Alex Sigmund, DVM, DACVO, joins our host Adam Christman, DVM, MBA, to provide some tips and tricks for recognizing and dealing with veterinary ocular emergencies

The Vet Blast Podcast presented by dvm360: Eye to eye: Navigating ophthalmology emergencies

Although they are bound to enter the veterinary clinic at some point, not all veterinarians are as excited about the eyes as this week’s guest, Alex Sigmund, DVM, DACVO. To help general practitioners feel more comfortable when a ocular emergency comes into their clinic, Adam Christman, DVM, MBA, and Sigmund chat about the common ocular emergencies general practitioners could see, and how to go about diagnosing and treating them.

: et's start with the basic one, because these are the ones that people tend to scream at when they have, like, proptosis eye coming down. So you know, What? What? How do we stabilize that kind of a patient?

: Yeah, when a proptosis comes in, it is usually a trauma, unless you are a pug, [or] brachycephalic dog, where their eyes can just kind of pop out sometimes if they fall off the couch, but usually it's going to be a traumatic injury. And so you do want to assess this patient with a physical exam, make sure you don't see any other signs of trauma. Because a lot of times we get a little excited Well, I do about the eye, and there is the rest of the body you got to worry about, so you want to make sure that there's no puncture wounds, other things that you need to worry about, if this was like a dog fight or hit by car or something like that. These are emergencies that need to be addressed sooner rather than later, because when that eye is proptosis, it has a lot of tension on the optic nerve, which is only going to lessen their visual prognosis. 

So there are a few things to look at when you're trying to assess whether this eye should go back or not. And I think kind of the biggest one to remember is how much blood is there. If there is a lot of blood around this eye, then it probably does not need to go back and it should just be a nucleated now, if this is a relatively clean proptosis where there's just a little bit of subconjunctible hemorrhage, and those are ones, I'm going to be more willing to put back and, you know, replace them. If there's a ton of blood inside of the eye, then I'm also a little bit worried about trauma inside of the eye that we just can't see because you can't have these compressive injuries that actually that sounds really bad, crack the inside of the eye without rupturing it and those dogs do not do well either.

Podcasts

Alex Sigmund, DVM, DACVO, shares his expertise on dealing with ocular emergencies on this episode of The Vet Blast Podcast presented by dvm360. 

Eye to eye: Navigating ophthalmology emergencies

In a session delivered at WVC 2025 titled 

From skin scrapes to culture: The base kitchen tools for feline dermatology

, Domenico Santoro, DVM, DrSc, MS, PhD, DECVD, DACVD, DACVM, explained that although cats often display similar clinical patterns, the underlying pathologies can vary greatly. This variability makes it all the more important to employ a careful, methodical diagnostic approach.

Santoro opened his session by stressing the importance of a detailed patient history. He noted that in feline dermatology—more so than in canine cases—collecting an accurate history is indispensable. “Being able to ask the right questions and extract the necessary information is essential,” he explained. This detailed history sets the stage for all subsequent diagnostic tests, ensuring that clinicians are better prepared to interpret physical findings in the context of each patient’s unique background.

Moving from history to hands-on techniques, Santoro highlighted impression cytology as one of the simplest yet most effective methods. He noted, "The impression, to me, is probably…the easiest to do and the most informative [diagnostic] that we have." By gently pressing a slide against an affected area, veterinarians can quickly capture critical cellular details. This rapid technique provides immediate insights into inflammatory processes, the presence of fungal elements, or other abnormalities.

Another key technique discussed was tape cytology, which is useful for sampling dry lesions or hard-to-reach areas such as interdigital spaces. Santoro pointed out that while the method is straightforward, its success depends on precise application to ensure maximum sample yield without compromising the diagnostic quality.

Santoro also covered trichography—the valuable art of hair plucking. He advised that collecting hairs by hand (as opposed to using forceps) minimizes trauma and preserves the integrity of hair shafts. This method can reveal subtle structural abnormalities and even parasitic infestations that might otherwise go unnoticed, he said.

A significant portion of the session was devoted to differentiating between superficial and deep skin scrapes. Santoro explained that for broad sampling in cases such as suspected scabies, superficial scrapes are sufficient, as they do not induce capillary bleeding. In contrast, deep skin scrapes are performed until slight bleeding is observed—an indicator that the scrape has reached the dermis. Santoro stated, “And that's [how] you know that you are in the dermis. That's really the only way to know..."

