Brittany Lancellotti, DVM, DACVD, explains to viewers what it means to have remission from itch 

VIdeo interview with Brittany Lancellotti, DVM, DACVD

During the Fetch Long Beach conference in Long Beach, California, 

 sat down with Brittany Lancelloti, DVM, DACVD, to discuss what remission from the itch means for those canine clients suffering from canine allergic dermatitis, and what to warn clients about. 

The following is a transcript of this video:

 So, the concept of remission from itch is something that I like to use to explain to clients, that I'm never going to cure their dog from the dog's allergies but what I can do is work on getting the dog's allergies in remission. And sometimes, the allergies will come out of remission. But when we think about the animal's itch score on a scale of 1 to 10, if an animal has an itch score of 2or less, we consider consider that to be a normal level of itch. So if I can get that animals itch score at a 2 or less, then I will consider them to be in remission from their disease. But flares happen, and clients should be forewarned that that's something to expect with management of the disease. But if we address the primary triggers and we find a therapy that keeps them in remission, we can minimize how many flares that they have.

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In interview with dvm360, Brittany Lancellotti, DVM, DACVD , shares what the remission of itch is, and what it means for patients

Remission from the itch 

Diagnosing and managing feline atopic dermatitis (FAD) can be difficult for clients, and can even be a challenge for veterinary professionals can diagnose due to the complexities the causes can create. Also, despite some conceptions, cats are not small dogs so their treatment can require more of a tailored approach.

During her lecture at the 2024 Fetch Long Beach conference in Long Beach, California, Ashley Bourgeois, DVM, DACVD, shared with the audience how to approach these itchy feline patients in your practice, and what tools veterinary teams can utilize to get to the bottom of these dermatological conditions and improve patients quality of life.

“So why is feline dermatology unique? Well, it's not as common, right? We see lots of days where we just see allergic dogs coming in the doors. There's really not too many days they that are just cats. Though I could have days that are cat heavy but don't have days where it's just cats. I definitely have days where it's just dogs,” explained Bourgeois.

“Why is that? I think a lot of it is that maybe there's a genetic component, but a lot of it is recognition, right? When the pandemic happened, all the owners who had allergic dogs were all of a sudden working from home and spending all of their time with them, called us right? Because all of a sudden they could notice the chocolate lab was slurping their paws next to them, because they were much more obvious with their symptoms, where cats are more isolated. So a lot of times what happens is that they are over grooming or itching. They go away, right? So they do it in the closet, they do it under the bed, and owners don't usually see it,” she continued.

Bourgeois also explained that another reason that makes feline dermatology unique an challenging is because cats are natural groomers. So if they are suffering from FAD, their owners could chalk it up as to them just cleaning themselves and that is normal. Another cause could potentially be resistance to oral medications or veterinary visits from clients. However, Bourgeois explained that it might not always be due to a lack of trying. She shared with the audience a client who had tried multiple times to get his kitten in the carrier and was unsuccessful.

For feline patients that come into general practice, there are occurrences during wellness they will ask the clients if their cat is itchy and they will say no and then during the wellness exam, discover there is no fur on the patients stomach. Clients would then say that the pet has obsessive-compulsive disorder. However, she also shared that she wanted all attendees to know that when it comes to psychogenic alopecia, this is an extremely rare diagnosis.

“One thing I really want you guys to recognize, psychogenic alopecia is exceedingly rare. So I'll see that done as behavioral thing, like they're more behavioral, and will be thrown on behavioral medications. One of my really good friends is actually on his way here now and speaking tomorrow and Sunday, [Christopher Pachel, DVM, DACVB, CABC] is a phenomenal behavioral behaviorist in Portland, and we do a lot of lecturing together. W hen we lecture together, he basically says, You got an over grooming cat kick it to derm before they see us, because it's not that common that we actually see psychogenic alopecia,” she explained.

When there is an itchy cat in the clinic, the quality of life for both that pet and the client suffers because that pet is in pain and the owner wants to help. Bourgeois explained that although the choices to treat these pets does feel limited, putting everything in your corner to use is crucial for managing these cats. She explained that flea control is a must, despite if the cat is ‘indoor only’ or not. The flea control can help combat symptoms that are caused by fleas or if there is a flea allergy and something else, it can also help with symptoms to lead veterinary teams on the path to helping the pet.

Diet trials are also a useful tool for teams, despite their difficult when it comes to feline patients.

