2 common misconceptions about diet trials

Julia Miller's diet trial myths

Julia Miller, DVM, DACVD, outlines practical guidelines for selecting diets, counseling owners, and avoiding the pitfalls that can compromise trial success.

Okay, yeah—so I love talking about diet trials. The goal for my diet‐trial lecture is to make it very approachable, so that practitioners can identify which cases are appropriate for a diet trial, learn the rules of a diet trial, choose the best diet for their patient, and then successfully complete the diet trial. That includes communication tips and tricks for clients. I think it’s essential to equip veterinarians with talking points so they feel confident walking into exam rooms and saying, “I know this patient needs a diet trial. Here’s how I’m going to counsel you, and here’s how we’ll get it done properly.”

I see two big misconceptions routinely as a dermatologist. First, people often choose over‐the‐counter diets for their diet trials—but you really need prescription diets when you suspect a food allergy in a dog. Prescription diets are critical; they are the backbone of the diet trial. Second, many practices do not counsel clients enough. Diet trials require a lot of communication, and you must ensure you have time in your schedule and an educated staff to help clients understand exactly what it takes to complete a diet trial. I see so many patients whose owners are spending money on a prescription diet, but then they add chicken or other foods because the dog “doesn’t like” the diet. That misunderstanding sets the trial up for failure.

Diet trials are very doable—but they require rigorous communication. We’ll discuss how to verbally counsel clients and also how to use handouts effectively. I also want to emphasize that currently, blood tests for food allergies are not accurate. I see veterinarians using blood food‐allergy testing and telling clients, “Your dog must be allergic to X, Y, or Z based on this test.” Multiple studies have shown that those tests do not accurately determine whether a dog (or cat) has a food allergy or identify the specific allergens. I wish there were an “easy button”—blood draw, test says “allergic to beef,” and we avoid beef. But these tests aren’t reliable, and I do not recommend using blood food‐allergy testing for patients.

Videos

Julia Miller, DVM, DACVD, busts diet trial myths and shares her thoughts on allergy testing.

2 common misconceptions with diet trials

Megan Brashear, RVT, VTS (ECC), explains how veterinary team members benefit from self-advocacy in the workplace.

Advocating for your career

Megan Brashear, RVT, VTS (ECC), senior manager of veterinary nursing at the Purdue University Veterinary Hospital in West Lafayette, Indiana, presented lectures on self-advocacy and other personal growth topics at the North American Veterinary Community (NAVC) SkillShop in Orlando, Florida. In a 

 interview, Brashear explains why veterinary team members, especially technicians, need to advocate for themselves in the workplace.

The following is a transcript of the video.

 Especially for veterinary technicians, we find that their role...kind of expires. After 3 to 5 years, a lot of them are leaving the profession. So, self-advocacy is really understanding what you want to do [and] where you want your career to go, and that's personal for every person. So, figure out what your goals are, where you want to go, [and] what you want to be doing. Then I want to talk to [veterinary technicians] about how to get there, how to talk to your boss, how to talk to your team, [and] how to get yourself to that place.

Benjamin Bergstrom, DVM, MS, DACVO, talks about causes and treatment options for these lenticular diseases in cats and dogs

Understanding and managing cataracts and lens luxation in cats and dogsBenjamin Bergstrom, DVM, MS, DACVO, talks about causes and treatment options for these lenticular diseases in cats and dogs

Benjamin Bergstrom, DVM, MS, DACVO, owner of The Eye Vets in Nashville, Tennessee, discusses cataracts and luxation of the lens in cats and dogs ahead of his lecture “Cloudy with a Chance of Cataracts: Diagnosis and Management of Lenticular Disease,” at the Fetch dvm360 Conference in Nashville. In this interview, Bergstrom explains causes of these lenticular diseases as well as their treatment options, noting differences in the causes of luxation between species and in treatment approaches.

Below is the transcript of the video, which has been lightly edited for clarity:

 We will discuss cataracts, which is what we most commonly think of when we think of lenticular disease, diseases of the lens. The most common procedure associated with the development of cataracts is cataract removal. So, as cataracts progress to a point where an animal's vision is compromised, my objective as an ophthalmologist is, I want an animal to be able to see and see the best that they can, so removing the cataract can restore normal vision in a lot of instances.

