Jason B. Pieper, DVM, MS, DACVD talks about recurrent infections and nonresponsive cases of otitis externa

Managing prolonged cases of otitis externa 

What steps should veterinarians take in the face of a prolonged otitis externa case? In an interview with 

, Jason B. Pieper, DVM, MS, DACVD, assistant professor at Iowa State University explains that veterinarians should determine whether the infection fully resolves or recurs, the latter of which could indicate underlying issues such as allergies, foreign bodies, or autoimmune diseases. In the interview, Pieper talks about recurrent infections, as well as nonresponsive cases, and what each scenario entails.

Below is a partial transcript which has been edited for clarity

 So those prolonged cases of otitis externa, the chronic ones, I think it kind of depends on, does the infection go away or not? I think that's kind of the big question mark I always have, if it goes away and then it comes back, then the question is, ‘what is that underlying problem that is going on?’ You know… whether it's the allergy, the mass, foreign body, you know, autoimmune diseases, endocrinopathies—is it those that's causing it to come back again and again? Because if that's the case, those underlying problems really need to be addressed, otherwise you're going to constantly have that inflammatory cycle going again and again. So I think if it goes away, completely resolves, no signs for a month, 2 months, 3 months…then I would consider that a recurrent otitis.

Then there's the ones that just are non-responsive otitis. If it's that chronic nonresponsive otitis externa, realistically, then I worry ‘is there something deeper down in there if we’re not responding?’ You know…one of the concerns we have now is this biofilm. Is there a biofilm that's protecting that bacteria and not allowing your medications to get in there to kill it? You know, do we need to clean, break down that biofilm to actually allow the antibiotic to get in there to kill it off? So that can be a big concern with those cases….

Videos

What to do for prolonged cases of otitis externa 

Shelters United has launched a free Veterinarian of Record (VOR) training program. Supported by a grant from Mars Veterinary Health, the program is designed to help veterinarians and animal welfare organizations (AWOs) establish and maintain successful partnerships.

“The Vet of Record Training Program provides an expanded and mutually beneficial model for veterinarians who want to help homeless pets awaiting adoption while building their practice with an evergreen source of new clients,” Mal Schwartz, Shelters United founder and CEO, said in a news release. “Rescue staff and volunteers who take the training course will learn how to work with veterinarians in a way that minimizes the conflicts that often arise from their different perspectives.”

Shelters United is a cooperative buying program that serves nonprofit AWOs. It’s VOR program provides a framework for veterinarians and AWOs looking to build profitable and impactful relationships, according to the organization. The VOR Training Program is built on the foundation of the Shelters United VOR Toolkit, developed with funding from PetSmart Charities and in collaboration with experts from the University of Florida’s Shelter Medicine program. This comprehensive toolkit provides veterinary teams and shelter leaders with the knowledge and resources needed to support AWOs, improve pet healthcare, and strengthen community connections, according to Shelters United.

The VOR program offers an online training course that provides lessons and interactive experiences to teach veterinarians and AWOs how to work together and use the tools provided in the toolkit. Veterinarians and AWO professionals who access the course can explore how to create successful AWO-veterinarian partnerships, review components of a written legal agreement, and earn 1 hour of RACE-approved continuing education credit.

“As a family-owned, purpose-led company that’s committed to building a more sustainable future for veterinary medicine, Mars Veterinary Health is honored to help make the Shelters United VOR training program,” Molly McAllister, DVM, MPH, global chief medical officer at Mars Veterinary Health, said in a release. “We look forward to seeing how the training contributes to a mutually beneficial VOR model that increases access to care for shelter pets, improves relationships between veterinarians and animal rescues, and makes it easier for veterinarians to give back to their local communities through shelter work.”

Shelters United launches free training to help veterinarians make a difference in their communities. News release. Shelters United. February 27, 2025.

