Do you feel that placing all your dental eggs into February, National Pet Dental Health Month, leaves the other 11 months of the year jealous? If so, consider embarking on a yearlong dental journey, dedicating each month to plunge into a specific dental subject. This, akin to eating a large meal 1 bite at a time, allows for a deeper understanding of each discipline’s complexities, evidence-based therapeutic strategies, and evolving paradigms.

An introduction to various areas of dental care with suggestions for each month are as follows:

Periodontal disease, incited by plaque, is the upregulation of inflammation leading to the progressive destruction of tooth support affecting 80% of dogs.

 Embracing diagnostics and therapeutic approaches tailored to each stage of periodontal disease will be time well spent, effectively managing and preventing this common ailment.

There are 4 recognized stages of periodontal disease, each with specific diagnostic criteria and treatment.

Using a diagnostic test alerting to the presence of thiols (caused by gram-negative oral bacteria) incorporated into every wellness visit will result in greater awareness (

The stages of periodontal disease are as follows:

Mild inflammation and redness of the gingiva; slight bleeding on probing.

Treatment: professional dental cleaning to remove plaque and calculus (tartar), followed by diligent home care with brushing (or wipes) and daily Veterinary Oral Health Council (VOHC)—approved dental product use.

Diagnosis/treatment: supragingival and subgingival scaling, polishing, and irrigation, followed by probing to assess pocket depths or attachment loss. Home care remains crucial to decrease the progression of the disease.

With tooth support loss, diagnosis can be made with probing and intraoral radiographs showing bone loss between the cementoenamel junction and the apex.

Treatment: advanced gingival surgery or extraction of the affected teeth.

Many patients experience tooth support loss diagnosed through probing and intraoral radiographs and through-and-through furcation exposure.

Early intervention and consistent daily (or better, twice daily) home care with VOHC-accepted dental wipes, water additives chews, and tooth brushing as well as twice-yearly dental checkups and care can significantly reduce periodontal disease progression and its associated health risks.

Most pet owners will have their animals examined semiannually to help them have longer and healthier lives.

 Tooth resorption affects approximately 30% of mature dogs

 Resorption becomes painful once the lesion progresses to oral cavity exposure.

Tooth resorption is progressive and classified with 5 anatomic stages

 and 3 radiograph types. The radiograph types dictate treatment.

Therapy options include follow-up, extraction, or coronectomy with gingival closure, depending on the clinical and intraoral radiograph findings.

Tooth resorption is considered to be progressive.

Root replacement resorption is diagnosed radiographically (

), with decreased root opacity compared to adjacent teeth and lack of periodontal ligament space. This type 2 root resorption can be successfully treated with coronectomy and gingival closure, isolating the root from the oral cavity, which allows continued replacement with bone. Extraction is the treatment for all other forms of root resorption (types 1 and 3) that have either compromised the tooth or are exposed to the oral cavity (

Marked generalized gingival and oral mucosal inflammation is termed stomatitis. Its etiology is multifactorial, implicating plaque. Extraction of the cheek teeth or all teeth and subgingival root fragments is curative in many cases in approximately 60% of cases (

). Carbon dioxide laser ablation and alternate-day prednisolone are often helpful in refractory cases.

When caudal oral cavity inflammation is present, the prognosis is guarded even with full mouth extractions.

Repository steroids and antibiotics are not indicated in the treatment of stomatitis.

The extraction of all teeth and subgingival root fragments is usually curative.

Peripheral odontogenic fibromas (POFs), gingival enlargements (

), and cysts are benign oral swellings. Peripheral odontogenic fibromas (formerly known as fibromatous and ossifying epulis) are benign, often slow-growing tumors arising from periodontal structures (gingiva, periodontal ligament, and bone). POFs can be further subclassified as peripheral odontogenic fibromas and acanthomatous ameloblastoma.

Figure 4: Multiple gingival enlargements in a boxer dog; the extensive left mandibular mass histopathology confirmed peripheral odontogenic fibroma.

Many oral masses enlarge over time, placing pressure and causing discomfort on the periodontal ligament space. Early intervention can be curative to alleviate the need for major oral surgery. 

Oral cytology examined before excision can create a surgical plan that alleviates the need for incisional biopsy.

Excision with at least 1 cm clean margins renders an excellent prognosis.

Oral melanoma, fibrosarcoma, squamous cell carcinoma, osteogenic sarcoma, and plasma cell tumors are the most common malignant oral tumors in dogs. Squamous cell carcinoma is the most common oral tumor in cats.

