caloric restriction @25% MER for months 1-4 and @40% MER for months 5-6; on package feeding instructions reflect 40% restriction.

Breakthrough Diet Transforms Metabolism and Supports Mobility A new research-driven diet offers a unique nutritional approach to healthy weight loss with joint health benefits while improving select metabolic indicators. Purina® Pro Plan® Veterinary Diets OM Metabolic Response + Joint Mobility was shown to reduce body fat and minimize loss of lean body mass in a six-month weight-loss study.* 5 Features of the diet include a 3:1 protein-to-starch ratio, natural fiber to contribute to satiety and a high level of omega-3 fatty acids (EPA) to help nutritionally manage dogs with joint conditions.

PERFORM A COMPLETE NUTRITIONAL ASSESSMENT

Protect with more precision.

Ask open-ended questions to draw out more detail from the client. (For example, “Tell me everything you feed Shadow from first thing in the morning throughout the entire day.”) Ask the client for permission to talk about their pet’s weight. If the client says yes, emphasize the health benefits of weight loss and the health concerns associated with obesity. Express empathy, not judgment. 3 PROVIDE A TAILORED RECOMMENDATION Consider the client’s lifestyle, goals, expectations and the human-animal bond. 2 SECURE CLIENT BUY-IN Involve the client in decision-making by exploring nutrition options together. Make a clear nutritional management recommendation, then elicit client feedback and modify recommendation as necessary. Schedule regular weigh-ins, initially 1 to 2 weeks later. Focus on achieving a body condition score (BCS) goal and rate of weight loss (1% to 2% per week) rather than a final weight. Encourage clinic staff to applaud both pet and client as the pet sheds pounds and eventually reaches ideal weight. This could entail a social media post, a success board in the lobby, or a printed certificate of 4 FOLLOW UP AND MONITOR 5 CELEBRATE SUCCESS! achievement. The veterinary staff can get creative to determine what works best for the individual clinic.

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References

Alvarez EE, Schultz KK. Effect of personal, food manufacturer, and pet health statements made by a veterinarian during a pet wellness appointment on a dog or cat owner’s decision to consider changing their pet’s diet. J Am Vet Med Assoc,2021;259:644–650. Alberga AS, Pickering BJ, Hayden KA, et al. Weight bias reduction in health professionals: A systematic review. Clin Obes,2016;6:175–188. Phelan SM, Burgess DJ, Yeazel, MW, et al. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev,2015;16;319–326. Pearl RL, Wadden TA, Bach C, et al. Who’s a good boy? Effects of dog and owner body weight on veterinarian perceptions and treatment recommendations. Int J Obes (Lond),2020;44(12):2455–2464.

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REASON #3: Heartworm disease in cats is more common than most veterinarians realize.

While heartworm can be more difficult to recognize and diagnose in cats than dogs, this doesn’t mean it is uncommon. Again, the major difference from canine disease is that most cats experience disease from immature heartworm vs. the adult worms seen in dogs. Unfortunately, the relatively small proportion of cats tested for heartworms has led to low numbers of cats being given heartworm prevention.

Tom Nelson, DVM, Medical Director, Animal Medical Centers of N.E. Alabama, Anniston, Alabama

*Please note the opinions of this article are the expressed opinion of the author and not directly endorsed by VETgirl.

