Treating an itchy pet means considering several different factors and medications. There is not a one-size-fits-all approach to targeting the source of an itch. Adam Christman, DVM, MBA, of 

, spoke with Julia Miller, DVM, DACVD, about multimodal treatment plans for a pet and what options are out there for pet owners.

 Topical treatments for canine pruritus vary widely. What are the key considerations when selecting a topical therapy for an itchy dog?

 There are a few things to consider. Is it just an itch? Is it an itch accompanied by a bacterial or yeast infection? Does the dog have greasy or dry skin? Unfortunately, treatment must be patient tailored, but the good news is there are a lot of products on the market to fit the needs of every pet.

Could you elaborate on the role of topical corticosteroids in managing pruritus in dogs? How do you balance their efficacy with potential adverse effects?

 I’m careful with topical corticosteroids. Most of the steroids available in the US are potent, which means if you use them too much, they can cause the skin to thin. The skin can then get blackheads, tear easily, and be more prone to infections. I believe topical steroids are useful, with the caveat of using the right dose for the right patient.

 How do you address adherence issues with topical therapies in dog owners? Are there specific strategies or tips to improve adherence to treatment plans?

 The market has changed in the last few years, mostly because of the realization that leaving on certain products, like shampoo, can be difficult for pet owners. There are sprays, mousses, spot-ons, and other products that make it much easier for clients to be [adherent]. With
every client, I ask, “What can you do?” so I don’t send them out the door with a product they won't use.

Distractions make application easier for pets. Giving a pet a special treat or a lick mat alongside their treatment mixes the good with the bad. It could make them less likely to run away.

 Could you discuss the importance of proper skin barrier maintenance in dogs experiencing pruritus and how topical therapies contribute to this aspect of care?

The epidermal barrier is something we have done more research on in recent years. We think of allergic animals both from the inside out and the outside in. It is important to keep the skin hydrated, so the epidermal barrier remains intact. If it breaks apart, allergens, microbes, and yeast can penetrate the skin, leading to secondary bacterial infections and a greater itch. Certain medications like Apoquel or Cytopoint are more effective with a healthier skin barrier.

 In cases where systemic therapies are also prescribed, how do you determine the synergistic role of topical treatments in managing itchiness alongside oral medications?

 Allergy management is multimodal. It is unlikely I will send a client home with only 1 treatment and call it a day. If you approach an itch from a whole-animal perspective, it helps you use less medications. It also lessens the number of allergic flares. I’m able to reduce the necessity of medications by supporting the epidermal barrier. On top of pills, I’m usually checking in with clients about whether they could use a spot-on treatment or spray to better enhance the efficacy of the treatment.

 What emerging topical therapies or innovations do you find promising in alleviating itching in dogs? 

 PYOspot is a spot-on treatment that goes along the top of the animal like a flea preventive treatment and has been proven to reduce bacterial pyoderma. Bio-Bomb is also an incredible product that, without being too greasy, hydrates noses and paw pads. The next product I recommend is Essential 6, which is an essential oil that moisturizes the skin. What I love about this line of products is they are wholistic and seek to benefit the pet as much as possible.

Articles

Examining an itch from the outside in and the inside out

Under the skin

Staffing and other challenges faced by veterinary practices are fueling discussion about how we can improve access to care for veterinary patients. These conversations are critical to animal health and welfare, and the American Veterinary Medical Association (AVMA) welcomes the rigorous conversation and engagement they are drawing from stakeholders across our profession.

One of the important roles that the AVMA is uniquely positioned for is providing timely, accurate, and data- driven information and analysis to inform answers to such questions. To this end, the association undertook a survey

 in September 2023 to understand current attitudes, wants, and needs of pet owners.

The AVMA Pet Owner Attitude Survey was fielded to better understand animal owners’ attitudes and experiences following the COVID-19 pandemic and their thoughts on some of the trends in veterinary care that emerged from the pandemic. Administered online, the survey was completed by 1000 pet owners across the United States. Quotas were used to ensure participants were representative of US adult pet owners.