Articles

Shelters United launched its' Veterinarian of Record online education program with support from a grant

New training program aims to help build veterinarian partnerships with animal welfare organizations

Elanco Animal Health and Medgene, a South Dakota-based animal health company focusing on vaccine technology, have entered into an agreement which includes the commercialization of a highly pathogenic avian influenza (HPAI) H5N1 vaccine for dairy cattle, developed by Medgene.

 The partnership comes at a time when bird flu cases are on the rise, with infections observed in 

 as well as several wild and domestic mammals, including cats, dogs, 

The vaccine has met all platform technology guidelines requirements from the USDA, according to the company. It is now in the final stages of review for conditional license approval.

“Medgene has an established reputation of supporting animal owners and their veterinarians with our USDA-licensed platform technology and bioinformatics software to design transformational vaccines,” Mark Luecke, CEO of Medgene, said in a news release.

 “With our critically important H5N1 vaccine for dairy cattle in the final stages of approval, we’re excited to partner with Elanco to quickly bring this much needed solution to US dairies.”

Medgene’s vaccine platform technology in cattle received prior approval from the USDA, which accelerated Medgene’s H5N1 vaccine development, according to the company.

 The company also has existing vaccine manufacturing supply ready for deployment to support the US dairy herd, said Elanco.

Recommendations for veterinarians evaluating feline cases of H5N1

Currently entering its fourth year, the H5N1 outbreak has affected 973 dairy herds, with 17 states in the US experiencing outbreaks in dairy cows as of February 21, 2025.

 “The cross-species transmission of the disease into nearly 1,000 dairy herds across the US since March 2024, along with zoonotic transmission to people, shows that more interventions are quickly needed. This virus is prevalent and predicted to persist over time, thus a cattle vaccine will be critical to slow virus spread between birds and cattle,” wrote Elanco in a news release.

“As egg prices soar and milk production wanes in infected dairies, the need for new solutions to curb disease spread is evident,” Jeff Simmons, president and CEO of Elanco said.

“Elanco is pleased to partner with Medgene to bring customers options to fight this devastating disease and believes this product will become part of a routine vaccination protocol for the US dairy industry. This partnership further strengthens our diverse dairy portfolio and advances our One Health platform of animal health solutions, not only benefitting our dairy customers, but helping curb disease spread for our poultry customers, and working to improve egg prices for consumers.”

Zoetis also has an H5N1 vaccine, for which it received a conditional license in 2016 and a contract award for the USDA’s National Veterinary Stockpile. The vaccine was later utilized by the US Fish & Wildlife Service in 2023 to protect California condors.

USDA confirms new avian influenza genotype in dairy cattle

More recently, the USDA issued a conditional license for a vaccine—Avian Influenza Vaccine, H5N2 Subtype, Killed Virus, developed by Zoetis—to protect chickens against the H5N2 subtype of HPAI, a newer strain of HPAI detected in the US in early 2022.

 Causing severe disease in birds, HPAI H5N2 has a high mortality rate in these animals. However, this subtype of avian influenza has a lower zoonotic transmission when compared to H5N1, with fewer reports of infection in mammals.

Still, HPAI H5N2 outbreaks in birds have been observed in several countries in the last few decades, including Canada, Mexico, South Africa, Haiti, and the US. In May 2024, Mexico confirmed the first recorded human case of H5N2 in a 59-year-old man with underlying conditions, who later died due to complications. The patient had no history of exposure to poultry or other animals.

Fewer than 10% of cows in a herd have shown signs of illness, with lactating cows being most impacted.

 Common clinical signs of H5N1 in cows include low appetite and reduced milk production. Abnormal appearance of milk, such as milk that is thickened and/or discolored is another sign of infection.

Elanco enters agreement with Medgene to commercialize highly pathogenic avian influenza vaccine in dairy cattle. News release. Elanco Animal Health Incorporated. February 22, 2025. Accessed February 27, 2025. 

https://www.elanco.com/en-us/insights/elanco-enters-agreement-with-medgene-to-commercialize-hpai-vaccine-in-dairy-cattle

Bautista-Alejandre A. New study finds cows can transmit avian flu to other mammals. 

