Learn how IDEXX is enhancing the lives of animals, people, and the planet.

IDEXX: Contributing to something bigger

At the recent 2021 Atlantic Coast Veterinary Conference (ACVC), Kristen Oliver, VN, DipAVN (Surgical), CVT, CCRP, CVPP, VTS (Physical Rehabilitation) highlighted several medical and nonmedical conditions that can be treated through rehabilitation, plus shares the benefits of utilizing this approach.

View the video below for the entire discussion. The following is a partial transcript

Kristen Oliver, VN, DipAVN (Surgical), CVT, CCRP, CVPP, VTS (Physical Rehabilitation)

: There is very limited scope to what we can't treat. We do treat oncology patients just to help with their mobility while they undergo certain types of chemo or radiation or after amputation. So there is an awful lot of what we can treat [such as] postsurgical, presurgical, weight loss, [and] neurologic conditions.

Videos

During a recent dvm360® interview, seasoned veterinary technician Kristen Oliver discussed a few different conditions that can be treated with rehabilitation.

Various veterinary conditions that can be treated with rehabilitation 

Drs Cline and Saker elaborate on how to educate your clients and staff on what to look for in pet food, plus why it is important to have a full-time boarded veterinary nutritionist at a manufacturing company.

Episode 2: Unsound science: What constitutes as good or bad pet food (come back)

When every pet is unique, how do you find the best diet for your patient? Martha Cline, DVM, Diplomate ACVN, and Korrin Saker, DVM, PhD, Diplomate ACVN discuss what questions to ask to find the best option for your patient, including when to consider prices.

Episode 1: Diet recommendations for your patients 

This article is sponsored by Vetoquinol. 

Superficial bacterial folliculitis, also called superficial pyoderma, is a commonly diagnosed dermatological condition in dogs.

 These infections are secondary to primary conditions affecting normal skin barrier function (eg, allergic skin disease, trauma, burns), keratinization (eg, nutritional deficiency, liver disease), and immune regulation (eg, neoplasia, autoimmunity, endocrinopathy).

 Cats less commonly develop superficial pyoderma perhaps because of decreased adhesion of staphylococci to feline corneocytes, but the primary issues causing infection are similar to those seen in dogs.

The primary pathogen associated with superficial pyoderma in dogs and cats is a normal resident of the skin, 

 As the normal homeostasis of this organism is disrupted from a primary disease, these gram-positive cocci invade deeper regions of the epidermis and hair follicle epithelium, increase in number, and enhance inflammation.

Classical clinical lesions of superficial pyoderma include papules and pustules that may eventually progress to alopecia, epidermal collarettes, scales, and crusts. Often the skin is erythematous and pruritic. Chronic cases may demonstrate lichenification, hyperpigmentation, and scarring alopecia from long-standing inflammation and infection.

 Cats may develop even more unique cutaneous reaction patterns and skin lesions—especially when allergic skin disease is present—including miliary dermatitis, eosinophilic plaques, rodent ulcers, and eosinophilic granulomas.

Identifying and addressing the primary disease is paramount in achieving complete, permanent resolution of the superficial pyoderma. Therefore, treatment is multifactorial and aimed at addressing the primary disease, reducing skin inflammation, and treating the infection directly. Current guidelines for the treatment of superficial pyoderma in dogs recommend the use of topical antimicrobials as sole therapy whenever possible; however, overuse of systemic antibiotics remains common.

Topical therapy has many benefits including direct antimicrobial effects without use of an antibiotic, reduction in antibiotic-resistant bacterial populations, restoration of the normal skin barrier, enhancement of skin hydration, physical removal of keratinous debris, and removal of offending allergens from the haircoat.

 However, topical therapy is met with challenges that impede clinical application. Adherence is the biggest concern when recommending topical therapy to pet owners. Frequent bathing or application of medicated solutions to the skin can be difficult when busy owner lifestyles combine with a nonadherent patient. Skin inflammation can be painful and animals may be resistant to topical therapy. Cats are fastidious groomers and may lick away a medicated topical therapy before it can achieve appropriate contact time. Additionally, some topical agents can cause oral erosions and ulcerations or even gastrointestinal disturbance when groomed off. For these reasons, systemic antibiotics continue to be a common prescribing practice for superficial pyoderma.

