Referral Pearl


Referral Pearl

Volume 3. Issue 1






Lunch and Learns with A CVSEC Specialist!


The Center for Veterinary Specialty + Emergency Care is proud to announce that we are taking our 2017 "PAWS4CE Series" on the road visiting our Referring Community!  Our first CE was held at Legacy Veterinary Hospital in Frisco on Tuesday, April 4th.

Dr. Kent Julius chose the topics of discussion and two of our CVSEC Specialists, Dr. Jen Mahon and Dr. Eloise Stikeman presented to his Team.

Dr. Mahon:  "Initial Stabilization of the Thoracic Trauma - or any Trauma Patient"

Dr. Mahon:  "Using the Ultrasound Probe In Patient Assessment - i.e. Fast Scan"

Dr. Stikeman: "Use of Budesonide in Inflammatory Bowel Disease (IBD), Dosing and Usage, Systemic Effects, and Current Case Study Underway at CVSEC."

*** Please contact Shelley Martin at or 972.820.7099 to schedule a "Lunch and Learn" with one of our CVSEC Specialists.  We would love to come and visit your facility and meet your Team!

Dr. Mahon presenting to the Team at Legacy Veterinary Hospital - Frisco.


"Thank you CVSEC for coming out and presenting such an in-depth "Lunch and Learn" at my hospital!  It was much more than any of us expected.  I really appreciate your Specialists being available for the topics of our choice AND for spending as much time as needed for all of our questions.  We will be happy to schedule the next one!" 

Dr. Kent Julius

Legacy Hospital was founded by Dr. Kent Julius is 2003.  He opened a 2,000 sq. ft. shopping center at the corner of Lebanon and Legacy.  At that time he did not offer grooming and had very limited boarding.  Over the next 5 years, Legacy grew from 4 employees and 1 Veterinarian to 11 employees and 2 full-time Veterinarians!  In the winter of 2008 the Team at Legacy moved into their current 6,000 sq. ft. facility.  There are currently over 20 employees and 5 Doctors on staff at their beautiful hospital! 

"Since opening in 2003 our focus has remained on the best possible patient care and customer service.  We like to provide our patients and clients a high quality veterinary service in a friendly, unique, clean and organized setting."




Jen Mahon

Diplomate, American College of Veterinary Emergency & Critical Care Medicine

Dr. Jen Mahon completed veterinary school at Tufts University Cummings School of Veterinary Medicine in 2012, and completed a one year internship in Albuquerque, NM.  She returned to Tufts for a three year residency in Emergency and Critical Care, and achieved Board Certification in the American College of Veterinary Emergency and Critical Care in 2016.

Prior to being a Veterinarian, she worked as a Veterinary Technician in Pennsylvania, Massachusetts, and Texas.  While working as a Technician, Emergency and Critical Care captured her heart and mind and hasn't let go since. Her favorite Patients are the sickest ones, and getting them well enough go home is her goal.  She loves to treat sepsis, trauma, multi-organ disease, and has a special interest in mechanical ventilation for dogs and cats.

In her spare time Dr. Mahon loves to do yoga, bike ride, and knit, but not all at once. She enjoys spending time with her partner and their three cats and exploring all that Dallas has to offer.


Anaphylactic Shock (Apollo's Story)

Apollo is an approximately 2 year old pit bull who was adopted about 2 months ago by a family that found him wandering the woods behind their home.  They brought him to the Allen shelter to see if anyone would claim him, and after 5 days, he was released to their care and Apollo went to his new amazing home! 