. August 2, 2024. Accessed February 27, 2025. 

https://www.dvm360.com/view/new-study-finds-cows-can-transmit-avian-flu-to-other-mammals

Current situation: Bird flu in dairy cows. US Centers for Disease Control and Prevention. Accessed February 27, 2025. 

https://www.cdc.gov/bird-flu/situation-summary/mammals.html#:~:text=In%20recent%20years%2C%20HPAI%20H5N1,such%20as%20tigers%20and%20leopards

McCafferty C. USDA issues conditional license for H5N2 vaccination.

. February 17, 2025. Accessed February 27, 2025. 

https://www.dvm360.com/view/usda-issues-conditional-license-for-h5n2-vaccination

Apostolopoulos V, Rodriguez-Morales AJ, Diaz B, Mehta R, Sah R. First confirmed human case of H5N2 virus infection in Mexico: An emerging zoonotic concern. 

Avian influenza virus type A (H5N1) in US dairy cattle. American Veterinary Medical Association. February 20, 2025. Accessed February 27, 2025. 

https://www.avma.org/resources-tools/animal-health-and-welfare/animal-health/avian-influenza/avian-influenza-virus-type-h5n1-us-dairy-cattle#:~:text=On%20March%2025%2C%202024%2C%20the,here%20and%20background%20information%20here

The vaccine is in the final stages of review for conditional license approval 

Two animal health organizations to commercialize H5N1 vaccine for dairy cattle 

You know the importance of full mouth dental radiographs for your patients. However, the time it takes to get a diagnostic full mouth study is making you second guess this step.

If you want to ensure all patients get full mouth dental radiographs in a reasonable timeframe, and the bisecting angle technique makes you anxious, this article is for you. The subtle changes to the bisecting angle technique that will feel like “cheater codes” as well as this author’s approach to “bad radiographs” will be addressed.

These 2 things will help you and your team get consistently better radiographs faster. However, before we get to the “cheater codes” and “bad radiographs” we will start with a general overview of the 2 main intraoral dental radiology techniques: Intraoral Parallel Technique (IPT) and Bisecting Angle Technique (BAT).

The IPT is the same technique used to acquire diagnostic images for the rest of the body. The plate or sensor—

 will be used for both throughout the article—used to capture the image is positioned parallel to the target anatomy. The generator, also called the tube head, is positioned perpendicular to both the sensor and the patient.

The IPT is preferred as it allows for the most accurate image of the target anatomy with minimal distortion.

 If we could use this method for full mouth dental radiographs in our canine and feline patients it would be ideal. However, because of the absence of a vaulted palate and the presence of a mandibular symphysis, the sensor can only be placed parallel to the entire tooth for the mandibular molars and, in some patients, the most caudal mandibular premolars.

: The Cieszynski rule of isometry; where side AB is the angle of the tooth root, BC is the angle of the sensor and BD is the bisecting angle and therefore the angle to which the tube head must be perpendicular to in order to obtain an accurate dental radiograph.

The anatomic differences between humans and veterinary patients means that the majority of our patient’steeth will require the BAT to obtain radiographs. The BAT is most commonly used in patients’mouths where the IPT cannot be used. However, it can be used for all teeth in patients’ mouths.

This is because the BAT is based on a geometric theorem: Cieszynski rule of isometry (

). This theory, coming from the geometric Law of Isometry, is applied to dental radiographs to obtain an accurate image when IPT cannot be used. The law has also been called the theory of equilateral triangles

, stating two triangles are equal if they have 2 equal angles and a shared side.

The reason for all this geometry is to ensure the image captured has the least amount of distortion. The other way to consider this is that BAT is a way to create an IPT when the sensor cannot be placed parallel to the entire tooth. Remember, the IPT has the tubehead directed perpendicular to BOTH the tooth and the sensor, which is not possible for most of our patient’s teeth. By bisecting the angle between the sensor and the tooth, this creates the angle to which the tubehead can be placed perpendicularly,similar to the IPT. While the BAT works for all teeth, the canine teeth given their curvature present a challenge. This article will first focus on the approach for imaging the majority of teeth and then will review the slight changes needed for imaging canine teeth.