Oral neoplasia accounts for 6-7% of all cancers in dogs, and 3% of all feline cancers.

 Because of the aggressive nature of malignant oral tumors, early intervention carries the best prognosis.

Excision with at least 2 cm clean margins renders a guarded to good prognosis. (

Rostral tumors carry a more favorable prognosis than caudal tumors.

There is an oral melanoma vaccine administered by oncologists after debulking.

Follow-up radiation therapy is often indicated after excision to clean up residual cancer cells.

Figure 5: Curative excision with greater than 2 cm clean surgical margins in all directions.

Temporomandibular joint (TMJ) diseases in dogs and cats include ankylosis, luxation, osteoarthritis, congenital abnormalities, traumatic fractures, and neoplasia.

These often-painful conditions can severely hinder the ability of dogs and cats to eat, drink, groom, and vocalize, leading to chronic discomfort and a diminished quality of life. Early diagnosis and prompt treatment are crucial to avoid complications including jaw misalignment (

), bone erosion, and permanent nerve damage.

Figure 6: A 17-week-old kitten with traumatic malocclusion.

TMJ ankylosis involves surgical intervention to free up the rostral mandible from the affected joint.

Cranial dorsal TMJ luxation often can be cared for with a pencil or tuberculin syringe placed between the caudal cheek teeth accompanied by mouth closure to replace the luxated condyle in the glenoid fossa.

Dental and jaw fractures are common because of fights, automobile accidents, and hard chew products owners buy for their dogs to relish. Unfortunately, dentoalveolar trauma often leads to damage, infection, and pain.

Physical examination after mandibular trauma often reveals malocclusion resulting from the collapse of the rostral mandible toward the side of the injury in unilateral fractures. Dropped jaws (inability to close the mouth) occasionally occur from bilateral fractures.

Fractures of the mandibular bodies can be classified as favorable or unfavorable. Favorable mandible fractures run dorsocaudal to ventrocranial. The upward pull of the masseter and temporalis muscles and the downward caudal influence of the digastricus muscle compress the fracture. Stabilization of the tension surface may be required for bony healing (

Unfavorable mandibular fractures run from dorsocranial to ventrocranial, distracting the fracture fragments. The alveolar crest bone is considered the tension surface, while the ventral cortex is the compression surface. Fixation devices must be load-bearing since no natural mechanism for fracture reduction exists.

Figure 7: Noninvasive stabilization with suture and buttons.

Month 8 spotlights the interplay between oral health and inflammation (

), including gingivitis, contact mucositis, and stomatitis.

As in humans, oral inflammation in animals is painful. Chronic inflammation fuels bacterial invasion and threatens systemic health.

Gingivitis (no loss of tooth support) treatment includes dental scaling, polishing, and irrigation followed by daily home care.

For contact mucositis initial care, strict plaque control, pentoxifylline 20 mg/kg orally twice a day, and niacinamide at 250 mg orally twice a day are also helpful. Alternatively, extraction of the contacting tooth is usually curative.

Tooth fractures are classified as complicated (exposed pulp) and uncomplicated (enamel or enamel and dentin exposed). Some tooth fractures also extend subgingivally (crown-root fractures). Understanding what to do for patients affected with traumatized teeth can be challenging due to the variations of presentation. 

Complicated crown fractures create direct access of bacteria and oral debris to the pulp. Initially, the tooth will be sensitive.

When the pulp is not exposed, and the dog or cat is an adult, generally nothing needs to be done unless there is radiograph evidence of periapical pathology.

In a young—less than 2-year-old—dog or cat, the pulp is large, relatively close to the fracture site, and sensitive to heat, cold, and pressure. Tooth restoration is indicated in these cases.

When the pulp is exposed, and the dog or cat is an adult, vital pulp therapy can be performed if the trauma occurred within a 48-hour window.

Month 10: Choosing the right chew for your patients

Maintaining oral hygiene in pets requires a multipronged approach, including methodical home care. Dental chews have become increasingly popular as a convenient option for at-home oral care, promising to remove or at least decrease plaque and prevent tartar buildup. With many brands, textures, and claims on the market, we face a critical task: helping our clients navigate the dental chew maze to choose the most effective options.

The first step in making informed recommendations is understanding the types of dental chews and their mechanisms of action. Common categories include the following:

Abrasive chews, which typically feature complex textures, including rawhide, are designed to scrape away plaque and debris through physical chewing action.