The results are eye-opening. They indicate that some of the dramatic and far-reaching proposals pitched as solutions to access issues—such as a virtual veterinarian-client-patient relationship (VCPR) or the creation of a new midlevel position between the credentialed veterinary technician and the veterinarian—would, in fact, be met with resistance from pet owners.

 of pet owners agree that having the veterinarian physically examine their pet and talk to them in person is what leads to the best care. Only 4% disagree, while 8% are indifferent.

 of pet owners would feel more confident in their veterinarian’s treatment plan for their pet if the veterinarian examined the pet and met with them in person before using telemedicine.

These survey results belie the claims of groups and individuals pushing to allow the establishment of a VCPR virtually, without any in-person examination or visit to the premises. Although proponents claim this would increase access to care by allowing telemedicine appointments for animal owners who do not otherwise visit a veterinarian, these data suggest differently.

It’s clear that pet owners prefer and instinctively recognize the importance of establishing an in-person relationship with their veterinarian, prior to seeking virtual care. For clients to embrace and trust telemedicine, we need to acknowledge and honor these preferences.

Once an in-person VCPR has been established, telemedicine can be an important tool to improve the effectiveness, continuity, and efficiency of veterinary care, and for growing relationships with clients.

Owners prefer veterinarian-led care and value pet health and safety

 of pet owners prefer that a veterinarian—not someone else, like a proposed midlevel practitioner— oversee their pet’s care. Only 7% disagree, and the other 14% have no opinion.

 of pet owners put their pet's health and safety above all else as a top priority for veterinary care.

A proposed midlevel position is being suggested by some as a remedy to the staffing struggles and related barriers to veterinary care that were exacerbated by the COVID-19 pandemic. However, the survey responses fail to support this notion.

Instead, the findings suggest that most pet owners intuitively know what many of us recognize as true—that allowing someone other than a veterinarian to diagnose, prognose, make treatment recommendations, prescribe, or perform surgery would jeopardize patient health and safety. Indeed, respondents voiced a strong preference for veterinarian-led care, and they opposed delegating responsibility for care decisions to nonveterinarians.

Simply put, a new midlevel position would not improve access to care because most owners do not want it.

 of pet owners waited less than a week for their last nonemergency appointment, and 60% waited 3 days or less.

 of pet owners waited less than 2 hours to be seen the last time their pet had an immediate medical emergency.

These numbers, along with other data from Vetsource and VetWatch showing declines in clinic visits,

 are evidence that the demand for veterinary services is normalizing to prepandemic levels. They also refute outdated claims that pet owners seeking to visit the veterinarian in person are unable to do so on a timely basis— another justification cited by supporters of a virtual VCPR and the creation of a new midlevel position.

The most important consideration for any proposal to address our profession’s workforce challenges is that it must prioritize patients’ needs. A virtual VCPR and a midlevel position are the wrong answers—both because they would put patient health and welfare at risk and because they are not what clients want.

If your state is among those considering a virtual VCPR or introducing a new midlevel position, you can help by sharing these survey findings with your state policymakers and working with your state and local veterinary medical associations to build understanding of the need for the in-person VCPR as well as the dangers of a new midlevel position.

The most effective approaches to the staffing challenges we face in our veterinary practices are those that focus on retaining staff—especially veterinary technicians, veterinary technologists, and veterinary technician specialists— leveraging them to the top of their degrees and utilizing technology to drive efficiency.

Telemedicine is an important tool in our toolkit. It is not a substitute for in-person veterinary care, but proper use of telemedicine can most certainly enhance and expand care delivery. The AVMA provides resources that empower veterinarians to explore and integrate telemedicine and other telehealth services that animal owners are seeking. Find them online at avma.org/ telehealth.

1. 2023 Pet Owner Attitude Survey: key findings. American Veterinary Medical Association. November 2023. Accessed November 15, 2023.
https://www.avma.org/sites/default/files/2023-11/AVMA-2023-Pet-Owner-Attitude-Survey-For%20Release-20231101.pdf

2. Veterinary industry tracker. Vetsource. Accessed December 7, 2023.
https://vetsource.com/resources/veterinary-industry-tracker

3. Veterinary market trends. VetWatch. Accessed December 7, 2023.
https://www.vetwatch.com/veterinary-market-trends/#site-content

Recent survey findings revealed which practice trends may be affecting client satisfaction

What pet owners really want

“Good oral exams can save lives,” said Naomi Hoyer, DVM, DAVDC, assistant professor of dentistry and oral surgery at Colorado State University’s College of Veterinary Medicine and Biomedical Sciences in Fort Collins. Lifting the lip during every physical examination can help veterinarians to identify oral masses when they are small.

