Increased efficiency could lessen the need for more staff in companion animal practice.

OBJECTIVE: To evaluate technical efficiency of US companion animal practices. SAMPLE: 60 independently owned companion animal practices selected from the 2022 AVMA Veterinary Practice Owners Survey. PROCEDURES: A ratio of the weighted sum of outputs to weighted sum of inputs was computed for each practice (ie, decision-making unit [DMU]). Inputs included labor (hours worked) and capital (fixed costs and number of exam rooms). Outputs (or production) included annual gross revenue, number of patients seen per year, and number of appointment slots per full-time-equivalent (FTE) veterinarian per year. Data envelopment analysis was used to optimize the ratio and estimate relative efficiency (RE) scores. RESULTS: 25 (42%) practices were classified as having high efficiency (RE = 1 or 100% efficient), 26 (43%) as having moderate efficiency (RE > 0.7 but < 1.0), and 9 (15%) as having low efficiency (RE ≤ 0.7). Mean RE scores for moderate- and low-efficiency practices were 0.83 and 0.66, meaning they could have reached their current production levels with 17% or 34% less resources. Per the model, if all 60 practices were 100% efficient on the RE scale, 22 fewer FTE veterinarians, 47 fewer FTE veterinary technicians and assistants, and 43 fewer FTE nonmedical staff would be needed overall. CLINICAL RELEVANCE: These preliminary findings suggested that efforts to optimize efficiency could allow companion animal practices to meet demands for their services without necessarily needing to hire more staff. Such efforts might include engaging support staff to their full potential and implementing automated processes. Additional research is needed to identify routines or workflows that distinguish high-efficiency practices from others.

Effectiveness of various language strategies for helping pet owners appreciate the value of preventive care.

OBJECTIVE: To identify more effective language strategies for helping pet owners appreciate the value and importance of preventive veterinary care and encouraging more regular visits. SAMPLE: 15 pet owners representing a mix of demographic and other characteristics. PROCEDURES: This qualitative study began with a communication and research audit, followed by interviews with subject matter experts, development of language stimuli (messages about the importance of veterinary care and encouraging pet owners to prioritize wellness visits), three 2-hour online focus group sessions with study participants (4 to 6/group) to test and discuss the language stimuli, and 1-hour one-on-one interviews with 5 of these participants to measure emotional responses to optimized stimuli. RESULTS: Language stimuli testing showed that simply telling pet owners how veterinary care is valuable does not work. What did work was focusing on the pet owner's relationship with their pet, tying preventive care into the animal's overall health and happiness, and emphasizing a veterinarian's experience versus their qualifications. Personalized recommendations were perceived as most valuable to owners. Addressing cost head-on, demonstrating understanding, empowering pet owners to ask questions, and providing payment options were identified as strategies that could help owners see they can afford routine care now. CLINICAL RELEVANCE: Results suggested that by focusing on experience, relationships, and personalized care, veterinarians can address pet owners' concerns while promoting the importance of preventive care, including regular checkups. Additional research is needed to evaluate the impact of this language on pet owner perceptions, behaviors, and outcomes in clinical settings.

Benefits of practice ownership among US private practice veterinarians extend to professional quality of life.

Objective: To estimate the effects of practice ownership on wellbeing of US private practice veterinarians. Sample: 1,217 practice owners and 1,414 associate veterinarians (ie, nonowners) who participated in the 2021 AVMA Census of Veterinarians and Practice Owners Survey. Procedures: A professional quality of life instrument was used to measure compassion satisfaction (CS; a positive attribute), burnout (BO), and secondary traumatic stress (STS) in practice owners and nonowners both as scores and as score categories (low, moderate, and high CS, BO, and STS). For hypothesis tests, propensity score matching was used, with owners (n = 595) matched to nonowners (595) on several demographic and employment factors. Results: Owners had significantly (P < .001) higher CS scores (mean ± SE, 34.1 ± 0.3) and lower BO scores (26.1 ± 0.3) than nonowners (32.8 ± 0.3 and 26.9 ± 0.3, respectively), but STS scores were comparable between groups (27.4 ± 0.3 and 27.5 ± 0.3; P = .55). The prevalence of low CS scores and high BO scores was significantly (P < .001) higher for nonowners versus owners (53.8% vs 42.7% and 51.6% vs 46.4%, respectively). Both owners and nonowners had a high prevalence of high STS scores (81.8% and 83.2%, respectively; P = .53). Clinical Relevance: Results suggested that practice ownership confers a benefit to private practice veterinarians in terms of CS and BO, but not STS. The prevalence of poor CS, BO, and STS scores was higher than reported previously for 2016 to 2018, suggesting an impact of the COVID-19 pandemic. The high prevalence of high STS scores in both groups warrants attention and action to protect the welfare of the veterinary workforce and support optimal patient care.

