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This episode of The Vet Blast Podcast tackles the rise of detection of gastrointestinal parasites in fecal testing. Guest Cathy Meeks, MS, DVM, DACVIM, talks about how medication resistance and better diagnostics both factor into this trend.

Below is a partial transcript. Listen to the full podcast for more.

: These parasites are ever evolving. So they're creating resistance to what we commonly would treat with. And so that's making them more hardy, either that's making them last longer and live longer. So I do think that there's a quite a bit of reasons why we're seeing an increase in parasites, but unfortunately, the resistance to the dewormers is playing a big role in that as well.

Podcasts

Investigating the causes behind the apparent increase in gastrointestinal parasites and what clinicians can do about it

Why are gastrointestinal parasites on the rise in fecal testing?

With the rise of pet ownership in the United States, community pharmacies are seeing a rise in animal related prescriptions come through their doors. Pharmacists are receiving prescriptions for new patients across a variety of species like dogs, cats, birds, horses, rabbits, that they might not have seen before. You may be thinking: Are community pharmacies trained to handle prescriptions for different species?

Journal of the American Pharmacists Association

 has published a study that sought to identify, understand, and solve potential medication errors related to veterinary prescriptions. Researchers looked at a hard copy of the prescription compared to an image of the ultimate label.

On the prescribing end, veterinarians often omitted key information that is needed for a pharmacist to fill a veterinary medication. To fill animal prescriptions, weight and species is vital information to fill a medication safely, but veterinarians failed to provide weight on almost every prescription. Without the animal’s weight, pharmacists cannot check if the medication dosage is correct. Although not legally required, weight is clinically required for the pharmacist.

With the variability in weight and species, pharmacists often compound prescriptions to fit their patient. Of the prescriptions included in the study, 16.7% were medications that needed to be compounded for the patient. Compounding a medication includes any combination, mixing, or alteration in ingredients that changes the original medication. Although most pharmacists are properly trained, the FDA prohibits compounding of medications unless done by a 503b outsourcing facility that has been approved by the agency. None of the pharmacies in the studies were outsourcing facilities, but they still compounded the prescriptions and gave them to the patient.

On the filling end, the study found that pharmacists often did not catch the omission of the key information. With the weight being excluded from most of the prescriptions, it is unknown how pharmacists are filling these medications safely.

Another issue involved prescriptions for controlled substances. On many of these studied prescriptions, the veterinarian did not include the DEA number. It is important to note that DEA requirements for controlled substances are about the use of the controlled substance, not the species of the patient. Veterinarians and their patients are not exempt from DEA regulations and are required to include the DEA number on each prescription.

Investigators concluded that training needs to be improved for both the pharmacists filling the prescription and the veterinarians prescribing the medication. Researchers found that handwritten prescriptions had more errors than verbal prescriptions, which could be attributed to how veterinarians were taught in school. Only 22.2% of veterinarian students know how to physically write a prescription, indicating that they are being taught mostly electronic prescribing mechanisms. With 83.9% of veterinarians employed in small private practices, they often do not have the luxury of an e-prescribing system. According to the authors, students should be taught how to write prescriptions and include necessary information for pharmacists to fill medication safely. This same idea applies for pharmacists and pharmacy school. Schools need to teach pharmacy students about the requirements of veterinary prescriptions, so they can be prepared in practice.

McDaniel M, Glazier E, Truong N, et al. Veterinary prescription errors in a community pharmacy setting: A retrospective review. 

. 2022;62(2):512-518. doi:10.1016/j.japh.2021.11.007

Articles

A recent study sought to identify, understand, and solve potential medication errors related to veterinary prescriptions.

Veterinary prescriptions can be challenging for community pharmacies

Erik Zager, DVM, DACVECC, discusses toxicology emergencies on an episode of 

Pet toxicity cases are on the rise in the United States, with the ASPCA Animal Poison Control Center reporting that it handled 401,550 such cases in 2021, a 22% increase from 2020.