Enzymatic chews contain enzymes like lysozyme, which help break down and loosen plaque for easier removal.

Dental treats often resemble regular treats and are formulated with plaque-reducing ingredients.

Veterinarians and staff can influence their clients’ choice of safe and effective dental chews.

The VOHC has accepted 72 dog and 17 cat products that decrease the accumulation of plaque or tartar.

Articles

Veterinary teams can incorporate oral health into their practice 1 evidence-based bite at a time

How to approach pet dental care year-round

Last year, Guide Dogs for the Blind (GDB) expanded its pool of volunteer puppy raisers with a 

hybrid puppy-raising initiative in Northern California

. Anyone who lived within 50 miles of its headquarters campus in San Rafael, California was qualified to submit an application. This was the first time GDB tried a new pilot program offering online training, webinars, and in-person workshops. Previously GDB exclusively used in-person, hands-on training and informative meetings.

Family in hybrid puppy raising program holding their guide dog puppy, Sandra. (Photo courtesy of Guide Dogs for the Blind and Business Wire)

Now, GDB is expanding once again to Oregon for another hybrid puppy-raising program.

 Following the success seen with the pilot program in Northern California, GDB hopes that expanding to Oregon will help attract applicants who may not live near a puppy club or have lifestyles that do not easily accommodate regular club activities.

“GDB wants to meet volunteers where they are, providing individuals and families with a way to contribute to the guide dog puppy raising program while balancing other commitments and activities,” said Guide Dogs for the Blind president and CEO, Christine Benninger, in the news release. "Our innovative hybrid puppy raising model is geared toward attracting and retaining a broader spectrum of volunteers, ensuring a flexible and enriching experience for all.”

GDB’s Hybrid Puppy Raising team will be accepting interest forms from people who live within 75 miles of its Boring, Oregon campus and an introductory meeting to discuss the hybrid program will be available on March 23, 2024, at the Boring campus, and again on March 28 via Zoom.

 The meeting is designed to help interested parties decide which puppy-raising model is right for them.

Volunteers who are chosen to raise GDB puppies will raise them from ages 2 to 15 months. During this time, the puppies should be developing confidence and obedience, while also getting as much socialization as possible from monitored activities. These efforts ultimately prepare puppies for thei future roles as guide dogs to recipients in need, K9 Buddies for police and military officials, or breeding dogs for GDB. Once these puppies reach 15 months of age, they will return to the GDB campus for formal training conducted by GDB professional trainers.

More information about the program or application can be found on the GDB website.

Guide Dogs for the Blind unleashes new puppy raising program to expand volunteer base in Oregon. News release. Guide Dogs for the Blind. February 13, 2024. Accessed February 14, 2024. 

https://www.businesswire.com/news/home/20240213800822/en

Expanding outreach with a new hybrid puppy-raising program

Guide Dogs for the Blind expands to Oregon

Diseases primarily affecting the pericardium account for approximately 5% of all patients with cardiovascular disease.

 Although primary pericardial disease represents a small percentage of the total number of cardiac diseases in small animals, it is an important cause of right heart failure in dogs. Primary pericardial disease in cats is uncommon; most frequently representing a sequelae of primary myocardial disease. Several types of primary and secondary pericardial diseases occur, the most common of which are those resulting in pericardial effusion.

There are several congenital diseases of the pericardium recognized in small animals. Although peritoneopericardial diaphragmatic hernias (PPDH) are the most common type of congenital abnormality encountered (Figure 1), sporadic reports of partial pericardial defects and intrapericardial cysts have been published.

Figure 1: Lateral and ventrodorsal radiographs of a cat with a peritoneal pericardial diaphragmatic hernia (PPDH). Notice the irregularity of the cardiac silhouette as well as the variable density within the pericardial shadow consistent with omental and hepatic herniation.(All images courtesy of Miller)

Diseases causing pericardial effusion are the most common causes of clinically significant pericardial disease in dogs. Idiopathic intra-pericardial hemorrhage and neoplasia of the heart, heart base, or pericardium are the most common causes of hemorrhagic effusion in this species.

 Clinically important tumor types in dogs include hemangiosarcoma of the right atrium, commonly seen in golden retrievers and historically in German shepherd dogs. Aortic body tumors (chemodectoma, nonchromaffin paraganglioma) with invasion of the heart base are most seen in aged brachycephalic breeds such as Boston terriers and boxers. Less common tumor types include ectopic (heart base) thyroid carcinoma, mesothelioma, and metastatic carcinoma. A well-recognized but uncommon cause of intrapericardial hemorrhage in small breed dogs is left atrial tear secondary to severe chronic endocardiosis of the mitral valve. Infectious causes of pericardial effusion including coccidioidomycosis are uncommon but represent an important cause of pericardial disease in endemic regions.