Associations between career choice and educational debt for fourth-year students of US veterinary schools and colleges, 2001-2021.

OBJECTIVE: To determine whether career choice and starting salary of new DVM graduates in the US were associated with their educational debt accrued during veterinary school. SAMPLE: Up to 48,527 fourth-year students at US veterinary schools who responded to the AVMA Senior Survey in 2001 through 2021 and accepted a full-time position or advanced education opportunity. PROCEDURES: To determine whether career choice was associated with educational debt, multiple linear regression was performed, controlling for graduation year, gender, age, marital status, having children, tuition level, and school location. The correlation between educational debt and starting salary was also determined. RESULTS: On average, mean educational debt increased by $6,110 each successive year. A mean of 60.5% of respondents accepted positions in private practice (public practice, 3.3%; advanced education, 36.2%). Respondents choosing public practice had a mean of $24,913 less debt than those choosing advanced education, controlling for other factors. Respondents choosing public practice also had less debt than those choosing private practice, but debt did not differ significantly between private practice and advanced education. The correlation between educational debt and starting salary was significant but low (r = 0.177). CLINICAL RELEVANCE: Findings suggested that the amount of debt incurred during veterinary school was associated with new veterinarians' career paths. Notably, graduates with higher debt levels appeared to seek higher paying jobs or clinical training that might lead to higher paying jobs, leaving public practice-a field in which critical needs have been identified-underrepresented despite the availability of loan forgiveness programs and other incentives.

Nonveterinarian staff increase revenue and improve veterinarian productivity in mixed and companion animal veterinary practices in the United States.

OBJECTIVE: To determine the contributions of veterinarians and support staff to revenue and veterinarian productivity (ie, number of patients seen/full-time-equivalent veterinarian/wk) in private mixed and companion animal practices in the US and identify staff-to-veterinarian labor ratios (SVLRs) that maximized these 2 practice outputs. SAMPLE: 409 owners of mixed and companion animal practices who participated in the 2020 AVMA Practice Owner Survey. PROCEDURES: Data regarding owner demographics, practice characteristics, labor (defined as mean total hours worked/wk), and gross revenue in 2019 were obtained from participating practices. Multivariable ordinary least-squares regression was used to identify factors associated with revenue and productivity as well as the SVLRs at which revenue and productivity were maximized. RESULTS: For each 10% increase in total veterinarian hours worked per week, revenue increased by a mean of approximately 9%. A 1-unit increase in total number of technician hours used to support 1 hour of veterinarian work was associated with a 20.5% increase in revenue but with no change in productivity. The same increase in total number of nonmedical staff hours was associated with a 17.0% increase in revenue and 14.4% increase in productivity. In terms of revenue, the optimal SVLRs for veterinary technicians and nonmedical staff were 9:1 and 8:1, respectively. In terms of productivity, the optimal SVLR for nonmedical staff was 10:1. CLINICAL RELEVANCE: Findings confirmed the important role of nonveterinarian staff in revenue and veterinarian productivity in mixed animal and companion animal practices and may be useful for making evidence-based staffing decisions.

Characteristics of and comparisons between US fourth-year veterinary students graduating with and without educational debt from 2001 through 2020.

