Богдан Маліцький/stock.adobe.com

Happy Monday dvm360 readers! We hope you all had a fantastic weekend, except losing that hour of sleep for Daylight Savings. We are so excited to be heading down to Charlotte, North Carolina this week to kick off our first Fetch conference of the year. Join the dvm360 staff, keynotes Joya Griffin, DVM, DACVD, and Phillip Bergman, DVM, MS, PhD, DACVIM (Oncology), and other key industry leaders to earn 17+ credits throughout the weekend. This is not a conference to miss, so register 

As the team prepares to head to the Queen’s City, here is what you can find this week on dvm360.com:

The dvm360 team will be complying a list of lectures not to miss, keynote address teasers, events to attend, and more! Be sure to check in throughout this week for this sneak peak, and throughout the conference for the dvm360 editorial team's conference coverage.

On this week’s episode of The Vet Blast Podcast presented by dvm360, our host Adam Christman, DVM, MBA, invited back special guest Renee Schmid, DVM, DABT, DABVT, senior toxicology at Pet Poison Helpline, to chat about spring toxins veterinary professionals need to be mindful of.

Vetsource, a pet pharmacy service and veterinary analytics company, shared the findings of its recently released white paper stating visits are declining and the frequency between veterinary visits are lengthening, in result causing challenges, and maybe opportunities, for veterinary professionals.

During an interview with dvm360, Brian Sutherland, DVM, DACVS-SA, shares the differences between palliative procedure and definite repair ahead of his upcoming lecture at Fetch Charlotte.

The US Department of Agriculture announced late last month a $1 billion strategy to mitigate highly pathogenic avian influenza type A H5N1 that will assist the poultry industry, with hopes of lowering egg prices.

Articles

Here is a sneak peek at this week’s headlines

Sneak peek: dvm360 kicks off Fetch Charlotte, and other veterinary news

Advancing in the veterinary profession or industry not only paves the way for career growth but can also foster positive change in the industry. As exemplary professionals step into new leadership roles, they bring with them unique perspectives, creative solutions, and a commitment to evolving their organizations and the broader veterinary landscape.

The following individuals are being spotlighted in this week’s “Paws and profits” column:

Stanley Howell, MBA chief operations officer, Wedgewood

Staney Howell, MBA. (Photo courtesy of Wedgewood)

Stanley Howell, MBA has been appointed Wedgewood’s new chief operations officer. In his new role, Howell will spearhead the company’s initiatives to streamline supply chain operations, improve service delivery, and support the growth of the Blue Rabbit platform—Wedgewood’s online veterinary pharmacy platform. Howell is certified as Six Sigma and Lean Black Belt, Change Agent, and Organizational Business Designer. Prior to his appointment at Wedgewood, he held leadership roles at Bristol Myers Squibb, Novartis, and Merck.

“I’m thrilled to join Wedgewood at such a transformative moment,” said Howell in a company release.

 “The company’s commitment to operational excellence and customer service aligns perfectly with my passion for driving efficiency and continuous improvement. I look forward to working with our teams to support veterinarians with the best possible pharmacy solutions, ensuring they can focus on what matters most—caring for their patients.”

Stephanie Hastings, AA, director of marketing, Aurora Pharmaceutical

Stephanie Hastings is joining Aurora Pharmaceutical as its new director of marketing. In her new position, Hastings is leading the organization’s marketing strategy, brand development, and communication initiatives. A trained anthropologist, Hastings has experience in highly regulated health and wellness, as well as agriculture industries.

I am thrilled to join Aurora Pharmaceutical and contribute to their success in the animal health industry," said Hastings in a news release.

 "Aurora is known for its dedication to innovation and quality, and I look forward to driving marketing initiatives that further enhance the company's presence and value to customers."

Libby Coleman Todd, DVM; James M. Weber Jr., DVM, MBA

Libby Coleman Todd, DVM. (Photo courtesy of American Veterinary Medical Association)

James M. Weber Jr., DVM, MBA. (Photo courtesy of American Veterinary Medical Association)

The American Veterinary Medical Association (AVMA) has announced that Libby Coleman Todd, DVM and James M. Weber Jr., DVM, MBA, will be joining their board this July. Todd will direct District 3, representing AVMA members living in Tennessee, North Carolina, South Carolina, Alabama, and Mississippi. Weber will direct District 5 and represent members in Michigan, Ohio, West Virginia, and Kentucky.