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and intestinal absorption is independent of vitamin D levels. The urine is the main route of calcium excretion. 2,3 Rabbits may have less carbonic anhydrase within the thick ascending loop of renal tubules. However, literature supporting this is sparse. 4,5 Rabbits have high water intake and urine output with daily fluid requirements of approximately 100 ml/kg/day. 6 GUINEA PIGS Males have numerous accessory sex glands including large vesicular glands in which stones can become lodged. 7 The penis is S-shaped and males have a baculum. There is intromittent sac containing two horny styles located caudoventral to the urethral opening at the tip of the glans penis. The female urethra is readily distensible, and the urinary papilla is located outside of the vagina, like most rodents. Females have a vaginal membrane. Guinea pigs also have a high urinary excretion of calcium. CHINCHILLAS Male chinchillas possess a baculum. Males also have well developed accessory sex glands and produce a post-mating plug. Chinchillas can produce a wide range of urine specific gravities, but are often concentrated. 8,9 Chinchillas excrete the majority of their calcium in the feces, not urine. 10 Urolithiasis by Species FERRETS Historically sterile struvite uroliths were the most common urolith type in the United States. In a study evaluating urolithiasis from the Minnesota Urolith Center from 1981-2007, 67% of the stones submitted were struvite. 11 However, the prevalence of this stone type has shifted over time. In a more recent retrospective study (2010-2018), the most common stone type in ferrets in North America is now cystine, with 92.6% of submissions being primarily cystine in composition. 12 This is in contrast to uroliths in other countries with cystine urolithiasis making up only 26.8% of the submissions from Europe and Asia. 12 In this study, the odds of submission of a cystine urolith decreased with age with the median age of ferrets with cystine urolithiasis being two years of age and those with other stone types, four years of age.

that predispose them to urinary obstructions. 11,12 Urinary pH may influence the type of stone that develops as well. Diets higher in plant proteins may produce more alkaline urine, which favors the formation of struvite stones. While the naturally more acidic pH of ferret urine makes cystine insoluble. 1 In a retrospective case control study of ferrets with cystine urolithiasis, 94% of the cases with cystine stones received a grain-free diet. 13 While dietary management or prevention of this disease may be challenging, emphasis should be put on a high quality animal protein diet. Cystinuria is associated with an inherited genetic mutation in humans, dogs and cats. 14 Ferrets in the United States have minimal genetic diversity, and a similar underlying genetic mechanism likely contributes to this disease process. 15,16 Research is ongoing in this subject. RABBITS The most common urolith in rabbits is calcium carbonate. Other stone types include ammonium magnesium phosphate and calcium oxalate. Rare reports include silica, struvite and a single cases of calcium sulfate dihydrate from a rabbit eating gypsum based plaster. 17 The prevalence of urolithiasis in pet rabbit populations is unknown but estimated to be 2-10%. 18 Most stones are located within the bladder, however urethroliths, ureteroliths and renoliths also occur. Rabbits can also develop uroliths within the vaginal vestibule secondary to urine pooling or uroliths that were urinated into the vestibule. 19 In addition to true urolithiasis, rabbits may develop micro urinary calculi (MUC), which is more commonly referred to as bladder “sludge.” This is differentiated from normal calciuria as it precipitates to form microscopic calculi within the bladder. This appears to be a relatively common condition in rabbits. Predisposing factors for naturally occurring urolithiasis are less well described in rabbits than in ferrets. Things like obesity, lack of voiding, infection, and urinary nidus may universally predispose animals to stone formation. Ureteral obstruction itself can predispose rabbits to nephrolithiasis of the contralateral kidney. 20,21 Certain biochemical changes associated with urolithiasis in rabbits include increasing plasma calcium and sodium, likely due to their high calcium absorption and excretion. 18 A study evaluated the

SMALL ANIMALS Urolithiasis in About to see a blocked small mammal or exotic patient? If you missed Sarah Ozawa, DVM, DACZM’s webinar on April 20, 2023 entitled Urolithiasis in Small Mammals, read the highlights below! Sarah Ozawa DVM, DACZM

SMALL ANIMAL WEBINAR

WATCH FULL WEBINAR

Introduction Urolithiasis is a common condition in exotic small mammal species. While the diagnosis may be an incidental finding, many cases are symptomatic and may present as an emergency. Much of our knowledge is extrapolated from small animal medicine, keeping in mind the limitations of patient size and differing anatomy and physiology. Understanding the common stone types, predisposing factors, signalment, diagnostics and treatment of this disease is instrumental in the management of urolithiasis in exotic small mammal species. Anatomy and Physiology FERRETS The ferret bladder is relatively small and thin walled and easily distensible. The male (hob) has a baculum that is J-shaped. 1 This runs from near the tip of the penis to caudal to the ventral rim of the pelvis. The urethral orifice opens on the ventral surface of the glans penis and the preputial opening is caudal to the umbilicus. Additionally, the prostate is fusiform in shape and surrounds the proximal urethra. Prostatic disease can occur as a sequela to