This visible bleeding signals that the scrape has reached the deeper dermal layer, which is important for detecting conditions such as demodicosis where mites reside deeper in the skin, he said. By appropriately selecting between these 2 techniques, clinicians can ensure that they’re sampling the correct tissue depth to capture the subtle differences in pathology.

Through the presentation, Santoro reinforced that these techniques are both cost-effective and highly informative. By combining a thorough patient history with methods such as impression and tape cytology, trichography, and targeted skin scrapes, veterinarians may significantly enhance their diagnostic accuracy. "Diagnostics are essential for the dermatology practice…They're very easy…extremely informative, and most of these methodologies cost nothing, or close to nothing,” he said.

Santoro D. From skin scrapes to culture: The base kitchen tools for feline dermatology. Presented at: WVC; Las Vegas, NV. March 2-5, 2025.

Articles

At WVC 2025 in Las Vegas, Nevada, Domenico Santoro, DVM, DrSc, MS, PhD, DECVD, DACVD, DACVM, covered the essential tools for feline dermatology in practice.

Quick overview of foundational diagnostic strategies in feline dermatology 

Diabetes is most common in cats that are middle-aged or older, with many of these felines being geriatric. As a result, comorbidities in feline patients with diabetes are especially common. In their lecture 

Treatment Approach to the Diabetic Cat with Comorbidities

, presented at the 2025 WVC Annual Conference in Las Vegas, Nevada, J. Catharine Scott-Moncrieff, Vet MB, DACVIM (SAIM), DECVIM; and Thomas Schermerhorn, VMD, DACVIM (SAIM), talked about the management of feline patients with diabetes, with a particular focus on patients with comorbidities. Some of the session’s highlights included treatment options for feline diabetic patients with pancreatitis and chronic kidney disease, among other common comorbidities.

According to Scott-Moncrieff and Schermerhorn, comorbidities cause insulin resistance, impairing insulin action in the tissues. “This [insulin resistance] is overcompensated for by additional production of insulin and also by additional production of [intestinal alkaline phosphatase] (IAP) or aniline, which then is deposited in the pancreatic beta cell and leads to continued beta cell dysfunction,” explained Scott-Moncrieff.

 “So insulin resistance, lack of beta cell function can either cause…diabetes or worsen diabetic control in an established diabetic.”

Recognizing pancreatitis in feline patients with diabetes is extremely important, as this condition is very common in cats. According to Scott-Moncrieff, studies have suggested that it is possible that up to approximately 67% of cats show some evidence of pancreatitis, with roughly 45% of apparently healthy cats also showing signs of the condition.

In the session, Scott-Moncrieff explained that most of the time, pancreatitis is subclinical in feline patients with diabetes. “If [the pancreatitis is] completely subclinical, I mean, even with their diabetic control, the problem is the clinical signs of pancreatitis can be super subtle. So sometimes we really don't know if there are low levels of clinical signs of their pancreatitis. Some studies have definitely shown that cats with evidence of subclinical pancreatitis have lower emission rates and poor glycemic control,” she said.

For these cases, patients should be monitored, including appetite and variations in glycemic control. If changes in glycemic control are observed, veterinarians should look for pancreatitis more thoroughly.

Scott-Moncrieff also emphasized the importance of monitoring for direct remission. “If cats have relapsing-remitting pancreatitis, if their pancreatitis subsides, they may go into diabetic remission and need to know about that… because we don’t want them presenting with hypoglycemia,” she stressed.

In patients with clinical pancreatitis, acute or severe forms of the condition can cause inflammation of the pancreas, leading to reduced insulin secretion and potentially resulting in hyperglycemia. The inflammation also causes “waxing and waning” insulin resistance, explained Scott-Moncrieff.

Clinical pancreatitis in felines can also have the same “waxing and waning” effect on their appetites. “Most importantly, cats with clinical pancreatitis also have waxing and waning appetites…intermittent anorexia, and this can be hugely challenging,” said Scott-Moncrieff.

For these patients, Scott-Moncrieff explained, sodium-glucose cotransporter 2 (SGLT2) inhibitors are not a good treatment option. Instead, these felines need to be treated with insulin. Adding appetite stimulants, as well as nausea and pain relief medication is also recommended. Nutritional support may be needed. Additionally, Scott-Moncrieff recommends patients follow a diabetes-focused diet.

As the leading cause of death in cats, chronic kidney disease (CKD) affects up to 40% of felines over the age of 10, and 80% over the age of 15.

 Cats with diabetes and CKD at IRIS stage 1 or 2 may be good candidates for SGLT2 inhibitors but need to be systemically stable, explained Scott-Moncrieff. However, newly diagnosed cats with an IRIS stage of 3 and 4 should be treated with insulin.

