FAQs for Veterinarians:

How can I learn more about SAGE?

We enjoy getting to know our primary doctors! Please call to arrange a visit to tour any of our facilities and meet our doctors and staff. You’re also invited to attend our monthly Diagnosis Dinners where you can hear our clinicians give talks on a variety of topics and can also discuss cases with them. Please call one of our hospitals to be placed on the mailing list. Look at our News/Events page for upcoming events.

Your doctors often work at different SAGE facilities. How do I keep track of them?

We support our SAGE doctors when they request to attend required continuing education or need some time off while balancing the needs of the community to ensure adequate coverage of services. Rest assured, if you are looking for one of our specialists, give us a call at any location and our Client Service Coordinators will make sure your message arrives in a timely manner to the location where the doctor is that day.

How may I receive SAGE informational materials to share with clients?

We have informational brochures for SAGE’s variety of services, window clings to direct clients to the closest SAGE facility for after hours emergencies, magnets with our contact information, etc. Please contact our Marketing department with your specific request and we will either deliver the items in person to your clinic or mail them to you.

Do you offer RACE approved CE?

Yes, at various times of the year, our doctors will provide RACE approved continuing education lectures at our hospital locations. Our annual Symposium also offers a variety of RACE approved lectures and workshops. For more information, please click here.

Will SAGE take my client away from me?

No, SAGE wants to partner and team up with our primary veterinarians, not take away their business. SAGE supports our primary vets by ensuring our communication with you and your client is clear in that we are an extension of care and services. We purposely do not offer standard wellness plans, vaccination appointments, flea preventatives, straight forward spays or neuters, etc. Our focus is on specialized and emergency care.

How to Facilitate the Treatment of Injection Site Sarcomas (ISS) in Cats

What is a feline injection site sarcoma?
Feline injection site sarcomas are tumors that can develop at sites of injections. Certain vaccines have been implicated as being more likely to cause this cancer, but various non-vaccine injections have been implicated as well. It has been estimated that about 1 in 10,000 vaccinations results in the development of these tumors in cats.

What is the biological behavior of ISS?

ISS are locally invasive tumors that penetrate through surrounding tissue with tumor “roots”. These “roots” can extend further out than what can be seen or felt on

palpation. These tumors have about a 20-25% chance for metastasis in general, but the metastatic potential for each individual tumor will vary depending on its grade.

How is ISS treated?
The treatment of each ISS will depend on the size and location of the tumor, and the health of the patient. It is common that a combination of treatments such as surgery, radiation therapy, electrochemotherapy, or chemotherapy may be recommended for patients with this disease.

What is the prognosis for cats with ISS?

The prognosis for cats with ISS varies depending on many factors, including the size, location, grade of the tumor, and the treatment modalities chosen to treat it. An oncologist can help better assess the prognosis of an individual depending on these factors.

How can the risk for developing ISS be reduced? Vaccinations are extremely important in preventing certain infectious diseases, some of which can be deadly. The answer is not to stop administering vaccinations since that would potentially allow for outbreaks of infectious diseases in cats and can be a public health concern for deadly diseases like rabies. Instead, you should consult with your primary veterinarian about which vaccinations are indicated for your cat and which are less likely necessary.

Besides only administering vaccines that are thought to be necessary for each individual, cat owners should monitor vaccination sites for the development of lumps and nodules. Nodules that form at injection sites may be an inflammatory reaction that may resolve on their own, but they should all be evaluated by a veterinarian to rule out an ISS.

What are indications for radiation therapy?

Radiation therapy (RT), along with surgery and chemotherapy, are the three main pillars of treatment for cancer in veterinary medicine today; however, unlike surgery and chemotherapy, the applications of RT often are not well understood since the equipment, licensing, and training required for administering this form of therapy typically limits its availability to certain specialty veterinary and human hospitals. There are a number of different modalities in which RT can be applied, such as with radiopharmaceuticals like iodine 131 for the treatment of feline hyperthyroidism, plesiotherapy with the application of a strontium probe to small superficial cancers, or most commonly, teletherapy (external beam radiation therapy) from a linear accelerator. Older forms of teletherapy with Cobalt-60 or orthovoltage machines are becoming less and less common.