hyperandrogenism associated with adrenal disease and mimic the presentation of urolithiasis. These anatomic variations result in a male ferret predilection for obstructive urolithiasis and may make catheterization challenging. The urethra in the female opens into the vaginal vestibule. In ferrets, the range for creatinine is small and the total creatinine is lower compared to other species. Therefore, small elevations in creatinine may be significant in ferrets. Given their carnivorous diet, the urine pH is normally acidic. RABBITS The bladder normally lies within the caudal abdomen to pelvic canal but is very distensible. There is no baculum in the male. The female urethra exits within the vaginal vestibule. Pigment from endogenously synthesized compounds or ingested plants are commonly excreted in the urine resulting in a yellow to red coloration. The urine is normally cloudy in color due to ammonium magnesium phosphate and calcium carbonate precipitates. Rabbits have a unique calcium metabolism compared to other mammals. Serum calcium is directly related to dietary calcium

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Webinar Highlights

Overall male ferrets appear to present more often with urolithiasis, likely due to their anatomical characteristics

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In cases of obstructive urolithiasis, catheterization is often necessary. Heavy sedation utilizing benzodiazepines, opioids and/or alpha agonists or ketamine or general anesthesia is recommended. Catheterization is particularly challenging in the male ferret due to the small diameter of the penile urethra, the acute angle of the urethra at the caudal aspect of the pelvic canal, possible extraluminal compression at the level of the prostate, and the J-shaped os penis. The urethral opening is on the ventral surface of the glans. Dilation with retrograde flushing, using a stylet such as small gauge suture material or a small gauge IV catheter can aid in placement. Recommended materials include silicone catheters, tom cat catheters, jugular catheters, and red rubber catheters in larger males. Body wrapping the catheter to the male is recommended in addition to e-collar placement. In female ferret and rabbits, in general ventral recumbency with the hindquarters elevated is recommended for catheterization. An otoscope, nasal speculum or endoscope may aid in placement. Female guinea pigs and chinchillas are relatively easy to place a urinary catheter due to the external urinary papillae. Surgical treatment will depend on the location of the stone, size of the patient and emergent necessity of the surgery. A cystotomy is relatively straightforward in most species and preferred over a urethrotomy. If a stone is present within the urethra, retrograde flushing should be attempted to move the stone into the bladder for removal. Urohydropropulsion can also be utilized in cases of microurinary calculi in rabbits to attempt to dilute or remove the sludge like material from the bladder. If the stone is located within other areas of the urinary tract a urethrotomy, ureterotomy, pyelolithotomy or nephrotomy may be required. The feasibility of those surgeries is dependent on patient anatomy and size. Other reported surgeries include perineal urethrostomy and tube cystotomy, especially in cases where urethral catheterization is not possible. There are now several reports of the long- term use of low-profile tube cystotomies in ferrets. 31 However, complications such as chronic urinary tract infections and myocarditis have been reported. In cases of end stage hydronephrosis or obstructive ureterolithiasis, a nephrectomy may be considered. A lateral flank approach has been reported in rabbits. 32 However, if functional renal tissue remains, it is preferred to leave the kidney in place and treat medically. Alternatively, in other species a subcutaneous urinary bypass (SUB) systems or ureteral stent may be recommended in these cases. In rabbits, utilization of implantable devices has proven challenging due to their high urinary excretion of calcium and predilection for mineralization. In three rabbits with ureteral stent placement, encrustation of the stent occurred in all cases resulting in re-obstruction. 33 Additionally, in a case of a SUB placed in a rabbit, the contralateral kidney obstructed and the shunting port developed an obstruction. 34 At present, there are concerns over long-term prognosis with these devices in rabbits.

