A Look Ahead For 2010December 30, 2009What’s new and improved? It’s an appropriate question as we greet a new year. We asked some veterinary leaders to envision advances and other influences likely to affect veterinary practice in 2010 and beyond. Their insights covered considerable ground, from targeted therapies to regenerative medicine, diagnostic imaging to diet and nutrition. Collectively, the view ahead is not of giant leaps but of carefully placed steps, with advice to keep one eye on the economics and the other searching for that elusive target: the cutting edge. Our insiders didn’t have to strain to find reasons for optimism. “Looking at the big picture, I’m excited about 2010 and the future,” says Leah Cohn, DVM, Ph.D., vice president of the American College of Veterinary Internal Medicine. More Specialists Dr. Cohn’s first choice for an area of impact and expansion: specialization. She expects to see not only the number of specialists grow but also an acceleration of the shift from academic settings to private specialty practices. The trend is good for clients because we will see “vast increases in knowledge and treatment options,” she says. But it’s also good for practitioners, she adds, because while she sees generalists as excellent clinicians, “No one can …
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Treating Advanced Periodontal DiseaseDecember 30, 2009 Periodontal disease is the most common disease of companion animals—more common than kidney disease, diabetes and lymphoma. Most dogs and cats show early signs of periodontal disease by 4 years old. Many practices are realizing there’s more to the treatment of periodontal disease than just cleaning and polishing. Advancing your knowledge of perio-dontal disease treatment is good for the patient and good for your practice. What follows is a list of dental pearls highlighting today’s approach to periodontal therapy. 1. Don’t call it a “prophy.” Don’t call it a dental, either. These terms grossly underestimate the effort required in most veterinary patients. The term “prophy,” shorthand for “prophylaxis,” is simply inaccurate. In our patients, we are rarely just preventing disease and more commonly treating existing disease. Calling this procedure a “prophy” is like referring to an engine rebuild as an oil change. Other terms have been proposed that more accurately describe the extent of treatment. COHAT is an acronym gaining in popularity. It stands for comprehensive oral health assessment and treatment. In our practice, we often refer to various aspects of the procedure to ensure that clients comprehend the steps that may be …
Retina Re-Attachment SurgeryDecember 4, 2009 Because of the skill level, cost and time involved in treating retinal detachments, only a few veterinary ophthalmologists perform the procedure in the U.S., says Robert Munger, DVM, Dipl. ACVO, of Animal Ophthalmology Clinic in Dallas. “Retina issues are some of the most challenging cases that a veterinary ophthalmologist can be presented with,” Dr. Munger says. “Because of the difficulty with the procedure, those who perform the procedure often get referrals from other ophthalmologists in addition to primary caregivers.” Brad Nadelstein, DVM, Dipl. ACVO, of Animal Eye Care in Virginia Beach, Va., is one of the U.S. vets who perform retina reattachment surgery. He gets referrals from ophthalmologists all over the East Coast. “There is a long learning curve,” Dr. Nadelstein says. “It took about five years of practicing this surgery before I felt confident. A surgery initially took me eight to 10 hours, and now after 12 years of surgery it generally takes two to four hours.” The procedure requires, in part, making three microsurgical incisions. One hole is for a light source, one for vitreous and one to remove fluid. “Vitreous is the transparent jellylike substance behind the lens of the vertebrate …
When Cataract Surgery Isn’t PossibleDecember 4, 2009 Although cataract surgery has a high success rate, the procedure may not be financially feasible for some owners, and some animals’ health contraindicates surgery. One option that claims to reduce the lens opacity is PetVisionPro, a nutraceutical eye drop that has been on the market for five years. The manufacturer, Ader Enterprises, says the product also works on lenticular sclerosis cases. Using the product means applying one to two drops per affected eye two to three times per day for up to 45 days. “We want to educate veterinarians that an alternative exists to cataract surgery,” says Alfredo Paredes, president of Ader Enterprises Inc. of San Diego, Calif. “The wholesale price ranges in price for $65 for two bottles and resale is $125-140 per package.” The product cannot be used by an animal also using steroid-based medication or on an animal with a diabetic or nuclear cataract. The company says the sooner a cataract is addressed, the higher the likelihood PetVisionPro will be able to help restore vision. “I have used it in three canine patients to date,” says Judith M. Shoemaker, DVM, of Always Helpful Veterinary Services in Nottingham, Pa. “I’ve used it …
Vets Need To Get Tougher On Fleas And Ticks, Experts SayAugust 5, 2009 Flea, tick and heartworm prevention may be part of a DVM’s regimen, but lack of client education is contributing to an increased number of potentially zoonotic disease carriers in the U.S., parasitology experts say. “There’s not enough aware- ness of the significance of the problem,” says Michael Paul, DVM, executive director of the Companion Animal Parasite Council (CAPC), an independent group established five years ago to create guidelines for optimal control of internal and external parasites. “Heartworm, for example, is essentially 100 percent preventable, yet 250,000 cases of the disease are diagnosed a year.” Though heartworm doesn’t endanger humans, the parasite continues to be a major threat to canine and feline wellness. Studies show that lack of parasite prevention efficacy isn’t the issue–rather, it is awareness and compliance. “When only 50 percent of animals whose owners provide veterinary care are on prevention and 25 percent of the population as a whole is making a prevention attempt, the impact is drastically affected,” Dr. Paul says. “It’s along the same vein as people who continue to smoke or don’t wear their seat belt. They are in denial they will be affected.” Where Danger Lies Animals venturing …