Todd is a native of Alabama with 24 years of experience practicing. She holds a certificate of thanatology from the University of Alabama and is currently the state’s delegate in the AVMA House of Delegates. She is also a member of the AVMA House Advisory Committee.

“I have learned so much about the AVMA and the immense responsibilities of the Board of Directors over the last several years. I want to continue my leadership journey as a district director so I can support and inspire other veterinarians that seek to enrich our profession,” wrote Todd in her candidate statement, according to the AVMA.

For more than three decades, Weber has played an active role in the Kentucky VMA (KVMA), including positions as president and executive board member. He represented the KVMA on the Kentucky Agricultural Council and chaired the Public Relations and Governmental Relations Committees, the latter since 2007. In addition, he served as a veterinary medical officer with the US Department of Agriculture’s (USDA) Food Safety and Inspection Service.

“I have had a longtime interest and desire to participate in organized veterinary medicine at the local, state, and national levels. I feel that such involvement is vital to promote the profession,” said Weber in his candidate statement.

VetnCare has appointed Matthew J. Kirchner as the company’s CEO. Kirchner has experience in health care services, medical devices, biotechnology, and pharmaceuticals with a focus on organic business growth and “optimized” operations.

 According to a company release, Kirchner will also be part of the company’s board of directors.

“Having spent the majority of my career in human healthcare, I’m excited to bring my business expertise and personal passion for animals to such an important field. Pet care will continue to be a top priority for so many, and we are dedicated to leading with comprehensive and innovative care,” said Kirchner in the release.

Wedgewood appoints Stanley Howell as chief operations officer to drive growth and operational excellence. News release. Wedgewood. February 6, 2025. Accessed March 7, 2025. 

https://www.wedgewood.com/newsroom/wedgewood-appoints-stanley-howell-as-chief-operations-officer-to-drive-growth-and-operational-excellence/

Aurora Pharmaceutical appoints Stephanie Hastings as director of marketing. News release. Aurora Pharmaceutical. January 28, 2025. Accessed March 7, 2025. 

https://prnmedia.prnewswire.com/news-releases/aurora-pharmaceutical-appoints-stephanie-hastings-as-director-of-marketing-302362416.html

Todd, Weber elected to AVMA Board. News release. American Veterinary Medical Association. February 7, 2025. Accessed March 7, 2025. 

https://www.avma.org/news/todd-weber-elected-avma-board?utm_source=delivra&utm_medium=email&utm_campaign=todays-headlines-news

VetnCare announces Matthew J. Kirchner as chief executive officer; founder Dr. Andrew Moffatt to continue leadership role as chief medical officer. News release. VetnCare. January 28, 2025.

New leadership moves at Wedgewood, Aurora Pharmaceutical, VetnCare, and the AVMA

Paws and profits: Leadership in the veterinary profession

A career-oriented program aiming to increase the number of emergency and specialty veterinarians is seeing continued growth. The EmERge program by BluePearl Pet Hospital, a division of Mars Veterinary Health, is expected to graduate its’ largest class in 2025, following a doubling in enrollment over the past year.

To meet the current needs of companion animal healthcare in the US, up to 55,000 additional veterinarians will be needed by 2030.

“There is a shortage of specialists that’s pretty dramatic,” Lenore Bacek, DVM, MS, DACVECC, vice president of clinical affairs at BluePearl, said in a 

interview at the 2025 WVC Annual Conference. "It's multifactorial. I think, unfortunately, a lot of people have left academia, and that's where standard training typically happens. So, I think from a BluePearl perspective, we've tried to enhance our residency programs [and] partner with universities to try to…fill that gap and really address it in a few different ways."

EmERge is one of the BluePearl programs working to help alleviate the industry shortage of veterinarians. A paid, full-time, 1-year training program, it is available to veterinarians and recent veterinary school graduates, and features a hybrid format with online modules, labs, mentoring, and hands-on experiences.

Chelsea Giese, DVM, emergency veterinarian at BluePearl, was considering leaving the veterinary profession prior to participating in the EmERge program. “For me, it was mentorship. I worked with some great senior doctors, but they were obviously very busy, and so I did not have a designated mentor. There were cases that would come in that I felt like I did not know how to handle, and I didn't know who to go to, to help address those cases. So that led to a lot of anxiety [and] just feeling like I wasn't doing the job that I wanted to be able to do, or provide the care that I always wanted to be able to provide,” Giese said in a 

interview at the 2025 WVC Annual Conference.

