“So the first thing that we have to start off [with] is saying that a dedicated diet trial, today, is necessary for performing a correct diagnosis for a food-allergic dog,” began Galia Sheinberg, DVM, ESP, DLACVD, co-owner and founder of Dermatología Especializada Centro Veterinario Mexico, in Mexico City, in her lecture 

Practical aspects and innovations in diet trial for food allergy diagnosis

, presented at the 2025 WVC Conference in Las Vegas, Nevada. However, as Sheinberg explained, not all “itchy” patients should go on diet trials, and a detailed clinical history could help determine if the patient is a suitable candidate for this test. Among many points she presented in her lecture, Sheinberg shared some common errors that are made by veterinarians relating to diet trials.

According to Sheinberg, one common mistake veterinarians make when it comes to canine patients experiencing pruritus includes recommending a diet trial to each one of these patients, in every circumstance. “We have to understand when it’s really worth recommending a diet trial,” emphasized Sheinberg.

Oftentimes, the patient criteria for starting a diet trial are wrong, explained Sheinberg. “Maybe this dog was never itching before and it’s their first time they’re having issues, and somehow, automatically, they get prescribed or recommended a diet trial,” she continued. “So maybe [for] those dogs [it] was not necessary. …Maybe they had another diagnosis that wasn’t even related to their diet.”

“And most of the patients who are on a specific diet were never challenged, so they believe they’re on the right diet, but they’re still struggling,” said Sheinberg. To address this issue, she explained that taking a thorough clinical history is crucial. For veterinarians or clinics that may not have the time to go through a detailed clinical history with clients, developing a questionnaire or form for clients to fill out before the consultation may offer a solution.

When discussing feeding history with clients, it is important to know not only what the patient is currently eating, but what their diet has been like in the past. Information like whether the patient has been on a hydrolyzed or protein-selected diet, and if it was done correctly, should be discussed.

The fat fecal chart in the patient’s gastrointestinal (GI) history is also important. “Nowadays, as dermatologists, we understand that a lot of our patients have GI disturbances, and [clients] come in and… they don't tell us about it unless we ask. So, we need to know if [patients are] having any GI disturbances at all, how many bowel movements per day they're having, etc.,” explained Sheinberg.

If the patient has been on medication, and how they responded to it, needs to be discussed as well. As Sheinberg explained, some dogs have been on numerous medications, leading to the perception that they have failed every treatment. “But you really need to find out the timeline and the reasoning behind those failures and look at the skin and put everything together to see if the diet even had an opportunity to make a difference,” she emphasized.

Lastly, veterinarians should talk about the patient’s ears with clients, as many pet owners do not know there is a connection between the ear disease and the skin. However, it is important to “ask questions that are at the level of…clients so [that] they can identify the problems and understand what [is being asked].”

“…there's a lot of dogs that will have recurrent ear disease related to food allergies. It can be environmental, of course, but we can miss those if they come in for a skin problem or itching when they're not presenting with ear disease,” said Sheinberg.

Another mistake that Sheinberg has frequently witnessed is having patients undergo a diet trial for the wrong duration of time, whether it be too long or too short. “What I commonly see as a dermatologist…[in]…patients that have undergone a diet [trial] is that the duration of the diet [trial was] wrong,” said Sheinberg. “Maybe they didn't do the diet correctly, but a lot of patients believe they've done a diet trial, but they haven't done it in the right way.”

Because of this, factors relating to owner compliance should be taken into account. These factors include considering whether the home is suitable for the trial (ie., does the home have multiple pets, small children, elderly, owners with inconsistent feeding practices?); whether the owners are willing to change or restrict the dog’s diet; and whether the patient may have access to other food. In these cases, focusing on managing the patient’s symptoms and pursuing an environmental allergy diagnosis may be more appropriate, as a food trial is likely to have a higher failure rate and could result in wasted time, money, and the risk of losing the client.