Indications for external beam radiation therapy include the primary treatment of specific tumor types, adjuvant treatment in addition to surgery and/or chemotherapy for better tumor control, and for palliation to improve quality of life for advanced cancer cases.

Primary treatment for specific tumor types: The use of external beam radiation therapy for the primary treatment of tumors is recommended for several specific tumor types, namely nasal tumors of various histologies, as well as other tumors that cannot be surgically resected. Previous studies have shown that patients treated with rhinotomy plus RT have similar survival times to patients treated with RT alone. Patients treated with surgery alone had similar survival times to those who received no treatment, therefore making RT the most effective way of treating nasal tumors. Other tumors that can be effectively treated primarily with RT (if surgery is not feasible) include intracranial tumors such as pituitary macroadenomas and meningiomas. Round cell tumors are known to be exquisitely sensitive to RT, so localized round cell tumors for which surgery or chemotherapy are not feasible or effective will often shrink away with RT. A definitive course of RT consists of treatments given daily for a total of 16-21 total fractions.

Adjuvant treatment: In many cases, the complete local excision of a tumor is not feasible, so RT is recommended as adjuvant therapy to eliminate the residual disease left behind or to slow the regrowth of an excised tumor. Tumor types most frequently treated in this fashion include incompletely excised mast cell tumors and soft tissue sarcomas. Incompletely excised canine mast cell tumors that are treated with adjuvant RT have a less than 10% chance of local recurrence. Low to intermediate grade soft tissue sarcomas that are incompletely excised and treated with adjuvant RT have a tumor control rate of 75-85% for 3-5 years. Cats with injection site sarcomas treated with RT followed by surgery have disease free intervals of about 1-1.5 years with a median survival time of about 2 years.

Palliation: Palliative RT is most frequently recommended for terminal patients with advanced cancers. The aim of palliative RT is to shrink the tumor temporarily and provide relief of pain and discomfort associated with the tumor. Typically between 2 and 6 fractions are administered, as opposed to the 16-21 fractions given for definitive RT. Tumors that are commonly palliated include oral tumors, large soft tissue sarcomas, and osteosarcomas, but may include tumors of nearly any histology where surgery is not an option.

The side effects of external beam RT are typically divided into acute effects and late effects. Acute effects are the effects seen with rapidly dividing tissues such as skin and mucosa and include dry or moist desquamation and mucositis. These effects can be expected to occur to some degree usually 2-3 weeks after starting radiation, but are typically transient, lasting a few weeks. Late effects occur with slowly dividing tissue such as bone, nervous tissue, and other connective tissues and can occur anywhere from 6 months to several years later and include fibrosis, necrosis, and secondary tumor formation. Late effects generally have a very low incidence of occurrence, but can be relatively serious if they do occur. Definitive radiation protocols are generally associated with lower rates of late effects, whereas palliative protocols tend to be associated with fewer acute effects but a higher rate of late effects, which is why palliative protocols are generally reserved for advanced cancer cases where the patients are unlikely to ever be affected by late effects.

Is SAGE a corporation?

SAGE is a San Francisco Bay area locally-owned partnership, owned by 14 partners who all practice in each of our 4 facilities. Though we are large in size and offerings, we are cognizant of remaining local and community based. Our management team has corporate experience, and we have benefited from their experience with growing the organization and streamlining our processes, however by design, our culture is such that we are flat-management based with little to no hierarchies. Everyone at SAGE has an important role to fill regardless of their title.

What does SAGE stand for?

The SAGE name is not an acronym and was chosen due to a variety of reasons. First, the definition of the word “sage” is someone who is wise and venerated for their possession of wisdom, judgment and experience. We feel our team exemplifies this description and shares their knowledge for the greater good. Second, a sage plant is an aromatic herb plant native to California which identifies our presence in the San Francisco Bay area.

What does your Logo stand for?

The SAGE logo is comprised of a shield to stand for protection, a paw print to identify our commitment to small companion animals, a leaf to illustrate the sage plant (and our name), and the colors of sage green and brown to represent our ‘down to earth’ CA presence.