OBJECTIVE: To characterize and compare fourth-year students of US veterinary schools graduating with and without related educational debt (ie, DVM debt) from 2001 through 2020. SAMPLE: 45,756 fourth-year veterinary students who participated in the annual AVMA Senior Survey from 2001 through 2020. PROCEDURES: Survey data were summarized for variables hypothesized to be associated with DVM debt. Multivariable modeling was used to investigate associations between these variables and the likelihood of graduating with DVM debt. RESULTS: Mean DVM debt increased fairly steadily from $56,824 in 2001 (n = 1,587) to $157,146 in 2020 (2,859). Of 45,756 students, 6,129 (13.4%) had no DVM debt. Attending Tuskegee University and having children (both men and women) were associated with an increased likelihood of DVM debt. Attending certain other veterinary schools and more recent survey year were associated with a decreased likelihood. For 2020, the likelihood of DVM debt decreased with increasing percentage of tuition paid by family and increased with increasing percentage of tuition paid by educational loans, being a woman with children, and increasing total cost of attendance. No association was found with state cost of living index or per capita income. CLINICAL RELEVANCE: Results suggested a growing rift between US veterinary students who cannot afford tuition and fees without accumulating financially concerning levels of debt and those who have the financial ability or family situation to fully fund veterinary school. Efforts should be undertaken to recruit across socioeconomic statuses and provide meaningful scholarships to students with greatest financial needs to support diversity, equity, and inclusion in veterinary medicine.

Compassion satisfaction, burnout, and secondary traumatic stress among full-time veterinarians in the United States (2016-2018).

OBJECTIVE: To determine prevalences of low compassion satisfaction (CS), high burnout (BO), and high secondary traumatic stress (STS) scores among full-time US veterinarians and estimate effects of selected demographic, employment-related, and education-related factors on those scores. SAMPLE: 5,020 full-time veterinarians who participated in the 2016, 2017, and 2018 AVMA Census of Veterinarians surveys. PROCEDURES: Data were obtained from census surveys regarding demographic, employment-related, and education-related factors, and scores assigned to items from a professional quality-of-life instrument designed to measure CS and compassion fatigue (ie, BO and STS) were compared between and among various demographic and employment groups. RESULTS: Overall, 35.5% of veterinarians were classified as having low CS scores, 50.2% as having high BO scores, and 58.9% as having high STS scores. Controlling for other variables, high educational debt was associated with low CS, high BO, and high STS scores. Veterinarians who spent ≥ 75% of their time working with dogs or cats had higher BO and STS scores than did those who spent < 25% of their time. Veterinarians with more experience and higher annual incomes had higher CS scores and lower BO and STS scores. Women had higher BO and STS scores than did men, but no gender differences were observed in CS scores. CONCLUSIONS AND CLINICAL RELEVANCE: Several variables were identified that may put veterinarians at higher risk than others for compassion fatigue and low CS. These findings may be useful in the development of resources and targeted initiatives to support and defend veterinarian well-being.

Risk Factors Associated with Lifespan in Pet Dogs Evaluated in Primary Care Veterinary Hospitals.

The objective of this population-based retrospective cohort study was to identify factors associated with lifespan in pet dogs evaluated at primary care veterinary hospitals. Dogs ≥3 mo of age that visited any of 787 US hospitals at least twice from January 1, 2010, through December 31, 2012, were included. Survival curves were constructed for dogs by reproductive status, breed, body size, and purebreed (versus mixed-breed) status. Multivariate Cox proportional hazard regression was performed to identify factors associated with lifespan. There were 2,370,078 dogs included in the study, of whom 179,466 (7.6%) died during the study period. Mixed-breed dogs lived significantly longer than purebred dogs, and this difference was more pronounced as body size increased. Controlling for other factors, dogs of either sex had a greater hazard of death over the study follow-up period if sexually intact rather than gonadectomized. For dogs who lived to 2 yr of age, the hazard of death decreased with increasing frequency of dental scaling. Our findings support previous reports of the impact of body size and gonadectomy on lifespan and provide new evidence in support of ultrasonic dental scaling and mixed breeding.

Factors associated with hematuric struvite crystalluria in cats.

OBJECTIVES: The aim of the study was to identify any dietary, signalment, geographic and clinical factors associated with hematuric struvite crystalluria (HSC) in a population of cats that visit general care veterinary hospitals in the USA. METHODS: In total, 4032 cats that had a first-time diagnosis of HSC and 8064 control cats with no history of hematuria or crystalluria were identified from medical records of all cats examined between 2007 and 2011 at 790 US veterinary hospitals. Extracted variables included age, sex, neuter status, breed, diet, urinalysis results and history of cystitis. Potential associations between these variables and HSC were estimated. RESULTS: Controlling for other factors, young cats fed a dry diet had an increased likelihood of HSC relative to young cats fed a non-dry diet. However, as age increased, the likelihood of HSC declined for cats fed a dry diet and increased for cats fed a non-dry diet. Moreover, the odds of HSC were significantly greater when cats were unneutered (vs neutered; odds ratio [OR] 45.52) or had a thin (vs heavy) body condition (OR 23.81), diagnosis of cystitis (OR 2.84), urine protein concentration >30 mg/dl (OR 4.72), alkaline (vs neutral) urine pH (OR 3.34), pyuria (OR 23.67) or bacteriuria (OR 2.24). CONCLUSIONS AND RELEVANCE: The present study provides estimates of the strengths of association between HSC and certain signalment and clinical characteristics of cats. This information could help clinicians to perform a more directed screening for struvite crystalluria in certain cat populations. Follow-up studies that build on the findings of this study could explore the clinical importance of HSC in cats.