 For patients who are undergoing a diet trial, careful monitoring throughout the process is essential.

Prior to even beginning a diet trial, veterinarians must carefully assess the patient’s clinical history to determine whether the patient is a suitable candidate for the trial. Moreover, ensuring proper duration of the trial and considering owner compliance can improve the success of diet trials and save time, money, and help keep the client.

To summarize, the following factors are indicators that a diet trial may be appropriate for a patient, according to Sheinberg

Non-seasonal canine atopic dermatitis (CAD) cases with skin issues triggered or aggravated by dietary factors

Young dogs (1 year or younger) presenting with non-seasonal itching, otitis, recurrent pyoderma, Malassezia infections, hot spots, or respiratory symptoms such as sneezing, conjunctivitis, and asthma linked to food consumption

Older dogs that show CAD symptoms later in life, independent of gastrointestinal factors

Patients with recurring otitis after other potential causes have been ruled out

Gastrointestinal markers may comprise recurrent, intermittent or ongoing diarrhea; more than 3 bowel movements per day; grass-eating; belching; borborygmi; vomiting; and gas.

A history of several diet changes in attempts to alleviate GI symptoms or find a diet the dog can tolerate

Sheinberg G. Practical aspects and innovations in diet trial for food allergy diagnosis. Presented at: 2025 WVC Annual Conference; Las Vegas, Nevada. March 2-5, 2025.

Articles

What makes a patient a suitable candidate for a diet trial?

Clinical history and patient selection for diet trials

For veterinary practices, online reviews can be an essential part of the clinic because reviews can bring in more clients or defer them based on what they see online. Because of this, managing them is a crucial job the clinic must take on in a way that creates trust and client retention, but also show the team and clinic to be humble, resilient, and think strategically.

, The Online Review Survival Kit: Thick Skin, Quick Wit, and a Dash of Humility

 at the 2025 WVC conference in Las Vegas, Nevada, Rhonda Bell, CVPM, PCM, CDMP, shared her survival guide that veterinary staff members can take back to their clinics to help them maneuver all reviews, the good, the bad, and maybe even the ugly. 

According to Bell, online reviews have become an important part of decision making by modern consumers because it provides social proof, which is the psychological tendency to look at other people’s experiences to decide for themselves. When it comes to the reviews, it also creates a peer consensus that can shape the clinic's perspective in their community and those online before they even step foot in the veterinary clinic. Bad reviews can even impact staff, where potential team members may not be interested in joining a practice after reading its reviews online or hurt the morale of the staff currently employed in the clinic.

“We can actually dissuade people from not leaving a review based on the fact that we respond. So remember how much fun we like conflict? A lot of people who leave reviews are also conflict averse. That's why they went online. They didn't call you. Right? So if they know that you are going to respond to all reviews, good and bad, they may not even leave you one because they're too afraid that you're going to continue that conversation. They know you're watching. So use that in your favor as well,” Bell explained.

“That's a good way to try to set up an environment of prevention. The other thing you can do when you're responding is you can say, ‘I'm sorry you had a bad experience. We'll be calling you to discuss this in person.’ So you're going to scare the pants off the guy who wrote the review and anyone else who's coming behind him who's reading it going, they call you and talk about it? Never mind,” she continued.

Bell also explained that although reviews are important, it’s not necessary to respond to all of them. There are certain reviews that can be left on Google, Yelp, Facebook, or other review sites that can be acknowledged without engagement, or even better off ignored. The key for practices is to know when to engage with reviews and when to not.

For bad reviews, they can be done in a way that does not have any intention of providing the clinic productive feedback based on their experience, rooted in a misunderstanding, or completely hostile. Bell explained that when it comes to these types of responses, it is more powerful to not respond than to engage.

: From genuinely concerned clients who may have had an unpleasant experience, a misunderstanding or unmet expectations. These reviews tend to be more specific or provide ways to improve the practice based on their experience. Normally, these reviews are worth addressing with empathy and can show the clinic areas they can improve in.