Special breed predilections have been noted above and most frequently, animals with pericardial disease are presented with vague signs. Clients will frequently describe lethargy, exercise intolerance, and anorexia. Occasionally, patients with more advanced disease will be presented for signs of right heart failure including abdominal distension, respiratory difficulty, or syncope.

Signs of elevated right heart pressures are consistently present in patients with clinically significant pericardial disease. Jugular venous distention (Figure 2) or positive hepatojugular reflux are invariably present, but commonly overlooked. Heart sound intensity is frequently diminished. Lung sounds may be diminished if pleural effusion is present. Other auscultatory abnormalities (gallop rhythms, cardiac murmurs, arrhythmias) are very uncommon. Dogs with left atrial tears secondary to chronic degenerative valvular disease will have a systolic murmur that may decrease in intensity when compared to previous examinations. Hepatomegaly and free abdominal fluid may be found. If the disease is chronic, significant weight loss may be observed.

Figure 2: Jugular venous distention in a dog with a chemodectoma, large volume pericardial effusion, and resultant cardiac tamponade.

Thoracic radiography usually demonstrates abnormalities when there is significant accumulation of pericardial fluid. The cardiac silhouette loses its angles and waists and becomes globe-shaped (Figure 3). Most cases are not "classic" and require integration with the other data. Pulmonary vascularity is often reduced from low cardiac output in contrast to congestive heart failure (CHF) from cardiomyopathy or valvular disease in which the pulmonary vascularity may be increased (especially the pulmonary veins).

Figure 3: Lateral and ventrodorsal radiographs of a dog with large volumetric pericardial effusion. Note the lack of specific chamber enlargement patterns. The sheer degree of enlargement of the cardiac silhouette should raise the suspicion of pericardial effusion.

Electrical alternans is a beat-to-beat voltage variation of the QRS or ST-T complexes (Figure 4). It may be recorded in as many as 50% of patients with pericardial effusion. Elevation of the ST segment is commonly recorded in patients with pericardial disease. Reductions in QRS voltage (R < 1 mV in Lead II) are commonly recorded in dogs with pericardial effusion. In the author's experience, arrhythmias other than sinus tachycardia are uncommon in primary pericardial disease.

Figure 4: Lead II electrocardiogram showing atrial tachycardia with an average heart rate of 180 bpm. Additionally, the 1:1 variation in R-wave amplitude is consistent with a diagnosis of electrical alternations, a common finding in patients with large volume pericardial effusion.

Echocardiography is the most sensitive and specific non-invasive method of detecting pericardial effusion currently available (Figure 5). The hemodynamic consequences of pericardial effusion depend not only on the amount of pericardial effusion present but also the rapidity with which the effusion has accumulated. A small or moderate amount of fluid that accumulates rapidly (left atrial rupture) may produce significant hemodynamic compromise, while a large effusion that accumulates over months may have little hemodynamic effect.

Figure 5: Right parasternal short axis view obtained at the level of the mitral papillary muscles. A large anechoic separation is noted between the epicardium and the pericardium characteristic of pericardial effusion.

Pericardiocentesis is the treatment of choice for initial stabilization of dogs and cats with pericardial effusion and cardiac tamponade. When performed properly, pericardiocentesis is associated with minimal complications. Before performing pericardiocentesis, it is necessary to shave and surgically prepare a large area of the right hemithorax (sternum to mid thorax, third to eighth rib). Local anesthesia is sometimes adequate; however, mild sedation is frequently necessary. It is important to ensure that the pleura has been infiltrated, as pleural penetration seems to cause significant discomfort. The patient is placed in sternal or lateral recumbency, depending on demeanor (Figure 6). Occasionally, pericardiocentesis can be accomplished in the standing animal, but adequate restraint is essential to prevent cardiac puncture or pulmonary laceration. Electrocardiographic monitoring during the procedure is helpful since epicardial contact often causes ventricular arrhythmias.

The puncture site is usually determined based on the location of the heart on thoracic radiographs. This is most commonly between the fourth and sixth rib spaces at the costo­chondral junction. Ultrasound guidance is infrequently necessary unless the volume of effusion is very small, or the effusion is compartmentalized.

