Otitis can be a challenging condition to manage in canine patients, so recognizing common compliance challenges can help ensure each patient is getting the proper care. Making it a team effort between veterinary teams and clients can make it easier to understand the challenges each client faces when it comes to treating pets.

Missing links In the medical management of chronic otitis—

at the Veterinary Meeting & Expo conference in Orlando, Florida, Elizabeth R. Drake, DVM, DACVD, shared some of the obstacles she has encountered with clients when treating otitis patients, how she gets around them, and the crucial aspect of understanding client expectations and lifestyles.

Drake told attendees it is better to say "treatment obstacles" instead of "compliance obstacles" because owners want to do the right thing, but they may struggle to do so without a maintenance plan. For patients with otitis, it can be challenging for clients to apply topical medications because of how painful the ears can be, making them wish for a “magic pill” of some kind. Although this magic solution is not available, understanding the challenges clients could face with treatment can help teams design a therapeutic plan for each client.

Drake, for example, stated if the pain is preventing clients from treating the otitis with topical solutions, an oral steroid could be considered for a few days to decrease the pain and swelling for the patient to be more comfortable. Veterinary teams can also choose products that can be administered in measured-dose syringes rather than a predetermined number of drops. Because owners have to count the number of drops to make sure the patient is getting the correct amount, this can take longer, making it harder for the patient to get the full dose if they are in pain.

Besides pain, the sizing of the ear canal can also present an issue for administering the medications needed. Drake shared findings from some of her research conducted with students at Iowa State University, and 

“What we were able to show, using CT scan and measurements by the radiologist, is that body weight is directly a linear relationship to the volume of the ear canal. And that seems very logical, but that means some of the medications that are labeled for 8 drops or 4 drops, or what have you, have no chance of being successful in a dog with a large, large, large ear canal," she explained.

“And so the body weight is linear, except for the brachiocephalic breed, it's where you really can't tell, just like when you're trying to use an endotracheal tube, it's hard to predict the size. So the larger the dog, a big Hound Dog 2, mils of medication is a lot more than the label allows for,” Drake continued.

Veterinary teams may also need to consider the client's lifestyle when it comes to designing a plan for them. For example, with organisms like 

 spp, which is likely to develop resistance, it can be important to utilize a chelating agent like tris-EDTA, especially when the veterinarian is prescribing enrofloxacin to minimize the resistance. When prescribed together, owners are likely to administer these products separately as a ”flush” and “ear drop,” which mean the owner may abandon the flush portion of the regimen or it will occur less often than necessary, which can be more common in a busy household. Drake explained this is why the chances of success will improve if veterinary teams are looking for “one-stop” treatment.

Drake also explained that sometimes, when it comes to administering treatment, sometimes veterinary teams need an alternative or creative approach to make sure the patient is getting the medication they need, and the owner has success administering it. 

For expectations with treatment, the desired outcomes for the patient can differ between clients and veterinary teams. Drake explained most clinicians will wish for their patients to be comfortable at a minimum, and everyone wants to discuss the origin of the problem. This may not be possible for those patients suffering from chronic conditions, but making an improvement in a pet's quality of life is always a welcomed occurrence with treatment, Drake stated in her provided proceedings.

Clients tend to want to treat the condition once and then never again. It is common for clients to ask for surgical intervention when presented with this mentality. However, if the primary problem is allergic disease, inflammation, pruritus, and lichenification of the ear tissue that remains post surgery will continue, despite if whether a total ear canal ablation and bulla osteotomy are performed.

Drake E. Missing Links In The Medical Management Of Chronic Otitis

 Presented at: Veterinary Meeting & Expo; Orlando, FL. January 25-29, 2025.

Articles

Anticipating obstacles can help ensure the successful treatment of dogs suffering from otitis. 

Overcoming client challenges in canine otitis treatment 

The growth and establishment of veterinary facilities and services help improve pet care by providing pet owners with greater access to veterinary services for their pets. As the number of veterinary clinics and facilities grow and existing facilities expand, wait times for veterinary care decrease. Moreover, the offering of more advanced veterinary services gives pet patients a greater opportunity to receive the diagnoses and treatment they need. In turn, patients receive faster diagnoses and treatments.