These kinds of reviews tend to be irrelevant or inflammatory in nature, often coming from people who have never actually been a client to the practice. In some cases, these types of reviewers can mobilize in groups and flood review platforms with negative comments. When it comes to these, it is best to not respond because it could escalate the impact of the trolls and packs.

 If the clinic is getting these types of reviews, it should be reported to the platform they are being left on. Many review sites will remove content that violates their terms of service.

If you respond to these kinds of reviews, it is possible to react emotionally, which can backfire, reinforce the initial complaint or invite further criticism. In these cases, it is best to take a moment to determine if the review warrants a response or can simply be noted. Responding to these types of reviews can create the negative impact of over engagement which can waste valuable time as well as emotional energy. Over-engagement can also potentially cause a situation to escalate, especially if the reviews are “troll”-like or pack attacks, which is when nonclients join in on bad reviews to create negativity. Bell believes in these scenarios; it is best to not respond. 

When it is time to respond to a review, once it has been deemed on that it is necessary, it should be crafted in a way that is professional and empathic to the reviewing, meaning it should contain 3 key components:

Acknowledge the clients experience by addressing the concerns without becoming overly explanatory or defensive. The responder should recognize the situation and the potential emotional toll it had on the client, patient, and the rest of the family.

Be empathetic. It can go a long way, especially when dealing with issues involving animal care, to show empathy. Teams can simply acknowledge the concerns the client has about the care their pet received to humanize the response.

Invite the responder to have a conversation offline instead of continuing it on a public platform. This can keep all the information regarding their incident confidential and demonstrate how the practice values the input of its clients to address it directly.

Bell encourages responders to not get into specifics in the response, especially if it involves pricing or a medical decision because it could lead to further criticism or a misinterpretation. She said if the review mentioned the name of the pet, it can be used in the response to be empathetic to the client and get back on the same page.

Before hitting send on that response, be sure to take a moment to step back and become emotionally grounded. If teams craft messages when they are emotional, it can lead to coming off more defensive or even unprofessional when it comes to the language. It is also important to make sure the responses are just not for the reviewer, but for anyone who could be reading the reviews of the practice, so be sure to keep the long-term reputation of the clinic in mind when crafting response.

Finally, staff wellbeing needs to be considered during responses, because that negative review can affect everyone’s morale. Owners or practice managers can have an open discussion about the review sin a supportive way to help foster a culture that sees the criticism as a possibility to grow.

“Don’t ignore positive reviews. There's a lot of power in responding to positive reviews. Remember social proofing, it tells people that you're paying attention, that you're watching closely. It also thanks the people who stopped and took the time to help you out. If you only respond to the negative ones, you're kind of alienating those guys who actually did something good for you because you never said thank you, right? And it doesn't have to be anything long. ‘Thanks so much for that 5 star review. We really appreciate it. Can't wait to see you guys again’ Don't do the same one every time. There's no copy and paste. Be a real person,” said Bell. 

Online reviews can have a great impact on the reputation of a veterinary practice, but they will all not be great ones. Learning how to deal with the bad with empathy can help turn the negatives into a positive, with opportunities to grow as a practice and as individuals, plus strengthening the ties and trust with the clinic’s community and clients.

She concluded her lecture by also suggesting that once resolving the reason the client left the bad review, asking if they would take it down and write a good one instead. Explain to them that the team works really hard to keep good reviews and that it would be unfair to them if the issue was resolved that was beneficial to both parties, but the bad review remained. Some people never think to ask, Bell concluded, but reminding them can help improve the clinic's online presence.

Bell R. The Online Review Survival Kit: Thick Skin, Quick Wit, and a Dash of Humility. Presented at: WVC; Las Vegas, Nevada. March 2-5, 2025.