The size of the needle or catheter used is dependent on the size of the animal. In cats, a 19-to-21-gauge butterfly catheter is typically appropriate. In large dogs, a 14- or 16-gauge over-the-needle catheter is used (Figure 7).

The needle or catheter should be attached to a 3-way stopcock, extension tubing, and a syringe to allow constant negative pressure to be applied during insertion and drainage. Care should be taken to avoid the large vessels that run along the caudal border of the ribs.

Once the catheter has been inserted through the skin, negative pressure should be applied. If pleural effusion is present, it will be obtained immediately upon entering the thoracic cavity. It is most commonly a clear to pale yellow color. As the catheter is advanced and contacts the pericardium, a scratching sensation will be noticed. Minimal advancement will result in penetration of the pericardium.

Figure 6: Patient positioned in sternal incumbency with a large area both clipped and prepped for sterile puncture using a large over-the needle catheter.

Figure 7: Basic supplies used for pericardiocentesis.

Most pericardial effusions are hemorrhagic and have a "port wine" appearance (Figure 8). Once effusion of this character is obtained, the catheter should be advanced over the needle, and the needle removed. The remainder of the drainage should be performed using the catheter. Advancing the needle too far will result in contact with the epicardium. This is often felt as a tapping or more intense scratching sensation and commonly results in ventricular arrhythmias. These arrhythmias are usually self-limiting following retraction of the needle or catheter.

Figure 8: Characteristic “port wine” appearance of pericardial effusion. Although the fluid appears very hemorrhagic, the PCV is approximately 10% arguing against acute hemorrhage or cardiac perforation.

Potential complications include cardiac puncture (with resultant hemorrhage or arrhythmias), coronary artery laceration, lung puncture or laceration, and dissemination of infection or neoplasia throughout the thoracic cavity. Diagnostic evaluations of fluid obtained should include PCV and cytologic evaluation. Bacterial culture and sensitivity should be performed if indicated by cytologic evaluation. Caution should be exercised when evaluating the cellular component of pericardial effusion. Clinically important neoplasia of the heart and pericardium (hemangiosarcoma, chemodectoma) commonly do not exfoliate, resulting in frequent false negative evaluations. Reactive mesothelial cells within the pericardial sac are commonly over-interpreted as being neoplastic, causing false positive results (Figure 9).

Figure 9: Cytologic sample from a patient with confirmed idiopathic hemorrhagic pericardial effusion. The cytologic characteristics of the intrapericardial mesothelial cells can be incorrectly interpreted as representing neoplasia

The long-term prognosis for dogs with hemorrhagic effusion is dependent on the underlying etiology. With idiopathic hemorrhagic pericardial effusion, a single pericardiocentesis is curative in approximately 50% of the cases.

In the remainder, repeat pericardiocentesis may be necessary to control clinical signs. Fluid may reaccumulate rapidly (within several days) or may not recur for months to years. In patients requiring more than 2 taps, the author recommends subtotal pericardiectomy. Following the initial pericardial tap, administration of oral prednisolone (starting at a dose of 1 mg/kg orally every 12 hours, then gradually tapering off over a two-to-three-week period) may be beneficial. Although anti-inflammatory doses of prednisolone are commonly administered to dogs with idiopathic pericardial effusion, there are no controlled studies to confirm the efficacy of this therapy. Subtotal pericardiectomy is usually curative in dogs with idiopathic pericardial effusion.

If cardiac or pericardial neoplasia is the cause of the pericardial effusion, the recommended therapy is influenced by the suspected tumor type. Aortic body tumors are commonly associated with slow growth and are late to metastasize. Subtotal pericardiectomy may afford palliation for up to three years. Recent studies have suggested that stereotactic radiation therapy radiation therapy coupled with Paladia may further improve survival.

 Hemangiosarcoma of the right atrium is associated with a poor long-term prognosis and pericardectomy is not recommended in these cases. Additionally, most hemangiosarcomas involving the right atrium or right ventricle are not amenable to surgical removal. The tumor has commonly spread to the lungs at the time of diagnosis and a small number of these patients may also have neoplastic lesions in the spleen or liver at the time of initial diagnosis.