Below are recent veterinary facility expansions and growth:

UC Davis veterinary hospital Neurosurgery Specialty Service (California)

The University of California, Davis (UC Davis) veterinary hospital recently announced the establishment of a Neurosurgery Specialty Service focused on providing advanced surgical solutions for complex neurological conditions.

According to the university, the service offers neurosurgical interventions and clinical trials such as craniotomies, spinal mass resection, correction of cranio-cervical junction abnormalities and spinal malformations, minimally invasive spine surgery, hydrocephalus treatment, wobbler and lumbosacral stabilization, stereotactic brain biopsy, and more.

“This new specialty at UC Davis will allow our hospital to offer more exclusive surgical offerings previously not available in California, such as intracranial endoscopy for hydrocephalus, minimally invasive spinal surgery, and stereotactic brain biopsies,” Vishal Murthy, DVM, DACVIM (Neurology), assistant professor at the university, said in a university release.

 “Our neurosurgeons take on complex cases, often referred by other neurologists, using the best tools, and regularly push the envelope of veterinary neurosurgery.”

“We are committed to providing cutting-edge surgical solutions for complex neurological conditions in our animal patients,” continued Murthy.

 “With a goal to provide personalized, high quality, collaborative neurosurgical care, we are thrilled to offer these new services to improve outcomes for our patients.”

Terravet Real Estate Solutions veterinary clinic acquisitions (Georgia)

Three veterinary practices have been acquired by Terravet Real Estate Solutions, a real estate group that specializes in veterinary properties. The acquisition of the 3 practices totaled $5.37 million and include Animal Medical Clinic of Peachtree City and Animal Medical Clinic of Fairburn, as well as the pet boarding facility Animal Medical Clinic’s Pet Care Center & Hotel.

 The 3 properties comprise 19,649 sq ft in total, with their locations strategically planned to “support the growing suburban communities southwest of Atlanta,” according to Terravet.

 Their locations improve access to quality veterinary care, said the company.

“This expansion into Atlanta is an exciting step forward for Terravet, reinforcing our mission to support veterinary practices with modern, accessible facilities,” said Daniel Eisenstadt, CEO of Terravet Real Estate Solutions, in a news release.

 “We’re proud to collaborate with…Vince Obsitnik [DVM] and the Animal Medical Clinic team, whose dedication to compassionate, high-quality care aligns perfectly with our values.”

“My business partners and I did an extensive investigation into options available for our veterinary properties and opted to join the Terravet REIT. We value the opportunity to diversify and enhance the value of our investment and to partner with the professional team at Terravet,” said Obsitnik.

Warren R. UC Davis launches Neurosurgery Specialty Service. News release. University of California, Davis. January 28, 2025. Accessed January 29, 2025. 

https://www.vetmed.ucdavis.edu/news/uc-davis-launches-neurosurgery-specialty-service

Terravet Real Estate Solutions expands into Atlanta metro area with $5.37 million acquisition of three veterinary facilities. News release. Terravet Real Estate Solutions. January 27, 2025. Accessed January 29, 2025. 

https://www.businesswire.com/news/home/20250127234300/en/Terravet-Real-Estate-Solutions-Expands-into-Atlanta-Metro-Area-with-5.37-Million-Acquisition-of-Three-Veterinary-Facilities

Take a look at these veterinary centers newly opened or coming soon

Clinic center: Updates on new veterinary centers

Iridociliary cysts in dogs and cats occur when part of the epithelium fills with aqueous humor. It may become separated from the iris, which causes a round mass to form and float within the anterior chamber. In an educational session at the Veterinary Meeting & Expo (VMX) hosted by the North American Veterinary Community (NAVC), Kate Myrna, DVM, DACVO, a professor at the University of Georgia in Athens, also explained that iridociliary cysts (also known as iris or uveal cysts) typically originate in the back of the pigmented epithelium of the iris or ciliary body of the iris.

“They’re little, fluid-filled sacs. They are usually incidental, but there are a couple of exceptions to this,” Myrna told VMX attendees.

In some cases, an iridociliary cyst can obstruct a patient’s vision. If needed, these benign cysts can be ruptured with a diode laser.

“In dogs, because of gravity, these balls will usually float to the bottom of the anterior chamber, and when you light them from the side, you'll be able to see through them. There can be one, there can be multiple. You can start with one and end up with more later. And sometimes they can sneak back behind the pupil. So you maybe saw [a cyst] one day and the next day you didn’t see one at all. They do float,” Myrna said. “Feline iris cysts more typically extend from the pupillary margin and are much darker.”

