Veterinary ophthalmologist Jennifer Sheahan, DVM, DACVO, shares the role that nutrition plays in veterinary ophthalmology

Video interview with Jennifer Sheahan, DVM, DACVO

During an interview with dvm360 prior to the Fetch Long Beach Conference in Long Beach, California, Jennifer Sheahan, DVM, DACVO, recounts cases where dietary indiscretions, such as feeding a dog fatty foods, have led to acute eye conditions like milky, cloudy eyes, which can be mistaken for cataracts, the eye's leaky blood-eye barrier, which allows dietary substances to affect the eye post-surgery, and more.

So, there are certain conditions that we see in dogs. For example, you might see an acute case where [the client says], 'oh my gosh, we woke up this morning and my dog is blind. His eyes look like a zombie, [his eyes are] completely clouded over.' And then we look at them and it's just like milky, cloudy white color... And, oftentimes, part of the history question taking is 'Hey, did you feed a fatty meal last night? Did he get into any of the garbage?' And they're like, 'yeah, actually, you know, I gave them some of my In-N-Out.' You'd be surprised with diabetic patients. I used to think [clients] would control what [their pets] eat. They can't eat fatty foods, and it can throw off their diabetes.

I had a client that had cataract surgery, and then, the next day, they came back in and... they were like, 'we woke up and my dog's blind again, and the cataracts came back.' I was like, 'that's impossible.' What happened? So, they came in and we see them the day after surgery always, and I was like, 'Oh my God, there's so much fat inside the eyeballs.' And [I asked] 'did your dog have any super fatty foods?' And [they said], 'well, we wanted to celebrate the new eyes and give them a treat. So we gave Muffin,' our diabetic dog, 'In-N-Out on the drive home.' And I [said], 'oh, yeah, definitely don't do that. He's diabetic.' 

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Jennifer Sheahan, DVM, DACVO, recounts cases where dietary indiscretions, in an interview with dvm360 at the Fetch Long Beach conference.

The role nutrition plays in veterinary ophthalmology 

Like many other veterinary professionals, Kwane Stewart, DVM, knew from a young age he wanted to become a veterinarian. As a graduate of Colorado State University in 1997, he began his career as a shelter veterinarian. However, also like many other veterinary professionals, he began to experience burnout and was not sure if he wanted to stay in the profession. As it happens with superheroes in comic books, he had a moment in life that altered the course of his forever.

During his keynote address on day 2 of the 2024 Fetch dvm360 Conference in Long Beach, California, Stewart took attendees on the journey through his career from first patient he treated through his street medicine work. He also spoke about how an overheard moment that actor Brad Pitt was having with someone else reminded him how everyone, despite where you live or how much you have, is connected through pets.

For 5 years, Stewart served as a shelter veterinarian in Modesto, California, and did not realize the amount of euthanasia work would be included in his job. As he went through the years, he described feeling like a part of his soul was being stolen, so he began to consider leaving the position entirely. He explained that one day, about 3 years into the 5 years he spent there, he was outside of a 7-11 convenience store when he came across a man with a dog sitting outside that he had come across multiple times prior to that moment. Stewart noticed that the man's pet was suffering from a flea infestation and it was destroying his skin.

“I walked out to the gentleman, and I introduced myself. I said, 'my name is Dr Kwane Stewart. I see your dog has some sort of skin issue,' and he was exasperated, desperate. He said, ‘Yes, I don't know what's going on. I don't have any money. She's miserable. I'm miserable. She’s not eating. And I said, Well, if you're here tomorrow, I'll return with something that should help. That took me back to the shelter for 1 more day, and I returned as promised, and it was $3 out of my pocket and 5 minutes of my time. Sorry, $3 out of the shelter's pocket...I owe the shelter $3 to this day,” Stewart shared with the audience.

“I treated the dog, and then I saw the same man and the same dog about a week and a half later, the dog was transformed. The hair was coming back, the infection was gone. She jumped up on me and gave me a kiss, and the man was sitting the exact same spot with tears in his eyes just said, ‘Thank you for not ignoring me’”

Stewart shared that this is the moment that stopped him from leaving the veterinary profession and began his work as a street veterinarian. In that moment with the man outside of 7-11, Stewart made a pledge to never stop helping those in need like him, and 13 years later, her kept his promise.

