In this video interview with dvm360, isa Restine, DVM, DABVP (Feline), and Allison McGrath, MS, shared what the VISHDAAL is and how it helps veterinary professionals and clients identify behavioral changes to help diagnose pets earlier, and get them the treatment they need sooner.

VISHDAAL and diagnostic challenges in senior cats

When evaluating senior feline patients, behavioral changes can often go undiagnosed because clients may believe the cat is simply aging or think that whatever is happening with their pet is not serious enough to bring to their veterinarian's attention. Because of this, professionals cannot treat these pets because they cannot treat what they do not know is happening. 

, Lisa Restine, DVM, DABVP (Feline), and Allison McGrath, MS, shared what VISHDAAL is and how it helps veterinary professionals and clients identify behavioral changes to help diagnose pets earlier, and get them the treatment they need sooner.

Below is a partial transcript, edited lightly for clarity. 

 What does VISHDAAL stand for, and can you explain why these behavioral signs of CDS [Cognitive dysfunction syndrome] can be difficult for owners and veterinarians?

 I think the 2 reasons [why this is underdiagnosed] are the pet owners and the veterinarians. For cat owners, a lot of those signs can attribute to what they would consider normal aging when it's not normal. It's not [necessarily] going to happen to every cat. I think cat owners are extremely perceptive, and they may notice these subtle changes, but they just don't think that it's important or they're not going to bring it up to the veterinarian because, "Well, my cat's just getting older, and I don't need to talk about it."

And I can say, as an owner of a senior cat, I did that, too, so it's very easy to...miss some of those signs as important. And on the veterinary side, I think time is a huge factor. The questions that we need to ask in order to get to the level of understanding that is required to start this whole diagnostic process are pretty extensive, and we don't have a lot of time in the clinics. So unless you're taking measures to be preprepared for your exam, or you're expecting to have this conversation, it's not something that happens on a regular basis.

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Discover insights on senior feline health and behavior changes in this interview with dvm360.

Earlier this year, the CDC published a report on a rabies outbreak in an urban feral cat colony in Maryland and issued a reminder on the need for public education on rabies prevention and the health risks linked to feral feline populations. According to the CDC, a rabid feral cat was identified in August 2024, leading to 3 people requiring postexposure prophylaxis—a preventive treatment administered after a person or animal has been exposed to a disease.

According to the report, which was published in the CDC’s August 21 

, the Cecil County Health Department notified the Maryland Department of Health that an aggressive feral cat had been captured and euthanized and later tested positive for rabies.

 The cat interacted with multiple people, leading health authorities to believe that more than 300 people had been exposed to the rabies virus. As a result, a contact-tracing initiative with local animal control, Maryland Department of Health officials, and the CDC was launched.

Ultimately, health officials determined that the number of people needing PEP was lower than first anticipated. The report noted that the cat belonged to an unmanaged colony of approximately 20 cats and kittens in Baltimore County, Maryland. Additional cats from the colony were captured and euthanized, but later tested negative for rabies.

Still, the CDC said it is possible that other rabies cases in the colony might have occurred but went undetected or unreported.

“Unmanaged cat colonies, such as the one described in this report, can pose public health risks and require extensive resources to prevent adverse human and animal health outcomes,” the federal agency continued. According to the CDC, managed cat colonies have a designated caretaker or community program that tends to the colony, providing veterinary services like spaying, neutering, and vaccination, which includes the rabies vaccine.

“When cat colonies are managed, caretakers often attempt to maintain high rabies vaccination coverage and use sterilization programs to facilitate a natural phaseout of the colony,” the CDC emphasized, stating more research is needed to better understand how free-roaming cats interact in urban environments and how that may influence rabies transmission and human exposure.

The United States sees approximately 200 to 300 reports of rabid cats each year, making these felines the most commonly reported rabid domestic animal in the US. Still, more than 90% of animal rabies cases are associated with wild animals such as raccoons, foxes, bats, and skunks.

 Without prompt PEP treatment, a rabies infection is almost always fatal.

 However, human rabies cases are still rare, with less than 10% of human rabies deaths in the US reported each year.

“The AVMA [American Veterinary Medical Association] policy on 'Free-Roaming Abandoned and Feral Cats' recognizes that while there is no single strategy for addressing unowned free-roaming cats in every situation, any intervention should include thoughtful consideration of multiple potentially competing factors including but not limited to, the welfare of the cats and wildlife themselves, the ecosystem in which the intervention will be conducted, and public health impacts."