Myrna emphasized that smoothness and shape are key to identifying a cyst associated with the iris, and they often transilluminate with a bright light. “They look like an emulated balloon, and tumors just don't grow like that. You can't see the light pass through the tumor,” she said.

During her talk, sponsored by Domes Pharma, Myrna verbally walked attendees through a series of close-up images of iridociliary cysts in patients. One image of a canine patient served as an example of a cyst that was almost fully translucent. “This was a gold star day because a student spotted this on their exam, and I about lost it,” Myrna said. “I was so excited, because it is virtually invisible, and that's just because the iris tissue is so light.”

According to Myrna, iridociliary cysts are associated with an inflammatory condition that is sometimes referred to as 

 The disease occurs exclusively in golden retrievers, golden and labrador retriever cross bred dogs and golden retriever and poodle cross bred dogs.

“Those cysts stay behind the iris, and they are exfoliating pigment. So, you can imagine, as the pupil constricts, the cysts rub on the lens, and they leave these streaking pigment lines,” Myrna said. “Now we call it 

because frequently it has this big, bloody cyst that juices out a bunch of gross fluid.”

Golden retriever uveitis disease is progressive with cysts continuing to grow and darken, and, in more serious cases, secondary glaucoma may develop, which can lead to eye loss. “It does not act like uveitis in that anti-inflammatories don’t seem to change the course of the disease,” Myrna said.

Most dogs diagnosed with golden retriever uveitis are older than 5 years, and the average age at the time of diagnosis is 8-10 years.

 The disease prevalence in North America is estimated to be between 5% and 10%, according to Myrna.

 “This is much more common in the northeast and the Midwest,” she added.

Iridociliary cysts can cause vision interference, but are benign in nature. However, Myrna noted that their primary importance in identifying an iridociliary cyst lies in “differential diagnosis” from iris melanoma.

Myrna K. I’m seeing spots! What to do with brown spots in the eye. Presented at: Veterinary Meeting & Expo; Orlando, FL. January 25-29, 2025.

Golden retriever uveitis—what dog owners need to know. Veterinary Vision Center. October 1, 2021. Accessed January 29, 2025. 

https://veterinaryvisioncenter.com/golden-retriever-uveitis-what-dog-owners-need-to-know/

Kate Myrna, DVM, DACVO, discussed the ophthalmologic condition during a session at the 2025 Veterinary Meeting & Expo.

Looking at iridociliary cysts

In this interview with dvm360, Alex Sigmund, DVM, DACVO, shares when he treats corneal ulcers with medical management and when he treats them with corneal debridement

Interview with Alex Sigmund, DVM, DACVO

During an interview with Alex Sigmund, DVM, DACVO, ahead of his lectures at Veterinary Meeting & Expo (VMX), he shared with dvm360 when veterinary professionals should be treating ulcers with medical management and when cases call for corneal debridement. Through the interview, Sigmund explains the steps he takes to determine whether or not an ulcer is indolent, which determines if a debridement is necessary or not. 

The only time that I'm doing a corneal debridement is that, if I am sure that it is an indolent or non healing ulcer. You can also hear them called SCCED ulcers, Boxer ulcers. These are all the same thing where these are superficial ulcers that just are really frustrating from the get go, and they just do not want to heal without kind of stimulating them to heal. So we want to look at features of those ulcers that would indicate to us that it's indolent. So number 1, it's superficial. They are always superficial. Number 2 is that it's an ulcer that's been lasting too long, and it's still superficial. And 3, we want to look for that loose tissue hanging out around the edges of the ulcer. 

Videos

Alex Sigmund, DVM, DACVO, shares when veterinary professionals should manage corneal ulcers with medical management vs. corneal debridement

Navigating corneal ulcers: Medical management vs. debridement

During the 2025 Veterinary Meeting & Expo (VMX) in Orlando, Florida, Covetrus, a technology-enabled veterinary practice improvement company, announced the integration of artificial intelligence (AI)-powered workflow and treatment board capabilities to its Covetrus Pulse platform. The new developments will help streamline veterinary operations, lower administrative burden, improve business insights, and promote client loyalty, according to the company.