Since participating in the EmERge program, Geise said she is happy in the profession and feels “satisfied every day” when she goes to work. Having mentorship was key. “Joining the BluePearl EmERge program was the best decision I have ever made not only for my career but also for my overall happiness,” Giese added in a news release.

 “Since going through EmERge, I have learned more than I could have imagined and developed invaluable skills that I will take with me for the rest of my life. EmERge has turned me into a competent and confident clinician and has prepared me to tackle any emergency case that comes through the door.”

Joining EmERge in its’ mission to alleviate a veterinarian shortage, the BluePearl House Officer Training Programs offer internships, externships and residencies to provide early career veterinarians with opportunity for advancement of their medical knowledge through mentorship and hands-on experiences. These programs offer rotating and specialty internships that help participants identify potential career paths or future residency training programs, for which BluePearl has achieved a 94% success rate in matching interns. The training programs also provide residency programs in support of board certification and overall career success, and veterinary students can also take advantage of externship opportunities at more than 100 hospitals in the company’s network, according to BluePearl.

“Developing programs that train and mentor the next generation of emergency and specialty veterinarians is crucial in combatting the veterinary professional shortage,” Bacek added in the release. “Both EmERge and our House Officer Programs are incredible opportunities for current and future veterinarians to find a fulfilling career in emergency and specialty veterinary medicine. We have had an overwhelmingly positive response from program participants and encourage anyone who is interested to visit our website and learn more.”

Training and mentorship programs from BluePearl aim to combat veterinary professional shortage. News release. BluePearl Pet Hospital. February 27, 2025.

Tackling the veterinary professional shortage. Mars Veterinary Health. August 2023. Accessed March 7, 2025. 

https://marsveterinary.com/tackling-the-veterinary-professional-shortage/

A pair of growing initiatives from BluePearl Pet Hospital aim to help alleviate an industry shortage of doctors

Programs are working to advance emergency and speciality veterinary medicine

The veterinary industry has grappled with declining clinic visits and slowed veterinary spending for years.

 While price increases and an influx of new pet owners have helped maintain practice revenues, the current economic climate poses new challenges for both pet parents and veterinary teams.

Findings from a 2023 Trupanion-led veterinary survey paint a startling picture:

Pet parent finances impact 6 of 10 treatment plans

Three in 5 pet parents delay care for their pets due to cost

Pet parents would stop treatment if the bill reached $1,500

Pet owners face increased barriers to veterinary care today—often having to choose between financial well-being and their pet’s health, or life in some cases. As priorities continue to shift and discretionary spending on pet care takes a backseat to essential expenses, practice visit volumes may dwindle further, threatening the health of pets and our industry.

Now more than ever, we need a solution, and that solution is pet insurance. Hundreds of thousands of veterinary practices and pet owners in the United States and 

 have already realized its value and utility. Amidst growing economic uncertainty, pet owners and veterinarians alike have turned to it to help manage care costs and ease the financial impact of inflation.

Shifting perspectives, one paid invoice at a time

As more pet parents and veterinary teams experience the immediate and direct value of quality medical insurance for pets, support for its use grows. Just look at the numbers.

In the past 5 years, Trupanion’s paid veterinary invoices tripled from $1 billion in 2020 to $3 billion, signaling a necessary perspective shift among pet parents and veterinary professionals. This rapid acceleration reflects a growing recognition of the value high-quality pet insurance brings and the necessity of proactively managing veterinary expenses—particularly as more pet parents realize the high costs associated with pet healthcare and veterinary teams experience firsthand

Since 2020, Trupanion has experienced significant growth in both payout amounts and the number of claims paid, showing increases of 121% and 92%, respectively and paid approximately $271 million for around 1.2 million invoices. By 2024, this payout rose to around $601 million for approximately 2.4 million invoices.

When comparing 2020 through 2024 with the previous 5 years, Trupanion saw an approximate 180% increase in payout amounts and a roughly 141% rise in the number of claims. From 2015 to 2019, the total payout was $780,023,284, covering 3,946,682 invoices. From 2020 to 2024, the total payout reached $2,176,191,791, encompassing 9,513,220 invoices.

Furthermore, in examining Trupanion’s impact on in-house pharmacy sales, data researchers discovered that hospitals that actively grew their insured client base benefited from increased pharmacy sales. Hospitals utilizing Trupanion software installed in 2022 saw a 3% increase in pharmacy-related claims in 2023 compared to 2021.

