Joya Griffin, DVM, DACVD, discusses available treatment options for pet with pruritus, plus factors to consider when choosing the treatment option

Treatment options for pruritic diseases

 interview, discusses one of her sessions delivered at the 2025 Fetch Charlotte conference taking place March 14-16 in Charlotte, North Carolina, Joya Griffin, DVM, DACVD, talks about treatment options for pruritic diseases in cats and dogs. In this video, Griffin also discusses how veterinarians can determine which treatment option is best for each patient.

Below is the interview transcript, which has been lightly edited for brevity and clarity:

 For treating atopic dermatitis, it's a diagnosis of exclusion. So I always make sure that I've ruled out food hypersensitivity and have them on a good, consistent flea control program because that will help to prevent flea reactivity. Even if they are not flea-allergic, that will help to prevent that kind of as a flare factor for those allergic dogs.

And then for treating the itch, when we're going through these diagnostic trials, we have lots of options available with Janus kinase inhibitors like Apoquel and Zenrelia. You can also use Cytopoint, which is a monoclonal antibody; and then steroids; those do have their place in our diagnostic trials because you can use them for a short period of time. For Cyclosporine or Atopica, I typically use for more chronic cases, so when I'm trying to approach the pruritic pet, I usually don't start with those because they Atopica takes a little bit longer to start to work, so it's best used for more chronic cases once you have a true diagnosis.

The treatment option is really based off of the severity of the pet, the duration of their itching, and really their response to other therapies. So I really look at each patient, kind of holistically, and figure out what's going to be the best for them. Some patients have other comorbidities or other medications that they may be on that would prevent them or maybe make a certain treatment less doable. And then I always talk to the pet parent about what their thoughts and feelings are surrounding different chronic medications, and we find what's going to be the best fit for them.

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Joya Griffin, DVM, DACVD, discusses available treatment options for patients with pruritus, plus factors to consider when choosing the treatment option

To initiate this year’s dvm360 Fetch Charlotte conference in North Carolina, Philip Bergman, DVM, MS, PhD, DACVIM (Oncology), former global director of clinical studies at Mars Veterinary Health, delivered a keynote address on some of the top clinically relevant advances in veterinary oncology. Among the advancements discussed were a new, highly effective drug for nausea and vomiting; a vaccine for melanoma; and a pharmacogenetic test related to ‘white feet don’t treat.’

A more effective treatment for managing nausea and vomiting

As Bergman explained, vomiting is a significant problem in both human and animal oncology patients, even outside of those undergoing chemotherapy. Many patients receiving surgery, radiation, or tyrosine kinase inhibitors (TKIs) will experience nausea and subsequently vomiting.

In animal patients, more than 90% will experience vomiting with cisplatin if untreated and approximately 10% to 20% may have overt delayed vomiting. Although the approximate percentage of patients who experience vomiting is known, the percent of those who experience nausea remains unknown, according to Bergman.

“...it’s easy for clients to know what overt vomiting is, but if you ask them, ‘Did Fluffy have any nausea over the last 3 weeks?’ invariably, they'll say ‘no.’ But if you actually arm them with what nausea looks like in the dog, then all of a sudden they say, ‘Yes, oh yeah, I do remember Fluffy walked up to the food bowl, kind of licked their lips, walked away—kind of like the waterfalls we have when we're nauseous,” said Bergman during his session. “So I think we actually underestimate the amount of nausea that our patients go through, and we know that there's huge quality of life implications to that.”

Much like the human medication Emend, an NK1 receptor antagonist for treating nausea and vomiting, particularly related to chemotherapy, Cerenia—a novel, veterinary-only medication for treating vomiting and nausea in cats and dogs—is also an NK1 receptor antagonist that is highly effective. As Bergman explained, the FDA-approved drug has been found to successfully block Ipecac—a direct-acting emetogen— 

Apomorphine, an indirect-acting emetogen, giving the drug “superior broad spectrum efficacy.”