Matthew W. Miller, DVM, MS, DACVIM (Cardiology) earned both a Doctor of Veterinary Medicine and Master of Science degree from The Ohio State University. He completed a small animal medicine and surgery internship at the West Los Angeles Veterinary Medical Group and a cardiology residency at The Ohio State University. He is a diplomate of the American College of Veterinary Internal Medicine (Cardiology). Miller has served as a faculty member at Texas A&M University’s College of Veterinary Medicine and Biomedical Sciences where he achieved the position of full professor with tenure. He is currently the founding medical director and a staff cardiologist at the Animal Medical and Surgical Center in Scottsdale, Arizona, and Thrive Pet Healthcare’s National Specialty Director of Cardiology.

Baisan R, Condurachi E, Turcu C, Vulpe V. Prevalence of cardiac diseases in small animals: a five-year single-centre retrospective study. 

https://agmv.ro/wp-content/uploads/2021/06/35_40_Baisan_6.pdf

Cabon Q, Carmel EN, Cabassu J. Cholecystopexy and Pericardial Pseudocyst Removal in a Dog with a Congenital Peritoneopericardial Diaphragmatic Hernia. J Am Anim Hosp Assoc. 2017;53(5):270-276. doi:10.5326/JAAHA-MS-6457

MacDonald KA, Cagney O, Magne ML. Echocardiographic and clinicopathologic characterization of pericardial effusion in dogs: 107 cases (1985-2006). 

. 2009;235(12):1456-1461. doi:10.2460/javma.235.12.1456

Carvajal JL, Case JB, Mayhew PD, et al. Outcome in dogs with presumptive idiopathic pericardial effusion after thoracoscopic pericardectomy and pericardioscopy. 

. 2019;48(S1):O105-O111. doi:10.1111/vsu.13129

Shaw SP, Rush JE. Canine pericardial effusion: diagnosis,treatment, and prognosis. 

Hansen KS, Théon AP, Willcox JL, Stern JA, Kent MS. Long-term outcomes with conventional fractionated and stereotactic radiotherapy for suspected heart-base tumours in dogs. 

. 2021;19(1):191-200. doi:10.1111/vco.12662

Unlocking insights into diagnosis, treatment, and prognosis in small animal cardiology

Pericardial disease: The forgotten cardiac malady

Video interview with Craig A Clifford, DVM, MS, DACVIM (Oncology)

Canine lymphoma: new approaches to diagnostics and treatment

Content sponsored by Dechra Veterinary Products, Inc.

“[Phenotyping] provides me information when I see the case and allows me to make more streamlined consult with the [patients’] owners,” said Craig A. Clifford, DVM, MS, DACVIM (Oncology), at the recent Fetch 

 As the veterinary industry shifts toward more individualized care approaches, canine lymphoma treatments and diagnostics are undergoing notable change. Because the different types of lymphoma have varying survivability rates and respond to treatment differently, the veterinary world is starting to put more focus on diagnostics and phenotyping.

Prior to planning treatment for canine lymphoma, a crucial step is to determine which classification the patient falls into; around one third of dogs are considered to have T-cell lymphoma, while around two thirds are considered to have B-cell lymphoma, and <2% of dogs are null cell.

T-cell lymphoma typically comes with a worse prognosis, with only around 50% of T-cell patients responding to a single dose of doxorubicin compared to around 100% of B-cell patients.

 T-cell lymphoma is also more common in certain breeds like Boxers, Golden Retrievers, Australian Shepherds, Asian lap dogs, and Siberian Huskies. Breeds that more commonly have B-cell lymphoma include Cocker Spaniels and Dobermans.

Because the phenotype of lymphoma drastically affects prognosis, it’s imperative that practitioners consider a patient’s classification prior to speaking with pet parents to ensure there is transparency throughout that conversation. “Now that we’re treating [canine lymphoma phenotypes] differently, it is important to know.” said Clifford. “It certainly plays a role in prognosis and knowing this information is going to be important.”

Tests involving immunohistochemistry, immunocytochemistry, PARR, and flow cytometry can be performed to determine the patient’s phenotype and the resulting treatment protocol.

“Many oncologists—most of us now, I would say—utilize different protocols, but for the longest time, we kept just giving [patients] cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP),” said Clifford. “It didn’t do as well, and we never changed what we were doing.”

Veterinarians turned to mustargen, vincristine, procarbazine and prednisone (MOPP), which led to improved remission periods compared to previous methods.

 “The overall survival was better than CHOP,” said Clifford. “The challenge with MOPP…because of the mustargen, you have to have a fume hood and closed chemotherapy system.” Additionally, because of the number of drugs involved in CHOP protocol, it’s considered intensive.