“We can fix oral cancer a lot of the time when it’s found early,” Hoyer stated during a session at the 2024 Veterinary Meeting & Expo in Orlando, Florida.

 “A lot of the early work up of oral neoplasia is doable in [general] practice,” she continued, providing general practitioners a road map for approaching oral masses in dogs and cats.

Once an oral mass is identified, Hoyer encourages veterinarians to make an educated guess as to whether it is benign or malignant based on the characteristics of the mass. Important considerations are as follows

: Benign masses most commonly arise from gingival tissue while malignancies can arise anywhere in the mouth.

: Benign masses typically match the pigment of the surrounding tissue while malignancies are more likely to differ in color.

: Benign masses tend to be rounded while malignancies are more likely to be irregular.

: Benign masses are less likely to destroy bone while malignancies can cause dramatic loss of bone.

The size of masses can vary greatly, regardless of whether they are benign or malignant. Size depends on how long the mass has been present and the type of mass. Additionally, surface ulceration can be present in both benign and malignant masses. With benign masses, ulceration may occur on masses that are in a location allowing for tissue trauma when the pet chews.

Malignancies are more likely to become ulcerated as they grow. Developing a differential diagnosis list for the mass allows veterinarians to plan how to obtain a definitive diagnosis and prepare the client for what comes next.

“Oral tumors do not exfoliate well,” said Hoyer. She recommended veterinarians skip aspiration and move right to a biopsy. However, she implored veterinarians to “please take pictures before you biopsy.” Photos can help the pathologist as well as provide essential information to the specialist who may perform follow-up treatment.

Incisional biopsies are preferred when malignancy is suspected. The tissue sample should be taken from the center of the lesion to avoid making a definitive surgery larger. Excisional biopsies are reasonable when benign lesions are suspected. Hoyer said that she tells her clients, “If I guess wrong and this is a malignant tumor, then we need more [treatment]. If I guess right, then we are done.”

When obtaining biopsies, it is important to avoid compromising adjacent teeth while collecting a large sample or multiple samples to maximize the ability to get a definitive diagnosis. Avoid the use of laser and cautery in the mouth.

Clients should be prepared for possible outcomes, including the need for referral for more definitive surgery pending biopsy results. For clients that are not interested in referral, having a definitive diagnosis can help to give a prognosis and set expectations for what the pet may experience.

In dogs, a majority of oral masses—53.6%

—are benign. Common benign lesions include gingival hyperplasia, peripheral odontogenic fibroma (POF), which was previously referred to as an epulis, and canine acanthomatous ameloblastoma (CAA). Common malignant lesions include oral melanoma, squamous cell carcinoma, and fibrosarcoma.

POFs are typically slow growing but can vary in appearance. They often arise in the gingiva overlying teeth, which makes them impossible to close. Owners should be advised that some postoperative bleeding is normal in these cases, but the tissue will heal quickly. Most of these growths are resolved by a conservative excisional biopsy. If they regrow, the adjacent tooth will need to be removed, as these can arise from the periodontal ligament.

CAAs are benign, locally aggressive tumors that occur most commonly in the rostral oral cavity. They can cause some bony destruction, which may lead to a suspicion of malignancy prior to biopsy. Hoyer cautioned that these nodules may grow more rapidly after biopsy is collected. A larger surgical excision is needed to remove these growths, but they rarely metastasize and have a good prognosis following definitive surgery.

Melanomas are the most common oral tumor in dogs. Although many are pigmented, an amelanotic variety exists. Owners should be prepared that these tumors grow quickly and often metastasize. Treatment involves large surgery and ancillary treatments such as immunotherapy or radiation with or without chemotherapy.

Squamous cell carcinomas are red, raised, ulcerated growths that typically cause extensive bony destruction and are likely to metastasize. Treatment includes wide surgical excision and radiation therapy. Prognosis is improved for masses present in the rostral oral cavity as definitive surgery is more feasible.