According to Bergman, recent studies have suggested that Cerenia may also help reduce diarrhea.

The vaccine for canine malignant melanoma

Canine malignant melanoma is the most common oral tumor of dogs, accounting for approximately 4% of all canine tumors.

 As Bergman explained, chemotherapy has poor efficacy against this cancer, and prior to the melanoma vaccine, treatment options were limited, with many of them being only being effective at obtaining local control.

The melanoma vaccine, however, uses a needle-free delivery system—the Bioject system—which spreads the vaccine throughout the skin. As a result, this therapy is better at inducing an immune response compared to a traditional needle-based delivery method.

 As Bergman explained, the vaccine, which received full USDA approval in 2009, shows best outcomes with stage 1 melanoma because veterinarians have the “longest runway” for inducing an immune response.

“All right, how many folks have heard of this thing called ‘white feet, don't treat?” Bergman asked his audience during his session. The phrase ‘white feet, don’t treat’ refers to the MDR1 mutation in certain dog breeds, particularly those with white feet, that can lead to dogs developing neutropenia and thrombocytopenia if they are administered ivermectin.

However, the pharmacogenetic test determines whether a dog has one or 2 alleles, helping to identify at-risk breeds, which include Australian Shepherds, Collies, Silken Windhounds, McNabs, and long-haired Whippets. According to Bergman, the mutation affects 65% of long-haired Whippets.

At the end of his section on ‘white feet, don’t treat,’ Bergman posed a question to the audience: “When should we really be testing these dogs? Should it be when they get cancer?” he asked. Bergman emphasized that these canines should be getting tested when they are puppies. Understanding whether these puppies carry the mutation can help identify which drugs may pose risks to them, ensuring safer treatment options throughout their lives.

“Thankfully, the cost for that test has come way down,” he said.

Bergman P. Top 10 advances in veterinary oncology. Presented at: Fetch Charlotte; Charlotte, North Carolina. March 14-16, 2025. 

Huston L. Ivermectin for dogs. The Spruce Pets. October 6, 2023. Accessed March 14, 2025. 

https://www.thesprucepets.com/is-ivermectin-safe-dogs-and-cats-3384698#:~:text=Ivermectin%20Sensitivity%20in%20Collies%20and%20Similar%20Breeds&text=Symptoms%20of%20neurotoxicity%20include%20lack,generally%20safe%20for%20these%20dogs

Articles

Philip Bergman, DVM, MS, PhD, DACVIM (Oncology), kicked off the 2025 Fetch Charlotte conference with his keynote address on key innovations in veterinary oncology

Advances in veterinary oncology: From a melanoma vaccine to genetic testing

A dog’s quality of life can be significantly affected by noise phobia and anxiety. However, intervention with a comprehensive approach can be beneficial to the canine patient as well as the client.

In an educational session at the 2025 Fetch dvm360 Conference in Charlotte, North Carolina, Christopher Pachel, DVM, DACVB, CABC (IAABC), owner and lead clinician at the Animal Behavior Clinic in Portland, Oregon, provided an overview of noise phobia and anxiety in dogs. The lecture included intervention strategies that can be used to help mitigate physical and emotional distress.

Pachel began his talk describing fear, phobia and anxiety, emphasizing that these emotional responses are not the same and the severity of responses vary. “There's a whole range here, from normal, appropriate fear and anxiety all the way up to significantly pathological, significantly dangerous, both to the individual as well as to others in their immediate vicinity,” Pachel said.

The perception of fear for the patient has an identifiable trigger that causes distress and often results in a survival mode response. This response may reflect the patient’s past experiences.

A phobia is nonadaptive and may prompt persistent or excessive fear. Severity of the response may be out of context to the intensity of the stimulus, according to Pachel. Triggers can be discernible objects or situations such as thunderstorms, fireworks or other sudden and loud noises. In a video example shown during the lecture, a dog reacted to an owner’s sneeze with apprehension, and backed away until realizing there was no threat.