On March 20th, Apollo suddenly vomited and collapsed outside.  He was brought to his Primary Care Veterinarian, McKinney Animal Hospital (Dr. Ewa Cissik).  Blood work showed that Apollo could not clot his blood, and one of his liver values was high, suggesting anaphylaxis.  They placed an IV catheter and gave him an injection of epinephrine, and referred him to CVSEC

On presentation to CVSEC, Apollo was in shock- he was weak, with a high heart rate and thread pulses, all classic signs of shock.  We started him on IV fluids to treat shock, and started to thaw frozen plasma to replenish clotting proteins.  We also ran some diagnostics, and one of the key diagnostics was an AFAST.
AFAST stands for "abdominal focused assessment for trauma and shock.  It is a type of ultrasound, or sonogram, which is performed within 2 minutes.  It's not a comprehensive, organ-by-organ test; rather, it looks at a few key areas of the abdomen to allow for rapid assessment and treatment. The striking findings for Apollo were that he had a small amount of fluid collected in his belly, and his gall bladder bore what is called a "halo sign".  The halo sign is a bright ring of fluid, and can serve as a marker of anaphylactic shock. 

Anaphylactic shock is seen with some frequency in our ER, about 1 case every week or two, and is more common in dogs than in cats.  The causes of anaphylaxis can vary from a bee sting to a plant to a drug, but in most cases, the trigger is never identified.  Anaphylaxis differs from a typical allergic reaction in a few ways.  First, in anaphylaxis, shock and collapse are hallmarks, and vomiting or diarrhea is very common.  In an allergic reaction, usually facial swelling or hives are seen on a dog that is still wagging its tail and acting very normal.  Second, the way anaphylaxis is generated in the body is different at the cellular level than an allergic reaction as well, which may explain the difference in the way the two processes appear.  And third, the treatment is vastly different.  Dogs with allergic reactions are usually treated with an antihistamine and maybe a steroid and discharged within an hour or two (the exception to this is if hives develop in the throat, constricting the airway- that is an emergency!).  Patients with anaphylaxis are usually hospitalized for days; require intensive care and monitoring, IV fluids, transfusions, and IV drips of epinephrine (adrenaline) to keep them alive.  Anaphylaxis is survivable, but the best outcomes result from prompt Veterinary attention.  Fortunately for Apollo, he collapsed right in front of his family, so they were able to respond quickly and appropriately. 

Apollo spent 3 days in the Hospital, received three transfusions of plasma, and a lot of medications.  After about 12 hours of treatment, he started to eat and drink.  On his last day of hospitalization, he was off all IV medications, and went home to his family that evening. 

Apollo's story is a success for three reasons:

1. His family had an appropriate and rapid response to his development of shock.

2. His Primary Care Vet, Dr. Cissik, treated him appropriately prior to referral.

3. The CVSEC team is very familiar with the treatment of anaphylaxis and we know that in order to get Patients through, we have to act aggressively. 

By:  Dr. Jen Mahon




Internal Medicine
Budesonide Case Study Reminder

  • Study purpose:  To investigate the long-term effects of a locally acting enteric steroid (budesonide) on proteinuria
  • Hypothesis:  Long-term use of budesonide will result in significant proteinuria
  • Inclusion Criteria:  Dogs with IBD initiating therapy with budesonide

We are looking for Pets with chronic gastrointestinal disease to participate in a study investigating the proteinuric effects of budesonide.  Patients will undergo endoscopic biopsies and treatment for IBD with parallel observations of proteinuria over the duration of treatment.


What Benefits are Procured to the Client?

  • In addition to a comprehensive work up and treatment for the chronic enteropathy, Patients who qualify for study enrollment will receive:

A large discount on the endoscopy procedure and histopathology of the GI tract

Complimentary budesonide medication for the duration of the three month study period

Complimentary food as indicated for the Patient at the start of the study

If you are interested in this case study, please contact Dr. Eloise Stikeman at or 972.820.7099.





Copyright © 2017 Center for Veterinary Specialty + Emergency Care, All rights reserved.
"As one of or Top Referring Facilities, you have been included on our monthly newsletter mailing list - The Referral Pearl."