“If we're doing diet and talking about food, it's really important to know how to perform diet trial. And this can sound so simple, but it is often not that simple for our clients to really understand what a diet trial means. So obviously, we want to ditch the itch, as we talked about, don't start a diet with a cat who looks like the one I just showed you, and say, bye, bye. See you in 8 weeks, you're going to lose trust in you as a veterinarian. You know they're going to look for other sources, because the food is not going to act that quickly. We do have a slowly transition for a couple of reasons, not only for [gastrointestinal] tolerance, right? We don't want to sleep closely.

“But what are cats really good about avoiding things if it's different, right? So if almost you switch to the food, there's like, and then they go on hunger strike. We don't have that grace with cats, right? Dogs can kind of be like you do hunger strike for a while, like I never planned on doing a diet trial and causing hepatic lipidosis. It's not on my list of things to do for that day, so I really want to make sure you transition slowly,” she explained to attendees.

When working with clients with an itchy cat, talking to them can help teams also better understand how to help improve the quality of life for both pet and owner. Bourgeois shared as she concluded her lecture about a patient she had where the patient would get car sick and it made it hard for the client to bring the pet in. Bourgeois suggest they try something for the car sickness and gave the cat Cerenia and sent them on their way. She shared the client called her in tears when they returned home saying no one would listen to her about her pet but Bourgeois.

Clients want to help their pets, and by providing options on treatment, advise on diet trials, and explaining what to look out for, they can help some cats less itchy and scratchy.

Bourgeois A. The Itchy and Scratchy Cat: How to Provide Relief When Options Seem Limited. Presented at: Fetch dvm360 Conference; Long Beach, CA. December 6-8, 2024.

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Feline dermatitis is a condition that effects cats with multiple causes, and here is how you can help 

Managing feline atopic dermatitis

How to create a diet plan for combating overweight body conditions in canines was the highlight of an educational session at the 2024 Fetch dvm360 Conference in Long Beach, California. Presenting speaker Leilani Alvarez, DVM, DACVSMR, CVA, CCRT, director of integrative and rehabilitative medicine at Schwarzman Animal Medical Center in New York, New York, began her lecture by addressing the prevalence of obesity in dogs and the need for weight management.1

In the US, a 2022 survey showed that 59% of dogs were obese. Collected by the Association of Pet Obesity Prevention, this data also indicated that obesity was rising, with an increase of 3% in prevalence since the previous survey in 2018 that showed 56% of dogs were obese.

“Obesity is the No 1 problem we all see is veterinarians, and there are a lot of strategies that I have learned over the years,” Alvarez said.

She first discussed the comorbidities associated with obesity in dogs with includes widely known conditions such as diabetes, osteoarthritis and hypertension. “Every single body system is affected by being obese. Some that you might find surprising, and I think owners find surprising,” she told the Fetch audience.

Alvarez recalled 2 pet owners that she had conversations with about their pets’ body conditions. “Have you noticed that your overweight patients often have more allergies? Have you noticed that your overweight patients often have respiratory conditions as well? Those are likely linked to their obesity,” she said.

“The other one that I think owners don't realize is cancer. Being obese puts the dog in a state of systemic inflammation, and what is the precursor to most cancers? Chronic inflammation. So certainly being overweight and obese does predispose to cancer, as well as other metabolic and endocrine disorders,” Alvarez explained.

“Another one that seems to surprise people is kidney dysfunction. People don't think about being overweight as causing kidney disease, because most of our kidney patients are really skinny, but what did they look like years priors. And really that's common in all of these [conditions] is that the way the mechanism by which obesity causes all of these comorbidities is because it causes chronic inflammation,” she added.

A key component of any diet plan is obtaining ‘buy-in’ from the pet owner, and that starts with an appointment to discuss weight loss strategies. Alvarez noted that even small weight loss achievements can help improve a pet’s quality of life and body condition, such as reducing pain and lameness.

I recommend starting with simple and small goals, targeting 1% to 2% weight loss per week with frequent follow-up visits—initially once weekly for the first 4 weeks, and then every 2-4 weeks,” Alvarez said. “Owners always ask me, ‘so how much weight should my dog be?’ And I'll say, ‘what I don't want you to think about is where am I going to be at the end? Let's think about next week.’ So, plan just 1 week at a time, that is much more tangible for owners, and it's much more simple instructions as well.”

She noted that veterinarians will often recommend a reduction in caloric intakes as a solution to losing weight. “When dogs are more the 15% overweight, simply reducing caloric intake is likely to fail in successful weight loss,” she said.

