Dermatology and nutrition: Beyond food allergyApril 29, 2019 When dogs and cats present with skin disorders, the initial approach is to collect a history, do a physical exam, and then perform diagnostic tests to rule in or rule out common conditions. After establishing a tentative diagnosis, most veterinarians will next consider which medications are most appropriate (e.g. antibiotics, antifungals, parasiticides). It is not as common to consider diet and nutrition as part of the workup and treatment for dermatologic disorders, other than performing elimination diet trials for suspected cutaneous adverse food reaction (food allergy). However, the right diets, nutrients, and sometimes nutritional supplements can have a significant benefit in improving or resolving certain skin disorders. This article highlights some of the options for incorporating nutritional science into the management of dermatologic disorders. Cutaneous adverse food reaction The most common presentation for a dog or cat with cutaneous adverse food reaction (CAFR) is nonseasonal pruritus, although other syndromes such as otitis externa and gastrointestinal (GI) upset may occur.1,2 While some companies offer "food allergy testing" using serum, saliva, or even hair clippings, the only valid diagnostic test is an elimination diet trial. There are a number of veterinary therapeutic diets that can be used for diet trials and …
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New bill would allow California veterinarians to recommend cannabisApril 22, 2019A new bill introduced to the California legislation could repeal an original ban on veterinarians recommending cannabis to their clients. The bill, SB 627, would allow licensed veterinarians to discuss the use of and recommend medicinal cannabis or related products on an animal patient for any condition for which these products provide relief. The bill would also prohibit a veterinarian who makes a recommendation under these provisions from being punished, or denied any right or privilege, for recommending these products. Currently, The Veterinary Medicine Practice Act authorizes the board to revoke or suspend the license of a person to practice veterinary medicine, or to assess a fine, for discussing medicinal cannabis with a client while the veterinarian is employed by or has an agreement with a Medicinal and Adult-Use Cannabis Regulation and Safety Act (MAUCRSA) licensee and is distributing advertising for cannabis in California. Further, the bill would permit pet owners to purchase medicinal cannabis or medicinal cannabis products on a veterinarian's recommendation.
Mars Petcare introduces new division focusing on collaborationApril 9, 2019Mars Petcare has announced the launch of Kinship, a collaboration platform for start-ups, veterinarians, and industry collaborators that provides them access to data, science, and industry expertise. "We're excited about our new global division, Kinship, becoming a unique collaboration platform for entrepreneurs and innovators to create new products and services delivering on our purpose: a better world for pets," says Mars Petcare president, Poul Weihrauch. "There are extraordinary opportunities in data, science, and connected technology. Match them with the expansive reach, resources, and core capabilities of a global industry leader like Mars, and together we can create a powerful force for transforming pet care." The initiative will focus on three main areas: • Health care: Kinship will look for new ways to provide pet owners with care options that are more accessible, effective, and personalized to fit the needs of their pets. • Nutrition: By working together with its partners, Kinship will find new ways to support pet health through nutrition. • Science: Kinship will work with experts to uncover ways to help change pet care through science by applying new discoveries from microbiome biology to machine learning. "Our ambition for Kinship is to bring together the brightest minds …
What does 503B compounding mean for the future of veterinary medicine?April 3, 2019Modern compounding—often referred to as 503A—is a niche business, providing patient-specific formulations to satisfy individual needs. Because commercially available drugs are marketed almost exclusively for humans, compounding has become an essential resource for veterinary medicine. Veterinarians often depend on 503A pharmacies to provide preparations at lower concentrations and in more palatable dosage forms to optimize treatment for their patients. However, without proper management and regulations, 503A compounding can potentially be detrimental. Presently, 503A pharmacies are not required to adhere to Current Good Manufacturing Practice (cGMP) objectives put forth by the U.S. Food and Drug Administration (FDA) to ensure pharmaceuticals achieve a specified standard of safety. The quality of products produced in a 503A facility depend on the pharmacy's voluntary conformance with cGMP, which can be substantially cost-prohibitive, requiring anywhere from $50,000 to $100,000-plus of investment for a single formulation. Testing on raw materials and finished products may be performed to an extent depending on the facility, but the data are often incomplete, testing only one or two factors while omitting others that would affect the product's overall quality. The variability of cGMP compliance from pharmacy to pharmacy paves the way for omissions in procedures that can lead to patient harm. …
Vital pulp therapy in dogs and catsMarch 29, 2019Last month, we discussed the rationale behind and approach to conventional (orthograde) endodontic therapy. Orthograde root canal therapy removes the entire contents of the pulp chamber in the root canal system. Vital pulp therapy is a different kind of endodontic procedure, performed instead on teeth that have had recent pulp exposure. Determining whether it's best to perform vital pulp therapy or orthograde root canal therapy for an individual tooth is a judgment call. Most dentists gravitate toward orthograde root canal therapy whenever possible, since it involves removing the entire contents of the pulp and minimizes the likelihood of possible future pain and infection by not leaving to chance whether remaining pulp maintains its vitality. However, orthograde root canal therapy may not be an option for young teeth, as they lack a closed apex. In the past, it was a rule of thumb that vital pulp therapy be performed within 48 hours of pulp exposure in dogs older than 18 months of age and within two weeks in dogs younger than 18 months of age. However, the sooner vital pulp therapy is performed after pulp exposure, the better the chance of success. Therefore, even when a patient is younger than 18 …