Later in his session, Clifford introduced a Laverdia®-CA1 (verdinexor tablets)

a noveltreatment for all types of canine lymphoma. He explained that in a phase II study, the clinical benefit rate across both B-cell and T-cell, naïve, and relapse cases was 55%, with a median duration of benefit of 71 days (range 21-273 days).

 T-cell cases demonstrated clinical benefit in 71% of the dogs, whether naïve or relapse.

Laverdia®-CA1 is conditionally approved, which means it has demonstrated a reasonable expectation of effectiveness for the treatment of canine lymphoma.Its use is limited to canine lymphoma while it is under conditional approval. Conditional approval allows commercial sales and marketing of the medication for a period of up to five years while the pivotal field efficacy study is being conducted.The results of the pivotal field efficacy study will be submitted to the FDA CVM for full approval.

The key takeaway Clifford presented to the audience is that Laverdia®-CA1 empowers general practitioners to take an active role in treating lymphoma patients, especially in cases where chemotherapy is not an option. When pet owners do not want to move forward with chemotherapy (or cannot due to financial constraints), Laverdia®-CA1 adds another tool to the toolbelt in treating canine lymphoma. As an oral drug administered by the pet owner at home, it is convenient as well.

“We know that for the clinicians in primary care practice, all they had before this was just prednisone to send the dog home with…” said Clifford. “So, to be able to offer a viable alternative, there’s no reason that primary care should not have this in their clinic.”

Clifford C. What’s New in Canine Lymphoma? Presented at: Fetch dvm360® Conference; Long Beach, California. December 1-3, 2023.

Sadowski AR, Gardner HL, Borgatti A, et al. Phase II study of the oral selective inhibitor of nuclear export (SINE) KPT-335 (verdinexor) in dogs with lymphoma. 

. 2018;14(1):250. Published 2018 Aug 24. doi:10.1186/s12917-018-1587-9

Videos

As the industry learns more about canine lymphoma, it’s clear that there is no one-size-fits-all approach to treatment

(from left to right) Dean Andrew Hoffman, Richard Lichter, Anson Tsugawa, V’98, Nadine Chien, and Dr. Alexander Reiter (image courtesy of Penn Vet)

The University of Pennsylvania School of Veterinary Medicine (Penn Vet) Board of Advisors, clinicians, administrators, and donors officially commenced the construction of its $2.8 million brand-new state-of-the-art Richard Lichter Advanced Dentistry and Oral Surgery suite at Ryan Hospital. The clinic will be for comprehensive oral and restorative small animal patient care as well as clinical instruction and research.

“The new suite’s impact will deliver care to more patients and significantly shorten appointment wait times with the increase in the number of dentistry and oral surgery stations,” said Alexander Reiter, professor of Dentistry and Oral Surgery and chief of the Dentistry and Oral Surgery (DOS) Service, in an organizational release.

“The addition of the cone-beam computed tomography (CBCT) system will greatly enhance our clinicians’ diagnostic imaging ability to plan for complex surgeries, like cleft palate repair, oral tumor removal, and maxillofacial trauma surgery, and because of its immediate proximity to 9 other surgery suites, this advanced imaging modality will provide more efficient care for other surgical patients, such as in neurology and orthopedics.”

In the 1970s, PennVet became the first veterinary school in North America to offer a program dedicated to veterinary dentistry and oral surgery and would later go on to establish the first veterinary dentistry and oral surgery residency training program in the United States in 1989.

 According to the release, the clinical specialists at Penn Vet will be able to use the new suite to provide care to more patients but also give clinicians a chance to learn more about oral diseases and conditions such as head and neck cancer.

“Contributing to Penn Vet is important since I have witnessed first-hand the role their veterinarians play in saving the lives of animals who come to Ryan Hospital in dire circumstances,” said Richard Lichter. “It was natural for me to want the hospital to have the most modern and state-of-the-art dentistry and oral surgery capabilities. Through my charitable foundation, the Richard Lichter Charity for Dogs, I have had the opportunity to provide care for dogs in their time of maximum need, and Penn Vet has been a trusted partner in that endeavor.”