Advancements in pet insurance software are also fueling pet insurance growth through enhanced veterinary experiences.

Novel technologies, like Trupanion’s Veterinary Portal and VetDirect Pay, use artificial intelligence (AI), large language models, and retrieval-augmented generation to allow providers to adjudicate claims and pay invoices directly to veterinary practices instantly, in real time.

This streamlined process simplifies practice operations by eliminating tedious paperwork and reducing the time spent on financial discussions. With the increasing cost of veterinary care, eliminating up-front costs for pet owners can also be a crucial factor in ensuring timely and lifesaving treatment for patients.

Since Trupanion surpassed $2 billion in paid claims in 2023, it has averaged $48.6 million in monthly payments to veterinary practices and pet parents—equating to about $1.5 million per day. Out of this $48.6 million in monthly payouts, roughly $23.2 million has been paid directly to practices through VetDirect Pay. Currently, 85% of claims submitted through the Veterinary Portal are paid directly to veterinary practices.

Underscoring the Veterinary Portal’s success in transforming hospital experiences, Trupanion has seen an approximate 164% increase in its use since 2019, growing from around 4,100 active hospitals to more than 10,800 hospitals today.

Despite Trupanion’s swift growth in paid claims and the 6.25 million insured pets across the US, there continues to be concerns about the practicality and utility of pet insurance—and in some regard, this is rightfully so.

Most pet insurances today operate on a dated reimbursement model, where pet owners must pay upfront for care and then file a claim to get reimbursed days or weeks later. What this model fails to address are the immediate financial constraints of the pet owner, assuming they have the funds to cover costs upfront. This is not a realistic assumption, especially in today’s inflationary environment.

What the reimbursement model does yield is cumbersome paperwork added to front desk workloads and continued financial barriers to pet health. These poor experiences, alongside recent insurer policy cuts, have created widespread skepticism and doubt around pet insurance viability, which could encourage pet owners to view pet insurance as a complex and deceptive business ploy.

Unlike the reimbursement model, Trupanion’s system expedites the claims process with the ability to pay its portion of veterinary invoices directly to practices at checkout, within minutes or less. What results from this streamlined approach are fewer barriers to care, stronger client-veterinarian bonds, and pet parent peace of mind, knowing they can say “yes” to optimal care with little to no upfront costs. At the same time, practices see increased client visits, improved adherence to treatment plans, and prompt pursuits of recommended diagnostics and testing—which ultimately can lead to earlier interventions and healthier pets. The growing rate of acceptance and reliance on high-quality pet medical insurance should be seen as a positive development for the entire veterinary system. 

According to the 2023 Trupanion-led veterinary survey, 77% of veterinary professionals prefer a client with pet medical insurance. When asked about the reasoning behind this preference, the overwhelming responses were to provide pets with the best available treatment and to prevent stressful financial conversations with owners. Despite this, more than 80% stated they do not have a single insured patient at their practice.

These findings tell us that most veterinary teams know what pet medical insurance can do for their practice, increase their ability to pursue the best treatment options and protect themselves from emotionally charged financial conversations with clients. Quality pet insurance delivers solutions to these and broader industry issues—we just need some momentum.

While external forces have caused these recent changes, deliberate actions taken by each of us can create similar perspective shifts. This could mean taking steps that move us away from a reactive care model, where treatment plans are compartmentalized to align with pet owners’ financial capabilities, towards a proactive care model, where the gold standard of veterinary care is the only level of care ever provided—from the early puppy days to the golden years and everything in between.

With collective and deliberate changes, a world where pet care is accessible to all is within reach.

Larkin M, Nolen RS. Less foot traffic at veterinary practices spells declining revenue. American Veterinary Medical Association. Published October 29, 2024. Accessed January 31, 2025. 

https://www.avma.org/news/less-foot-traffic-veterinary-practices-spells-declining-revenue

Larkin M. Pet population continues to increase while pet spending declines. American Veterinary Medical Association. Published October 10, 2024. Accessed January 31, 2025. 

https://www.avma.org/news/pet-population-continues-increase-while-pet-spending-declines

 joined Trupanion in 2013 and currently serves as Chief Executive Officer. In this role, she oversees all aspects of the company's growth, including product development, distribution, pet acquisition, international expansion, and the introduction of new products and channels. Before joining Trupanion, she spent over 7 years in brand, customer, and digital marketing at one of the world's largest pet insurance providers in the UK. Tooth’s passion for animals stems from her childhood on a farm, where she held a lifelong dream of becoming a veterinarian. This deep-rooted love for pets fuels her dedication to promoting the importance of pet medical insurance.