 To help clinicians address this issue, Erik Zager, DVM, DACVECC, joined 

™ to discuss animal toxicity treatment options. Zager is a board-certified emergency and critical care specialist and co–department head of the emergency and critical care services at Philadelphia Animal Specialty & Emergency in Pennsylvania. Zager and host Adam Christman, DVM, MBA, examined common pet toxins and explored a new FDA-approved drug called Clevor (ropinirole ophthalmic solution) from Vetoquinol for inducing vomiting in dogs.

Zager began with a primer on some common categories of toxicities for which veterinary professionals should be prepared. Nearly half of all calls received by Pet Poison Helpline involve animals ingesting human medication,

 but Zager added that veterinary medication can also cause an emergency: “We see human medications that dogs ingest accidentally. [We see] veterinary medications also. Sometimes a dog is supposed to be on 1 tablet of a pain medication and gets into the whole bottle.”

Adding to the list of common toxicities he sees in practice, Zager stated, “We see plants around the house that have certain toxicities. Recreational drugs can be a big thing, especially with legalization of marijuana [being] prevalent, and we see a lot of marijuana ingestion.”

Christman commented on the importance of response time in emergency cases and asked Zager about when to involve a third-party poison control service. Zager said, “As an emergency doctor, [if] someone calls [about] chocolate [toxicity], I know exactly how to calculate how much chocolate [their dog has ingested]. I can have them come right [in] and get [the dog] to vomit.” However, Zager said, “Certain types of human prescription drugs or other types of chemical products, cleaning things [are also toxic to dogs]....As much as I’d like to know all the things in the world, I don’t have a complete repository of every toxin in my brain. So having them call poison control is sometimes helpful because they can calculate the toxic dose and figure out what the treatment steps are.”

New and traditional emetic agents for decontamination

On treating a toxiciology emergency in the clinic

, Zager said, “Decontamination is one of our first steps, and so [we induce] emesis or vomiting...Traditionally, apomorphine was the go-to, but luckily now there’s an FDA-approved drug [called] Clevor. It’s actually an eye drop, so [it is] very easy to administer [with] very good efficacy to induce emesis.”

Diving into the details of the drug, Zager added, “[Clevor] comes in little individual packets, open them right up, and then it’s just a little eye dropper. The packets tell you exactly how many eye drops go in [and] whether to split it between the 2 eyes, if the patient has 2 eyes. Emesis usually happens within 20 to 30 minutes. You can [administer the dose] a second time if they don’t vomit, but [it’s] pretty quick [and] efficacious in getting them to vomit. Again, [it’s a] very important step in the decontamination process.”

He also explained how to stop vomiting after it has been induced: “Similar to morphine, [Clevor] does have ability for reversal [with] just a dose of metoclopramide. And luckily, you get them to stop vomiting because oftentimes the next treatment is activated charcoal. Giving a patient who’s already vomiting activated charcoal can sometimes be difficult, so it’s important to be able to get them to stop vomiting as quickly as you get them to start.”

To wrap up his thoughts on the new drug, Zager said, “We’re past syrup of ipecac at this point. We got into apomorphine, [but] having an FDA-approved drug [now] is great. Sometimes it’s a little difficult to get [away from] what you’re used to, but veterinary medicine is about making sure you’re up to date, embracing new products, and advancing your practice every day.”

ASPCA Animal Poison Control Center reaches 4 million cases of pet toxicity, a significant milestone in keeping animals safe in emergency situations. News release. American Society for the Prevention of Cruelty to Animals. March 9, 2022. Accessed May 25, 2022. 

https://www.aspca.org/about-us/press-releases/aspca-animal-poison-control-center-reaches-4-million-cases-pet-toxicity

Top 10 human medications poisonous to pets. Pet Poison Helpline. Accessed May 25, 2022. 

https://www.petpoisonhelpline.com/pet-owners/basics/top-10-human-medications-poisonous-to-pets/

Erik Zager, DVM, DACVECC, discusses animal toxicity emergencies and a new eye drop emetic for dogs.