All antibiotic use, despite duration or frequency, contributes to the development of antibiotic-resistant bacterial populations on the animal and in the environment.

 From that very first dose, bacteria are constantly evolving to implement inherent and acquired resistance mechanisms necessary for survival. One well-recognized mechanism is oxacillin resistance through the 

gene, which produces a penicillin-binding protein receptor with poor affinity for β-lactam antibiotics.

 Even more concerning than these oxacillin-resistant strains are those that develop multidrug resistance, which is defined as resistance to 3 or more antibiotic drug classes. This may happen over time with repeated antibiotic exposure or after a single dose of certain antibiotics such as fluorinated quinolones.

 The continued emergence of antibiotic-resistant bacteria inhibits the successful treatment of bacterial infections in pets and humans. As veterinarians consider how their antibiotic use contributes to this growing pandemic, they must look for alternative, safe, effective, affordable, and convenient antibacterial treatment modalities.

Investigation into the photobiological effects of light therapy has been ongoing for the past 50 years. Photobiomodulation (PBM) therapy is a type of light treatment that uses visible or near infrared light to promote therapeutic benefits including induction of tissue healing and regeneration and inhibition of biological responses that induce pain or inflammation. The treatment distance, wavelength, fluence, pulse parameters, spot size, and irradiation time influence the effects of light energy on tissue. Visible light with wavelengths ranging from 400 to 700 nm can stimulate positive photobiomodulatory effects that promote wound healing, reduce inflammation and pain, modulate stem cell populations, and reduce bacterial contamination of wounds.

Once visible light enters the skin, it is absorbed by the cells and initiates chemical changes dependent on the wavelength (or color) of light and the chromophore within the skin.

 Within each cell, membrane-bound organelles called mitochondria contain chromophores that absorb the light energy and begin making energy (adenosine triphosphate; ATP) via activation of cytochrome c oxidase. Outcomes of the mitochondrial respiratory pathway activation include stimulation of secondary messenger pathways, production of transcription factors and growth factors, and increased ATP production. However, excessive light energy exposure will overstimulate mitochondrial respiration and cause expenditure of all ATP reserves, which creates oxidative stress resulting in damaging elevations of nitric oxide, production of harmful free radicals, and activation of cytotoxic mitochondrial-signaling pathways leading to apoptosis.

 This is why creating PBM therapy protocols is important for targeting the beneficial effects while avoiding unintended harm.

Specific benefits of light energy within the visible light spectrum can be broken down into each color of light. Blue light (400-500 nm) has a lower penetration depth and primarily interacts with keratinocytes, reduces bacterial adhesion and growth, and increases intracellular calcium and osteoblast differentiation.

 Green light (495-570 nm) affects the superficial tissue and alters melanogenesis, reduces hyperpigmentation of the skin, and reduces tissue swelling.

 Red light (600-750 nm) penetrates deeper into the dermis and subcutis where it acts on cellular mitochondria to reduce inflammation and promote collagen synthesis through fibroblast proliferation and production of transforming growth factor-β, fibroblast growth factor, platelet derived growth factor, and others.

 Red light has proliferative effects on mesenchymal stem cells and induces proliferation of epithelial colony forming units important for tissue repair and regeneration.

Phovia, sold by Vetoquinol, is a form of fluorescent PBM therapy utilizing a blue light emitting diode (LED lamp, 400-460 nm) and topical photoconverter gel that emits low-energy fluorescent light (510-600 nm) when illuminated by the LED lamp.