Webinar Highlights Prevention of urolithiasis is challenging, as the etiology in most species is unknown. In all species, an appropriate diet should be recommended as previously discussed. Increasing water intake is also helpful as urolithiasis is more likely to occur in concentrated urine. This can be done by increasing water rich food sources or increasing drinking water intake. Certain species In larger animals, minimally invasive endoscopic techniques may be feasible. Cystoscopy can be performed in larger female rabbits and guinea pigs. 35 There is a report of vaginoscopy to remove a vaginal calculi in a rabbit. 19 Due to the distensible nature of the female guinea pig urethra,, manual removal, with or without the utilization of retractors may be possible with distal urethroliths. Percutaneous cystolithotomy has been successfully performed in ferrets with a positive outcome in three out of four cases. 36 Extracorporeal shock wave lithotripsy has been used in rabbits as an experimental model. This resulted in histopathologic damage to extrarenal tissue such as the liver and lung and is therefore not recommend in clinical veterinary patients at this time. Cystoscopic lithotripsy is feasible in the female guinea pig however. 37 While not yet utilized in small mammal patients, burst wave lithotripsy shows promise and warrants further research. 38 Medical dissolution of stones is not often effective in small mammal species. Struvite dissolving diets made for cats and dogs are not palatable for ferrets and compliance is challenging. Additionally, these diets are unlikely to have sufficient protein for ferrets. Other medications to alter urinary pH have similar challenges with palatability. Anecdotally, medications like potassium citrate and hydrochlorothiazide have been used in rabbits and guinea pigs to reduce the formation of calcium-based stones. In a retrospective study of lower urinary tract disease in guinea pigs, potassium citrate was associated with a positive response to treatment and may help reduce the recurrence of urolithiasis in at risk animals. 39 Interestingly, in this retrospective study, the majority of the guinea pigs with urolithiasis were medical managed (72%) with a combination of fluids, nonsteroidal anti-inflammatory drugs, analgesics and benzodiazepines. 39 Other medical management treatments may include fluid therapy and alpha blockers to relax the urethra (e.g. prazosin). Recently however, prazosin has been suggested to increase the rate of urinary obstructions in cats and its use may require additional consideration in small mammal species. All these drugs are not approved in small mammals and their use and dosage are often extrapolated from small animal medicine. Continued on Page 14

effect of dietary calcium on urolithiasis in rabbits fed diets of varying calcium concentrations for a total of 25 weeks. Rabbits fed primarily alfalfa, a high calcium food item, had more urinary sediment on ultrasound, but none of the rabbits in this study developed urolithiasis or tissue mineralization. 22 While diet is often blamed as a cause of urolithiasis in rabbits, calcium should not be excluded from the diet as it is a necessary nutrient. Instead, priority should be placed on increasing water intake and limiting dietary items with excessive calcium levels. GUINEA PIGS The most common urolith type in guinea pigs is calcium carbonate. 23 Older literature may cite calcium oxalate as the most common stone type, which is likely due to the methodology of stone detection and diagnosis. Most uroliths are present in the bladder, followed by the urethra and the ureter. Uroliths can also be present within the seminal vesicles in males and there is a single case of a urolith present within a urethral diverticulum in a guinea pig. 24 A recent retrospective study of urolithiasis in guinea pigs discussed 158 cases diagnosed between 2009-2019. 25 In this study, both males and females were represented, but males often presented at a younger age. Females more commonly developed distal urinary stones, likely secondary to their distensible urethra. Overall females had a longer survival time than males. Factors that were associated with non-survival in guinea pigs with urolithiasis included increased age, anorexia, weight loss, male sex, and lower body temperature at intake. Importantly, recurrence of urolithiasis occurred in 14% of the cases and is an important aspect of disease management to discuss with owners.

