New CAPC study shows Lyme disease is spreadingMay 7, 2019Research from the Companion Animal Parasite Council (CAPC) indicates seroprevalence of Lyme disease in dogs is not only increasing in the Northeast, where it is considered endemic, but also spreading into areas that were previously thought to not be at risk for this serious, zoonotic tick-borne disease. ("Seroprevalence" in this case refers to the prevalence of dogs exposed to Borrelia burgdorferi, the pathogen responsible for causing Lyme disease in the U.S. based on serologic tests—hereafter referred to as "prevalence.") Study results were published in the December 2018 issue of Environmetrics, the official journal of The International Environmetrics Society (TIES). This milestone study, titled "A Large-scale Spatio-temporal Binomial Regression Model for Estimating Seroprevalence Trends," suggests canine prevalence rates for Lyme disease are rising and that those rates are increasing most in areas where the pathogen has recently encroached. Specifically, exposure in dogs to B. burgdorferi is rising in states not traditionally considered to be areas of high Lyme risk. Significant increases in the percentage of dogs testing positive for exposure have also been seen in areas that have not yet reported significant human incidence. These findings suggest canine Lyme prevalence could serve as an early warning system for changes in …
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Getting to the root of pyodermaMay 7, 2019Scaling, hair loss, papules, pustules, and epidermal collarettes. All are clinical signs pointing toward canine pyoderma. The culprit may seem clear at first glance; however, veterinarians must look at the bigger picture to address the underlining issue. It's important to first understand the meaning of pyoderma, particularly regarding the depth of infection, says Elizabeth Layne, DVM, Dipl. ACVD, clinical instructor at the University of Wisconsin-Madison, School of Veterinary Medicine. The most common form of pyoderma is superficial bacterial folliculitis, a bacterial infection of the upper part of the hair follicle, caused by Staphylococcus pseudintermedius. Deep bacterial infections (presented as swelling, nodular lesions, and oozing draining tracts) can occur, but that is a different diagnostic and therapeutic approach, Dr. Layne adds. Superficial bacterial pyoderma is almost always secondary to some kind of skin abnormality, such as atopic dermatitis. Other skin diseases (e.g. flea allergy dermatitis, sebaceous adenitis, or primary seborrhea) can also result in superficial pyoderma, Layne notes. Systemic illness or immune compromise may lead to superficial bacterial pyoderma as well. Since pyoderma commonly masks another condition, a vicious treatment cycle can ensue if the underlining problem isn't identified. "Veterinarians often recognize the signs of infection and treat with antibiotics …
Taking ECGs to the next levelMay 6, 2019The ECG has been a routine test in veterinary practice for decades, and is commonly used for diagnostic purposes, as well as an anesthesia and critical-care monitoring tool. Although the principles of ECG diagnosis remain the same, the ways in which an electrocardiogram can be recorded have changed in recent years. Some of the changes in technology now allow general practices to have access to services that were previously only provided by specialty clinics. Some of the newer technologies also allow screening ECGs to be obtained easier and faster than their conventional counterparts. Why get an ECG? When obtaining a "standardized" ECG, we generally have been taught to use alligator clips and to place the patient in right lateral recumbency. This, of course, requires time and generally two people: one to restrain the animal and the other to run the machine. Further, this technique generally is not amenable to exam room use. A newer option is to consider using a direct chest lead. To decide which technique is best for a particular clinic, it is important to know what ECGs can be used for. The simplest and most important feature of an ECG is it allows a definitive rhythm diagnosis …
Surgical endodontics: When all else fails...May 6, 2019In my previous two columns, we looked at conventional (orthograde) root canal therapy, along with vital pulp therapy. This time, we will discuss surgical (retrograde) endodontics. In instances where orthograde root canal therapy has failed, a decision needs to be made to either perform a second orthograde root canal therapy or to proceed to the next step: surgical endodontics. Extraction would be a third option for a failed root canal procedure if the owner no longer chooses to salvage the endodontically diseased tooth. Besides its use as a treatment when orthograde root canal therapy fails, retrograde root canal therapy may be the chosen course of action when an instrument breaks off while performing an orthograde procedure. Instruments most likely to break off in the canal include Lentulo spiral paste fillers, barbed broaches, and rotary files. Sometimes the detached instrument portion can be entombed in endodontic filling material during orthograde obturation, but if not, a retrograde procedure may be warranted. The procedure What is surgical root canal therapy? A surgical approach is made over the apical portion of the root, and bone is carefully removed to expose the root area (Figure 1). The apical 4 mm of the root is surgically …
How to improve your surgical skillsMay 6, 2019What can you do to improve your surgical skills? Assuming your career path does not include a surgery internship or a residency and board certification, here are some tips to raise the surgical bar. Prerequisites Some traits are self-understanding. In order to perform surgery, you need to have dexterity and think in 3D. You'll also need the following: "Good hands"—no shaking allowed. A keen sense of observation. Observe the patient. Observe the tissue. Observe others perform surgery. Some will teach you what to do, while others will teach you what not to do. Use the correct suture material, the correct needle, and the correct size. Know and apply the seven principles of William Stewart Halsted, MD, our 19th-century forefather (see The basics of surgery). Speaking of forefathers… believe the sayings they crafted: "Measure twice, cut once." "If it's worth taking out, it's worth turning in" (i.e. masses belong in the lab, not the trash). "There are routine surgeries, but there is no routine anesthesia." "Dilution is the solution to pollution." It is critical to thoroughly understand anatomy, indications, and surgical approaches. Reading books to acquire a good understanding of anatomy and a great knowledge of approaches is a must. But …
Is cranberry effective for treating UTIs?April 29, 2019Like most herbal remedies, cranberry has traditionally been employed for a wide variety of unrelated problems, ranging from diseases of the liver and stomach to blood disorders and even cancer.1 These days, however, it is pretty firmly established in the minds of pet owners—and many veterinary professionals—as useful for urinary tract infections (UTIs). It may be surprising, then, to learn there is little convincing evidence to support the effectiveness of cranberry in preventing or treating UTI. The question of whether cranberries, in some form, have value in treating or preventing UTIs is a pretty old one. In addition to historical claims among herbal medicine practitioners, there are scientific references on the subject going back to the 1960s.2 An early theoretical rationale for using cranberry to treat UTIs was it inhibited bacterial growth by acidifying the urine.3,4 However, later research has not substantiated this theory, and this rationale is no longer commonly used to explain the purported benefits of cranberry in preventing or treating a UTI.1,5 The more popular theory today is compounds in cranberry juice, particularly a group called proanthocyanidins, interfere with the attachment of some bacteria to the bladder mucosa, reducing colonization and the establishment of infection.6,7 This …
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 …
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. …