The other disease process, or another disease process that we talk about, is luxation of the lens in both the dog and the cat, [which] can happen for different reasons. So, luxation of the lens, again, means separation from its normal attachments in the eye, which is normally behind the pupil. It can shift into the front of the eye—which is an ocular emergency in dogs—can fall to the back of the eye in dogs; that can happen as a primary birth defect, birth inherited issue. In cats, it most commonly happens secondary to chronic inflammation in the eye, or uveitis.

To remedy the situation, in dogs, the gold standard of care is removing the lens. If they luxated anteriorly, we make an incision in the eye, remove it, close the eye. We have the option of also pushing the lens back to the back of the eye, closing the pupil with a medication to keep it in a safer place back in the back of the eye.

In kitties, however, we don't have to immediately consider surgical intervention. A lot of times, we can medically manage cats with pressure medications, anti-inflammatory medications. The most important part about cats is, because it happens secondary to chronic inflammation, is figuring out what the source of chronic inflammation is.

Understanding and managing cataracts and lens luxation in cats and dogs

In the Fetch dvm360 conference session “A New Category of Care: A Practitioner's Guide to Proactive, Noninvasive Screening of Lumps and Bumps”—available on-demand through dvm360 Flex—Natalie Marks, DVM, CVJ, CCFP, Elite FFC-V, discussed a product using heat diffusion technology. The tool offers a noninvasive way to scan for dermal and subcutaneous masses and is for use in dogs only.

The technology can aid in detecting malignant tissue and providing guidance on next steps, as well as help with surgical planning, noted Marks. However, it is not a replacement for fine needle aspirates. “This [technology] is to guide where we use cytology because cytology is still necessary. We need cytology for dermatology. We need cytology, of course, to analyze lumps and fluids and all kinds of things that we need clinical pathology results for,” emphasized Marks.

The heat diffusion tool contains a thermal scanner and a heat source, as well as a camera, to scan for potential cancer in canine patients. “Essentially, what happens is, when we have a mass...and we use the scanner, it's going to heat the desired tissue at about 42 degrees Fahrenheit for 10 seconds, so it heats it up pretty quick, and then we allow that tissue to cool for 30 seconds. So, in a time frame of 40 seconds total, it's going to detect how the heat is distributed and then how it's diffused within the tissue itself,” explained Marks during the session.

As Marks noted, malignant cells show a different diffusion pattern than benign or healthy tissue. For example, mast cell tumors heat up and cools down faster than healthy tissue, whereas lipomas heat up faster but cool down slower. The heat diffusion tool uses this information during scanning of tissue to detect abnormal tissue.

After the scan, screening findings will appear in the HT Vista Result Dashboard, with the platform showing the patient’s cancer risk value along with an interpretation. Users are also able to view the thermal image from the scan and a brief recommendation that can be shared with the client.

According to Marks, the technology “has the ability to diagnose a mast cell tumor with 90% specificity.” Additionally, it has a 98% negative predictive value based on a study of more than 1600 masses.

 The negative predictive value is defined as the likelihood that a patient with a negative test result actually does not have the disease. “If we're saying [the results say the mass] is a low-based cancer risk...is a lipoma, you can feel 98% certain it's a lipoma,” said Marks.

With the scanning technology, a cancer risk of less than or equal to 10% is considered low. Masses such as lipomas and benign epithelial sebaceous adenomas may fall under this category. Recommendations for this category include monitoring and routine follow-ups.

Cancer risk results of greater than 10% up to 50% are considered moderate by the HT Vista technology. For these masses, further investigation is recommended.

“In [the moderate] category, the best thing about this is we now can give [the] client the option. There [are] clients out there that if you said [the scan results are] between 10% and 50%, they're okay with that. There [are] clients out there [that if] you said it's a 3% cancer risk, they're not okay with that, right?” said Marks. “But it's important that we're able to now give them some data to make an informed decision versus just the black-and-white of ‘we can aspirate it, or we can't—I don't really know what's going on.’”

Meanwhile, masses with results of 50% or higher are considered high risk for cancer. These masses are commonly mast cell tumors and further investigation is required.

According to Marks, 1 in 4 dogs will develop cancer during their lifetime. Moreover, 47% of dogs die of cancer by the age of 10, making it a leading cause of death among these canines.

 “For your practice, that's about 500 dogs a year are going to die from cancer no matter what you do,” said Marks.