Now that both intraoral dental radiography techniques have been reviewed, we can progress to the “cheater codes” to help improve your technique and speed.

The first way to simplify the BAT is to simplify the angles involved. Although many authors

 advise to place the sensor “as parallel as possible” to the tooth, it is this author’s recommendation and others

 that the sensor be placed perpendicular to the tooth. This small change in sensor positioning allows for a 90-degree angle between the tooth and sensor which is visually much simpler to bisect: 45 degrees. (

To ensure the sensor is perpendicular to the long axis of the maxillary teeth, the sensor should be placed parallel to the hard palate. For the mandibular teeth: using the patient’s tongue to fill the intermandibular space will give your sensor a flat surface to lay against that is perpendicular to the tooth roots. (

Positioning your patients in dorsal recumbency allows you and your team to complete the entire Comprehensive Oral Health Assessment and Treatment (COHAT) , including full mouth dental radiographs, without moving the patient or disconnecting any monitoring equipment. With the patient in dorsal recumbency, rotate their head 45°. By rotating their head and using the above simplification the bisecting angle will now be a vertical line which results in the tubehead angle being 0° or horizontally positioned. (

: A patient in dorsal recumbency has their head titled at a 45° with the sensor place parallel to plate (90° to the maxillary fourth premolar)—blue line. The angle of the teeth is shown by the purple line. This results in the bisecting angle being a vertical line, shown in light green. This requires the tube head, red arrow, to sit horizontally or parallel to the table in order to be perpendicular to the Bisecting angle.

Once you get the correct angle for the first radiograph in the quadrant, do not change the angle of the patient, sensor or the tubehead. The only change to be made is to the move the sensor and tubehead either mesial or distal along that quadrant. This will save time by not rechecking any of the angles.

The biggest challenge to the bisecting angle simplification are the canine teeth. This is because while the rest of our patient’s dentition have similar angles between the crowns and roots, the canine teeth do not. (

Instead of using the angle of the crown for the canine tooth, the angle of the rostral mandible should be used. This is because the root of the canine tooth follows that curvature. (

) Canine teeth are a bit of an anatomical exception, given their crowns and roots do not have the same angle, you need to use the root angle to get the correct bisecting angle. 

Often a nondiagnostic radiograph, missing part of the tooth or inappropriate angle, is called 

. The radiograph is only bad if you do not then use it to help you get the diagnostic radiographs you want.

In this author's experience teaching dental radiography, most participants are quick to be critical of nondiagnostic radiographs. They often change patient, sensor and tubehead positioning or angle all at once. 

This dental radiograph of a feline’s right maxillary canine, premolars and molar is nondiagnostic because of the angle.

Instead, it is important to focus on the positives of the nondiagnostic radiograph, to determine what should not be changed. The main 2 things to focus on are whether the angle is correct and whether the teeth of interest are in the radiograph in their entirety. 

is a nondiagnostic image. It is nondiagnostic because the apex of the roots are not included in the image, however, the angle of the image is correct. Therefore, the only change that should be made is a sensor movement.

Once the sensor was moved further into the mouth, in a palatal direction, the entire root structure of right maxillary molars (109/110) are included in the image as well as the distal root of the maxillary fourth premolar (108). (

) The part of the sensor that could be seen outside of the mouth or beyond the teeth in image (a) corresponds to the black space in the dental radiograph in previous figure. It is important to line up the long side of the sensor with the cusp of the tooth/teeth to ensure the entire senor is used. This sensor placement is similar to collimating full body radiographs: ensuring 

 the target anatomy is within the radiograph.

Other times a “bad” radiograph may be caused by angles and not sensor placement. In those instances, the angle of the tube head may need to be corrected.