Anxiety is the anticipation of a threat, according to Pachel. The outcome is more unpredictable, and the trigger may be difficult to identify. “We can tell that they're stressed, but there's not really something that we can pin our finger on as to what exactly is eliciting that emotional state. This often happens in scenarios where ‘something bad’ has happened before, or in scenarios where the outcome is somewhat unpredictable, or in scenarios where the animal doesn't have any degree of control or agency over those outcomes or consequences,” he added.

One video example of anxiety Pachel shared with Fetch attendees involved a shaking, visibly apprehensive dog that waited by a window for teen boys in the family to come home from school. He explained that boys were known to “rough house,” frequently causing distress for the dog.

Fear, phobias and anxiety often lead to coping strategies that can be classified as active or passive. “So, the active responders, these are often the animals who are likely to move. They’re pacing. They’re exit-seeking. They're panicking, but that's manifesting as movement and more active strategies,” Pachel said. “We also have some of our animals that engage in more passive strategies, where they essentially freeze, hunker down, and respond more with immobility.”

Escaping the situation, a form of fight or flight for survival, is one form of an active response. Physically, a pet may experience hypertension, tachycardia or other autonomic changes. “These physical responses are actually normal,” Pachel said.

Passive physical responses include autonomic inhibition such as hypotension and bradycardia; and increased neuroendocrine activity such as cortisol secretion. Passive response also includes freezing when a threat is inescapable.

“Individual differences in learning history and experiences, socialization, and stimulus exposure context can significantly influence the development of these and other coping strategy variations,” Pachel said. In helping an animal manage their fear, phobia or anxiety, he noted that “there isn't a one-size-fits-all [solution] here.”

Medical conditions may be contributing to a patient’s behavior perceived as fear, phobia or anxiety. Once a medical condition has been ruled out or identified, an appropriate treatment plan can be created. 

To manage a patient’s emotions and behavioral responses, there are a variety of intervention strategies that can help. Desensitization and counterconditioning can help modify a patient’s response to canine noise phobia, for example. “This involves controlled exposure to noise below the stress response threshold and gradually increasing intensity, paired with positive reinforcement,” Pachel said.

Comfort tactics can include pheromones and nonpharmaceutical products. Use of a pheromone diffuser or products such as Thundershirts or iCalm can help destress an animal. Playing calming music and allowing a pet a safe space with favorite items such as blankets or toys, can also be beneficial.

To comfort a patient experiencing fear, pharmaceuticals can also help. Pachel noted that maintenance medications are most useful for frequent and unpredictable triggers, while quick-acting situational drugs help manage predictable, infrequent triggers.

Overall, Pachel said, a comprehensive approach is needed to manage fear, phobia and anxiety, and timing for an intervention is important for its’ success. Effective treatment for these emotions and their responses can improve the quality of life for the patient as well as the owner.

Pachel C. Canine noise phobia and the anxiety patient. Presented at: Fetch dvm360 Conference; March 14-16, 2025. Charlotte, NC.

At the 2025 Fetch dvm360 Conference in Charlotte, North Carolina, presenter Christopher Pachel, DVM, DACVB, CABC (IAABC), provided an overview of noise phobia and anxiety in dogs.

Understanding phobia and anxiety in patients

Amanda Shelby talks about what an ECG can and can't tell you

Amanda Shelby interview ECG

 interview, Amanda Shelby, RVT, VTS (Anesthesia; Analgesia), explains that while an ECG is an essential tool for visualizing the heart’s electrical activity, it cannot confirm mechanical function or guarantee that the heart is effectively beating. She reminds practitioners of the importance of evaluating the entire clinical picture rather than relying solely on monitor readings.