How rising prices have prompted a surge in the use of pet insurance

Amid an accessibility crisis, one solution has come to the fore

Employee retention is a significant challenge in the veterinary industry. With high burnout rates, emotional stress, and demanding workloads, keeping veterinary professionals engaged, motivated, and loyal is vital. Team members need to feel valued, recognized, and empowered in their roles to maintain a thriving practice. But how can veterinary leaders achieve this?

Caitlin Keat, BS, MS (Image courtesy of Empowering Veterinary Team) 

This article will explore actionable strategies to foster a culture of appreciation within veterinary teams. From recognizing achievements to prioritizing financial incentives, this article covers everything you need to know to create a positive and productive workplace.

Why employee appreciation matters in veterinary medicine

Veterinary professionals dedicate their careers to helping animals, but the work inevitably involves interacting with people. These interactions with team members, leaders, and clients and how they are handled, can have a significant impact on their desire to stay. According to American Animal Hospital Association, a lack of appreciation and a lack fair compensation are the most likely factors to cause employee attrition.

 When veterinary professionals feel valued, they are more engaged, productive, and committed to their work.

Improved client satisfaction due to a happier, more engaged team

Stronger and more positive workplace culture

By incorporating the following employee appreciation strategies, veterinary leaders can create a practice where their teams feel recognized and motivated.

A simple “thank you” can go a long way in a high-stress environment like veterinary medicine. Expressing gratitude regularly helps employees feel valued for hard work and dedication. However, sincerity is key as people can easily detect when appreciation is forced or inauthentic. Veterinary teams can express gratitude effectively in the following ways:

Verbally thank your team during group meetings

Send personalized messages recognizing exceptional work

Implement a “Hero of the Week” program

Demonstrating gratitude fosters a culture of appreciation among team members, which boosts workplace morale and alleviates stress Teams could also consider doing a digital “Wall of Gratitude” in their practice where staff can recognize each other’s contributions.

Veterinary teams thrive when given meaningful responsibilities and the autonomy to perform their roles effectively. By trusting them with their responsibilities, it fosters a supportive environment where everyone can thrive. Employers can empower their teams by:

Clearly define job roles and responsibilities

Provide the necessary tools, equipment, and resources

Trust veterinary technicians, assistants, and receptionists to excel in their roles

Encourage independent decision-making within appropriate boundaries

An empowered team leads to improved efficiency, client satisfaction, and overall morale.

 Set high expectations. People will meet the bar you set so raise it as high as you can.

While a simple thank you is a key part of recognition it should also extend beyond that one-on-one acknowledgement. Public acknowledgment of hard work can boost morale and encourage employees to continue striving for excellence. Teams can recognize employee achievements by:

Announce accomplishments to your whole staff at meetings, rounds, or digitally

Feature team members in newsletters, on your website or in social media posts

Provide awards for outstanding performance

Celebrate work anniversaries and major milestones

 Never take credit for your team’s hard work—always give recognition where it’s due.

Your veterinary team consists of talented professionals with unique skills—make sure you’re leveraging them effectively. Encouraging employees to share their expertise benefits your practice and boosts their job satisfaction. Employers can tap into their team’s expertise by:

Identifying the experts within your team and make sure the whole practice is aware

Utilizing the skills vested in your licensed team members

Seeking input from staff when implementing new protocols or procedures

 Supporting continuing education and skill development keeps employees engaged and enhances patient care.

Veterinary teams need opportunities to learn and grow within their careers. A lack of professional development can lead to stagnation and higher turnover rates. Effective growth strategies include:

Offer financial support for CE, certifications and degree programs

Provide access to industry webinars and training programs

Establish a regular cadence of onsite CE and skills trainings

Encourage attendance at veterinary conferences

 Develop a structured Growth & Development plan to enhance team skills and career advancement. Create a dedicated team to execute this plan!

Veterinary medicine is a highly personal and emotionally demanding field. Taking the time to know team members beyond their job roles fosters stronger workplace relationships. Employers can connect with their veterinary team by:

Remember birthdays and work anniversaries

Ask about their interests, hobbies, and pets

Know what’s going on outside of work and check in regularly

Show empathy during stressful or challenging times

Building genuine connections strengthens team cohesion and boosts morale.