The policy also states that appropriately managed colonies have the potential to significantly decrease risk to public health, wildlife, and ecosystems,” the AVMA wrote in response to the CDC report.

Ludmer S, Crum D, Wallace R, Hutson J. Rabies outbreak in an urban, unmanaged cat colony—Maryland, August 2024. 

. 2025;74(31):480-483. doi:10.15585/mmwr.mm7431a2

Rabies in the United States: protecting public health. CDC. September 30, 2025. Accessed October 27, 2025. https://www.cdc.gov/rabies/php/protecting-public-health/index.html#cdc_generic_section_2-animal-rabies-surveillance-in-the-u-s

CDC warns of rabies risks from feral cat colonies. American Veterinary Medical Association. October 16, 2025. Accessed October 27, 2025. https://www.avma.org/news/cdc-warns-rabies-risks-feral-cat-colonies

Community programs offering veterinary preventive care for free-roaming cat colonies can help mitigate public health risks, the CDC says.  

CDC warns of rabies risks following Maryland feral cat outbreak

What makes your veterinary practice unique? And what makes it stand out against the competition?

The core identity of what makes a practice unique is considered its’ DNA, according to Charlotte Weir, vice president of hospital success and industry relations at Roo and founder of 2525 Sunset Veterinarians in Houston.

 “Every practice has its own unique DNA, its own unique identity—its own culture, the values, the way your team interacts, the services you offer, client experiences you create. It's sort of what makes your practice yours and no one else's,” Weir said in a 

Charlotte Weir delivers a presentation on practice DNA during the 2025 Fetch dvm360 Conference in Kansas City, Missouri.

In a presentation at the 2025 Fetch dvm360 Conference in Kansas City, Missouri, Weir addressed the first impression of a practice’s DNA and why it matters. She noted that clean and well-maintained spaces convey professionalism, while comfortable seating and amenities—complimentary coffee and water, for example—provided to waiting clients and patients are welcoming features.

For clients, patients and practice staff, lights, scents, and sounds also contribute to the environmental aspects of practice DNA. Bright spaces and neutral scents promote comfort, Weir said. Noise mitigation and calming music can help reduce stress for patients and lead to fewer distractions for veterinary care providers.

Employing a hospitality mindset that balances medical professionalism with client-friendly customer service further enhances the impression a practice makes on pet owners. However, a practice’s DNA is more than its atmosphere and what it offers to clients.

Practice DNA is also about workflows, team culture, and creating a fulfilling work environment. Establishing and understanding this DNA helps strengthen the bonds between staff, relief veterinarians, and the clinic’s clients, according to Weir. “When we understand what our DNA is, we can better align our staff, relief veterinarians, and even our workflows to make our hospitals thrive,” she said.

Setting a clear definition of a practice’s DNA promotes empowerment for team members by setting clear expectations and allowing staff autonomy with accountability. Established DNA within a practice can foster a culture of efficiency and inclusion through open communication, emotional intelligence, and a welcoming environment. It can also include recognitions and appreciation, and generate opportunities for skill-building and career growth, Weir said.

Weir recommended acknowledging imperfections in a practice and having intentional conversations with staff to maintain a practice’s DNA and to initiate changes. These conversations can include talks with individual members of the veterinary team.

In a session at the 2022 Fetch dvm360 Conference in San Diego, California, Matthew McGlasson, DVM, CVPM, said he favors daily huddles with the entire staff that can be customized to the practice’s needs. A huddle can incorporate practice news, celebrate the previous day’s highlights, or have a veterinarian discuss a new procedure or medical development.

McGlasson also discussed 1:1 meetings for every practice employee with their supervisor. These meetings should be about what’s going well for them as well as any challenges. Employees should be encouraged to discuss any skills they're working on and how practice management can help, he said.

Other keys to communication include active listening, buy-in from the staff, and practice leadership and empowerment, according to Weir. Making progress happens as a team, Weir noted.

What makes a practice special and unique can be defined and communicated—with pride. For clients, this helps set expectations about the services provided. For staff, it helps ensure consistency in medical protocols and workflows, while also helping relief veterinarians integrate more efficiently, according to Weir.

“It’s really important to know your practice DNA, define it, communicate it, and just celebrate it. When you understand what makes your practice unique, you create a better environment for your staff, your relief vets, and ultimately, your patients,” Weir said.