Rhonda Bell, CVPM, PCM, CDMP, shares her guide for dealing with online reviews during her lecture at the 2025 WVC Conference 

Online reviews: To respond or not to respond 

Heartworm disease is not a new challenge for veterinary professionals, but according to Susan E. Little, DVM, PhD, DACVM (Parasitology), now is a great time for heartworms—and a bad time for dogs. The prevalence of heartworm is rising, making it more critical than ever for veterinary teams to take action.

“The challenges we’re facing with heartworm infection and the risk of heartworm infection in dogs in North America have never been higher. This is the worst it’s ever been for dogs because we’ve got the greatest risk of infection that we’ve ever faced. Thankfully, we also have some of the most powerful [preventives] we’ve ever had at our disposal,” Little said during her lecture.

At the 2025 WVC Annual Conference in Las Vegas, Nevada, Little presented "Heartworm Disease: Timely Updates on an Age-Old Problem," where she discussed the impact of rising mosquito populations on heartworm, plus the importance of additional testing. 

Just as it’s a great time for heartworm, it’s also an optimal time for mosquitoes. In recent years, mosquito populations have increased dramatically. Because heartworm transmission depends entirely on mosquitoes, this change has serious implications for veterinary medicine.

“There’s been really good data about the mosquito populations in North America over the last century, and from the 50-year period, the second 5 decades that they included [1996-2016]. It’s documented that there’s a 10-fold increase in the mosquito populations in North America. That is phenomenal, right?” Little said.

“There are a lot of theories about why that exists, and it’s not just [that] the...sheer number of mosquitoes [has] increased so much. There’s also a 2- to 4-fold increase in diversity of species. So, twice as many to 4 times as many species out there,” she continued.

Understanding internal parasite diagnostics

One factor believed to contribute to this rise is wetland restoration efforts in the United States. Because mosquitoes thrive in wet environments, these ecological restoration projects have inadvertently fueled an explosion in mosquito populations.

Because of this, Little emphasized the importance of year-round heartworm prevention. She urged veterinarians to discuss these changes with pet owners, ensuring dogs are protected every month, all year long. With mosquitoes actively transmitting heartworm and driving its geographic spread, veterinary teams must be diligent in their recommendations.

Little acknowledged that many veterinarians are frustrated by the challenges of heartworm testing, but she emphasized that early detection and treatment lead to better outcomes.

“We know that early detection and early treatment lead to better outcomes. That's true in most diseases, and it's certainly true in heartworm, but we also know that the antigen tests aren't perfect. False negatives occur,” she said.

“When I graduated vet school in [1993], I knew that early infections [and] all male infections—we were going to have a harder time picking those up, like only an antigen test. Antigen tests are sensitive, they're specific, they're phenomenal. But the sensitivity is usually 90% to 95%, which means you are missing 5% to 10% of the infections,” Little continued.

Because of this, it’s possible for a dog with heartworm to test negative on an antigen test. To improve detection rates, the Companion Animal Parasite Council and American Heartworm Society recommended 10 years ago that dogs undergo annual testing with both antigen and microfilaria tests.

Little explained that this 2-step testing approach increases diagnostic accuracy. For example, if a dog tests antigen negative but microfilaria positive, then heartworm infection is confirmed, and treatment can proceed. To simplify microfilaria testing in practice, she provided a step-by-step method:

“You collect that blood sample in practice, which you already have to do to run the antigen test. Many folks use a whole blood sample, which is what's necessary for a microfilaria test. And [it's] just a drop of blood on the slide, a drop of saline, cover slip, and examine. That's a microfilaria test,” she said.

Preventive care is the key to controlling heartworm disease, and client adherence is essential. Little suggested offering heartworm testing packages to ensure all necessary diagnostics are completed in 1 visit, minimizing the need for additional appointments and improving owner adherence.

By educating clients on rising mosquito populations, year-round prevention, and improved testing methods, veterinary teams can shift the balance—making it a bad time to be a heartworm and a great time to be a dog.

Little S. Integrating heartworm disease: timely updates on an age-old problem. Presented at: WVC Annual Conference; March 2-5, 2025; Las Vegas, NV.