Given the high calcium absorption and excretion in guinea pigs, similar to rabbits, dietary modifications are often included in the management strategy of this disease process. However, certain breeds of guinea pigs are predisposed to fibrous osteodystrophy due to calcium or vitamin D imbalances and therefore calcium should never be eliminated from their diet. 26 In other species, excessive vitamin C may lead to the formation of calcium based stones. 27 When hypercalciuric guinea pigs were fed increasing amounts of vitamin C, bladder calcification occurred. 28 While vitamin C is required in guinea pigs, there may be evidence that excessive supplementation could be detrimental. CHINCHILLAS Urolithiasis appears to be less common in chinchillas than other small mammal species. A retrospective case series described 15 cases of urolithiasis in chinchillas over a four year period. 10 The median age was 30 months and more males (14/15) than females were diagnosed with urolithiasis. Calcium carbonate also appears to be the most common urolith in chinchillas. 10 There is a single case of a semen-matrix calculi in a chinchilla. 29 Most uroliths are present within the bladder with fewer present within the urethra. The etiology in chinchillas is unknown. Insufficient water intake may play a role. Dietary causes are considered unlikely in chinchillas given the low amount of calcium that is typically excreted in the urine in chinchillas. 10 Treatment of Urolithiasis Most cases of urolithiasis in small mammals require surgical removal as medical therapy or dissolution is not typically effective. However, medical management is indicated in certain cases where urolithiasis is non- obstructive or unlikely to result in clinical consequences. 30

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Associate Spotlight

have water intake preferences with rabbits and chinchillas favoring open dishes and guinea pigs and degus having more individual preferences. 40,41 Attempting to treat or minimize predisposing factors may help prevent disease. This may include increasing exercise and promoting weight loss in cases of obesity or treating underlying mobility or sanitation issues. However, as there is likely a large physiologic and genetic component to the development of urolithiasis in these species, recurrence may be common.