Amanda Shelby, RVT, VTS (Anesthesia; Analgesia): 

I'm super excited to be speaking at Fetch. My name is Amanda Shelby. Apologies for my appearance—I just got back from a massage. You know, self care is important. I am a registered veterinary technician in the state of Indiana and a VTS in anesthesia and analgesia, a title I’ve held since 2010. My background in academia, especially in anesthesia and analgesia, has given me years of experience that led to this achievement and beyond.

Today, I’m focusing on topics closely related to anesthesia, sharing clinical pearls that you can incorporate into your everyday practice. I currently serve as a Senior Content Creator and CE Coordinator for VETgirl. In previous roles, I built “Think Anesthesia,” an educational platform, and I’m excited to continue that journey both virtually and in person.

For those joining me live at Fetch, you’ll experience my lecture titled “ABCs for ECGs,” which will also be available on demand. The three primary takeaways include understanding the importance—and the limitations—of ECG monitoring. The key concept is that an ECG is only the electrical reflection of the heart; it does not guarantee mechanical or actual heart beating function. I hope you become more comfortable recognizing both normal and abnormal ECGs in sedated or anesthetized patients, as well as in ER scenarios.

Let me share a personal experience: when I was just six months into being a credentialed technician and still learning my craft in anesthesia at a university, I encountered a patient arrest under anesthesia despite a normal ECG reading. I noticed a drop in carbon dioxide levels—an insight that reinforced the idea that while monitors are invaluable, they only capture part of the patient’s picture. Thankfully, with the guidance of a supervising resident, I was able to manage the situation and learn a valuable lesson that has inspired me to improve my ECG interpretation skills.

Remember, while ECGs are wonderful tools, they have limitations. I hope you never have to learn this lesson the hard way, as I did.

Amanda Shelby, RVT, VTS (Anesthesia; Analgesia), outlines how an ECG’s electrical data must be interpreted alongside clinical signs, as it does not necessarily reflect the heart’s mechanical performance

What an ECG can—and can’t—tell you

Joya Griffin, DVM, DACVD, talks about 2 of her dermatology sessions 

A veterinary dermatologist discusses pruritus and her upcoming keynote at Fetch Charlotte

In this interview, Joya Griffin, DVM, DACVD, practicing dermatologist with the Animal Dermatology Group in Louisville, Kentucky and star of the National Geographic Wild television series 

Treating the Itch That Won’t Quit: Diagnostic Approach to the Pruritic Pet. 

Griffin shares some of the diseases that cause pruritus, such as flea allergies and food hypersensitivity.

As the Day 2 keynote speaker at this year's Fetch Charlotte conference, taking place March 14-16, Griffin also previews the focus of her session, 

in which she will talk about her journey to veterinary dermatology, and more.

 So my lecture, ‘The approach to the pruritic pet’ really is focusing on how to gain a clear history on these itchy dogs and cats, and how to start our diagnostic protocol, so that we can actually get a true diagnosis as to what's causing the itch.

Some of the diseases that we see that cause pruritus include food hypersensitivity, ectoparasites like flea allergy and scabies. Secondary infections can also cause itching, and all of these things can complicate our true diagnosis, especially when we're trying to treat a dog or a cat with allergic disease and ultimately, atopic dermatitis.

I'm really excited about this year's Fetch, because I get to do a keynote, and in my keynote, I'm going to talk about my journey to veterinary dermatology and how I love making the extreme makeovers in my patients and being able to improve their quality of life and how they look and feel. So hopefully you tune in and it's an enjoyable, fun session and tells you a little bit about me and who I am and how I got to where I am.

The FDA announced it was conditionally approved sirolimus delayed-release tablets (Felycin-CA1; TriviumVet). The conditionally approved medication is for management of ventricular hypertrophy in feline patients with subclinical hypertrophic cardiomyopathy (HCM), making it the first product to receive approval for use in cats with this condition for any indication.