Bad time for dogs, great time for heartworm.

Updates on heartworm in the United States

Image Credit: © otsphoto - stock.adobe.com

At this year’s WVC Annual Conference, Jeba Jesudoss Chelladurai, BVSc, MS, PhD, DACVM (Parasitology; Immunology), delivered a session titled "Tackling Tough Topics: Resistance in Canine Parasitology."

 Among the many insights she shared, one key takeaway was just how important it is to schedule follow-ups after deworming to ensure pets remain parasite-free. “I am very surprised at how often, when I teach students, they're still in the [mindset of] ‘diagnose, treat, goodbye.” Chelladurai impressed upon the attendees that a single round of deworming is not enough due to the risk of reinfection and the emergence of drug resistance.

The rapid parasite life cycle and the challenge of drug resistance

Chelladurai reminded the audience that some species of hookworms (eg, 

) may complete their life cycle in dogs in as little as 2 to 4 weeks. This rapid cycle means that even if the initial deworming treatment appears successful, there is a high risk of reinfection almost immediately from the environment, she said.

Not only is reinfection a concern, but anthelmintic-resistant parasites have also been growing in prevalence, according to Chelladurai. “Anthelmintic resistance is a genetic trait. It is a heritable trait that goes from one generation of worms to their…offspring,” she said. In other words, anthelmintic resistance develops through genetic changes that can alter drug target sites, enhance parasite metabolism to break down the drug, or increase the parasite’s ability to expel the drug. These heritable adaptations allow resistant worms to survive treatment and pass resistance traits to future generations, making follow-up diagnostics essential.

For tapeworms, Chelladurai noted that the standard FDA-approved dose—which once reliably cleared infections—may fail. She discussed options such as adjusting praziquantel dosage or considering alternative treatments like nitroscanate in cases of suspected resistance. However, she emphasized that any changes to treatment protocols should be based on clinical judgment, resistance testing, and current veterinary guidelines to ensure efficacy and safety.

In the case of hookworms, she mentioned that resistance was first observed in greyhounds and has since been reported in other breeds. She also talked about genetic markers—specifically F167Y and Q134H—that indicate resistance in certain drug classes, although she did not pinpoint a product name beyond noting trends in the benzimidazole drug class.

Given these challenges, Chelladurai advised practitioners to schedule follow-up diagnostics and to not rely on a single deworming treatment alone. She explained that after conducting a fecal egg count reduction test, a reduction of greater than or equal to 95% is considered successful. However, reductions between 75% and 89% suggest potential resistance or the need for protocol adjustments.

If the reduction meets or exceeds 95%, it suggests that the deworming was successful, and any new parasites likely stem from reinfection (which tends to be less pronounced). However, if the reduction falls into a “gray zone” between 75% and 89%, this is a strong indicator that drug resistance may be at play. Values in this range imply that the parasites are not being effectively cleared by the treatment, she said.

If resistance is suspected, the next step would be to change the treatment protocol. This might involve switching to a different drug class or increasing the dose of the current medication among the options she discussed above. If a simple change in treatment doesn’t resolve the issue, she recommends consulting with a parasitologist for further guidance.

Chelladurai’s session at the 2025 WVC Annual Conference serves as an important reminder: Although deworming remains a critical part of pet care, confirming treatment success through follow-up diagnostics is essential in today’s landscape of evolving parasite resistance and rapid reinfection.

Chelladurai JJ. Tackling tough topics: resistance in canine parasitology. Presented at: 2025 WVC Annual Conference; March 2-5, 2025; Las Vegas, NV.

Fissiha W, Kinde MZ. Anthelmintic resistance and its mechanism: a review. 

. 2021;14:5403-5410. doi:10.2147/IDR.S332378

Miller MW. Diagnosing resistance in canine hookworms. 

https://www.cliniciansbrief.com/article/hookworm-dogs-drug-resistance-diagnosis

Valuable parasitology lessons from WVC 2025 shared by Jeba Jesudoss Chelladurai, BVSc, MS, PhD, DACVM (Parasitology; Immunology).