The renal function of these patients should be regularly monitored, and the IRIS guidelines should be followed. Additionally, these patients’ diet should be focused on the CKD.

“In summary, most...diabetic cats have type 2 diabetes, but unlike humans, they’ve historically been treated with insulin,” concluded Scott-Moncrieff. SGLT2 inhibitors offer a new treatment option for feline patients with diabetes that do not have major comorbidities. However, not all patients are suitable candidates for this new treatment option, including those with IRIS stage 3 or 4 of CKD and those with clinical pancreatitis.

Scott-Moncrieff JC, Schermerhorn T. Treatment approach to the diabetic cat with comorbidities. Presented at: WVC; Las Vegas, NV. March 2-5, 2025.

Chronic kidney disease. Cornell University College of Veterinary Medicine. January 2025. Accessed March 5, 2025. 

https://www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/chronic-kidney-disease

How should diabetic cats with these comorbidities be treated?

Pancreatitis and chronic kidney disease in feline patients with diabetes

Image Credit: © Ermolaeva Olga - stock.adobe.com

For treating canine allergic dermatitis, there are multiple treatment plans and medication options available for clients. After veterinary teams take patient history, review clinical signs the patient presented with, and rule out other common causes of pruritus, veterinary teams can then narrow down the triggers for the reaction and begin to consider the best course of action.

Anti-Hero: A variety of anti-inflammatory and antipruritic medications for canine allergic dermatitis

 at the 2025 WVC Conference in Las Vegas, Nevada, Brittany Lancellotti, DVM, DACVO, a practicing veterinarian at Skin and Ear in Los Angeles, California, shared some common challenges that veterinary professionals face when treating this lifelong disease, and discussed several medication options in an interview with dvm360.

Lancellotti explained to dvm360 during her interview that numerous challenges surround allergic dermatitis in dogs, affecting both pet owners and veterinary teams. For pet owners, the primary issue stems from the disease being lifelong, making managing client expectations crucial. Clients often seek immediate and effective medication solutions upon visiting the veterinary clinic. However, as with other chronic diseases in veterinary medicine, a quick fix is not possible for canine allergic dermatitis, as it is a lifelong condition.

“It is really important that we communicate with them that this is not going away. This is a disease that the animal will have for its lifetime, but here are some tools we can use to help make managing this disease easier for you at home,” Lancellotti explained during her interview.

On the veterinarian side, balancing medication benefits and risks can be a struggle. Lancellotti explained that any therapy implementation carries risks. The most effective approach to mitigate these risks is to ensure the therapy is targeted to the individual patient. This targeted approach helps identify the primary trigger, enhancing medication safety and improving disease control. Along with a targeted approach, Lancellotti shared other strategies that work well for patients.

Medications for canine allergic dermatitis

“I think utilizing strategies like using a dose range rather than a single specific dose for all patients, determining if an animal tolerates a specific medication form better than another, and discussing multiple options with the owner to find what works best for them is very helpful. This approach prevents client pushback on a rigid treatment plan and is crucial in maintaining the bond and trust we aim to establish with our clients,” said Lancellotti.

Understanding these challenges is crucial when considering the various medication options available for managing canine allergic dermatitis. In September 2024, Elanco announced that its ilunocitinib tablets (Zenrelia; Elanco) received FDA approval, becoming the second JAK inhibitor on the market. Zenrelia, a Janus Kinase Inhibitor (JAKI), reduces proinflammatory and pruritogenic cytokines IL-2, IL-4, IL-6, IL-13, and IL-31. These medications effectively reduce pruritus with minimal adverse effects and are safe for patients on other medications. However, Lancellotti informed attendees that these medications are ineffective in treating edema and contraindicated in canine patients under 12 months of age due to the risk of serious infections like bronchopneumonia and demodicosis. Initial safety studies of Zenrelia noted novel skin masses in some patients, but no increased risk of neoplasia was found. JAKI inhibitors like Zenrelia and Apoquel are administered orally daily for long-term symptomatic management of allergic pruritus. For Zenrelia, it is recommended to withhold the medication for 28 days before and after vaccination due to initial vaccine response study results. However, Lancellotti shared a subsequent study that showed no serious adverse effects of decreased response to vaccine boosters.

Another medication Lancellotti discussed is Lokivetmab, a canine monoclonal antibody that binds to IL-31, inhibiting its pruritogenic effects within 1–3 days, with effects lasting an average of 4 weeks. This treatment is safe for canines of any age, has no reported adverse effects, and can be used in patients taking other medications or with comorbidities. However, it has minimal anti-inflammatory effects. Lokivetmab is administered at the veterinary clinic at 2 mg/kg once monthly or as needed and is suitable for long-term management of symptomatic pruritus.