Feline HCM is a condition that causes the muscular walls of a feline patient’s heart to thicken, which decreases the heart’s efficiency, and can create other symptoms within other parts of the body. Currently, there is no cause of HCM clearly identified, but it is prevalent in certain breeds, including British shorthair, Chartreux, Maine coon, Persian, and Sphynx cats. Mutations of several cardiac heart genes has also been identified in some cats with HCM, suggesting genetics play a role.

Feline patients with HCM may not show any signs of being ill and can live for years in this subclinical phase. Others may present with congestive heart failure, including labored or rapid breathing, open-mouthed breaking, and lethargy. The presenting symptoms occur when fluid accumulates around or in the patient’s lungs. When it comes to HCM, a serious and life-threatening consequences is the formation of blood clots in the heart. The clots could move through the blood stream, causing thromboembolism. Although rare, feline patients with HCM are also at risk of sudden death.

Feline HCM Is extremely common in cats, affecting 1 in 7 of all pet cats, and for cats over 9-years-old, the prevalence is 1 in 3, making it the leading cause of mortality in adult cats.

Sirolimus, the active ingredient in Felycin-CA1, at a higher dose is used as an immunosuppressant in human patients receiving organ transplants. Felycin-CA1 is given to cats at a target dose of 0.3 mg/kg orally once a week and is not expected to be an immunosuppressive in patients.

In order for an animal drug to be eligible for conditional approval, it must address a serious or life-threatening disease or address an unmet need in animal or human health. The drug would also need to demonstrate effectiveness, requiring a complex or particularly difficult study or studies. Felycin-CA1 met this requirement because subclinical HCM progresses to clinical HCM, impacting daily functioning in cats and could be fatal. Felycin-CA1 also addresses an unmet animal need because there were no other drugs approved for use in feline patients with ventricular hypertrophy due to subclinical HCM. 

“Felycin-CA1 is the first and only medication shown to reduce the ventricular hypertrophy that is the principal feature of subclinical HCM. It provides a valuable treatment option for veterinarians and pet owners and will transform the way feline HCM is managed’ said Stuart Fitzgerald, Chief Scientific Officer at TriviumVet, in an organizational release.

For Felycin-CA1, demonstrating effectiveness required a complex or particularly difficult study or studies because the detection of subclinical HCM requires advanced diagnostic tests, which makes it difficult to enroll enough eligible cats.

Felycin-CA1 is only available by prescription from a licensed veterinarian, and cats should be screened for pre-existing live disease before starting the medication. This medication should also not be used in feline patients with diabetes mellitus or a pre-existing liver condition.

Felycin-CA is available in 0.4 mg, 1.2 mg, and 2.4 mg tablet sizes.

FDA Conditionally Approves Drug for Management of Ventricular Hypertrophy in Cats. News release. US Food and Drug Administration. March 14, 2025. Accessed March 14, 2025. https://www.fda.gov/animal-veterinary/cvm-updates/fda-conditionally-approves-drug-management-ventricular-hypertrophy-cats?utm_medium=email&utm_source=govdelivery

Cornell University. Hypertrophic Cardiomyopathy. Cornell University College of Veterinary Medicine. Accessed March 14, 2025. https://www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/hypertrophic-cardiomyopathy

Kaplan JL, Rivas VN, Walker AL, et al. Delayed-release rapamycin halts progression of left ventricular hypertrophy in subclinical feline hypertrophic cardiomyopathy: results of the RAPACAT trial. 

. 2023;261(11):1628-1637. Published 2023 Jul 26. doi:10.2460/javma.23.04.0187

TriviumVet Secures FDA Conditional Approval for Feline Cardiology Disease. News release. TriviumVet. March 14, 2025. Accessed March 14, 2025. https://www.triviumvet.com/blog/triviumvet-secures-fda-conditional-approval-for-feline-cardiology-disease

Felycin-CA1 manages ventricular hypertrophy in feline patients with subclinical hypertrophic cardiomyopathy 