Ultrasound and telemedicineMay 27, 2019Don't just send him an ultrasound image and think he'll do business with you. "I will not read ultrasound images unless I've taught the person through doing the ultrasound," said Anthony J. Fischetti, DVM, MS, DACVR, department head of diagnostic imaging at the Animal Medical Center in New York, and president of Veterinary Ultrasound Society of the American College of Veterinary Radiologists (ACVR). "If I'm just reading still images from someone I haven't trained, I won't read them. I won't take their money, I won't try to make a diagnosis, and I kind of wish my colleagues would do the same," Dr. Fischetti said. Why? There's just too much to get wrong, he said. "You can make so many things look abnormal with ultrasound if you don't know the orientation of the probe or how the image was made," Fischetti said. In human medicine, often a relationship is already developed between those performing the ultrasound and the radiologist, so there's a level of trust and comfort. "We're just not there with veterinary medicine yet, and I'm personally against most telemedicine ultrasound," Fischetti said. Building relationships to improve trust and communication is also of utmost importance for Nathan C. Nelson, …
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Cornell Veterinary Biobank receives international accreditationMay 27, 2019Cornell University's College of Veterinary Medicine's Veterinary Biobank is the first biobank in the world to achieve the American Association for Laboratory Accreditation's (A2LA's) international certification. A2LA is an international accreditation body that assesses a range of laboratory types using standards developed by the International Organization for Standardization (ISO). Cornell's biobank received accreditation against ISO 20387, which requires facilities demonstrate the competence of their biobank's operation and ability to provide biological material and associated data for research and development. "Quality accreditation increases the confidence in our operation. It shows we are transparent about our processes, open to critique, and are doing high-quality work under a rigorous standard," says Marta Castelhano, DVM, MVSc, director of the Cornell Veterinary Biobank. To receive accreditation, each step in the process requires close inspection from A2LA. As a result, Dr. Castelhano, along with the rest of her team, developed, tested, and implemented almost 80 new standard operating procedures for the biobank in the last year. "The achievement of earning A2LA's first accreditation to the new ISO 20387 standard ensures Cornell's operations will function with the highest level of quality," says A2LA's general manager, Adam Gouker. "We're proud to be a part of this historic …
Gathering vital patient information with ultrasoundMay 27, 2019Anthony J. Fischetti, DVM, MS, DACVR, department head of diagnostic imaging at the Animal Medical Center in New York, had just finished his shift. It had been an odd day; two dogs that had turned yellow had been brought into the clinic. The first patient, an older dog, had a tumor at the entrance of the gall bladder into the intestines—a common bile duct obstruction. The second patient had collapsed, experiencing diarrhea and vomiting. "I used the ultrasound to diagnose that it wasn't the liver," said Dr. Fischetti. "It turned out the dog was hemolyzing." An old, corroded coin in the dog's stomach was causing zinc toxicity. Thanks to the ultrasound images, the endoscopist retrieved the coin and the dog improved. Fischetti, who also is president of Veterinary Ultrasound Society of the American College of Veterinary Radiologists (ACVR), as well as other experts, say ultrasound is a safe and simple way to get more information on ailing patients. "I think the real value of ultrasound is its noninvasive nature," said Nathan C. Nelson, DVM, MS, DACVR, a clinical associate professor of radiology at the North Carolina State University College of Veterinary Medicine. Why use ultrasound? Key considerations for adding …
Dogs can alert human risk to Lyme diseaseMay 27, 2019Health-care providers can now use dogs as a way to measure human risk for Lyme disease, according to a study by Companion Animal Parasite Council (CAPC). "This research shows how man's best friend continues to safeguard humans as a sentinel to alert humans where they are at greatest risk for Lyme disease," says CAPC executive director, Christopher Carpenter, DVM. "The model established in this research breaks new ground to give residents, travelers, and health-care providers a county-level map to help them identify areas of risk across the country." Through the study, researchers quantified the relationship between canine seroprevalence for the disease-causing bacterium, Borrelia burgdorferi, and Lyme disease in humans. Seroprevalence is used to calculate the number of dogs testing positive among all tested dogs within a county. The study showed a correlation between human incidence and dog seroprevalence. According to researchers, they were able to study more than seven years of nationwide canine diagnostic data as a result of dogs being tested annually for exposure to Borrelia burgdorferi. The collected data represented more than 400 million data points, which is usually difficult to obtain when looking directly at ticks and the environment. "By combining sophisticated statistical modeling with this …
Is it time we change our tune on telemedicine?May 24, 2019At some point, our profession got it into its collective head to start hating on telemedicine. Perhaps it was the image of non-veterinarians armed with third-tier vet tech degrees hunched over laptops banging out answers to questions they have no business fielding. And in their pajamas, no less! It's a mental picture my state's association—the Florida Veterinary Medical Association (FVMA)—is advancing this legislative season, as it seeks to limit telemedicine's reach into Sunshine State living rooms. And Florida is by no means alone in its quest to curb the telemedicine industry's growth. Most other state associations also are seeking a legislative solution to the perceived threat posed by online veterinary services. Telemedicine was front and center at American Veterinary Medical Association's (AVMA's) House of Delegates (HOD) meeting in January, the findings of which they'll likely present at this summer's conference in Washington, D.C. These are the best minds our profession has at its disposal, grappling with issues as fundamental as the nature of the veterinarian-client-patient-relationship (VCPR). It all comes down to the hands In its wariness of telemedicine, professional organizations like AVMA and state veterinary medical associations (VMAs) argue the definition of VCPR is at the heart of the …