Take notes, add milestones to your calendar, whatever helps you remember these details. You don’t need to memorize to show you care.

While a positive work culture is essential, fair compensation remains a crucial factor in employee satisfaction. All veterinary professionals deserve to be compensated fairly for their hard work. Employers can utilize these tips for ways to offer financial recognition:

Ensure competitive salaries that set new standards and support cost of living

Implement performance-based bonuses and incentives

Offer profit-sharing or student loan assistance programs

Provide annual raises based on performance evaluations

 Small, unexpected bonuses or gift cards can be a powerful way to show appreciation.

Create a veterinary workplace employees love

Creating a positive, inclusive workplace encourages long-term commitment. Whereas a toxic work environment can drive even the most passionate veterinary professionals away. A great veterinary workplace culture should have these key elements:

Encourage open communication and feedback

Support work-life management through flexible scheduling

Offer mental health support and resources

Foster a supportive and respectful team environment

Build a valued and supported veterinary team that wants to stay

Employee appreciation in veterinary medicine is not just a one-time initiative—it requires consistent effort. When people feel valued, they are more likely to stay committed to the practice, perform better, and contribute to a thriving work culture. By implementing these strategies, it can foster a motivated, engaged, and loyal team that enhances both patient care and client satisfaction.

Want to improve employee retention and satisfaction in your veterinary practice? Start implementing these appreciation strategies today!

Phase 1: A review. AAHA. Published February 26, 2025. Accessed March 7, 2025. https://www.aaha.org/resources/stay-please-phase-2/phase-1-a-review/

Here are some employee appreciation strategies that work

How to keep your team feeling appreciated all year-round

Diuretics wield their physiologic magic along various channels within the kidneys to create a thriving spillway that expels excess water. This lightens the load on the diseased heart, and prevents pooling in the lungs and beyond.

The cornerstone of therapy for congestive heart failure (CHF)

, diuretics block sodium reabsorption in the renal tubules, and the water that tags along. The result: boosted water excretion into the urine and reduced fluid burden on the heart.

“Different diuretic classes exert their activity at different parts of the ducts,” cardiologist Gordon Peddle, VMD, DACVIM, said in a lecture at the 2025 Unique Seminar Destinations Annual Winter Seminar in Cancun, Mexico.

Blood enters the kidneys for filtration of toxins and rebalancing of water, electrolytes and other components.

 First, it strains through the renal glomerulus, a nest of capillaries that filters out various elements into these ducts, or renal tubules. Here, passive substance exchange occurs within the renal epithelial cells lining the tubules, creating urine.

This exchange starts in the proximal convoluted tubule (PCT), where 60% of filtered sodium is reabsorbed into the renal epithelial cells. As much as 35% gets sopped up in the thick ascending loop of Henle (TAL), up to 10% in the distal convoluted tubule (DCT), and 2%to 5% in the collecting ducts. When the kidneys take up sodium, water follows.

If a compromised heart can’t handle the vascular fluid volume, it spills over into the lungs.

Carbonic anhydrase inhibitors (CAIs)—acetazolamide and dorzolamide ophthalmic—tweak the sodium-hydrogen passive exchange system in the PCT by reducing available hydrogen, which cuts sodium reabsorption.

 Because there are ample downstream sites for sodium uptake, CAIs have weak diuretic action, and are primarily used to manage glaucoma.

Osmotic diuretics like mannitol bring hyperosmolarity to the PCT and descending loop of Henle, thereby deterring water reabsorption.

 Best suited for treating glaucoma and cerebral edema, osmotic diuretics can elevate venous pressures in CHF patients, limiting its utility for managing heart disease.

The loop diuretics furosemide (Lasix), torsemide and bumetanide target the sodium-potassium-chloride transport system in the TAL.

 Known as ‘high ceiling’ diuretics, these short-acting drugs induce natriuresis and corresponding diuresis in a steep dose-response fashion.

A powerful pulmonary vasodilator, furosemide administered intravenously quickly improves oxygenation in CHF patients.

 Furosemide doesn’t clear pulmonary edema.Rather, Peddle explained, “it drops pulmonary pressure to reduce further pulmonary flooding.”

, aiding patients with reactive airway disease.A positive clinical response in a dyspneic dog or cat can confound differentiation between cardiac and respiratory etiology.