: This dental radiograph of a feline’s right maxillary canine, premolars and molar is nondiagnostic because of the angle.

shows all the desired teeth are in the radiograph, however, the angle is very foreshortened, making this image nondiagnostic. Given that all desired teeth are included in the image, the sensor should 

be moved, instead the angle of the tube head should be corrected.

was very foreshortened, which fits with a small angle, almost parallel, between the tooth and the tube head. 

 shows a very large angle, almost perpendicular, between the tube head and the tooth, which resulted in the very elongated dental radiograph shown in 

, which demonstrates the second radiograph in the feline patient. Both tube head angles in the above figure failed to follow the angles outlines above for BAT.

To get the diagnostic image for this feline patient the tube head must be at an angle between that in Figure 11a and Figure 11b. 

 shows the correct angulation of the tube head and corresponding, diagnostic, dental radiograph (

). This feline 'patient' was placed in dorsal recumbency with the head titled at 45°, which resulted in a bisecting angle that is a vertical line and therefore the tube head angle should be horizontal. 

Evaluating the 'good' parts of your nondiagnostic dental radiographs will help you get to a diagnostic radiograph faster than focusing on what is 'bad' about it. This, other tips or 'cheater codes' will help decrease the time needed to take full mouth radiographs. As with any skill, this will take time and practice to learn this new way of obtaining and evaluating your dental radiographs.

, is a specialist in small animal dentistry and oral surgery. She began her career in small animal general practice and, although challenging at times, she gained a great deal of dentistry education. The more she learned, the more her passion for dentistry grew as well as a desire to become a specialist. While Thomson enjoys all aspects of clinical practice, she also very much enjoys providing continuing education for all veterinary professionals in small animal general practice. There is a huge demand for veterinary dentistry and oral care, and she wants to support general practice teams to provide the best care to their patients.

Altier B. Tips for mastering veterinary dental radiology. 

, January 19, 2021. Accessed February 27, 2025. 

https://www.dvm360.com/view/tips-for-mastering-veterinary-dental-radiography

Wigg’s Veterinary Dentistry: Principles and Practice. 2

Altier B. The ABCs of dental radiology: dental radiology demystified (Proceedings). 

. September 1, 2019. Accessed February 27, 2025. 

https://www.dvm360.com/view/abc-s-dental-radiology-dental-radiology-demystified-proceedings-pdf

Niemiec BA. Dental Radiology Series: Techniques for Intraoral Radiology. 

. August 14, 2015. Accessed February 27, 2025. 

https://todaysveterinarypractice.com/dentistry/practical-dentistry-dental-radiology-series-techniques-for-intraoral-radiology/

A veterinary dentistry expert shares tips for achieving full mouth images using 2 main techniques and 'cheater codes'

How to get picture perfect dental radiographs in less time

The Association of American Feed Control Officials (AAFCO), an independent organization that guides state, federal, and international feed regulators with label standards, laboratory standards, and ingredient definitions, raised red flags regarding the newly reintroduced H.R. 597, also known as the Pet Food Uniform Regulatory Reform Act of 2025 or PURR Act 2025.

The bill was introduced by Congressmen Steve Womack (R-AR-3), Derek Schmidt (R-KS-2), and Josh Harder (D-CA-9) and aims to set uniform standards for canine and feline food and food labels across the United States. According to a release from the office of Womack, the proposed legislation would modernize the regulatory framework that governs pet food manufacturing, allowing pet food makers to invest in products that deliver nutritional benefits that are best for dogs and cats.

“Outdated, overbearing, and unnecessarily complicated regulations have stifled production and ingenuity across all American industries, including pet food. The archaic regulations currently in place have meant pet food producers in Kansas and across the country spend more time worrying about meeting mismatched guidelines and less time innovating new products; fortunately, the PURR Act provides a solution,” said Congressman Schmidt.

“By instituting uniform, streamlined pet food standards, we’ll be empowering businesses to succeed while ensuring that American pet owners have access to quality and nutritious food for their pets. I’m proud to introduce this bipartisan legislation with my colleagues and look forward to helping move it through Congress and voting for it on the House floor,” he continued.

The PURR Act of 2025 was originally introduced in Congress January 23, 2025, as a way to create a single federal regulatory process that would prohibit state governments from directly or indirectly establishing, maintaining, implementing, or enforcing authority or requirement relating to the labeling or marketing of pet food.