 This interaction results in the formation of multiple wavelengths of visible light, each with a unique depth of penetration and effect on the tissue as described above. Application is fast and simple. The affected skin may be clipped free of hair and cellular debris removed with gentle cleaning. The skin is allowed to dry before application of the photoconverter gel. Just prior to application, 1 ampule of fluorescence chromophore gel is added to 1 container of photoconverter carrier gel and mixed thoroughly. The mixture is applied in a 2-mm layer to the affected skin, and the LED lamp is held 5 cm above the lesion and used to illuminate the area for 2 minutes. The gel is wiped away using saline-soaked gauze. The application can be repeated immediately after 5 to 10 minutes of rest or a second application can occur a few days later. Twice-weekly applications are continued until the wound is healed. Appropriate eyewear is required to protect the operator from the intensely bright light. Application is pain free and stress free for the patient, so sedation is not typically required.

Phovia shows great promise as a safe, effective therapy for treatment of numerous inflammatory dermatoses in dogs including superficial pyoderma,

 Phovia as a sole therapy speeds time to healing by 36% in canine superficial pyoderma as compared with dogs receiving oral antibiotics alone.

 In one study, dogs with superficial pyoderma were treated with Phovia alone or with an oral antibiotic alone. Dogs treated twice weekly with Phovia demonstrated complete clinical healing in about 2.3 weeks (

< .05)whereas dogs receiving oral antibiotic healed in about 3.75 weeks.

 Additionally, Phovia speeds time to healing by nearly 50% in deep pyoderma when used with an oral antibiotic (5.7 weeks of treatment) compared with dogs receiving only oral antibiotic (11.7 weeks of treatment).

 The ability of this fluorescent PBM therapy to eliminate or significantly reduce duration of exposure to antibiotics will decrease the spread of antibiotic-resistant bacterial strains within pets and humans.

Phovia’s high safety profile makes it a beneficial tool to implement in everyday practice. Training the veterinary team to communicate therapy benefits with clients as well as to perform treatments is fast and easy. Training the veterinary technicians to perform treatments will give the veterinarian time to examine other patients. A single back-to-back application takes about 15 minutes, so pet owners can be in and out of the clinic quickly; however, the 2 weekly treatments can be separated by a few days if the veterinarian prefers to evaluate the patient more frequently. Additionally, when used as a sole therapy, clients are not required to administer oral or topical medications at home. This greatly improves treatment adherence and success. Instruct clients to use once-daily smartphone photos to document improvement at home. This can be useful when deciding how many treatments to perform. Most cases of superficial pyoderma will resolve completely by the third treatment.

 It is a good idea to communicate to clients that 3 to 4 weekly treatments may be required.

Phovia is a versatile, innovative therapeutic approach to numerous types of dermatitis.

 It is easy to implement in general practice, and is safe, pain free, and affordable. Phovia is highly effective for superficial and deep skin infections and eliminates the need for clients to administer numerous at-home treatments. This greatly improves the pet-owner bond and treatment outcomes by promoting adherence. Phovia accelerates time to wound healing, which decreases duration of antibiotic exposure and may reduce risk of antibiotic resistance development in these cases.

 Phovia’s efficacy against antibiotic-susceptible and antibiotic-resistant bacteria shows promise as an alternative therapeutic approach that promotes the principles of antimicrobial stewardship.

 If you are interested in purchasing this medical device for your practice, contact your Vetoquinol service representative.

Amelia G. White, DVM, MS, DACVD is an associate clinical professor of dermatology at Auburn University College of Veterinary Medicine.

Hill PB, Lo A, Eden CAN, et al. Survey of the prevalence, diagnosis and treatment of dermatological conditions in small animals in general practice. 

2006;158(16):533-539. doi:10.1136/vr.158.16.533

Hillier A, Lloyd DH, Weese JS, et al. Guidelines for the diagnosis and antimicrobial therapy of canine superficial bacterial folliculitis (Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases). 

2014;25(3):163-e43. doi:10.1111/vde.12118

Diesel A. Cutaneous hypersensitivity dermatoses in the feline patient: a review of allergic skin disease in cats. 

Halliwell R, Pucheu-Haston CM, Olivry T, et al. Feline allergic diseases: introduction and proposed nomenclature. 

Santoro D, Pucheu-Haston CM, Prost C, Mueller RS, Jackson H. Clinical signs and diagnosis of feline atopic syndrome: detailed guidelines for a correct diagnosis. 