17. Kucera J, Koristkova T, Gottwaldova B, et al. Calcium sulfate dihydrate urolithiasis in a pet rabbit. Journal of the American Veterinary Medical Association 2017;250:534-537. 18. Wong A, Gardhouse S, Rooney T, et al. Associations between biochemical parameters and referral centre in pet rabbits with urolithiasis. Journal of Small Animal Practice 2021;62:554-561. 19. Tarbert DK, Matos Rd. Endoscopic Removal of a Vaginal Calculus in a Domestic Rabbit (Oryctolagus cuniculus). Journal of Exotic Pet Medicine 2016;25:253-260. 20. 20. Itatani H, Yoshioka T, Namiki M, et al. Experimental model of calcium- containing renal stone formation in a rabbit. Investigative Urology 1979;17:234- 240. 21. Eddy AA, Falk RJ, Sibley RK, et al. Subtotal nephrectomy in the rabbit: A model of chronic hypercalcemia, nephrolithiasis, and obstructive nephropathy. The Journal of Laboratory and Clinical Medicine 1986;107:508-516. 22. Clauss M, Burger B, Liesegang A, et al. Influence of diet on calcium metabolism, tissue calcification and urinary sludge in rabbits (Oryctolagus cuniculus). Journal of animal physiology and animal nutrition 2012;96:798-807. 23. 23. Hawkins MG, Ruby AL, Drazenovich TL, et al. Composition and characteristics of urinary calculi from guinea pigs. Journal of the American Veterinary Medical Association 2009;234:214-220. 24. 24. Parkinson LAB, Hausmann JC, Hardie RJ, et al. Urethral diverticulum and urolithiasis in a female guinea pig (Cavia porcellus). J Am Vet Med Assoc 2017;251:1313-1317. 25. 25. Edell AS, Vella DG, Sheen JC, et al. Retrospective analysis of risk factors, clinical features, and prognostic indicators for urolithiasis in guinea pigs: 158 cases (2009–2019). Journal of the American Veterinary Medical Association 2022;1:1-6. 26. 26. Gallego M. Case report of a satin guinea pig with fibrous osteodystrophy that resembles human pseudohypoparathyroidism. Case Reports in Veterinary Medicine 2017;2017. 27. 27. Karam A, Mjaess G, Younes H, et al. Increase in urolithiasis prevalence due to vitamins C and D supplementation during the COVID-19 pandemic. Journal of Public Health 2022;44:e625-e626. 28. 28. Singh P, Kiran R, Pendse A, et al. Ascorbic acid is an abettor in calcium urolithiasis: an experimental study. Scanning microscopy 1993;7:28. 29. 29. Higbie CT, DiGeronimo PM, Bennett RA, et al. Semen-Matrix Calculi in a Juvenile Chinchilla (Chinchilla lanigera). Journal of Exotic Pet Medicine 2019;28:69-75. 30. 30. Bartges JW, Callens AJ. Urolithiasis. The Veterinary clinics of North America Small animal practice 2015;45:747-768. 31. 31. Huynh M. Permanent Implantable Medical Devices in Exotic Pet Medicine. Veterinary Clinics of North America: Exotic Animal Practice 2019;22:521-538. 32. 32. Martorell J, Bailon D, Majó N, et al. Lateral approach to nephrotomy in the management of unilateral renal calculi in a rabbit (Oryctolagus cuniculus). Journal of the American Veterinary Medical Association 2012;240:863-868. 33. 33. Rembeaux H, Langlois I, Burdick S, et al. Placement of ureteral stents in three rabbits for the treatment of obstructive ureterolithiasis. Journal of Small Animal Practice 2021;62:489-495. 34. 34. Huynh M. Permanent Implantable Medical Devices in Exotic Pet Medicine. Veterinary Clinics: Exotic Animal Practice 2019;22:521-538. 35. 35. Wenger S, Hatt J-M. Transurethral Cystoscopy and Endoscopic Urolith Removal in Female Guinea Pigs (Cavia porcellus). Veterinary Clinics of North America: Exotic Animal Practice 2015;18:359-367. 36. 36. Branquart M, Langlois I, Vachon C, et al. Removal of lower urinary tract stones by percutaneous cystolithotomy in domestic male ferrets (Mustela putorius): 4 cases (2017–2020). Journal of Exotic Pet Medicine 2023;45:38-44. 37. 37. Coutant T, Dunn M, Langlois I, et al. CYSTOSCOPIC-GUIDED LITHOTRIPSY FOR THE REMOVAL OF A URETHRAL STONE IN A GUINEA PIG. Journal of Exotic Pet Medicine 2019;28:111-114. 38. 38. Maxwell AD, Kim GW, Furrow E, et al. Development of a Burst Wave Lithotripsy System for Noninvasive Fragmentation of Ureteroliths in Pet Cats. 2022. 39. 39. Azevedo S, O’Malley B, Greene C, et al. Lower Urinary Tract Diseases in Guinea Pigs: A 14-Year Retrospective Study (2004–2018). Animals 2023;13:112. 40. 40. Tschudin A, Clauss M, Codron D, et al. Water intake in domestic rabbits (Oryctolagus cuniculus) from open dishes and nipple drinkers under different water and feeding regimes. Journal of animal physiology and animal nutrition 2011;95:499-511. 41. 41. Hagen K, Clauss M, Hatt JM. Drinking preferences in chinchillas (C hinchilla laniger), degus (Octodon degu) and guinea pigs (C avia porcellus). Journal of animal physiology and animal nutrition 2014;98:942-947.

Sponsored by Yarelie Hayes Customer Service Representative Yarelie has over a decade of experience supporting customers across different industries. She also held management positions, where she passionately drove her team to deliver an exceptional experience. She is committed to helping others and enjoys overcoming challenges. She previously worked for a tech software startup and has gained extensive knowledge and expertise with new and emerging technologies. Yarelie holds a Bachelor’s Degree in Business Administration from Strayer University. Outside of work, Yarelie enjoys kayaking, baking and being the sous chef to her husband.