While most state feed programs in the US support the FDA by reviewing pet food labels to ensure that permissible claims within the food's marketing are proven by data and do not mislead the consumer or are false, AAFCO believes that this bill, if passed, would eliminate the checks and balances currently in place to ensure transparency in products for the consumers purchasing them.

“The PURR Act would remove the ability for state-level regulators to provide the oversight that U.S. pets and pet owners deserve,” shared Austin Therrell, executive director of AAFCO, in an organizational release.

 “Today, state feed programs are the first line of defense protecting consumers from misleading or mislabeled pet food products by inspecting products and labels to ensure that any marketing claims on the label or packaging are accurate and have the necessary scientific data to validate the statements.”

Currently, state governments and the FDA work together under a national integrated food safety system, which allows the FDA to use the expertise and resources of state feed programs to make pet food safety inspections stronger. The partnership also protects consumers from unsafe, misleading or fraudulent advertising and labeling practices.

“Many consumers purchase pet foods and treats based on the dietary needs or allergen requirements of their pets. Lack of transparency would leave pet owners unable to know for certain which ingredients their pets may or may not be consuming, leading to potential health risks,” said Therrell.

“We will continue to advocate for innovation within the pet food industry in a safe and responsible manner that does not compromise the wellbeing of those the industry serves,” concluded Therrell.

Womack Leads Legislation to Set Uniform Standards for Pet Food. News release. January 21, 2025. Accessed February 27, 2025. 

https://womack.house.gov/news/documentsingle.aspx?DocumentID=408913

PURR Act of 2025 Raises Red Flags with AAFCO. News release. February 25, 2025. Accessed February 27, 2025. https://www.aafco.org/news/purr-act-of-2025-raises-red-flags-with-aafco/

The organization raised red flags over beliefs the legislation could negatively affect consumer protection, jeopardize the safety of pet food products, and more

AAFCO raises concerns over PURR Act of 2025 

On this week's episode of The Vet Blast Podcast presented by dvm360, our host Adam Christman, DVM, MBA, and guest Mark Massaro, DVM, discuss Massaro's journey to integrating AI dictation software at Mount Laurel Animal Hospital, and its sister hospitals. Throughout the episode, Massaro also shares his journey to veterinary medicine, including the deep ties the industry has to his family, how he found the right software for Mount Laurel, and the benefits the AI dictation software had on the veterinary professionals within, particularly the emergency services. 

AI is my big thing that I worked on recently. So [Christopher Torre, VMD], right, when I was hired, I was like, okay, so what like, what do you want me to work on? And he had all kinds of easy vet projects, but he said, I do want you to just start looking into, I went to a conference and I heard about these AI scribes that will write...SOAP notes for you and filter out some of the nonsense discussion. I want you to just look into it for me and kind of figure out all the different players in the space and which one might be the best fit for us. So I did this, like 3 month research project, looking at all the companies and doing demos and going back and forth and negotiating prices and again, because this is a unique account, a lot of them will charge per veterinarian, and that didn't really make sense for us. We have 120 veterinarians, so we ended up choosing VetRec who I know you know them, I introduced you them  recently, and we did a really slow roll out that was really key for us. It's because we have so many moving parts. And, you know, we only transitioned to ezyvet a couple of years ago, and so, you know, a lot of the teams are still getting used to ezyvet and Vet Radar, and so we didn't want to throw too many things at them all at once. So we kind of went one hospital at a time, one department at a time. But we really hit our stride a few months ago, and they, Oh, my God, do they love it,  especially the emergency service because again, when you're on emergency, you're seeing case, case, case, Mount Laurel's emergency [service] is super busy. Actually, I kind of found out how busy they were through the AI, because I'm able to track how many cases they're seeing using the AI.

Podcasts

Our host Adam Christman, DVM, MBA, and special guest Mark Massaro, DVM, discuss how AI dictation softwares are improving veterinary clinics