Penn Vet kicks off construction of new $2.8 million Richard Lichter Advanced Dentistry and Oral Surgery Suite. News release. University of Pennsylvania School of Veterinary Medicine. February 12, 2024. Accessed February 13, 2024. 

https://www.vet.upenn.edu/about/news-room/news-stories/news-story-detail/penn-vet-kicks-off-construction-of-new-richard-lichter-advanced-dentistry-and-oral-surgery-suite

Wagh M. Dentistry that makes a difference. University of Pennsylvania School of Veterinary Medicine. Published February 18, 2015. Accessed February 13, 2024. https://www.vet.upenn.edu/about/news-room/bellwether/bellwether-magazine/bellwether-winter-2015/dentistry-that-makes-a-difference

The Richard Lichter Advanced Dentistry and Oral Surgery Suite will be a state-of-the-art clinic within the Ryan Hospital

PennVet begins oral surgery suite construction 

Applying a phalangeal (foot) cast is a treatment commonly used for distal limb wounds of the pastern and the foot of horses. The foot cast provides more stability than bandages. Often foot casts have been used in previously nonhealing wounds of the heel bulb region that were treated with bandages. Additionally, the foot cast is often less expensive than bandaging over time. Data from a published study with 50 cases of distal limb wounds of horses treated with a phalangeal cast showed a good prognosis for soundness (89.4%) and cosmetic healing (89.5%).

Typically, horses are sedated, and a local nerve block (basi sesamoid) is performed for evaluation and treatment of the wound. In the studied cases, wound therapy consisted of wound debridement, lavage of the wound, wound closure (57%), cast application, and antibiotics (84%). Wounds with synovial structure involvement had additional treatment consisting of lavage of the synovial structure and local antibiotic administration via direct injection or regional limb perfusion. Continued local antibiotic therapy is important in these cases and may be administered by an intrasynovial catheter under the cast or sequential regional limb perfusions above the foot cast.

After the wounds had been repaired, a simple bandage consisting of a nonad- herent dressing (Telfa pad) and specialist cast padding was applied over the site. A stockinette was rolled to the level of the fetlock and doubled over. Orthopedic cast felt was placed just below the fetlock and white tape applied to hold the felt in place (

). Orthopedic cast felt can also be placed over the coronary band if needed. At this time the sedation was adjusted to ensure minimal movement during the next 5 to 10 minutes while the cast was setting. Next, a 3-in cast liner was applied with care to ensure no wrinkles above the coronary band. This was followed by 3-in casting tape, making sure it was applied evenly.

The casting tape was started at least 1 in below the top of the orthopedic felt at the top of the pastern. Then the casting tape was applied with even pressure overlapping by 50%, again ensuring there were no wrinkles above the coronary band (

). Wetting the casting tape with cooler water slowed cast tape setting and provided a longer time for application. The distal limb was elevated to incorporate the casting tape on the bottom of the foot (

). Finally, polymethyl methacrylate was added to the bottom of the foot to prevent it from wearing through the cast (

). The top of the stockinette was cut, pulled tight, and taped to the top of the cast. The bottom of the cast was covered with elastic tape or rubber and elastic tape to prevent slipping. Elastic tape was used to seal the top to prevent bedding from getting between the cast and the wound. 

Horses must be on strict stall rest while wearing a cast to prevent severe rub sores from forming. The top of the cast should be monitored daily for rub sores and the horse for lameness. If the rub sores start to penetrate the skin or increased lameness occurs, the cast should be removed. After cast removal, the previous wound site can be evaluated and treated and, if necessary, a foot cast can be reapplied.

In the study, there was no difference in outcome between horses that were treated in under 24 hours and those treated after more than 24 hours. Although the numbers were small, the 8 cases with wounds involving synovial structures did not have a significantly different outcome. (

). Wounds typically needed a minimum of 3 weeks of stabilization in a phalangeal cast, but some wounds required up to 8 weeks to heal. The foot casts were well tolerated and proved to be an effective treatment by stabilizing wounds involving the pastern and foot region.

1. Ketzner KM, Stewart AA, Byron CR, et al. Wounds of the pastern and foot region managed with phalangeal casts: 50 cases in 49 horses (1995-2006). 

. 2009;87(9)363-368. doi:10.1111/j.1751-0813.2009.00471.x

, is a board-certified equine surgeon at Tennessee Equine Hospital, based in West Thompson’s Station. She enjoys furthering her knowledge in equine surgery. Retrospective evaluation of her cases has helped contribute to this knowledge base. Where her findings have contributed to a change or advancement in a procedure, she has felt it important to present the information. She has done this in abstracts, publications, and speaking when she feels it is a relevant contribution to veterinary medicine and surgery. In her spare time, she enjoys running, skiing, and horseback riding.

An equine veterinarian outlines an effective treatment for stabilizing a wounded pastern or foot region