References

1. Di Girolamo N, Huynh M. Ch. 4 Disorders of the Urinary and Reproductive Systems in Ferrets In: Quesenberry K, Mans C, eds. Ferrets, Rabbits, and Rodents: Clinical Medicine and Surgery 4th eds. Philadelphia: Elsevier, 2020;39-55. 2. Eckermann-Ross C. Hormonal Regulation and Calcium Metabolism in the Rabbit. Vet Clin North Am Exot Anim Pract 2008;11:139-152. 3. Cheeke P, Amberg J. Comparative calcium excretion by rats and rabbits. Journal of animal science 1973;37:450-454. 4. Donnelly TM, Vella D. Ch. 11 Basic Anatomy, Physiology, and Husbandry of Rabbits In: Quesenberry KE, Orcutt CJ, Mans C, et al., eds. Ferrets, Rabbits, and Rodents (Fourth Edition). Philadelphia: W.B. Saunders, 2020;131-149. 5. Di Girolamo N, Selleri P. Ch 16. Disorders of the Urinary and Reproductive Systems In: Quesenberry KE, Orcutt CJ, Mans C, et al., eds. Ferrets, Rabbits, and Rodents (Fourth Edition). Philadelphia: W.B Saunders, 2020;201-219. 6. Brandao J, Graham J, Quesenberry K. Ch 12. Basic Approach to Veterinary Care of Rabbits In: Katherine Q, Christoph M, Connie O, et al., eds. Ferrets, Rabbits, and Rodents : Clinical Medicine and Surgery (4th edition). Philadelphia: W. B. Saunders, 2020;150-161. 7. Pignon C, Mayer J. Ch 21. Guinea Pigs In: Quesenberry KE, Orcutt CJ, Mans C, et al., eds. Ferrets, Rabbits, and Rodents (Fourth Edition). Philadelphia: W.B. Saunders, 2020;270-297. 8. Doss GA, Mans C, Houseright RA, et al. Urinalysis in chinchillas (Chinchilla lanigera). Journal of the American Veterinary Medical Association 2016;248:901-907. 9. Alworth LC, Harvey SB. Chapter 39 - Anatomy, Physiology, and Behavior In: Suckow MA, Stevens KA,Wilson RP, eds. The Laboratory Rabbit, Guinea Pig, Hamster, and Other Rodents. Boston: Academic Press, 2012;955-966. 10. Martel-Arquette A, Mans C. Urolithiasis in chinchillas: 15 cases (2007 to 2011). J Small Anim Pract 2016;57:260-264. 11. Nwaokorie EE, Osborne CA, Lulich JP, et al. Epidemiology of struvite uroliths in ferrets: 272 cases (1981–2007). Journal of the American Veterinary Medical Association 2011;239:1319-1324. 12. Hanak EB, Di Girolamo N, DeSilva U, et al. Variation in mineral types of uroliths from ferrets (Mustela putorius furo) submitted for analysis in North America, Europe, or Asia over an 8-year period. Journal of the American Veterinary Medical Association 2021;259:757-763. 13. Lamglait B, Brieger A, Rainville M-P, et al. Retrospective case control study of pet ferrets with cystine urolithiasis in Quebec, Canada: epidemiological and clinical features. Journal of veterinary medicine and surgery 2021;5. 14. Kovaříková S, Maršálek P, Vrbová K. Cystinuria in Dogs and Cats: What Do We Know after Almost 200 Years? Animals 2021;11:2437. 15. Gustafson KD, Hawkins MGa, Drazenovich TL, et al. Founder events, isolation, and inbreeding: Intercontinental genetic structure of the domestic ferret. Evolutionary Applications 2018;11:694-704. 16. Stockman J, Malka S, Lofgren N, et al. Cystine and amino acid concentrations in the urine of pet ferrets (Mustela putorius furo). Journal of Exotic Pet Medicine 2023.

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SECURITY Cyber THE CURRENT STATE OF CYBER SECURITY IN VETERINARY MEDICINE

BUILDING A CYBERATTACK Contrary to popular belief cyber criminals rarely seek out an individual business, unless that business will net them millions of dollars in ransom. Thus, how are cyberattacks crafted to attack smaller businesses and more importantly veterinary hospitals? The waterfall approach. When a cybercriminal looks to go after small businesses they build an attack like a waterfall. As a river flows down the river it looks for the path of least resistance. Thus, the cybercriminal will build an attack vector that looks for known exploits that will allow them to easily flow into the hospital. We can look at the steps used by cyber criminals by analyzing the seven links in Lockhead Heed Martins Cyber Kill Chain. The seven steps are:

Education is the most powerful weapon you can use to change the world.