Fibrosarcomas are more common in large breed dogs. They can be cured by wide surgical resection as they are slow to metastasize. Hoyer cautions veterinarians to be aware of one variety of fibrosarcoma that is histologically low grade but biologically high grade. This variant may sometimes be called a POF on initial biopsy but may quickly regrow and cause bony destruction, which are behaviors that are atypical of a POF.

When it comes to cats, “with very few exceptions, it is going to be squamous cell carcinoma,” said Hoyer. The majority of oral masses—approximately 58%

—of oral masses in cats are malignant. There are limited treatment options for these masses and the prognosis is poor, she noted.

Hoyer advised veterinarians to be vigilant in cat mouths as these tumors can have variable appearance. Whenever there are easy to extract teeth, she recommends collecting a bone biopsy from the surrounding bone. If the owner does not want to submit the sample right away, it can be kept and submitted if complications arise from the extraction site to evaluate for the presence of neoplasia.

General practitioners should feel confident in their ability to begin a workup for oral masses in many patients. After careful evaluation of the appearance of the mass, a suspicion of whether the mass is benign or malignant can be developed. This suspicion will guide the approach to biopsy and client communication. Definitive surgery and ancillary treatment will often require referral to a specialist, but when caught early, many oral tumors in dogs can have good long-term prognoses. Unfortunately, oral masses in cats are more likely to be malignant and carry a much poorer prognosis.

Hoyer N. Oral neoplasia: I can help you work it up. Presented at VMX 2024: Orlando, FL. January 13, 2023.

Cray M, Selmic LE, Ruple A. Demographics of dogs and cats with oral tumors presenting to teaching hospitals: 1996-2017. 

. 2020;21(5):e70. doi:10.4142/jvs.2020.21.e70

It is important to prepare clients for possible outcomes and create a plan to determine a definitive diagnosis

The diagnostic approach to oral masses

Dr David Dycus explains why canine osteoarthitis is a complex disease during this interview with dvm360 at Veterinary Meeting & Expo

Interview with David Dycus on canine osteoarthritis

When it comes to treating pet patients, a constant challenge that remains is their inability to communicate what is wrong with them like a human could. Because of this, it can be tricky to track progressions and see the quality of life of patients suffering from a disease like canine osteoarthritis. To combat this, a lot of factors need to be thought of and considered when it comes to a patient who potentially has this disease.

David Dycus, DVM, MS, CCRP, DACVS-SA, explains some of the reasons why canine osteoarthritis is a complex disease for veterinary professionals, plus why it is crucial to diagnose and treat this disease early. 

So the problem is when we diagnose osteoarthritis, it tends to be in the latter course of the disease. So we've lost a lot of time that we could have managed it. Unlike in people, osteoarthritis in the dog tends to come from secondary effects such as developmental orthopedic diseases. So it's not an old dog disease, and dogs don't get osteoarthritis just because they get old. And in fact, about 40% of dogs from about 8 months to 4 years, have radiographic evidence of osteoarthritis.

Young dogs and arthritis - Canine Arthritis Management. Accessed January 23, 2024. https://caninearthritis.co.uk/what-is-arthritis/young-dogs-and-arthritis/

Videos

Dr David Dycus explains multiple reasons that makes canine osteoarthritis complex, plus why it is important to diagnose sooner rather than later

Why is canine osteoarthritis so complex?

Innovative veterinary technology comes from Laurent Guiot DVM, DACVS, DECVS, in which he developed a robotic device to assist with minimally invasive orthopedic surgeries on dogs and cats. According to the news release from Thrive Pet Healthcare,

 this approach provides the possibility for a smoother and quicker healing process, can reduce the risk of infection, and can result in an overall less invasive surgical experience for the pet.

Dr Guiot's robotic surgery assistant. (Photo courtesy of ACCESS Bone and Joint Center and Thrive Pet Healthcare)

Guiot built the robotic assistant from a kit and customized parts using a 3D printer and can be controlled using an X-Box joystick, allowing him to precisely stabilize the patient's affected joint before inserting a securing screw. By leveraging this new technology, Guiot can perform orthopedic procedures without resorting to a large incision, opting instead for a smaller one.