Instead, Alvarez said she recommends transitioning a pet to a prescription diet that can provide higher amounts of protein for retaining muscle mass while adipose tissue decreases. “Feeding a therapeutic weight loss diet has also been linked with higher likelihood to both reach the target weight and keep the weight off long-term,” she said.

Exercise should also be incorporated into a weight loss plan, and Alvarez offered other tips. These tips included using puzzle feeders that increase the time a pet takes to complete a meal, calculating daily caloric requirements, and having pet owners use gram scales to measure food.

Alvarez also noted that having input from pet owners when implementing a diet plan often leads to improved adherence. Working together, a veterinarian can learn what aspects of a plan may be nonnegotiable and resolve those issues with alternative solutions.

“I learned the hard way that if you tell a [client] to stop feeding treats, they will continue to feed treats. They just won't tell [their veterinarian],” she said. Instead, she said that she encourages owner to feed treats to their pets with a discussion on the types of foods and when they are administered. For example, she said, it’s best to avoid fruits because of their sugar contents.

The 2022 survey results found that pet owners often have a different perception of a dog’s body condition than a veterinary professional. The survey showed 36% of respondents with dogs that were overweight or obese, classified their pets as having a “normal” or “thin” body condition when a veterinary professional asked.

Body condition charts can help illustrate an appropriate weight range for a pet. Alvarez suggested staying positive and refrain from making a client feel guilty by avoiding negative words such as “obese,” “fat,” “suffering,” and “painful.” Instead, she recommended focusing on wellness intentions such as wanting a pet to feel good and be happier and to have life longevity.

“Dogs that are obese have a reduced life expectancy and diminished quality of life. This is very well established, so even though the majority of owners who have overweight dogs [care for them] the way they do because they're trying to spoil them, they love them. [I] don't think they would do that if they realized they were going to spend less time and their dog has a lesser quality of life because of how they're feeding them,” Alvarez said.

For obtaining ‘buy-in’ from clients, it can also be mentioned that with improved pet health, they can save money on veterinary expenses. Furthermore, client incentives can help achieve buy-in for a diet plan, Alvarez said. These rewards can take many different forms. Some ideas she presented included printing an award certificate, providing a bandana with the clinic’s logo for the pet, or a free bag of dog food for meeting a milestone.

Alvarez L. Diet and exercise plans for overweight dogs. Presented at: Fetch dvm360 Conference; Long Beach, CA. December 6-8, 2024.

2022 Pet Obesity US Prevalence Survey. Association for Pet Obesity Prevention. 2023. Accessed December 7, 2024. 

https://www.petobesityprevention.org/2022

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT, discussed strategies for addressing obesity in dogs, while presenting an education session at Fetch Long Beach.

Managing canine weight with a diet plan

Veterinary opthamologist Jennifer Sheahan, DVM, DACVO, shares the common ocular diseases that general practitioners can come across in their clinics

Video interview with Jennifer Sheahan, DVM, DACVO

Before going to a veterinary ophthalmologist, patients suffering from ocular diseases will first find their way into their general practitioners office. During an interview with dvm360 at the Fetch Long Beach conference in Long Beach California, Jennifer Sheahan, DVM, DACVO, shared how dry eye can present itself in the clinic, and the outcome of it for patients suffering. 

So we often see dry eye in the veterinary ophthalmology field, and the most common cause for dry eye is autoimmune. People get dry eye as well. So the most common treatment for dry eye is immunosuppressants topically, just like in people, people have Restasis because with chronic dry you can go blind, it's itchy, it's uncomfortable, you can get ulcers and infections in the eye. You get eyelid masses. You know, little lumps and bumps as we get older, people get them. 

The same thing with animals. So you get eyelid masses. The good [and] Interesting thing about eyelid masses is that 87% of them are benign. So you know, the key to eyelid mass issues on the eyelid is that you want to take care of them early on, because once they exceed 25% of the eyelid margin. Then you have to borrow tissue from your forehead or cheek to recreate your eyelid they have come too big to do primary closure.

Jennifer Sheahan, DVM, DACVO, shares the common ocular conditions that general practitioners can be on the lookout for in their clinic

Common ocular diseases in general practice

What are the features of a good friendship? In a keynote session at the Fetch Long Beach conference December 6-8, 2024, Mary Gardner, DVM, cofounder and chief information officer of Lap of Love Veterinary Hospice & In-Home Euthanasia; and Eric Garcia, internationally recognized information technology (IT) and digital strategist working with veterinary practices, and founder of Simply Done Tech Solutions, shared anecdotes of their unwavering friendship rooted in accountability and mutual support, explaining that good friends can not only lift each other up, but help each other grow and navigate life.