Clint Latham J.D. Lucca Veterinary Data Security; Palisade, CO

Is your business Cyber-Safe? If you missed Clint Latham, JD’s VETgirl practice management webinar on June 1, 2023 entitled The Most Important Thing No One is Talking About, read the highlights below! In this webinar, Clint discusses the current statistics surrounding cyber security attacks in veterinary medicine, how cyberattacks are deployed, and what the hackers are after. Tune in as he shares industry examples that you can learn from and 5 simple things you can do to help protect yourself from cyber-crime!

- Nelson Mandela

Reconnaissance

Weaponization

SMALL ANIMAL WEBINAR

3. Delivery 4. Exploitation 5. Installation 6.

Command & Control

complicated and unique passwords for every account you use. They also easily integrate with Windows and Google’s Chrome web browser. They allow you to easily share passwords with staff and notify you if any of your passwords have been compromised. The best part is that when an employee leaves you simply deactivate their password manager access and don’t have to change every password in the hospital. 2. UPDATE, UPDATE AND THEN UPDATE AGAIN : One easy path down the river is through known exploits on the network. All technology software companies offer regular security updates. Some of these updates are known as Zero days, which indicate that these vulnerabilities are actively being exploited by criminals and you need to update immediately. Thus, you should regularly update anything that touches the internet. Not just computers and the software that they use. But also any IOT (Internet of Things) devices. Things like smart phones, tablets, smart thermostats, Amazon Alexa or Google Home devices, ring camera systems, and the list goes on. The eternal blue

Actions & Objectives

WATCH FULL WEBINAR

These tools then look for a weakness in area’s 1-3; which are then deployed to the World Wide Web. The most common attack vector is email phishing followed by business email compromise. A few industry examples include sending hospitals fake resumes embedded with Ransomware, or gaining access to the clinic email address, which then gets them access to cloud based practice management systems allowing them to create fake invoices to send to all of your clients. 5 SIMPLE STEPS TO PROTECT YOUR HOSPITAL The great news is that it doesn’t have to be expensive or complicated to start protecting your hospital from the waterfall of cyberattacks. Thus we are going to cover five actions you can take that will have the greatest impact on your veterinary hospital’s cyber security. 1. PASSWORDS : Start by leveraging a good password manager. The recent JBS & Kasyea attacks carried out by ReVil, using compromised password lists they acquired from the dark web. A good password manager will make it easy to create

WHY DON’T WE HEAR ABOUT ALL THESE ATTACKS? In June of 2020 the AVMA gave an online presentation concerning cyber security and why having a Cyber Security PLIT was important. The AVMA trust division stated that at the time of the presentation their average cyber claim was $135,000. Unfortunately, a ransom demand of $135,000 isn’t large enough to be newsworthy. In fact, in order for the federal government to get involved the ransom has to be in excess of $500,000. The sad fact is that just because we don’t hear about them doesn’t mean that it’s not happening. On June 3rd, 2021, the White House released an open letter to all businesses in the United States. They specifically state “no company is safe from cyberattacks”. Yet the veterinary industry largely thinks they are in some sort of safe zone. This is largely due to a lack of understanding how cyberattacks work.

Cyber security has become a bit of a buzzword in 2021. The high profile cyberattacks on businesses, like the Colonial Pipeline, CNA, Kasyea & JBS, have raised a lot of concerns amongst larger organizations. However, veterinary medicine largely remains unconcerned. With common messaging of “Why would anyone want Fluffy’s medical records” and “Our IT guy has us covered”. However, the statistics tell us that over one third of small to medium sized businesses were affected by a cyberattack. With veterinary medicine being lumped into the health care sector it’s hard to know exactly the number of practices that are affected each year. However, using the rough estimate of one third of small- medium sized businesses from the research of Malwarebytes, roughly 11,000 veterinary practices each year are affected by a cyberattack. That’s 228 veterinary hospitals per week!

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Webinar Highlights

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