Survival analysis to evaluate associations between periodontal disease and the risk of development of chronic azotemic kidney disease in cats evaluated at primary care veterinary hospitals.

OBJECTIVE To examine potential associations between periodontal disease (PD) and the risk of development of chronic azotemic kidney disease (CKD) among cats and determine whether the risk of CKD increases with severity of PD. DESIGN Retrospective cohort study. ANIMALS 169, 242 cats. PROCEDURES Cats were evaluated ≥ 3 times at any of 829 hospitals from January 1, 2002, through June 30, 2013. Cats with an initial diagnosis of PD of any stage (n = 56,414) were frequency matched with cats that had no history or evidence of PD (112,828) by age and year of study entry. Data on signalment, PD, and other conditions potentially related to CKD were extracted from electronic medical records. Cox proportional hazards modeling was used to estimate the association of PD with CKD after controlling for covariates. RESULTS PD was associated with increased risk of CKD; risk was highest for cats with stage 3 or 4 PD. Risk of CKD increased with age. Purebred cats had greater risk of CKD than mixed-breed cats. General anesthesia within the year before study exit and diagnosis of cystitis at any point prior to study exit (including prior to study entry) were each associated with increased CKD risk. Diagnosis of diabetes mellitus or hepatic lipidosis at any point prior to study exit was associated with decreased CKD risk. CONCLUSIONS AND CLINICAL RELEVANCE The findings supported the benefit of maintaining good oral health and can be useful to veterinarians for educating owners on the importance of preventing PD in cats.

Factors associated with anesthetic-related death in dogs and cats in primary care veterinary hospitals.

OBJECTIVE To identify risk factors for anesthetic-related death in pet dogs and cats. DESIGN Matched case-control study. ANIMALS 237 dogs and 181 cats. PROCEDURES Electronic medical records from 822 hospitals were examined to identify dogs and cats that underwent general anesthesia (including sedation) or sedation alone and had death attributable to the anesthetic episode ≤ 7 days later (case animals; 115 dogs and 89 cats) or survived > 7 days afterward (control animals [matched by species and hospital]; 122 dogs and 92 cats). Information on patient characteristics and data related to the anesthesia session were extracted. Conditional multivariable logistic regression was performed to identify factors associated with anesthetic-related death for each species. RESULTS The anesthetic-related death rate was higher for cats (11/10,000 anesthetic episodes [0.11%]) than for dogs (5/10,000 anesthetic episodes [0.05%]). Increasing age was associated with increased odds of death for both species, as was undergoing nonelective (vs elective) procedures. Odds of death for dogs were significantly greater when preanesthetic physical examination results were not recorded (vs recorded) or when preanesthetic Hct was outside (vs within) the reference range. Odds of death for cats were greater when intra-anesthesia records for oxygen saturation as measured by pulse oximetry were absent. Underweight dogs had almost 15 times the odds of death as nonunderweight dogs; for cats, odds of death increased with increasing body weight (but not with overweight body condition). CONCLUSIONS AND CLINICAL RELEVANCE Several factors were associated with anesthetic-related death in cats and dogs. This information may be useful for development of strategies to reduce anesthetic-related risks when possible and for education of pet owners about anesthetic risks.

Dietary factors associated with faecal consistency and other indicators of gastrointestinal health in the captive cheetah (Acinonyx jubatus).