Get the drop on toxicology emergencies

Good afternoon and Happy Friday! Did you know that today kicks off National Pet Hydration Awareness Month? With July being one of the hotter months of the year, it is important that pet parents understand and know the signs of dehydration to help their pets. So this July 4

 weekend, be sure to inform your clients and have them prepare for firework celebrations.

While you get ready for this holiday weekend, here is what was hot this week on dvm360.com:

 put forward by the Arizona Humane Society and the Humane Society of Southern Arizona was recently signed into law to help fight the veterinary shortage in Arizona.

 at the Directions in Veterinary Medicine conference (DIVM), Arielle Pechette Markley DVM, cVMA, CVPP, CCRT, DAAPM, discussed some tips for veterinary teams to use when performing physical exams on patients who could be suffering a soft tissue injury.

Our Australian correspondent, Phil Tucak, BSc, BVMS

 from the Australian veterinary scene, including the Australian Veterinary Association's new president as well as an update on the Climate Care Program.

 of The Vet Blast Podcast, Shawn Wilkie, CEO of Talkatoo, sat down with our very own Adam Christman, DVM, MBA, to discuss how to make medical record-keeping and charting less painful for veterinary professionals.

In their joint session at the DIVM conference, Matt Brunke, DVM, DACVSMR, CCRP, CVPP, CVA, and Kirsty Oliver, VN, DAVN (surgical), RVT, CCRP, CVPP, VTS (rehabilitation), the pair 

 a technique called radiosynoviorthesis (Synovetin OA) as a novel therapy approved for elbow OA management in canines.

Did you enjoy our coverage for the Directions in Veterinary Medicine conference and want to experience a dvm360 conference yourself? You are in luck! We are heading to Kansas City on August 26-28 so register 

 today to qualify for our early bird special.

News wrap-up: This week’s headlines, plus tips for performing exams on suspected soft tissue injury patients. 

How do you keep a pulse on the latest animal health care science to both elevate your skill set and meet your state license requirements for continuing education? Do you have a process in place for achieving your learning milestones? Whether you read case-based research, watch the latest procedure techniques, attend conference lectures, or engage virtually, you should have a plan! 

Here are 3 keys to unlocking your learning potential. 1. Choose quality vs quantity. Your learning efforts should be from the most widely known, and most credible experts within the veterinary profession. 2. Consider the frequency and cadence. Learning long-term requires continuous efforts so having healthy habits at a steady pace is both realistic and achievable. 3. Mix it up! Seek educational opportunities from multiple channels, such as articles, lectures, podcasts, videos, etc. This will engage your brain power in multi-modal learning, which reinforces comprehension.

To help you get started, we’ve compiled our upcoming CE opportunities and learning events for July, and remember, learners can register for an account at 

 to access CE credits, on-demand webinars, and CE articles. 

Register for these upcoming live webinars and save the date on your calendar. Can’t make these dates? All our webinars are accessible on-demand within a week after the live event.

Canine Otitis Externa: Causes, Diagnostic Approach and Management

This course will help veterinarians identify the underlying factors leading to otitis externa in canine patients and provide guidance for diagnosing and managing these patients.

Cannabis and CBD are now available to pet owners nationwide in over half of the United States. A pet parent can pick up an edible from a dispensary and send their dog straight to the ER! However, veterinarians have been cautioned about discussing or recommending cannabis and CBD by the AVMA and most state veterinary boards.

This class will present standards for the selection of products that are safe and meet label claims for potency; discuss the safe limits of use and doses of CBD based on published safety studies in the dog and provide a logical framework for dosing based on published studies and observations by veterinarians.