“The world as you view it, no matter how it is, it can be a dark place at times and we can go through our own personal challenges,” began Garcia in the session titled “Evolving Together Through Friendship, Accountability, and the Ever-Present Learning Curve.” “With Mary and I, no matter what's happening, we're always super happy about just how we view life, and we contribute a lot of that to having close friends and to being each other's best friends.”

Gardner and Garcia shared 7 features of their friendship, which Gardner and Garcia call their “friendship creed,” that help them bond and make the friendship a great one. These values consist of “brutal” honesty; “crushing” work, or putting in effort; laughing harder; fueling the fun; accountability; continuous learning; and having an inner circle.

“These are things that we really focus on every day when we're talking to each other or when things happen within our lives or goals and mindset,” said Gardner.

Garcia and Gardner explained that an important part of a good friendship consists of being able to be one’s authentic self. “You have to be okay with being silly in your friendship. You have to be okay with being who you are, to think about who you really are. Think about who you were in your younger years, in your early being. Think about that weird person that you used to be, that you suppress because societal norms asked you to be a certain way,” emphasized Garcia.

Good friends challenge each other to succeed and work hard, or “crush work,” as Gardner and Garcia explain. “We challenge each other every year in going into every single event that we do, whether speaking at a conference here or somewhere else. We're always like, ‘Bring your best a game. Do the best you can. Make sure your slides look good. Make sure you know what you're talking about.’ We always challenge each other, and ultimately, it led us to win an award [a few years ago] together in different categories,” Garcia shared. However, he also emphasized that this feature of a good friendship also consists of celebrating friends when achievements happen.

Being “brutally honest” and holding each other accountable

“It's really important, I feel, in friendship[s] to be able to be brutally honest with the person that you're good friends with,” explained Garcia. He emphasized the importance of having open conversations with friends, sharing that when Gardner is “brutally honest” with him, he does not “look at that brutal honesty and say that it hurts [his] feelings.”

Accountability, like open honesty, should also live freely in friendships. In the talk, Gardner and Garcia explained that they are constantly holding each other accountable and keeping each other in check. Earlier this year, Gardner took on the challenge of climbing Mount Kilimanjaro despite having never climbed a mountain and having no experience hiking. As Gardner and Garcia shared, Garcia helped hold Gardner accountable by reminding her to prepare for the climb.

Good friends push each other to continue learning new things, explained Garcia and Gardner. They shared that their friendship pushed both of them to search for a hobby and try new things—something they did not have prior to their friendship. 

“We often complain about what's wrong with the world… instead of complaining, we should channel that energy differently, and we should think about what we're doing to put good into the world,” said Garcia, quoting a lecture he attended on the art of happiness. He explained that both him and Gardner challenged each other to text the other for 31 days straight about something they did to “put good into the world,” pushing each other to learn more about the world.

Gardner and Garcia explained that it is important to surround oneself with people who “fuel your fire.” Friendships evolve and grow stronger when they are built on trust and support. Gardner and Garcia explained that it is all right to cut people who are not supporting you off, or those that are hindering personal growth.

During the session, Garcia shared an experience during the COVID-19 pandemic with a cyberbully who began attacking him and a business that he ran with Gardner. According to Garcia, Gardner supported him throughout the entire process. When Garcia addressed the issue publicly, both the community and Gardner stood by him.

“Unapologetically fight for your friends,” said Garcia.

Gardner M, Garcia E. “Evolving Together Through Friendship, Accountability, and the Ever-Present Learning Curve.” Presented at: Fetch dvm360 Conference; Long Beach, CA. December 6-8, 2024.

Mary Gardner, DVM, and Eric Garcia shared several facets of a successful friendship in their talk at the Fetch Long Beach conference in Long Beach, California

Building strong friendships

Allergic dermatitis in canines can cause quality of life issues for patients and lead to caregiver burden for pet owners. Complex cases can also be frustrating for clients and veterinary teams.

Understanding condition management frustrations and the unique experiences of patients, pet owners and veterinary teams can help guide treatment plans. In an educational session at the 

2024 Fetch dvm360 Conference in Long Beach

, California, talk, Brittany Lancellotti, DVM, DACVD, a Fear Free-certified practitioner at Veterinary Skin and Ear in Los Angeles, California, provided insights about these experiences from different perspectives.