Considering the unique challenges and diverse needs of each patient and client, individualized treatment plans are essential for treating canines with allergic dermatitis. Multiple options exist, each with unique indications and mechanisms. Individualized plans ensure clients receive the most appropriate medication and manageable treatment strategies, maximizing relief for pets living with this lifelong disease.

Lancellotti B. Anti-Hero: A variety of anti-inflammatory and antipruritic medications for canine allergic dermatitis. Presented at: Western Veterinary Conference; Las Vegas, Nevada; 2025.

The challenges veterinary professionals and clients face when dealing with a patient with allergic dermatitis, and what medications can help. 

Navigating canine allergic dermatitis

Twenty veterinary management professionals recently earned the Certified Veterinary Practice Manager (CVPM) credential from the Veterinary Hospital Managers Association (VHMA).

The CVPM credential is recognized in the industry as a sign of professional achievement and excellence. It is awarded to individuals who demonstrate the knowledge and experience required to successfully manage the evolving operations of modern veterinary practices.

Candidates must earn sufficient formal education and continuing education credits prior to taking the CVPM exam. Offered virtually to registered candidates throughout North America, the rigorous CVPM exam tests relevant management knowledge in human resources, law and ethics, marketing, organization of the practice, and finance.

Those individuals who meet the CVPM standards by successfully completing the assessment process are granted a time-limited credential. Credential holders are required to maintain continued competence to retain the credential.

The VHMA’s first class of 2025 includes the following credential earners: Tobra Avery, Cami Cotter,Ashley Egan, Mary Ghazanfari, Shelby Kathleen Hasting, Christina Hayden, Brandy Hendrix, Jen Jones, Rebecca May, Christine Theresa Merceruio, Elisa Michel, Christie Mory, Lindsey Moyer, Tiffany Nally, Kui Young Park, Taylor Perrotta, Abby Powell, Danielle Reske, Sara Kayleen Smith and Cindy Thompson.

The VHMA provides training, education, and resources to more than 5000 members and serves as a trusted resource on industry insights, research, and advocacy for the veterinary industry. The association’s main mission is the advancement and support of veterinary practice management professionals through development of professional competence with programs that include the CVPM certification.

Veterinary practice managers earn prestigious CVPM designation. News release. Veterinary Hospital Managers Association. March 5, 2025.

About certification. Veterinary Hospital Managers Association. Accessed March 5, 2025. 

https://www.vhma.org/certificatesandcertification/cvpmroadmap/cvpmaboutcertification

 The CVPM credential is recognized in the industry as a sign of professional achievement and excellence. 

VHMA newly certifies 20 practice managers

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During this interview with Dr Lancellotti, she shares things veterinary professionals the things they should consider when deciding a treatment plan for canines with allergic dermatitis 

Interview with Brittany Lancellotti, DVM, DACVO

at the 2025 WVC conference in Las Vegas, Nevada, Brittany Lancellotti, DVM, DACVO, a practicing veterinarian at Skin and Ear in west Los Angeles, California, provided listeners things that they should consider when deciding a treatment plan for their canine patients suffering from allergic dermatitis.

Clinical history and patient selection for diet trials

Lancellotti explains that in order to provide the best treatment for the patient, presentation, age, primary triggers, and other schools of thought are some of the multiple things that are important factors to be reviewed with the client and team to decide what is the best option for each itchy canine. 

Below is a full transcript of the interview:

My name is Dr Brittany Lancellotti, I am a veterinary dermatologist at Veterinary Skin and Ear in west Los Angeles. 

So when figuring out a treatment for canine allergic dermatitis, there are a lot of factors that veterinarians need to take into consideration, including the patients age, comorbidities, how that disease presents on the animal, are they more itchy, are they more inflamed, are there secondary infections going on whether or not this is seasonal or nonseasonal, is this something that has flared up acutely, or is this a chronic disease for that animal. So, determining the primary triggers is very helpful in addressing the disease, and those include food allergies, flea allergies, and environmental allergies but then taking into consideration how the animal disease is presenting and what other comorbidities they have can help you determine which anti-itch or anti-flamatory medication will give them the safest and most effective relief.  

During her recent interview with dvm360, Brittany Lancellotti, DVM, DACVO, broke down some of the key factors that veterinary teams should think about when treating canine allergic dermatitis.