Our mailing address is:

Center for Veterinary Specialty + Emergency Care

2700 Lake Vista Drive

Lewisville, TX 75067

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Referral Pearl
Volume 2. Issue 8

August 2016



Research at CVSEC:  Influence of Budesonide of Proteinuria on Dogs with IBD

In the management of inflammatory bowel disease and related conditions such as protein-losing enteropathies, corticosteroids remain the cornerstone of therapy to control inflammation and resulting clinical signs.  The chronic nature of the disease most often necessitates long-term use of steroids which poses risk of causing significant side effects over time.  In recent years there has been an increasing appeal to utilize budesonide in the treatment of chronic inflammatory gastrointestinal disease due its preferentially localized effects within the gastrointestinal tract.  This focused therapy is the result of the drug being poorly absorbed through the enteric mucosa and undergoing extensive first-pass hepatic metabolism thereby limiting its greatest influence to the intestinal wall.  In human patients, these unique properties of budesonide result in limited systemic side effects but this has not been replicated in the literature pertaining to canine patients.  A recent study demonstrated equivalent frequency of steroid-induced side effects observed in IBD dogs treated with budesonide as with prednisone.  The severity of the effects appeared reduced in those Patients receiving budesonide, however this did not achieve statistical significance.  It has also been demonstrated by numerous authors that budesonide is capable of influencing the hypothalamic-pituitary-adrenal axis resulting in suppression of endogenous steroids with long-term use.

Yet in spite of multiple research papers clearly documenting the systemic effect of budesonide, there remains an allure in its application over prednisone, particularly in Patients in whom a more systemic steroid might be contraindicated or of higher risk.  The classic example would be a diabetic dog who risks deregulation of glycemic control on prednisone or a Patient with congestive heart failure in whom we worry about fluid retention and exacerbation of cardiac disease.  Another realm in which the exertion of steroidal effects is of relevance is in the presence of renal disease.  It has been repeatedly shown that both excessive endogenous steroids (such as manifest in Cushing's disease) and exogenous steroid provision (such as prednisone) are capable of inducing significant proteinuria.  This effect has never been investigated in budesonide, however, thus rendering interpretation of proteinuria in a Patient receiving the medication very difficult.  This is of particular interest in the Soft Coated Wheaton Terrier, the poster-breed for protein-losing enteropathies and one in which a later manifesting protein-losing nephropathy can develop.  If the Patient has been receiving budesonide long-term, will we be able to recognize clinically significant proteinuria and appropriately attribute it to primary renal disease?  Similarly, will we be able to accurately stage a Patient with heartworm disease receiving budesonide who is found to be proteinuric in the pre-treatment evaluation?  Will we be able to have confidence in confining autoimmune dysregulation to the GI tract if we start to see proteinuria, a common marker of immune-mediated glomerulonephritis, in a Patient being treated for IBD with budesonide therapy?

The Internal Medicine Department at CVSEC has launched a new study designed to help answer these types of questions.  Dogs who have been diagnosed with an inflammatory enteropathy will be treated with budesonide and undergo serial urine protein evaluations to investigate if the drug is capable of inducing urinary protein loss over time like its systemically acting counterparts.  In order to interpret the data clearly, Patients will be excluded from the study if they have pre-existing proteinuria or any concurrent illness which may predispose to proteinuria over time (such as systemic hypertension, Lyme disease, or hyperadrenocorticism).  Eligible Patients will undergo a comprehensive gastrointestinal evaluation including endoscopic guided biopsies.  If the histopathology confirms a chronic inflammatory enteropathy, Patients will be treated with budesonide.  Adjunctive therapy (such as dietary manipulation, cyanocobalamin supplementation, or supplemental metronidazole therapy) will be permissible per the needs of the Patient.  In short, they will receive standard of care therapy for a diagnosed chronic inflammatory enteropathy whilst the urine is monitored for the presence of protein over time.

Clients who elect to enroll their Patients in the study will receive a significant discount on the endoscopy and biopsies with Animal Reference Pathology in addition to complimentary budesonide therapy for the duration of the study, courtesy of Pet Health Pharmacy. Any Patient with chronic GI symptoms not currently receiving prednisone may qualify for enrollment.