Here are our recently launched on-demand webinars:

The “Just Feed Less” Myth for Weight Management

Often veterinarians are recommending to “just feed less” to their clients suffering from obesity which can result in pet owners inappropriately reducing foods not intended for weight management, potentially causing deficient nutrient intakes, hungry pets, and ultimately failure in successfully managing the pet’s weight and body condition. Proactively identifying at-risk pets for overweight/obesity, feeding appropriate diets and amounts, monitoring our patients carefully and providing client support can help turn around the pet obesity epidemic.

Building Successful Associate Veterinarian Relationships

Whether it is a new grad or a 15-year veteran, implement these steps to grow and solidify a healthy relationship that in turn will help with a healthy bottom line. The DVM shortage is real. Attract and keep the talent you want.

CIV: What Use is a Vaccine in the Midst of an Outbreak?

Review the history of the 2 major influenza viruses of dogs as well as a presentation of the major clinical signs, including data from experimentally infected canines. Analyze feline data showing protection against feline herpesvirus 1 after 1 dose of an inactivated vaccine will be used to set the stage for the discussion of a study just completed in canines challenged with H3N2 on Day 7. Overall recommendations for managing new CIRDC outbreaks will be discussed.

The Privileges of Being a Part of the Human-Animal Bond

There’s a special triangle formed when the veterinarian is accepted into the bond between client and pet. We explore the history that has brought us to understand this bond. It’s fun to recognize evidence of the bond, including how we name our pets, converse with our pets, feed and clothe them, and celebrate with them.

: Carolyn Shadle, PhD, and John Meyer, PhD

How to Market Virtual Care to Your Clients

Learn how to promote virtual care to your clientele and ensure you stand out amongst the competition in the marketplace, by offering a superb client experience, that also will build strength within your VCPRs.

: Sarah Machell Bsc, DVM, and Emma Harris

Access this webinar on-demand coming soon. 

Join us for an in-depth discussion of true ophthalmic emergencies along with identification, appropriate diagnostics, and treatment options.

Cut it Out, Principles of Surgical Oncology

Not only will you be able to examine and decipher the principles of surgical oncology, we will also take a deeper dive into how the principles relate to surgical approaches for tumors and how surgical oncology principles can be utilized in your general practice.

: Sarah Sayler, DVM, MS, DACVS-SA, Veterinary Specialist, Oncology, Surgery

What Clients Want When They Seek Transparency in Healthcare

Understand how transparency improves conversations about logistics and scheduling; diagnostic, medical, and surgical procedures, and patient health from case-based data and thematic analysis.

Our CE articles are great for independent learners who prefer reading study. Learners can check out the Continuing Education section within each issue of the dvm360® magazine and engage in an online exam to earn CE at dvm360 Flex. Here’s our latest issue:

Feline Orofacial Pain Syndrome: The Gnawing Sensation

Feline Orofacial Pain Syndrome (FOPS) is characterized as a neuropathic pain disorder that was first reported in the 1990’s. The pathophysiology of the disease is poorly understood, however there is believed to be a genetic mutation within the Burmese breed and cross breeds. The human equivalents of this disease are Trigeminal Neuralgia and Burning Mouth Syndrome. Learn about the goals of treatment, the pathophysiology and how to improve the quality of life for patients with FOPS.

: Karissa Severud, DVM, Small Animal Rotating Intern, and Heather Towle Millard, DVM, MS, DACVS-SA

Join us August 26-28 in Kansas City, Missouri, for Fetch, a dvm360 conference! Hear from our inspiring keynotes, Christopher Pachel, DVM, DACVB, CABC, and Temple Grandin, PhD. Engage in The Ultimate Fetch Frenzy—a gamified CE unlike anything you’ve experienced. Choose from over 160 continuing education credits and learn from over 50 tracks of practical veterinary medicine, including companion animal, equine, exotic, and large animal sessions, and hospital design, hands-on labs, and technician CEs. 

Network and unwind at our welcome reception located at Bar K, a unique, 2-acre indoor/outdoor dog and people park, that includes a restaurant, beer garden, and musical entertainment.  

 available on most podcast channels, including, Apple, Google, and Spotify, to hear more about these trending topics for quick micro-learning moments.