Weir C. Catch a unicorn: understanding your practice’s DNA for relief vet success. Presented at: Fetch dvm360 Conference; August 22-24, 2025; Kansas City, MO.

Somers T. Nurturing 3 core elements to create a healthy culture in a veterinary practice. 

. December 26, 2022. Accessed October 27, 2025. 

https://www.dvm360.com/view/nurturing-3-core-elements-to-create-a-healthy-culture-in-a-veterinary-practice

Charlotte Weir discussed first impressions for clients and how workplace culture can empower staff in a Fetch dvm360 Conference presentation.

Using practice DNA to stand out

Canine cognitive dysfunction syndrome (CCDS) is a progressive neurobehavioral disorder that impacts senior pets and is often described as something like Alzheimer disease in humans, affecting both the patient’s daily functioning as well as the caregiver’s emotional well-being. Longevity is increasing due to improvements in nutrition, preventive medicine, and health care, meaning detailed awareness of this syndrome is increasing in importance.

During his lecture at the 2025 Hill’s Global Symposium, Christopher Pachel, DVM, DACVB, CABC, “Golden years, brighter minds: Innovations in Treating Canine Cognitive Dysfunction Syndrome,” explained more about the disease, including the risk factors and behavioral signs that these patients can start to show. 

"As veterinary caregivers, we have a unique opportunity in that we're seeing these animals. We're seeing these clients on a recurring basis, and we have the opportunity to evaluate these dogs and look for some of the signs of aging and some of the signs that we recognize associated with canine cognitive dysfunction are not actually evident on a physical exam," Pachel explained to attendees.

"We might give this dog a clean bill of health, and it's only when we ask a few more questions and really sort of understand the full picture of that case that that's when we start to see other changes, things like hearing loss or vision loss or mobility issues, and when we start looking at some of the other patterns...that's when we really start to understand the case in its entirety. Truly, to understand the depth of these cases, we need to look beyond just what we can see within our physical exams," he continued.

In canine patients aged 11 to 12 years, 28% of them exhibit one or more behavioral signs that are consistent with CCDS, and by age 15, prevalence increases to 68%.

 Factors that have been identified in association with this syndrome include age, body size, and activity level, with dogs showing signs of low physical activity being more likely to be diagnosed with CCDS; smaller breeds tend to have a later onset of CCDS compared with the larger ones. In research about CCDS, researchers noted that dogs aged 17 years with advanced CCDS often exhibit behavioral signs such as anxiety, restlessness, and altered human-dog interactions. Researchers also previously noted that it is possible for clients to initially treat these signs as normal aging, which could delay diagnosis and treatment.

For the severity of the condition, there is a strong correlation found between the presence of periodontal disease and CCDS severity, as well as changes in olfaction and visual impairment.

According to Pachel, canine patients with CCDS may present with nighttime vocalization, increased activity at night, and fragmented sleep, which can also have a negative impact on the client, causing emotional strain and fatigue. One study conducted on the syndrome emphasized the caregiver burden as high for the cases of CCDS that involve disorientation, incontinence, and sleep disturbance. It also found that this can cause a delay in diagnosis because of the caregiver’s stress, which sometimes could result in premature euthanasia decisions.

A validated questionnaire is the cornerstone of CCDS screening in general practice. Researchers compared 3 cognitive screening instruments: the Canine Dementia Scale (CADES), Canine Cognitive Dysfunction Rating Scale, and the Canine Cognitive Assessment Scale, on 597 senior dogs. CADES was more sensitive for identifying dogs with mild to moderate cognitive impairment. Overall, all 3 questionnaires showed good correlation with each other.

The DISHAAL mnemonic is widely used in clinical settings, but Pachel noted that it lacks formal validation. Despite that, its structured symptom framework has made it a practical tool for caregiver education and screening.

Each tool has its limits, such as recall bias, variability in the caregiver’s interpretation, and low specificity of CCDS. As a result, complementary diagnostics are being investigated.

When talking to veterinary professionals, owners will frequently ask whether behavior changes in their pet are something serious or normal aging, and some will even delay getting their pet's care due to fear of a terminal prognosis or uncertainty. Because of this, it is essential for veterinary teams to establish a strong foundation with clients by normalizing caregiver concerns, offering anticipatory guidance, and creating a safe space for them to discuss difficult decisions.