Experts spar over the use of furosemide in patients with renal insufficiency. “Lasix in kidneys equals bad, right?” Peddle said, “Well, sort of. There are some qualities of furosemide that are renoprotective.”

In the short term, furosemide enhances renal blood flow and slows cellular metabolism in the kidneys.

 But over time, it may worsen azotemia by impairing renal blood flow, and deplete important electrolytes.

“If blood flow is already bad in the kidneys,” Peddle cautioned, “then how will furosemide even get there?”

But every patient is trial and error, he emphasized. He preaches a measured tolerance for furosemide-wrought azotemia “when they are still eating and clinically healthy because you got them there slowly.”

Similar in chemical structure to CAIs, thiazide diuretics curb sodium and chloride reabsorption in the DCT and other segments.

 Its’ efficacy in diluting the urine is limited, however, due to numerous other tubular sites of sodium reabsorption.

These diuretics block sodium reabsorption either directly (amiloride, triamterene) or indirectly (spironolactone) via competitive receptor antagonism of the sodium-retentive hormone aldosterone.

 Because they act at the terminal portion of the nephron, where minimal sodium uptake occurs, these drugs have weak diuretic activity and are mainly utilized as part of a cocktail6. A “potassium-sparing” diuretic, spironolactone may cause hyperkalemia, particularly if used as a sole diuretic.

Sometimes diuretics are the architects of their own undoing: Successful diuretic therapy diminishes extracellular fluid over time, causing chronic activation of the renin-angiotensin-aldosterone system (RAAS).

 The kidneys respond by holding onto sodium and water, boosting blood volume.

By the ‘braking phenomenon,’ a slightly different mechanism, diuretic administration activates RAAS with successivedoses, provided there was a sufficient drop in extracellular fluid early on.

Lastly, increased downstream delivery of NaCl causes hypertrophy and hyperplasia of distal tubular segments, which expands the capacity for distal NaCl reabsorption.

Diuretic resistance can be countered by combination therapy.

 For instance, adding a thiazide to a loop diuretic suppresses NaCl transport in the TAL, PCT and DCT.

Likewise, adding angiotensin-converting enzyme (ACE) inhibitors and/or angiotensin receptor blockers (ARBs) to diuretics can alleviate CHF signs by downregulating rebound RAAS surges.

Diuretic strategies for dogs and cats in CHF

Peddle named loop diuretics as the first drugs to reach for when managing CHF in dogand cats. In dogs, furosemide administered intravenously has a rapid onset (5-20 minutes), and a duration of about 2 hours; peak activity occurs within 45 minutes.

Peddle cautioned against impulsive re-dosing. “Don’t panic and give more furosemide if it doesn’t work instantly. You can’t take away what you’ve given, but you can always give more,” he said.

Typical pulsed intravenous dosing starts at 2 mg/kg q1-4h, and should be lowered to q6-12h once breathing improves. According to Peddle, it is usually unnecessary to exceed 8-12 mg/kg total dosing over the first 24-hour period in hospitalized dogs.

Oral furosemide has a 30-60-minute onset of action

, a peak effect of 90 minutes or less, and a 4-6-hour duration. But dose efficacy in any one dog is difficult to predict, as oral absorption varies from 10% to 100%.

Cats are particularly sensitive to furosemide. Compared to dogs, they have a quicker and stronger response.

 Peddle recommended an initial intravenous dose of 2 mg/kg, followed by serial 1 mg/kg dosing on a schedule similar to that for dogs. Cats should max out at 4-8 mg/kg over 24 hours.

Once a dog or cat is stabilized and eupneic, oral furosemide administration can be initiated (2 mg/kg q12h). Patients with active respiratory signs may benefit from q6-8h dosing for 2-3 days, then twice daily. Peddle advocated careful monitoring of resting respiratory rates at home, plus renal/electrolyte checks within the first week of therapy.For patients with kidney disease, these numbers are particularly relevant.

Furosemide dosages can be bumped up to manage recurrent CHF episodes, but exceeding 12 mg/kg/day in dogs and 6-8 mg/kg/day in cats offers little incremental benefit, he noted. When adding additional diuretic classes to a loop diuretic, the dosage for the latter should not be reduced.

The oral loop diuretic torsemide has greater potency and duration than furosemide.

 The latter feature provides a smoother diuretic effect and enables once-daily dosing, but delays peak activity to at least 10 days following start of therapy.

These natural and pharmaceutical therapies aid by reducing the reabsorption of sodium and water