January 5, 2011
Back when automobiles began to replace the horse and buggy, veterinarians wondered how they would stay employed. If they could have peered into the future, to 2011, their worries would have subsided when they saw stem cells re-growing cartilage in osteoarthritic joints, tissue growing around prostheses and an array of other eye-opening breakthroughs.
“Advances in veterinary medicine amaze me,” says Mike Cavanaugh, DVM, Dipl. ABVP, the executive director of the American Animal Hospital Association.
Dr. Cavanaugh predicts a continuing growth in tele-medicine, saying primary care practitioners have access to specialists more readily now than ever before.
“An example where telemedicine is very useful is in the area of digital imaging,” Cavanaugh says. “A board-certified vet can look at images almost instantly. It used to be that veterinary colleges were the only places veterinarians could send images to or refer clients to. Now we’re all working together as a health care team.”
Experts consulted by Veterinary Practice News weighed in on other areas in which they see significant advancements coming.
Nutrition is being looked at more frequently not only to combat disease processes that have begun but to prevent them from happening altogether.
“Nutrogenomics is the convergence of nutrition and genetics,” says Jean Dodds, DVM, founder of Hemopet, an animal blood bank in Garden Grove, Calif. “Nutrogenomics [targets] the exact areas of physiology a patient might be at risk for before the patient ever experiences a symptom or gets the disease.
“This is preventive medicine in action. Being able to determine what an animal should optimally eat means development of a molecular dietary signature. I think the profession is finally relaying to clients that food is the basis for good health. This is the ultimate health plan.”
Veterinary nutritionists often question the level of nutrition training students receive in veterinary school, but the more attention that manufacturers show and increased owner interest have brought an evolution in the types of food produced and those recommended by practicing veterinarians.
“Nutrition means better health, better health means better immunity and that means less disease risk,” Dr. Dodds says.
She is a fan of NutriScan, a patented saliva-based diagnostic test for canine food sensitivity and intolerance. The new panel tests dogs for intolerance to corn, wheat, soy, beef, dairy and eggs.
Before NutriScan, serum testing was the only method available and is less effective, Dodds says.
The establishment of pain management guidelines for dogs and cats represented a leap forward in the acknowledgement that animals’ needs weren’t always being met for chronic issues, before, during and after surgery, and in emergency situations.
Today, certification courses teach veterinarians how and when to apply pain medication. The CVPP designation is given to certified veterinary pain practitioners.
“In the arena of pain management, the single most important global advance is the inauguration of the CVPP by the International Veterinary Academy of Pain Management,” says Robin Downing, DVM, Dipl. AAPM. “The first group of CVPPs completed their credentialing process within the past year.
“The credential is available and open to veterinarians,
certified veterinary technicians, CCRTs and CCRPs, as well as those human practitioners who train and qualify to treat animals.”
Dr. Downing, who practices at Windsor Veterinary Clinic in Windsor, Colo., says the certification is cutting edge.
“Pain care can be practiced in all areas of medicine across disciplines,” Downing says. “I am a bit disappointed by the apparent overall lack of awareness of innovation and changing standards of care among primary care practitioners. It is rare to see more than two or three raised hands at conferences when I ask who uses pain management guidelines. It is hard to understand why advancing pain care has not been a higher priority.”
Zachary Wright, DVM, Dipl. ACVIM (oncology), of VCA Veterinary Care Animal Hospital and Referral Center in Albuquerque, N.M., predicts that chemotherapy for people and animals will be obsolete in less than 20 years.
“Soon we’ll be using very specific targeted cancer drugs called tyrosine kinase inhibitors, which is the same class as Palladia,” Dr. Wright says. “Our goal is to use less toxic and less invasive treatments. There are vaccines available now for lymphoma, but we’re still discovering if it’s safe and effective. I believe we’ll be seeing a lot more vaccine therapy in the next five years.”
While Wright has high hopes for new DNA-based cancer treatments, Dodds thinks an advanced opportunity for vaccines is often overlooked.
“Titers are available and if used could decrease adverse reactions to vaccines,” Dodds says. “Normal references don’t apply to all animals; it alters depending on the animal’s age, breed and level of activity. Not only do veterinarians need to be more proactive about using titers over routine vaccines, but when titers are performed, the ranges must be considered accordingly.”
Veterinary medicine is at the point where practitioners use many of the same high-tech devices popular in human medicine—and sometimes beyond that.
“One of the most exciting advances in companion animal internal medicine is interventional medicine,” says Christopher G. Byers, DVM, Dipl. ACVECC, Dipl. ACVIM (SAIM). “Specialists use contemporary imaging methods to gain access to different structures of an animal’s body for diagnostic and therapeutic reasons.”
This can allow veterinarians to provide non-surgical alternatives so patients experience shorter anesthesia times, says Dr. Byers, director of intensive care at VCA Veterinary Referral Associates in Gaithersburg, Md. It also means a reduced cost to owners, shorter hospital stays and decreased mortality rates, he says.
Another less invasive technology—lasers for therapeutic and surgical purposes—continues to grow.
“The use of lasers in veterinary medicine has advanced tremendously in the past 15 years,” says Kenneth Bartels, DVM, MS, a professor of laser surgery at Oklahoma State University’s Center for Veterinary Health Sciences. “Class 4 surgical lasers used to photothermally vaporize tissue have been incorporated into large- and small-animal surgery.
“In small-animal surgery, the carbon dioxide laser has been implemented more commonly,” Dr. Bartels says. “It is highly absorbed in water and therefore is very precise in its ability to make incisions with minimal amounts of hemorrhage and potentially a decrease in pain and inflammation.
“In large-animal surgery, primarily equine upper respiratory work, fiber-delivered surgical lasers have been used extensively for minimally invasive endoscopic procedures. In the past few years, the use of Class 3B and Class 4 therapy lasers has increased.”
Research is advancing on the use of lasers at different wavelengths and fluencies, Bartels says.
“Veterinary medicine is moving forward at a rapid pace in both its economic and therapeutic impact,” he says. “There needs to be increased funding from the laser companies as well as from competitive funding agencies to continue to investigate the technology. Continued development of light-activated cancer therapy drugs as well as continued development of smaller, less expensive, more robust devices needs to be a priority.”
Some veterinarians argue that medical advances benefit only a small percentage of pets and that the cost is prohibitive for the majority of owners. However, practitioners using advanced technologies in practice say the client cost for new therapies is usually comparable to maintenance drugs.
“For example, functional food, treating disease with nutrition, is absolutely affordable to every client,” Downing says. “The mistake most practitioners make is forgetting to drill down to the actual cost per meal to feed therapeutic nutrition. Once clients understand that they will not be buying supplements and may be able to reduce or eliminate the cost of drugs, they appreciate that we are helping them to spend their money wisely.”
Some practitioners hope that pet health insurance becomes more popular, relieving owners of a financial burden when a more costly procedure is necessary.
“Pet parents expect the same level of care that they themselves receive,” Byers says. “But with the highest quality of medical care comes an appropriate price tag. While veterinarians shouldn’t price themselves out of business, we must respect our collective skills and expect appropriate compensation.”
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