Seven options to provide life-saving oxygenMarch 28, 2019There is arguably nothing more heart-wrenching than a patient who is suffocating. How you handle these patients could be the difference between life and death. Some colleagues can be hesitant to admit these patients and may advise clients to take them to an emergency or referral facility that may be much farther away. It doesn't have to be that way. Short-term, there really is no risk to oxygen therapy. So even if the disease process were not oxygen-responsive, there is no harm in providing therapy while you figure things out, assess the severity of the disease, and obtain diagnostics. Providing oxygen is an easy way to buy time. Empower your nurses to start some sort of oxygen therapy when your patient is exhibiting any of the following situations: • dyspnea of any kind; • shortness of breath; • abnormal respiratory sounds; • cyanotic gums; • severe anemia or hemorrhage; • increased respiratory rate; • head trauma; and/or • lateral recumbency. Although arterial blood gas analysis would be the most accurate way to assess pulmonary function, it is rarely available in general practice. Pulse oximetry is a cheaper and more available option. You …
Stoner news: Struvite diets for cats and dogsMarch 28, 2019While struvite uroliths may in some cases require surgical intervention, the recommended standard of care by the American College of Veterinary Internal Medicine (ACVIM) is medical dissolution with a therapeutic diet formulated to alter urine acidity and encourage water consumption. Dietary dissolution of struvite stones is both effective and inexpensive. Therapeutic diets limit calculogenic compounds (e.g. phosphorus and magnesium) and acidify urine. That makes the urine a less welcoming environment for stone formation and dissolves stones that are present. Concerns medical dissolution places pets at risk of urethral obstruction are not borne out by the literature, according to the ACVIM consensus statement, published in the Journal of Veterinary Internal Medicine (JVIM) in 2016. Dietary management itself has changed as well. The shift from struvite-only dissolution or prevention diets to combination struvite dissolution/prevention and calcium oxalate prevention diets is the biggest change in management of these uroliths, says Cailin Heinze, VMD, Dipl. ACVN, assistant professor of nutrition at Cummings School of Veterinary Medicine at Tufts University. Causes differ Struvite uroliths occur in both dogs and cats, but have different causes. In dogs, struvite stones—the most common type seen—develop almost exclusively as a result of urinary tract infections (UTIs) caused by …
Asymptomatic bacteriuria—To treat or not to treat?March 28, 2019Veterinarians and pet owners are highly motivated to find discrete, fixable problems when pets are unwell. Owners want the reassurance and sense of control that comes with knowing what the problem is and taking action. Veterinarians want to help our patients, while also satisfying clients. Their expectation is that we offer some clear preventive or therapeutic intervention justifying their time and the expense of coming to see us, as well as reassure them about their pets' condition. Finally, our medical training often emphasizes diagnosis and treatment as the core responsibility for a doctor; the importance of knowing when not to take action is frequently underemphasized.1,2 Such inherent bias toward finding and treating problems creates discomfort and resistance when scientific evidence suggests we should avoid some tests or treatments. Though there is widespread awareness of the risks of overdiagnosis and overtreatment in human medicine, these are relatively new and controversial concepts in the veterinary field.3,4 My own efforts in this column and elsewhere to suggest we might sometimes do better not to run a test (e.g. pre-anesthetic bloodwork)5 or prescribe a treatment (e.g. lysine)6 have generated the kind of pushback often greeting such suggestions. Nevertheless, we have a responsibility to …
Laser therapy—Indications and contraindicationsMarch 27, 2019Photobiomodulation—a.k.a laser therapy—has become commonplace in veterinary medicine, with knowledge gained over the last eight to 10 years coming from evidence-based data and shared clinical experience. Achieving predictable and reproducible results with laser therapy is dependent on properly managed treatments, proper dosing, effective use of therapy laser hardware and software, and appropriate treatment technique.1 Low-level laser therapy (LLLT) applies low-level (low-power) lasers to the surface of or in orifices of the body. Whereas high-power lasers are used in laser medicine to cut or destroy tissue, application of low-power lasers is said to relieve pain or stimulate and enhance cell function. Laser therapy is a unique and extremely gentle form of treatment with the ability to stimulate tissue healing, virtually without side effects. It is very different from laser surgery, as it avoids heating the tissue, which can cause cell and tissue damage. As such, photobiomodulation is often called "cold laser" therapy.2 What's it for? Laser therapy has been postulated to exert three main effects: reduction of pain, modulation of inflammation, and acceleration of healing.3 The primary categories with the strongest support—largely via experimental studies—include its use in pain, wounds, musculoskeletal conditions, neurologic pathology, and in conjunction with complementary medicine techniques …
Talking the talk—What to say when clients prefer raw dietsMarch 21, 2019One only needs to pay attention to the news or trending items on Facebook to see the spate of pet food recalls happening in our country. And with an uptick of pet parents feeding their dogs raw or freeze-dried raw food, it is important veterinarians have honest and open conversations with their clients about concerns surrounding these diets. The following is American Veterinary Medical Association's (AVMA's) position statement on raw diets: "AVMA discourages the feeding to cats and dogs of any animal-source protein that has not first been subjected to a process to eliminate pathogens because of the risk of illness to cats and dogs, as well as humans." Katy Nelson, DVM, medical director of Pet Health for Stop Aging Now, agrees. "Cooking or pasteurization through the application of heat until the protein reaches an internal temperature adequate to destroy pathogenic organisms has been the traditional method used to eliminate pathogens in animal-source protein, although the AVMA recognizes that newer technologies and other methods, such as irradiation, are constantly being developed and implemented," Dr. Nelson says. "Most veterinarians are going to listen to the governing body of our profession, as well as the Centers for Disease Control (CDC) and …