If you have any Patients that may be eligible, please contact Dr. Eloise Stikeman (estikeman@cvsecvet.comor 972.820.7099).  Or if you simply have questions about the use of budesonide in managing chronic inflammatory enteropathies, please reach out to any Doctor in the Internal Medicine Department or speak with Shelley Martin ( to discuss scheduling a CE Lunch & Learn at your Hospital on the Pearls of Managing IBD:  Budesonide and Beyond!






(972) 395-0786

6:30 PM to 7:00 PM

Meet and Greet  

7:00 PM to 8:00 PM: 



Dr. Karen Felsted


(Race approval pending for 1.0 CE credit.)


8:00 PM to 9:00 PM:



Dr. Eloise Stikeman

(Race approval pending for 1.0 CE credit.)


9:00 PM to 9:40 PM:



Dr. Debra Nossaman

(State approved for 0.5 CE credit.)


We would like to thank the four companies that are sponsoring our event!!



Registration fee:  $25 (Includes dinner, drinks, and door prizes!)

RSVP to Shelley Martin ( by 10.20.16.

Thank you to everyone that attended our CE in April at Maggiano's - Willow Bend.  We enjoyed seeing so many of you at the event.  It was a great success!!!

We are looking forward to seeing you at our 2017 CE functions!




Copyright © 2016 Center for Veterinary Specialty + Emergency Care, All rights reserved. 
"As one of our Top Referring Facilities, you have been included on our new monthly newsletter, The Referral Pearl". 

Our mailing address is:

Center for Veterinary Specialty + Emergency Care

2700 Lake Vista Drive

LewisvilleTX 75067

Add us to your address book

Want to change how you receive these emails?
You can update your preferences or unsubscribe from this list

The Referral Pearl
Volume 2. Issue 6

June 2016




When you or a family member are ill, you seek the best medical care available, which often includes referral to Specialists and even travel to advanced care centers.  The same can be true for our Pets.  The Internal Medicine Team at CVSEC stands ready to work with you to diagnose and treat your Patients with complex diseases.

Established in 2009, our team of Board Certified Internal Medicine Specialists has more than 20 years of combined experience improving the lives of dogs and cats suffering from a broad range of illnesses. We are also very proud to be the only hospital in the DFW area with an Internal medicine resident in training, who is a driving force for our team to remain current on the latest research and newly emerging tretment options. When you refer to the Internal Medicine Team at CVSEC, we will join you and your Client in the Triad of Care to provide Patients with specialized diagnostic testing and cutting edge therapeutic care.


In addition to the usual diagnostic tools you expect from an Internal Medicine Service, we also practice cardiology (including echocardiography), medical oncology, and are skilled in laparoscopy.  We have on-site CT enabling access to real-time advanced imaging of our patients.  The Internal Medicine Team at CVSEC is also the only specialty practice in DFW to offer tracheal and urethral stent placement.  Patients requiring hospitalization are provided personalized care in our 24/7 ICU staffed with experienced and compassionate Doctors and Technicians.  Our collaborative team approach to veterinary medicine delivers comprehensive and seamless care for your Patients and the Clients who love them.

If you have further questions about what sets our Internal Medicine Team apart from other hospitals, please feel free to call or come by for a visit and a tour.  We are excited to continue working with you and your clients for years to come. 


Thank you for your support!

Valeria Case, DVM
Diplomate ACVIM


Keven Gulikers, DVM, MS
Diplomate ACVIM


Eloise Stikeman, BVMS, Hons.,BSc


Tracheal Stent Placement


Internal Medicine's PAWS4CE Event







Copyright © 2016 Center for Veterinary Specialty + Emergency Care, All rights reserved.
"As one of our Top Referring Facilities, you have been included on our new monthly newsletter, The Referral Pearl".

Our mailing address is:

Center for Veterinary Specialty + Emergency Care

2700 Lake Vista Drive

Lewisville, TX 75067