Senior Care Advocates Fetch New AlliesAugust 5, 2009 Just 12 years ago, when the Food and Drug Administration approved the first non-steroidal anti inflammatory drug specifically for canine use, about 20 percent of general practitioners’ patients were geriatric. Now it’s 25 percent. The NSAID pain-manage-ment option was a great recognition of the needs of senior pets, but the research hasn’t stopped. Today, veterinarians are using new medications and surgical techniques to improve the quality and lifespan of aging pets. Research unveiling proce-dural and medicinal benefits for companion animals has been accomplished largely because canines serve as a medical model for human medicine. One procedure gaining acceptance in the profession is adipose- derived regenerative cell therapy, or fatty stem cell therapy. To date, more than 1,170 veterinarians are using it on canine, feline and equine patients, most of whom are at an advanced age. “Science has made it possible for pets to live to be geriatric,” says Robin Downing, DVM, of Windsor Veterinary Clinic and the Windsor Center for Animal Pain Management in Windsor, Colo. “It’s always been veterinary medicine’s desire to advance medical capabilities for animals, but we’ve accomplished more during my career than I ever imagined possible as a new graduate.” …
Give It A ShotJuly 10, 2009 The encroachment of housing developments on wildlife habitat has changed the rules of the vaccine game. Separate studies conducted by the Florida and Colorado veterinary medical associations revealed that more than 60 percent of dogs diagnosed with leptospirosis lived in urban or suburban environments. Previous findings showed dogs living in rural areas to be most susceptible. “Leptospirosis has changed its face over the last few years,” says Kari Swan, DVM, who works in professional services at Fort Dodge Animal Health of Overland Park, Kan. showed dogs living in rural areas to be most susceptible. “Leptospirosis has changed its face over the last few years,” says Kari Swan, DVM, of Fort Dodge Animal Health in Overland Park, Kan. “Wildlife doesn’t always relocate when people move in,” Dr. Swan says. “This means pets are susceptible to multiple transmittable diseases because the carriers are in their back yards. This is why veterinarians need to be vigilant and systematic about assessing all canine and feline patients’ risk for exposure to diseases that may be prevented with a vaccine deemed non-core.” All Dogs at Risk for Lepto The Florida and Colorado studies surveyed veterinarians in the states’ fastest-growing counties. …
Digital Imaging Helps Put Telemedicine On Fast TrackJuly 10, 2009 Count radiologist Brian Poteet among those excited to see veterinary telemedicine take steps to outgrow its infancy. He remembers the hurry-up-and-wait days of courier services and dial-up modems. “We’ve come light-years from where things were even two to three years ago,” notes Poteet, DVM, Dipl. ACVR, director of radiology and diagnostic imag-ing for Gulf Coast Veterinary Specialists in Houston. These days, the industry momentum favors digital imaging along with standardized systems and compatible equipment, allowing diagnostic information to be shared more easily and transmitted more quickly. These trends add options for veterinary practitioners, who increasingly want a second set of eyes on their radiographs, cytology, endoscopy, ultrasound and other case information. Clinics don’t have to lock in with one vendor for all their diagnostic equipment or with one telemedicine service for all their consulting. Advances make it easier for radiologists and other specialists to hang a shingle and as the number of consultants grows, affordability should increase, enticing more veterinarians to seek specialized assistance via telemedicine. “Over the long term, there’s no question we’ll also see a rise in the standard of care for veterinary medicine,” says Neil Shaw, DVM, Dipl. ACVIM, chief medical …
Flea, Tick Products Draw EPA ScrutinyJune 10, 2009 The U.S. Environmental Protection Agency is intensifying its evaluation of whether further restrictions on the use of spot-on pesticides for flea and tick control are necessary to better protect pets. The increased scrutiny applies to both over-the-counter and veterinary channel flea and tick products. An EPA spokesman said the move follows recent increases in reported incidents. More than 44,000 potential incidents associated with registered spot-on products were reported to the agency in 2008. Federal law requires EPA registrants to submit reports of possible adverse reactions that may be related to the use of their products whether or not the products were used properly and according to label instructions. A report does not indicate a cause-and-effect relationship between products and symptoms. EPA spokesman Dale Kemery said restrictions under consideration could include additional and more detailed label claims. “I just can’t say at this point,” Kemery said. “That’s what the evaluation will indicate.” Though flea and tick product incidents can involve spot-ons, sprays, collars and shampoos, most incidents reported to the EPA are related to EPA-registered spot-on products. Spot-ons are generally sold in tubes or vials and applied to one or more localized areas …
Economic Euthanasia On The RiseJune 10, 2009 Euthanasia can be the last act of love an owner shows her pet once disease or time has made death a greater comfort than life. This is the euthanasia veterinarians can accept and perform guilt-free. But now euthanasia has taken on a new and unsettling meaning for some veterinarians’ clients. Economic euthanasias are occurring at higher frequencies in practices where the community has been hit hard by the down economy. An increase in euthanasia performed when treatment is medically feasible leaves veterinarians to question how they can remain financially stable while helping clients and patients get what they need. The logic behind clients’ reasoning for pet euthanasia can be colorful, and veterinarians might question if they could have said something different to change the owner’s decision. But they are in a tough position when the treatment option is eliminated because of the cost. “We are seeing more euthanasias now than ever,” says Terry McInnis, office manager at After Hours Animal Emergency Clinic in Youngstown, Ohio. “The worst part is more clients are taking their pets home to die when they’re in need of treatment.” The After Hours clinic takes emergency visits for general practitioners …