July 5: Cathy Meeks, MS, DVM, DACVIM, Why are gastrointestinal parasites on the rise in fecal testing?

July 7: Pet Peace of Mind with guest Dianne McGill

July 12: Patient Rounds/Handoffs with guest, James Barr, Chief Medical Officer from BluePearl

July 14: End of Life Care with guests, Mary Gardener, DVM, and CIO, Lap of Love, and Coleen Ellis, Lap of Love

July 19: Personal Wellbeing with guest Amelia Knight Pinkston, DVM and Life Coach from IndeVets

July 21: Disney Plus TV show Pop Goes the Vet with guest Dr. Joya Griffin, DVM, DACVD of Animal Dermatology Clinic

July 29: Rabbit Care with guest Laila "Lyla" M. Proença MV, DVM, MS, PhD, DACZM from VetAhead

Have ideas for future continuing education opportunities or wish to educate fellow colleagues as one of our faculty? Tell us more at rlewis@mjhlifesciences.com.

Plan your educational goals with these upcoming continuing education events and learning opportunities



July CE: Unlock your veterinary learning potential 

The Companion Animal Parasite Council (CAPC) predicts heartworm disease, Lyme disease, anaplasmosis, and ehrlichiosis all pose “higher than average risks” throughout the US in 2022. CAPC prevalence maps show heartworm infections continuing to trend northeast into the mid-Atlantic region, while Lyme disease continues its march into the southwest.

 With today’s increasing risks of these vector-borne parasitic diseases and an ever-changing geographic prevalence of the parasites that cause them, an in-depth discussion on parasitic prevention is as critical as ever.

To examine these alarming trends, dvm360®’s Chief Veterinary Officer Adam Christman, DVM, MBA hosted a panel discussion with expert clinicians

 Katina Carter, DVM; Bill Carter, DVM; and Kara Johnson, pet parent and veterinary technician. The group shared their thoughts on the forces driving these trends, their current preventive strategies, and how to get better buy-in on preventative treatment from staff and pet parents alike.

Reflecting on the CAPC forecasts, the group all felt their anecdotal experiences in practice agreed with the prevalence data. “When I look back, even just 10 years ago, I don’t think we’ve seen such a variety tick-borne diseases and intestinal parasites that we’re seeing now,” said Christman.

Both Katina and Bill Carter said they are seeing an increase in these cases in their clinic based in southern New Jersey. “We’re seeing more heartworm, which I typically didn’t see in the New Jersey area as much,” said Bill Carter. “That’s kind of scary,” he added. Both clinicians mentioned treating an increased number of cases of hookworm, whipworm, giardia, and ehrlichiosis over the past few years.

Why are vector-borne parasitic diseases spreading beyond their typical geographic regions of prevalence (such as Lyme disease in the northeastern US)? The group touched on several factors that may play a role, such as climate change resulting in warmer, wetter winters and the rapidly growing rate of pet ownership in US households.

The discussion then turned to one factor in the spread of parasitic diseases that may be flying under pet parents’ radar: the rise of dog parks. Christman prompted the panel for their thoughts on a 2020 study in Parasites & Vectors that sought to assess the prevalence of gastroin- testinal parasites in dogs visiting off-leash dog parks. The study ultimately found intestinal parasites in 20% of dogs and 85% of dog parks across the country, stating routine administration of parasitic preventives can help reduce the health risk canines in the US.

“Dog parks are basically a daycare where nobody checks your vaccine records,” said Bill Carter. Commenting on the data, he said, “Because of the way they shed eggs...tapeworms and flukes...those are probably underrep- resented in the study.” He added, “That data that was collected came from July and August. That tends to be when the parasite burdens are the lowest because of the hot temperatures. The fact that we’re seeing this high burden in the middle of the summer makes me wonder what’s really going on in winter.”

“...which is exactly the opposite of what clients think,” Katina Carter pointed out.