"As a veterinarian with several practices, I understand first-hand the competitive pressures that veterinary practices continue to face," said Link Welborn, DVM, chief veterinary officer at Covetrus, said in a news release.

"Today, AI-driven automation is an essential tool to help alleviate administrative burdens, drive better insights, and improve operational efficiency. Through the thoughtful use of AI, we will gain greater insights into our patient's journey with the ability to personalize care and communications to increase overall satisfaction."

Covetrus Pulse is a cloud-based veterinary operating system (vOS) that consolidates apps into a single platform with customization options through app integrations. Users can connect to Pulse from any device at any time. As the industry’s first cloud-based vOS, the platform simplifies workflows across internal communications, scheduling, inventory, and prescriptions. It also helps professionals communicate with clients faster and more efficiently, as well as helps users create care plans for their patients.

In a recent announcement, Covetrus shared that the platform’s new AI capabilities include

Ambient listening and auto-generated subjective, objective, assessment, and plan (SOAP) notes

: AI-powered transcription listens to live conversations during appointments and automatically creates SOAP notes

: AI generates patient summaries using data from the practice management system (PIMS)

: AI improves collaboration among the care team by providing real-time updates on patient treatments

"Veterinarians are increasingly seeking ways to optimize their practice workflows while maintaining the highest level of care for their patients," Scot Gillespie, chief product and technology officer at Covetrus, said in the release.

"By integrating AI-driven automation into the Covetrus Platform, we are empowering veterinary teams to enhance efficiency, generate greater insights to support patient care, and increase personalized communication to support pet parents."

The use of AI-powered tools in the Covetrus Pulse platform can help veterinary professionals save up to 5 minutes during each appointment, resulting in up to an extra hour of time each day for every practitioner.

 The platform’s new AI features, like its visit summaries, SOAP note generation, and AI-suggested next-best actions can also help decrease administrative workload, which helps relieve staff burnout, according to Covetrus.

“Covetrus remains committed to advancing AI technologies to further support veterinary practices. By unifying data across the Covetrus Platform, veterinarians will ultimately have an end-to-end view of the client journey; be able to gain greater business insights through machine learning models; and deliver more personalized communications by surfacing customized recommendations for each patient,” wrote Covetrus.

Covetrus announces AI-powered workflow automation and treatment board capabilities enhancing the Covetrus platform. News release. Covetrus. January 26, 2025. Accessed January 28, 2025. 

https://prnmedia.prnewswire.com/news-releases/covetrus-announces-ai-powered-workflow-automation-and-treatment-board-capabilities-enhancing-the-covetrus-platform-302360244.html

Covetrus Pulse. Covetrus. Accessed January 28, 2025. 

https://covetrus.com/covetrus-platform/workflow-and-productivity-tools/covetrus-pulse/

The new integration of artificial intelligence to the Covetrus Pulse platform was announced at VMX

Veterinary operating system now includes AI features

When it comes to ophthalmic examinations, can be a scary experience for veterinarians. However, although the interpretations of findings can be challenging, the examination that leads to the interpretations follows a logical, anatomical order that does not necessarily require expensive equipment. Ron Ofri, DVM, PhD, DECVO, Hebrew University of Jerusalem, Israel, explained that the most important factors of the exam are not ophthalmic, such as darkening the exam room, a magnifying loupe, and a strong source of focal light.

, at the Veterinary Meeting & Expo (VMX) Conference in Orlando, Florida, Ofri, broke down how veterinary teams can make to make these exams easier for general practitioners. Throughout the lecture, he provided multiple steps veterinary professionals can follow to ensure these examinations are not as scary as they may appear to be.

Before veterinarians begin their exam, they need to pay attention to the patient’s signalment. Multiple ocular conditions seen in pets, particularly in dogs, can be breed or age-related, meaning a general history should be taken and a comprehensive physical examination conducted. Ofri explained that many ophthalmic disorders can be manifestations of systemic disease, which is why a history and physical examination are important places to begin. During the examination and history, if neuro-ophthalmological abnormalities are present, such as anisocoria, blindness, or strabismus, the patient’s neurological systems should be evaluated because this can indicate a neurological disease.

As you get ready to begin your exam, Ofri listed these items that veterinarians will need to complete the examination:

Schirmer Tear Test strips to measure tear production

Fluorescein stain to diagnose corneal ulcers

Fine forceps and swabs may be required to evert the lids.