Four bold questions about hand asepsisMay 24, 2019Hand asepsis is one of the most critical components of surgical asepsis to lower the risk of nosocomial diseases. In this column, we answer four critical and bold questions related to hand asepsis. Could you lose your driver's license by scrubbing in? With the emergence of alcohol-based hand-rub solutions (ABHRS), you may be concerned that with repeated use, you could have enough alcohol in your bloodstream to lose your driver's license. Alcohol is indeed absorbed through the skin, and you inhale plenty of it while scrubbing (or "rubbing"). So could a breathalyzer test be positive? A 2006 Australian study1 looked at 20 health-care workers and their use of ABHRS repeatedly over a short period of time: 30 applications in an hour! Then serum and breath ethanol and isopropanol absorption were assessed. Traces of ethanol were detectable in the breath of 30 percent of subjects at one to two minutes after application and in the serum of 10 percent of them at five to seven minutes postexposure. Serum isopropanol levels were undetectable at all time points. Even though ethanol did have a positive result, whether through cutaneous absorption or inhalation of fumes, neither level would be considered positive during a police-issued …
Why give it away? Keep revenue in your clinicMay 24, 2019 The last 20 years have been the perfect storm for general practitioners in veterinary medicine. The combination of the loss of spay and neuter services, the migration of vaccinations to low-cost clinics, and the exit of in-clinic pharmacy and retail to online sellers has affected the businesses of general practitioners in a truly significant way. I have felt the strong impact of these changes in my own practice. Historically, my clinic's revenue from routine services constituted 80 to 90 percent of my income. Today, these services account for less than 20 percent of revenue. With these changes and these hard figures, how do we not only stay afloat during this tumultuous time, but also thrive as business owners and medical professionals? The key lies in understanding where our industry has been, the current state of the union, and where the strengths of our individual practices lie to differentiate and flourish. The internet takes a bite One of the hottest topics in veterinary medicine has been the rise of online pharmacy. 1 (800) PETMEDS was king, and the new prince is Chewy.com. Now Amazon is eyeing the throne and your clients' dollars. The online pharmacy race has left the general …
TGen, Ethos develop diagnosis test for canine lymphomaMay 24, 2019A new test may assist veterinarians in more accurately diagnosing canine lymphoma. Developed by Ethos Veterinary Health, Ethos Discovery, and the Translational Genomics Research Institute (TGen), the test is based on the results of a study that analyzed 180 dogs with cancer. The teams used their test, ePARR, to confirm first whether the dogs in the study had lymphoma and then determined what type they had. Results indicate the test was more than 90 percent accurate among a range of lymphoma sample types. "An ongoing need exists for robust validation of molecular diagnostics in veterinary medicine. This study is an example of exhaustive validation of one such molecular test," says Will Hendricks, PhD, assistant professor in TGen's Integrated Cancer Genomics Division and one of the study's senior coauthors. "Overall, ePARR is more than 90 percent accurate across sample types and diagnostic settings." The researchers say not only could molecular-level investigations into dog DNA improve the health of dogs with cancer, but it could help understand cancer in humans, too.
Purina offers supplements for dogs experiencing anxious behaviorsMay 24, 2019Purina Pro Plan Veterinary Supplements has introduced a new management option for canines that experience anxious behaviors. Calming Care is a probiotic supplement that helps dogs cope with external stressors like separation, unfamiliar visitors or sounds, and changes in routine and location. The supplement also aids in maintaining positive cardiac activity during stressful events, promoting a positive emotional state. According to Jason Gagné, DVM, DACVN, director of veterinary technical communication for Pro Plan Veterinary Diets, a veterinarian should be sought out if a dog is displaying undesirable behaviors. "What might be perceived as just a characteristic of a particular breed or part of a dog's personality could really be an anxious behavior that needs attention." Pro Plan Veterinary Supplements surveyed 826 owners about anxious behaviors in dogs and found: • 62 percent have witnessed excessive barking, compulsive jumping and shaking, or trembling. • 35 percent believe their dog's personality is among the primary causes of one or more of its concerning behaviors. • 25 percent said these behaviors have impacted their lifestyle or caused a change in their routine. Further, with summer fast approaching, Purina notes that canine anxiety often intensifies during this period. "The summer …
Joint inflammation: Corticosteroids and other management strategiesMay 23, 2019Working horses are commonly diagnosed with, and are treated for, acute or chronic joint inflammation. For many decades, intra-articular (IA) injections of corticosteroids have been used to treat these conditions. However, considering how popular these injections are and the fact other treatment options exist, there is little consensus on questions regarding the "best" corticosteroid, how often such injections can be used, and how ultimately deleterious they are to joint cartilage. Treatment rationale Corticosteroid injections are one of the most commonly prescribed treatments for joint pain and inflammation resulting from osteoarthritis. Arthritis, of course, is inflammation of a joint. Uncontrolled, osteoarthritis is thought to lead to chronic changes in the cartilage and underlying subchondral bone. The cycle of inflammation, cartilage and bone damage, pain, and further cartilage and/or bone damage from ongoing inflammation can result in horses that are unable to perform for their intended use, or worse, are chronically lame and in pain. Corticosteroids are injected into joints in an effort to decrease inflammation. While the drugs are not directly pain-relieving, reducing joint inflammation can help interrupt the joint-inflammation cycle, thereby reducing pain. By decreasing pain and inflammation, horses are able to move more normally. Commonly used corticosteroids Three …