Why a follow-up is essential after deworming

Casey Locklear, DVM, discussed Credelio Quattro's capability and communicating that to clients. 

Communicating the capability of parasite protection to clients

Lotilaner, moxidectin, praziquantel, and pyrantel chewable tablets (Credelio Quattro: Elanco Animal Health) provides protection against 6 parasites, including 3 intestinal worms that can be transmitted to humans. In an interview with 

Casey Locklear, DVM, US medical strategic lead for Elanco Animal Health and a practicing veterinarian in Texas, discussed the combination drug’s capability and the importance of communicating that to clients. This parasite protection product is also being featured by Elanco at the 

The following is a transcript of the video:

: My general practitioner heart gravitates to preventing the preventable and making a strong medical recommendation so that I can help provide that canine patient with the best health possible, and really support the human animal bond. That's part of what lights me up about Credelio Quattro. It offers a broad range of parasite protection in a single chewable monthly tablet, making it easy for pet parents to protect against some of the most common and challenging parasites.

According to studies, Credelio Quattro has been shown to be 100% efficacious against tapeworms, with its industry-established dose of praziquantel, and we know that certain tapeworms, such as a kind of Echinococcus granulosus, which can be found throughout the United States, can be associated with zoonosis, and also can be very hard and difficult to diagnose. So it's important for the veterinary team to remember and to convey to pet owners that they really are taking a proactive approach by providing that dog with a broad spectrum coverage, including that team farm coverage on a monthly basis.

Learn more about canine parasites at WVC on Wednesday, March 5, 2025, at 7 am, during the “The Early Vet Catches the Worm!” session sponsored by Elanco Animal Health. The session will be presented by Susan Little, DVM, PhD, DACVM (Parasitology) at the Mandalay Bay Convention Center in Las Vegas.

Videos

Casey Locklear, DVM, discussed Credelio Quattro chewable tablets in a dvm360 interview. 

Communicating with clients about parasite protection

Susan E. Little, DVM, PhD, DACVM, discusses what diagnostic tests should be used for tapeworms, hookworms, and roundworms in dogs

, Susan E. Little, DVM, PhD, DACVM, Krull-Ewing professor of parasitology at the Center for Veterinary Health Sciences at Oklahoma State University in Stillwater, talks about different internal parasites of dogs. Specifically, she discusses different diagnostic tests available, and what parasites certain tests are better at identifying.

Below is a partial transcript which has been lightly edited for clarity

 ‘How common are the different…internal parasites and dogs?’ is a really great question because we don't always have good data to answer that question, it depends on the quality of the diagnostic tests that we have at our disposal, right? And so there can be challenges in diagnosing particularly tapeworms, heartworm and whipworm. Hookworms and roundworms absolutely matter, as does 

 and coccidia, but…the diagnostic tests are better at identifying those infections than...heartworms. And we have good diagnostic tests for all parasites, but they just all have limitations.

So, tapeworms is probably the most challenging internal parasite to diagnose with fecal flotation alone, and so that's what we're used to doing in practice is the fecal flotation, you know, direct microscopic examination of a preparation. And that works for hookworms and roundworms. It's a little more challenging for whipworms. For tapeworms, it's all but useless. We have sensitivity values of like maybe less than 50% for 

 flea tapeworm…the odds that you actually detect an infection with a flea tapeworm in a dog by fecal flotation alone is less than 5%. So they're just not helpful, and that's one of the reasons that antigen tests have been developed for flea tapeworms. So we've got better strategies now to find those infections and we're certainly finding them. We're seeing that we were overlooking them before, which means that the dog comes into the veterinary practice with a tapeworm infection and goes back home with a tapeworm infection if the right diagnostic test isn't done, or if it’s not anticipated, that that infection is present.