Ofri explained that realistically, the only expensive item that is required for these examinations is an applanation or rebound tonometer. These are needed to diagnose and monitor patients with glaucoma. A cheap alternative is the Schiotz indentation tonometer, which can provide veterinarians with a reliable reading with the proper calibration and practice. However, Ofri warned that, in any case, veterinarians should not attempt to measure pressure with their fingers. If the clinic does not have a tonometer, veterinarians can refer patients with suspected glaucoma for measurement of intraocular pressure.

As the patient walks into the room, the veterinarian should be observing the pet because being in an unfamiliar place can highlight visual deficits which can be examined more in-depth later in the examination.

Ofri explained that careful hands-off observation of the patient from a distance is needed, and professionals should ask themselves these questions:

Are the eyes of normal size and position?

Is there evidence of exophthalmos or buphthalmos?

Is there evidence of entropion or ectropion, usually of the lower lid?

Is their ocular discharge, and what is its nature if so?

After these questions are answered, Ofri explained the next step is checking the patient's orbital area to see if it is palpated to see if there are any abnormal swellings, fractures, etc. Veterinarians can use this opportunity to press on the globe through the upper lid of the patient, which can serve as a retropulsion test, and to proptose the 3rd eyelid, which allows inspection of its outer surface.

Next for the gross inspection is to inspect the eyelids. Veterinarians should carefully examine the skin looking for signs of dermatological disorders, just as alopecia, dermatitis, crusting, ulcerations, etc., as well as discharge. Veterinarians can evert the eyelids slightly to help visualize the conjunctiva lining of the patient's lids and 2 punctas. This moment can also be used to test the blink reflex by touching the skin around the eye.

Testing a patient’s vision is most commonly done by evaluating the menace response, which is making sudden threatening gestures that are supposed to cause a blink response in the patient. Ofri explained that it is important to understand this response involves the cerebral cortex integration and interpretation, meaning it is not a reflex.

To complete the menace response, one of the patient’s eyes should be covered while they evaluate the other. It is important to also not touch the eyelashes or hair of the patient to cause any type of wind movement.

Touching the patient’s eyelashes or hair or causing wind movement can trigger a false positive response. Ofri recommends veterinarians consider making the menace gesture behind a glass partition of some kind. A false negative can also occur in the menace response, with some reasoning being facial nerve paralysis, which can be ruled out by testing the patient's blinking reflex, young age, and the patient’s mental state. However, there are additional ways to test vision besides the menace gesture.

“Another way to check vision is doing the maze test, checking the animal's ability to navigate an obstacle course. Now mind you, when people build an obstacle course, they sometimes have a tendency to build an obstacle course that's fit for a military commando unit. No need to make it so difficult, just a couple of obstacles… that can be navigated by a normal animal. And one advantage of doing a maze test or an obstacle course is that it can be conducted both in light and dark,” Ofri explained to attendees.

Before closing his lecture, Ofri told those in attendance at his session to think of their ophthalmoscope as their stethoscope, just like he tells his students. He went on to explain that for everyone’s first day in the clinic after veterinary school, you are not entirely sure what you are doing but you know you need to use the stethoscope on the patient, even though you may be unsure about what you are hearing. However, as you continue to do exams and practice, you begin to learn and can start diagnosing cardiac and pulmonary problems. To Ofri, this is the same with the ophthalmoscope.

“Okay, first 100 patients, I promise you, you'll not see a thing. Next 100 maybe you'll catch a fleeting glimpse of the fundus for 1 second, 2 seconds, 3 seconds, 4 seconds. The more you do it, the better you'll be committed, and you can recognize normal variations. Then when a blind patient comes into your clinic complaining of blindness, you can perform a proper ophthalmoscopic examination. But if the first time you're going to try it is on a blind patient, forget it. You have no hope. So please do an ophthalmoscopic exam on every patient that comes into your clinic,” he concluded.

Part 2 of this article will be released later this week so be sure to check in at dvm360.com to make sure you do not miss it.

Ofri R. Ophthalmic Exam Made Easy! Presented at: Veterinary Meeting & Expo; Orlando, FL. January 25-29, 2025.

Ron Ofri, DVM, PhD, DECVO, shares how veterinary professionals can make eye exams easier for all during his recent lecture at VMX 