He stayed at the shelter for 2 more years, helping it go from one of the worst in the country with a 35% live release rate to nearly 80%, with a brand-new facility, educational programs, and more. Stewart credits this to the being probably the proudest time of his career. He would also then pack a bag and head to Skid Row in Los Angeles, walking the streets looking for those experiencing homelessness with pets to help provide care.

There is no hard medicine on the street, Stewart explained to attendees. A lot of the time, he is treating fleas, allergies, and lameness, and providing prevention and wellness care. 

Stewart then shared the story about meeting Richard. Although he was not unhoused at the time they met, Richard had been unhoused in the past, was a veteran who suffered from severe post-traumatic stress disorder and night terrors from witnessing combat. Stewart explained that the only thing that Richard said would help him is his dog, Courtney. The 2 crossed paths because Richard brought Courtney into the clinic because she was not urinating, and Stewart found she had 300 bladder stones.

“I wasn't trying to judge him, but we got to talk, and told me he lived in the trailer, and he was on Social Security, and just came by and I went back to make the estimates, and I was going to present it to him. I said, 'well, let's just treat Courtney today, get her in tomorrow, and we'll figure out the surgery portion when you come back,'” said Stewart.

“I knew that if I presented an estimate of $3000 it'd probably be hard for him to see that through. I said, 'would you mind,' and I didn't have the biggest social media at the time, 'if I posted your story on social media? See what kind of response I got? Maybe I can raise some money.' He said 'sure,' and that he didn't expect much. I didn't expect much [either]. I posted the story, and within 2 days, we raised $13,000 for Courtney,” he shared.

When they came back to the clinic, Stewart told them what had happened and that her care was paid for, asking what they wanted to do with the rest of the money. Richard told Stewart to keep the rest to pay it forward to someone else in with a pet in need.

Fast forward 13 years later, Stewart has kept his original promise to that man outside of 7-11 and his pet by providing care to pets, and their owners. He has worked with Richard to build free pet food banks on Skid Row, is working on legislation to help keep pets and their owners together, and has brought Project Street Vet to cities all over the United States. In 2023, Stewart was one of the finalists for the 

To close his lecture, Stewart shared that he has served as a animal safety representative for Netflix the last 9 years. During his time in this position, he had the chance to work on site for the movie 

 He shared with the Fetch audience that he would stand on the side monitoring the animals to make sure they were safe. During his time, he happened to overhear a conversation between Brad Pitt and another person on set, and he thought about what he had heard while he was walking on Skid Row later that day.

“I’m walking the streets, and meet a gentleman, and we get to talking about his dog. After while I was treating the dog. Now, earlier that same day, when I was on set with Brad, when he was stepping out [of the scene], I heard him for a little bit gushing about a dog. He [was saying] 'I come home, and she's there.' And I love hearing that he didn't sound like one of the most famous people in the world. He just sounded like a normal guy,” Stewart said.

“And when I was on the streets meeting this gentleman, whose name you will never know, he started talking about his dog. I swear, if I had closed my eyes for just a moment and thought about just 2 hours prior, again, this man, gushing about his dog and one of the most famous people in the world talking about their dog, they sounded like the exact same person. I thought that was so cool. It just reminded me how much animals, pets, their lives reduce us to just people, right? There's this really cool thread or connection that animals create between 2 human beings, and it was, it was one of my favorite experiences,” he concluded.

Stewart told the audience that this moment made him feel so lucky to be doing what he was doing and to have the career that he has. To close out his lecture, he wanted the audience to know that the people that are experiencing homelessness in their cities or the cities they visit for conferences. They just need help for something they love so deeply, their pets.

Stewart K. Why We Don’t Stop: The Unique Animal that is a Veterinarian. Presented at: Fetch dvm360 Conference; Long Beach, CA. December 6-8, 2024.

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Day 2 of Fetch Long Beach kicked off with Kwane Stewart, DVM, sharing the path his career took to land him where he is today 

Honoring a lifelong pledge

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.

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.

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

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