"[Guardians' perceptions of caring for a dog with canine cognitive dysfunction] looked at the caregiver burden that exists for individuals...and what they identified was that some of the clinical signs, like orientation, incontinence, disturbances, and sleep patterns had some of the greatest impact on those families. Not only did that have an impact on the day-to-day life and relationship and bond with those families, it also had an impact on some of the decision-making processes, as well as the timing for euthanasia, when that consideration of end-of-life care needed to be made," Pachel stated.

CCDS significantly affects aging dogs and their loved ones. So, as dogs in your practice continue to age, the importance of CCDS continues to grow and challenge the veterinary profession. By continually evolving through diagnostic tools, therapeutic innovations, and caregiver support strategies, teams can help clients and patients through this difficult time in more ways than one.

Pachel C. Golden years, brighter minds: Innovations in treating canine cognitive dysfunction syndrome. Presented at: Hill’s Global Symposium; October 27-28, 2025; Phoenix, AZ.

Taylor TL, Smith BP, Hazel SJ. Guardians' perceptions of caring for a dog with canine cognitive dysfunction. 

. 2024;194(2):e3266. doi:10.1002/vetr.3266

Haake C, Lapham L, Kaye L, et al.  Comparing standard screening questionnaires of canine behavior for assessment of cognitive dysfunction. 

. 2024;11:1374511. doi:10.3389/fvets.2024.1374511

Explore the latest insights on canine cognitive dysfunction syndrome and its impact on senior pets.

What is canine cognitive dysfunction syndrome?

The 2025 Hill’s Global Symposium is now underway! To begin 

’s coverage of the event, our team sat down with Chelsie Estey, MSc, DVM, DACVIM (Neurology), US chief veterinary officer of Hill’s Pet Nutrition, to learn more about her journey to taking on this new position, from pursuing fish medicine to then neurology, as well as advice she has for anyone interested in transitioning from a clinical to a business setting.

Chelsie Estey, MSc, DVM, DACVIM (Neurology), US chief veterinary officer, Hill’s Pet Nutrition (Image courtesy of Hill's Pet Nutrition) 

Chelsie Estey, MSc, DVM, DACVIM (Neurology): 

I'm the chief veterinary officer [CVO] at Hill's Pet Nutrition US. I'm a veterinary neurologist by training. I spent time in private practice in both New York and in Colorado before ultimately making the transition to industry, where I was in the animal health pharmaceutical industry for about 5 years before joining Hill's as the CVO about 6.5 months ago.

You stepped into the role as Hill's US [CVO] earlier this year. What has your journey been like to get to this point in your career?

If I looked back and I thought 10 years ago I would be the US [CVO] at Hill's Pet Nutrition, I most certainly would have probably said, 'No, I couldn't conceive of that being in my career path.' And I think that's one of the most exciting things about veterinary medicine: You never know where it's going to take you.

When I went to [veterinary] school, I planned to be an aquaculture veterinarian. I had worked with fish in graduate school, and that was my plan. Ultimately, I fell in love with neurology because I really liked both the medical and surgical aspects of that. Then after being in practice in a couple different states in the US, I decided to transition to industry when I joined a large animal health manufacturer.

Similarly, I would never have guessed that was going to be the path that I was going to take. But I think being open to those opportunities and thinking about different ways to use the skill set that veterinarians have...there are so many doors that can open. So [although] I would say it's been an interesting route, and probably not the one I would have thought I was going to take on the first day I entered veterinary school, it's been a really exciting and rewarding one. I love the role that I'm in now, and I'm so thankful for that journey.

What inspired you to get into fish medicine?

I was doing fish toxicology in graduate school. I am from Canada, so I did undergrad, grad school, and veterinary school in Canada. I really enjoyed working with fish at that time. And one summer during veterinary school, I spent a bit of time working on the Atlantic salmon sea cages, and I enjoyed that experience a lot, but I realized that probably wasn't for me long term. Later in my fourth year, I found neurology and really became passionate about that, so [I] ultimately decided to go in that direction.

 Do you have advice for somebody [who] is interested in maybe transitioning out of clinical and moving into more of a business veterinary setting?

Leadership opportunities typically exist within the medical director space or hospital administrator space. But then outside of the clinic, there are lots of areas of interest, potentially within industry.