“They think the snow destroys everything,” said Bill Carter. “It doesn’t work that way.”

Johnson said, “It definitely makes me feel good that I don’t go to dog parks. It’s sad to think that I can’t take the dogs to go play with friends, because I have to worry about them picking up intestinal parasites or really any sort of infectious disease from other dogs.”

Of course, veterinary professionals are not helplessly at the mercy of current trends. So how can clinicians help turn the tide?

Katina Carter feels that veterinarians should place a greater emphasis on proactively taking stool samples, due to the ever-present issue of noncompliance or imper- fect compliance with preventive medications. “I don’t think that in general practice we make a big enough deal about stool samples...It needs to [done] be a once a year.”

Bill Carter jumped in, adding, “A lot of the [patients] coming in are completely asymptomatic and shedding. We’re finding round[worms] and sometimes hook[worms] and whip[worms]—and these are animals that are not coming in for diarrhea. They’re not sick. They’re just the clients who have a lapse in their prevention.”

Each of the panel guests stressed the importance of year-round parasite prevention. They each recommend to patients—and give to their own pets—a combination of parasite preventive medications that defend against a broad spectrum of parasites. All 3 spoke about their experiences with Credelio (lotilaner) for flea and tick protection and Interceptor Plus (milbemycin oxime/ praziquantel) for prevention of heartworm disease and controlling roundworm, hookworm, whipworm, and tapeworm infections in dogs.

Johnson partially attributed her choice to the medica- tions being indicated for puppies as young as 6 weeks and 8 weeks old, respectively. “As soon as we can start preven- tion, that is very important,” said Johnson. “I rescued [my dog] at nine weeks [old], so it was perfect that I didn’t have to feel uncomfortable giving [the medications] that young.

Commenting on how this low age requirement helps with compliance, Christman said, “That’s a big sticking point. The point is that they can just transition all the way [to taking the medications] for the rest of their life. Other ones, you have to wait until they’re 6 months of age.”

Katina Carter added, “We also give them free doses the first time they come in as they’re growing so that it’ll just become a habit. By the time we finish seeing them, they’re already 4 or 5 months old and usually, can be on their adult dose and just get the whole year’s [supply of medication].”

Christman described this as “360-degree protection,” as the preventive regimen offers protection against 5 worms plus fleas and ticks. Johnson responded, “It’s all-around protection, and it makes me feel confident...it’s hitting all the bases, so everything is covered: heartworm, intestinal parasites, fleas and ticks...everything.”

Katina Carter said, “In the end, [prevention] can make our job easier...being proactive instead of reactive.”

Christman added, “As veterinarians, we don’t have a lot of time to really go over all the recommendations, so that’s one less thing for us to worry about. Having peace of mind knowing that the safety efficacy is in your flea and tick, heartworm, and parasite prevention, we can worry about other things [like] behavior, endocrinopathies, [and so on]. It’s always good to hear, knowing that you as a team feel confident about what you’re recommending that goes out that door.”

2022 Pet parasite forecasts. Companion Animal Parasite Council (CAPC). Accessed April 4, 2022. https://www.petsandparasites.org/expert-insights/ httpswwwpetsandparasitesorgexpert-insights2021forecasts/

Pet population still on the rise, with fewer pets per household. JAVMA News. American Veterinary Medical Association. December 1, 2021. Accessed April 4, 2022. https://www.avma.org/javma-news/2021-12-01/ pet-population-still-rise-fewer-pets-household

Stafford K, Kollasch TM, Duncan KT, et al. Detection of gastrointestinal parasitism at recreational canine sites in the USA: the DOGPARCS study [published correction appears in Parasit Vectors. 2020 Jul 13;13(1):348]. Parasit Vectors. 2020;13(1):275. Published 2020 Jun 1. doi:10.1186/s13071-020-04147-6

Vector-borne parasitic diseases are pushing the boundaries of their traditionally endemic regions. A panel of clinicians explains what you need to know.

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