Gastrointestinal diseases pose significant risks to captive cheetah survival and welfare. Multiple factors are thought to be associated with these diseases, but to date a comprehensive epidemiological survey of disease risk factors has not been conducted. A survey of diet and health parameters was completed for 184 captive cheetahs in 86 international facilities. Comparisons were made among dietary factors with respect to disease status and observed faecal consistency, incidence of vomiting and diarrhoea in the past 4 weeks. Extremely dry faeces were most common in cheetahs fed carcasses, but was still of low incidence (15%). Contrastingly, cheetahs fed commercially prepared diets had the highest prevalence of liquid faeces "always" or "often" (9%). Cheetahs fed raw meat diets had the highest prevalence of soft faeces with no shape (22%), as well as of firm and dry faeces (40%). No broad category of diet exerted any influence on the health parameters investigated. However, feeding of ribs at least once per week reduced the odds of diarrhoea (P = 0.020) and feeding of long bones (limbs) at least once per week was associated with a lower odds of vomiting (P = 0.008). Cheetahs fed muscle meat at least once per week had reduced odds of suffering from chronic gastritis (P = 0.005) or non-specific gastrointestinal disease (P < 0.001). The only factor identified as increasing the odds of chronic gastritis was feeding of horse "often" or "always" (P = 0.023). The findings of the current study build on existing empirical research to support a recommendation towards a greater inclusion of skeletal components. Current husbandry guidelines advocating the use of supplemented raw meat diets are likewise supported, but the use of horse meat, as well as commercially prepared diets for captive cheetahs, warrants caution until further research is conducted.

Risk factors associated with calcium oxalate urolithiasis in dogs evaluated at general care veterinary hospitals in the United States.

Calcium oxalate urolithiasis results from the formation of aggregates of calcium salts in the urinary tract. Difficulties associated with effectively treating calcium oxalate urolithiasis and the proportional increase in the prevalence of calcium oxalate uroliths relative to other urolith types over the last 2 decades has increased the concern of clinicians about this disease. To determine factors associated with the development of calcium oxalate urolithiasis in dogs evaluated at general care veterinary hospitals in the United States, a retrospective case-control study was performed. A national electronic database of medical records of all dogs evaluated between October 1, 2007 and December 31, 2010 at 787 general care veterinary hospitals in the United States was reviewed. Dogs were selected as cases at the first-time diagnosis of a laboratory-confirmed urolith comprised of at least 70% calcium oxalate (n=452). Two sets of control dogs with no history of urolithiasis diagnosis were randomly selected after the medical records of all remaining dogs were reviewed: urinalysis examination was a requirement in the selection of one set (n=1808) but was not required in the other set (n=1808). Historical information extracted included urolith composition, dog's diet, age, sex, neuter status, breed size category, hospital location, date of diagnosis, and urinalysis results. Multivariable analysis showed that the odds of first-time diagnosis of calcium oxalate urolithiasis were significantly (P<0.05) greater for dogs<7 years, males (OR: 7.77, 95% CI: 4.93-12.26), neutered (OR: 2.58, 1.44-4.63), toy- vs. medium-sized breeds (OR: 3.15, 1.90-5.22), small- vs. medium-sized breeds (OR: 3.05, 1.83-5.08), large- vs. medium-sized breeds (OR: 0.05, 0.01-0.19), and those with a diagnosis of cystitis within the previous year (OR: 6.49, 4.14-10.16). Urinary factors significantly associated with first-time diagnosis of calcium oxalate urolithiasis were acidic vs. basic pH (OR: 1.94, 1.22-3.10), presence of RBCs (OR: 6.20, 3.91-9.83) or WBCs (OR: 1.62, 1.03-2.54), and protein concentration>30 mg/dL (OR: 1.55, 1.04-2.30). Patient demographics and urinalysis results are important factors that can support risk assessment and early identification of canine oxalate urolithiasis. Therefore, periodic urolith screening and monitoring of urine parameters should be encouraged for dogs at risk of developing these uroliths.

Risk factors associated with the development of chronic kidney disease in cats evaluated at primary care veterinary hospitals.