One of the common paths for veterinarians will be to start in a field-based role, depending on the company. It may be a professional services veterinarian or professional consulting veterinarian, but those are often roles where veterinarians will join industry, start in a field-based position, and then from there, so many doors open up, whether it's in nutrition or pharmaceuticals. I think that being willing to try new things and use your skill set in different ways will allow you to move into some of those nontraditional roles within the industry.

Chelsie Estey, MSc, DVM, DACVIM (Neurology), shares her inspiring journey from veterinary neurology to becoming the US chief veterinary officer for Hill’s Pet Nutrition.

Q&A With Chelsie Estey, MSc, DVM, DACVIM (Neurology)

The FDA has issued an emergency use authorization for lotilaner (Credelio; Elanco Animal Health) to treat New World screwworm (NWS) infestations in dogs,

 marking the first time the FDA has granted such an authorization for both a NWS treatment in canines and any animal drug. The announcement comes as cases of the parasite have been 

confirmed less than 70 miles south of the United States–Mexico border

“This first-ever emergency use authorization for NWS in dogs gives veterinarians and pet owners peace of mind, knowing there's an authorized treatment option available as soon as they may need it,” Ellen de Brabander, PhD, executive vice president of innovation and regulatory affairs at Elanco, said in an Elanco news release.

The emergency use authorization of the isoxazoline provides veterinarians and pet owners with a treatment option should the parasite enter the US. According to Elanco, the FDA granted the authorization after evaluating a study on the efficacy of lotilaner against myiasis caused by NWS in naturally infested dogs.

, found that oral administration of lotilaner at the minimum recommended dosage in 11 infested dogs demonstrated 100% efficacy against 

 (NWS) larvae within 24 hours of treatment.

“Lotilaner demonstrated a rapid onset of action and a high efficacy against 

. We therefore recommend lotilaner for the effective treatment of myiasis in dogs,” the authors of the study wrote.

Still, the data supporting lotilaner’s benefits against infestations caused by NWS larvae are limited. The study involved only 11 naturally infested dogs in Brazil, and its relevance to dogs in the US remains unknown. Researchers believe the primary mechanism of action against 

 is the expulsion of live larvae. However, the combined use of mechanical removal and the absence of a control group make it difficult to isolate the drug’s specific effect, Elanco noted.

 The larval expulsion rate in the study was 80.5% at 2 hours post treatment and 93% at 6 hours post treatment, reaching 100% efficacy at 24 hours post treatment.

FDA conditionally approves drug to prevent and treat screwworm in cattle

A NWS infestation occurs when a NWS fly lays eggs on open wounds or other body parts of live, warm-blooded animals. The eggs hatch into larvae that then invade the tissues of the animal by burrowing themselves into wounds and feeding on the animal’s tissue.

According to the CDC, a small wound from a tick bite is enough to attract a female fly to feed and lay her eggs in it.

 One female can lay 200 to 300 eggs at a time and up to 3000 eggs over a 10- to 30-day lifespan.

“Any break in the skin—from a scratch to a surgical incision—can become an entry point for NWS, due to its aggressive and invasive nature," said Casey Locklear, DVM, a Texas-based veterinarian and parasiticide lead at Elanco.

"Preventing or rapidly treating existing wounds is critical to protecting pets from NWS. One way to limit self-inflicted scratching includes using year-round flea and tick protection, such as Credelio."

Elanco's Credelio (lotilaner) receives first ever FDA emergency use authorization (EUA) against New World screwworm (NWS) in dogs. News release. Elanco Animal Health. October 24, 2025. Accessed October 24, 2025. https://prnmedia.prnewswire.com/news-releases/elancos-credelio-lotilaner-receives-first-ever-fda-emergency-use-authorization-eua-against-new-world-screwworm-nws-in-dogs-302594317.html

Bautista-Alejandre A. New World screwworm detected less than 70 miles from the US-Mexico border. 

. September 22, 2025. Accessed October 24, 2025. https://www.dvm360.com/view/new-world-screwworm-detected-less-than-70-miles-from-the-us-mexico-border

do Vale TL, Costa AR, Miranda LM, et al. Efficacy of lotilaner against myiasis caused by 

 (Diptera: Calliphoridae) in naturally infested dogs. 

 2023;16(1):86. doi:10.1186/s13071-023-05661-z

About New World screwworm. CDC. Accessed October 24, 2025. https://www.cdc.gov/new-world-screwworm/about/index.html

The authorization is the first of its kind for dogs, as health officials track New World screwworm cases near the US-Mexico border.