“We have shown that our one-of-a-kind robotic-assisted procedure permitted accurate surgical execution in a couple of cases,” said Guiot in the release. “Like human doctors, veterinarians are always striving for the least invasive, most comfortable surgical experience for our patients, and our new procedure has helped us make great strides to that end.”

Robotic device used during orthopedic surgery. (Photo courtesy of ACCESS Bone and Joint Center and Thrive Pet Healthcare)

Recovery time after an open surgical procedure can take 8-12 weeks, depending on the specific condition being treated, the type of surgery performed, and the individual animal’s overall health and healing capabilities.

 After an open surgical procedure, animals are typically required to rest and limit their physical activity to allow for proper healing. However, this new technology could help with a faster recovery time, allowing pets to return to their normal activities sooner and reduce the overall impact on their quality of life. It also reduces tissue trauma and the risk of infection because of the smaller incisions. There is less damage to surrounding tissues and muscles and can also result in less postoperative pain. This development also reduces blood loss during surgery and can be especially beneficial for patients with underlying health conditions.

Guiot and his team at ACCESS Specialty Hospital-Los Angeles used this robotic technology on Zanee, a 5-year-old Maltipoo, and found that the dog was able to begin walking comfortably again just 2-weeks post-op.

“We’re looking forward to continued success using the robot to assist with orthopedic surgeries,” said Guiot. “We plan to invest in additional research to improve robotic arm performance.”

Guiot is a leading orthopedic surgeon at the Bone and Joint Center within ACCESS Specialty Hospital, under the Thrive network. The Bone and Joint Center offers orthopedic care for dogs and cats by combining veterinary surgeons’ expertise and cutting-edge resources. The center also offers 24/7 post-operative care for hospitalized patients recovering from surgery.

 Guiot graduated with a veterinary medicine degree in 2004 from the University of Liege in Belgium and is board-certified by the American and European College of Veterinary Surgeons.

Dog walks in record time after revolutionary robotic-assisted orthopedic surgery. News release. Thrive Pet Healthcare. January 10, 2024. Accessed January 23, 2024. 

https://www.thrivepetcare.com/thrive-guide/dog-walks-in-record-time-after-revolutionary-robotic-assisted-orthopedic-surgery?redirectUrl=/media-center

What to know about ACCESS Bone And Joint Center. Thrive Pet Healthcare. Accessed January 23, 2024. 

https://www.thrivepetcare.com/services/access-bone-and-joint-center

This innovative technology could improve and accelerate post-operative recovery time

New robotic device could improve patient recovery after orthopedic surgery

Veterinary Emergency Group (VEG) announced that it has launched a scribe role position in its hospitals, making it the first to do so in the veterinary medical field. The new position will work alongside doctors to help reduce the time they spend on documentation.

“By being the first to introduce a Scribe role to the veterinary medical field, we are positioned to make a huge impact on the industry and once again shift the paradigm,” said David Bessler, founder and CEO of the Veterinary Emergency Group, in an organizational release.

 “The Scribe role that has been used historically in traditional healthcare will offer a variety of benefits to the VEG team that includes burnout reduction, improved communications and workflow, customer benefit and career inroads.”

 the VEG Scribe position is cutting down documentation time by 87% ranging from 4 hours to 30 minutes. With the new position, VEG hopes this can help its doctors create a better work-life balance while raising morale, creating a ripple effect throughout each VEG hospital. The VEG Scribes are shown to increase medical quality and allow better communication between patients, doctors, and referring veterinarians through record-writing.

This new position will also help doctors provide undivided attention to clients by providing a better experience when in a VEG location, The VEG Scribes will also create more job opportunities within the veterinary emergency field as well as learn from other veterinary professionals within VEG. Currently, 100 VEG Scribes are working in various locations.

Veterinary Emergency Group is the First to Introduce a Scribe Role in the Veterinary Medical Field and Sets a New Industry-Wide Standard with Positive Outcomes. News release. Veterinary Emergency Group. November 29, 2023. Accessed January 22, 2024.

The VEG Scribe role will assist doctors by reducing the time they spent documentation per shift 