Quality of life (QOL) can decrease for an animal with allergic dermatitis, while also elevating the pet’s fear, anxiety and aggression. Dogs with the condition have also shown a significant decrease in trainability, according to Lancellotti.

In addition to emotional behaviors, clients may observe in pets with allergic dermatitis scratching, licking, chewing, rubbing, biting, head shaking, scooting or nibbling—all of which can worsen clinical signs of the disease. Allergic dermatitis can also cause disruptions in a pet’s play behaviors, in the job performance of working animals, and in sleep, Lancellotti added.

Those effects create an important welfare issue for these animals. However, Lancellotti said that early recognition of behavioral problems that may be associated with chronic allergic dermatitis of the skin and ear can lead to improved treatment outcomes and QOL for the animal and their owner and may help minimize pet relinquishment.

“The great news is that we have a lot of different options for individual relief from allergic dermatitis,” Lancellotti said. She followed with an overview of drug therapies that included glucocorticoids, modified cyclosporine, Janus kinase inhibitors, and lokivetmab.

Veterinary teams can work with clients to ascertain the best path forward with treatment plans. For example, Lancellotti said, a client that finds it difficult to clean a pet’s ear or administer medication may need to work with the veterinary team to overcome the challenge or pursue a new treatment tactic.

“Eliciting from owners any difficulties with the treatment and where the pet might be struggling can provide an opportunity to creatively troubleshoot and overcome the discrepancy between improvement of clinical signs and improvement in quality of life,” Lancellotti said.

In the lecture, Lancellotti noted that client education about allergic dermatitis should include an explanation of 

treatments are being recommended. Veterinary teams should also allow pet owners to share their concerns about the treatment plan and offer solutions to potential problems including how an animal is responding to therapies.

“There is no one size fits all treatment for these animals. Each pet is their own special snowflake, and so we'll adjust our management plan based on how that pet is responding. That means that good communication with the veterinarian is really crucial to finding a plan that works best,” she said.

Client expectations can be managed by communicating what the condition means long-term and how a pet’s QOL may be affected. Caregiver responsibilities such as expenses associated with treatment, including costs for doctor visits, condition management products and associated therapies, as well as the time commitment needed to continue addressing the condition, should be adequately conveyed.

A survey of 283 veterinary dermatology practice clients was conducted by the American College of Veterinary Dermatology in 2019. Respondents of the study—cited in Lancellotti’s lecture—reported their dogs had dermatology conditions that included pruritus, ear problems, coat changes, and skin lesions.

Results of the survey revealed that 73% of clients had visited their primary care veterinarian more than 3 times to have their pet’s dermatologic condition evaluated before being referred to a dermatology specialist. Forty-two percent of these clients reported visiting their primary care veterinarian an average of 5 times before receiving a referral.

“Now, going [to a veterinarian] 5 times and not having an answer is incredibly frustrating. Never mind the 5 times these pets are getting packed up, poked and prodded. That's also 5 times the owner has the opportunity cost of spending their time going back and forth to the vet visit. These repeat visits are just one thing that is going to contribute to caregiver burden, and that's the strain that an owner feels from the challenges of providing care to a companion animal,” Lancellotti said.

A treatment plan for managing canine allergic dermatitis should be individual to the patient since no 2 pets will respond exactly the same way to the same plan. 

"Symptomatic treatment should be aimed at targeting pruritus and/or inflammation, depending on the individual pet,” Lancellotti said. “With proper medication selection, once you understand the individual [patient] and the tools you have available, we can help relieve what that patient is going through, but also relieve what some of the owners are going through."

Lancellotti B. Quit your itchin: managing pruritis and client frustration from canine allergic dermatitis. Presented at: Fetch dvm360 Conference; Long Beach, CA. December 6-8, 2024.

Hanna B. Earlier dermatology referral rewards primary care practice (part 1): easing client expenses and enhancing patient care. 

. May 18, 2022. Accessed December 6, 2024. 

https://www.dvm360.com/view/earlier-dermatology-referral-rewards-primary-care-practice-part-1-easing-client-expenses-and-enhancing-patient-care

In an education session at Fetch Long Beach, presenter Brittany Lancellotti, DVM, DACVD, discussed how patient, client and veterinary care providers all contribute to improving outcomes for pet with skin condition