OBJECTIVE: To identify risk factors associated with diagnosis of chronic kidney disease (CKD) in cats. DESIGN: Retrospective case-control study. ANIMALS: 1,230 cats with a clinical diagnosis of CKD, serum creatinine concentration > 1.6 mg/dL, and urine specific gravity < 1.035 and 1,230 age-matched control cats. PROCEDURES: Data on putative risk factors for CKD were extracted for multivariate logistic regression analysis from the medical records of cats brought to 755 primary care veterinary hospitals. For a subset of cats evaluated 6 to 12 months prior to the date of CKD diagnosis or control group inclusion, the percentage change in body weight between those dates as well as clinical signs at the earlier date were analyzed for associations with CKD development. RESULTS: Risk factors for CKD in cats included thin body condition, prior periodontal disease or cystitis, anesthesia or documented dehydration in the preceding year, being a neutered male (vs spayed female), and living anywhere in the United States other than the northeast. The probability of CKD decreased with increasing body weight in nondehydrated cats, domestic shorthair breed, and prior diagnosis of diabetes mellitus and increased when vomiting, polyuria or polydipsia, appetite or energy loss, or halitosis was present at the time of diagnosis or control group inclusion but not when those signs were reported 6 to 12 months earlier. Median weight loss during the preceding 6 to 12 months was 10.8% and 2.1% in cats with and without CKD, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: The probability of CKD diagnosis in cats was influenced by several variables; recent weight loss, particularly in combination with the other factors, warrants assessment of cats for CKD.

A moderate fat, low-energy dry expanded diet reduces gain in body condition score when fed as part of a post neutering weight-control regimen in growing pet cats.

Neutering of cats has been associated with significant weight gain in the weeks following surgery. The present study aimed to evaluate the effectiveness of a moderate fat, low-energy dry expanded diet in reducing weight gain in growing pet cats when fed as part of a weight-control regimen over the 6 months post-neutering. Cats in participating primary care veterinary hospitals were enrolled at neutering and assigned to receive one of the two dietary treatments based on the hospital of origin. Owners of cats in the treatment group were instructed to feed the trial diet at maintenance (324·7 kJ/kg BW(0·711) per d). Instructions for the control group were to feed the cat's regular diet according to the manufacturer's recommendations. Body weight and condition were evaluated by veterinarians at enrolment, 2-weeks, and 1-4 and 6 months after surgery. Body condition score (five-point scale) was compared between enrolment and each subsequent visit, controlling for enrolment age and sex. Percentage change in body weight was evaluated via multivariate mixed modelling to account for repeated measures. A total of 187 cats (eighty-seven females and 100 males) with a mean age of 5·2 (sd 0·8) months and mean weight of 2·8 (sd 0·6) kg from fifty-one hospitals completed the trial. The odds of being scored as overweight were 4·1 times as great for cats in the control v. treatment groups (95 % CI 2·1, 8·2). Percentage change in body weight differed significantly with enrolment age (P = 0·007) and approached significance between diet groups (P = 0·08). Cats fed the trial diet had a significantly reduced incidence of overweight in the 6 months following neutering.

Risk factors associated with struvite urolithiasis in dogs evaluated at general care veterinary hospitals in the United States.

OBJECTIVE: To identify factors associated with development of struvite urolithiasis in dogs evaluated at general care veterinary hospitals in the United States. DESIGN: Retrospective case-control study. ANIMALS: 508 dogs with a first-time diagnosis of struvite urolithiasis and 7,135 control dogs. PROCEDURES: Electronic medical records of all dogs evaluated at 787 general care veterinary hospitals in the United States between October 2007 and December 2010 were reviewed to identify dogs that developed struvite urolithiasis and 2 groups of control dogs with no history of urolithiasis. Information extracted included diet, age, sex, neuter status, breed size category, hospital location, and date of diagnosis. Urinalysis results, urolith composition, and other disease conditions were recorded if applicable. Potential risk factors were assessed with univariable and multivariable regression analysis. RESULTS: Toy- or small-sized breeds had significantly greater odds of struvite urolithiasis, compared with medium- or large-sized breeds. Neutering significantly increased the odds of this outcome in females only; sexually intact females were more likely to develop struvite urolithiasis than were sexually intact males, but only up to 5 years of age. Urinary factors significantly associated with the outcome were basic (vs acidic) pH, presence of RBCs or WBCs, protein concentration > 30 mg/dL, and ketone concentration ≥ 5 mg/dL. CONCLUSIONS AND CLINICAL RELEVANCE: Evaluation of demographic characteristics and urinalysis results may be useful in the early identification of struvite urolithiasis in dogs. Periodic urinalysis in dogs is recommended because of the potential health impact of a late diagnosis of urolithiasis.