As Marks explained, these startling statistics are due to a lack of effective treatment options, client inability to proceed with treatment, lack of access to care, and late diagnosis. “I think when we have the ability to offer a noninvasive screening tool for cancer at our practice where we can take these subcutaneous and dermal masses and get an early diagnosis without an aspirate, without any surgery, without that intense cost that often goes along with advanced diagnostics, it helps us make these faster and earlier decisions about interventions, or at least giving that family the opportunity to do so,” Marks noted.

Marks N. A New Category of Care: A Practitioner's Guide to Proactive, Noninvasive Screening of Lumps and Bumps.

Articles

The scanning technology discussed during a Fetch dvm360 conference session offers a noninvasive way of scanning dog tumors

A heat diffusion tool for canine dermal and subcutaneous mass screening

La'Toya Latney, DVM, DECZM (ZHM), DABVP (Reptile & Amphibian), CertAqV, discusses several ways that general practitioners can incorporate reptile care into their clinics. 

Providing reptile care in primary practice

How can primary practices enhance their services with reptile care? In this video, La'Toya Latney, DVM, DECZM (ZHM), DABVP (Reptile & Amphibian), CertAqV, senior veterinarian at The Schwarzman Animal Medical Center in New York, New York, discusses several ways that general practitioners can incorporate reptile care into their clinics using tools and knowledge they already have on hand or have access to. Latney spoke to 

during the NAVC SkillShop in Orlando, Florida, where she presented lectures on reptile medicine.

Understanding the role of husbandry in reptile medicine

The following is a transcript of the video:

La'Toya Latney, DVM, DECZM (ZHM), DABVP (Reptile & Amphibian), CertAqV:

 [General practitioners] probably already have the tools, because medicine is medicine, right? Whether you're a fish, reptile, cat, dog…. [Clinics should be] comfortable with offering blood work. The way in which we acquire the blood samples is very similar to something they already learned in vet school for another species.... There are places where they can send the blood out. There are actually machines that a lot of people have, point-of-care machines, and [in] some of the critical care places, they could actually run the blood in-house.

[Get] them familiar with molecular diagnostics. There are a number of different companies that offer PCR [polymerase chain reaction] probes and PCR tests for specific reptile pathogens, and they're quite cost-effective. They actually end up being cheaper than [many] culture sensitivity panels for aerobic, anaerobic, and fungal. You can swab and send it out. They'll give you all of this information about what pathogens they may have found and what their…antibiotic genetic resistances for these things [are]. I think those are probably the biggest things.

Everyone knows how to do a fecal, but they [may say], ‘Yeah, I can do a fecal, but what's normal vs abnormal when I look under the microscope to see?’ So again, there are all these little things that they already almost have access to. It’s just a matter of feeling comfortable about where to send samples and how to evaluate them once they've been acquired.

La'Toya Latney, DVM, DECZM (ZHM), DABVP (Reptile & Amphibian), CertAqV, discusses several ways that general practitioners can incorporate reptile care into their clinics.

Benjamin Bergstrom, DVM, MS, DACVO, previews his Fetch session

Eye removal conversations

Benjamin Bergstrom, DVM, MS, DACVO, owner of The Eye Vets—a veterinary ophthalmology practice in Nashville, Tennessee—shares insights into his upcoming lecture “There’s No Eye in Enucleation: A Review of Treatment Options for Blind, Painful Eyes,” which will be presented at the Fetch dvm360 Conference in Nashville, May 30-31. In this interview, Bergstrom previews topics he will cover during his session. He also highlights 1 key takeaway that he hopes attendees will leave with, emphasizing the compassion and sensitivity that is needed when discussing eye removal with clients.

 I think one of the most important parts of this presentation is, it's a stressful time to start talking with pet owners about what's going to happen to an eye after we've lost the battle with diseases like glaucoma. And for a lot of pet owners, that's kind of the first time that they've experienced a major medical issue and the loss of an eye. When you try to conceptualize it as a person, you kind of put yourself in the pets position and it's hard.

And so, I just want to talk through eye removal in and of itself—how to come to the conclusion that it's time for it, how to make the pet owner comfortable with it. And then there are other options that we can provide to the owner if eye removal is just not something that they're interested in. But it's a tricky conversation, and addressing it in a way that is going to make the pet owner comfortable with the decision and, you know, ultimately provide better quality of life for the pet, better comfort for the pet is the most important thing.

Benjamin Bergstrom, DVM, MS, DACVO, shares a key takeaway from his upcoming lecture at the Fetch dvm360 Conference in Nashville, Tennessee