Ravens PA, Xu BJ, Vogelnest LJ. Feline atopic dermatitis: a retrospective study of 45 cases (2001-2012). 

2014;25(2):95-102, e27-e28. doi: 10.1111/vde.12109

Woolley KL, Kelly RF, Fazakerley J, Williams NJ, Nuttall TJ, McEwan NA. Reduced in vitro adherence of Staphylococcus species to feline corneocytes compared to canine and human corneocytes. 

2008;19(1):1-6. doi: 10.1111/j.1365-3164.2007.00649.x

Yu HW, Vogelnest LJ. Feline superficial pyoderma: a retrospective study of 52 cases (2001-2011). 

2012;23(5):448-e86. doi:10.1111/j.1365-3164.2012.01085.x

Nocera FP, Ambrosio M, Fiorito F, Cortese L, De Martino L. On gram-positive- and gram-negative-bacteria-associated canine and feline skin infections: a 4-year retrospective study of the University Veterinary Microbiology Diagnostic Laboratory of Naples, Italy. 

2021;11(6):1603. doi: 10.3390/ani11061603

Medleau L, Blue JL. Frequency and antimicrobial susceptibility of Staphylococcus spp isolated from feline skin lesions. 

Chermprapai S, Ederveen THA, Broere F, et al. The bacterial and fungal microbiome of the skin of healthy dogs and dogs with atopic dermatitis and the impact of topical antimicrobial therapy, an exploratory study. 

2019;229:90-99. doi: 10.1016/j.vetmic.2018.12.022

Weese JS. The canine and feline skin microbiome in health and disease. 

2013;24(1):137-145.e31. doi: 10.1111/j.1365-3164.2021.01076.x

Divala TH, Corbett EL, Stagg HR, et al. Effect of the duration of antimicrobial exposure on the development of antimicrobial resistance (AMR) for macrolide antibiotics: protocol for a systematic review with a network meta-analysis. 

2018;7(1):246. doi: 10.1186/s13643-018-0917-0

Morris DO, Loeffler A, Davis MF, Guardabassi L, Weese JS. Recommendations for approaches to meticillin-resistant staphylococcal infections of small animals: diagnosis, therapeutic considerations and preventative measures.: Clinical Consensus Guidelines of the World Association for Veterinary Dermatology. 

2017;28(3):304-e69. doi: 10.1111/vde.12444

Palma E, Tilocca B, Roncada P. Antimicrobial resistance in veterinary medicine: an overview. 

2020;21(6):1914. doi: 10.3390/ijms21061914

Summers JF, Hendricks A, Brodbelt DC. Prescribing practices of primary-care veterinary practitioners in dogs diagnosed with bacterial pyoderma. 

2014;10:240. doi: 10.1186/s12917-014-0240-5

Lloyd DH. Reservoirs of antimicrobial resistance in pet animals. 

2007;45(suppl 2):S148-S152. doi: 10.1086/519254

Pomba C, Rantala M, Greko C, et al. Public health risk of antimicrobial resistance transfer from companion animals. 

2017;72(4):957-968. doi: 10.1093/jac/dkw481

Zur G, Gurevich B, Elad D. Prior antimicrobial use as a risk factor for resistance in selected 

isolates from the skin and ears of dogs. 

2016;27(6):468-e125. doi: 10.1111.vde.12382

Descloux S, Rossano A, Perreten V. Characterization of new staphylococcal cassette chromosome 

) and topoisomerase genes in fluoroquinolone- and methicillin-resistant 

Staphylococcus pseudintermedius. J Clin Microbiol. 

2008;46(5):1818-1823. doi: 10.1128/JCM.02255-07

Krapf M, Muller E, Reissig A, et al. Molecular characterisation of methicillin-resistant 

from dogs and the description of their SCC

2019;233:196-203. doi: 10.1016/j.vetmic.2019.04.002

van Duijkeren E, Catry B, Greko C, et al; Scientific Advisory Group on Antimicrobials (SAGAM). Review on methicillin-resistant 

Staphylococcus pseudintermedius. J Antimicrob Chemother. 

2011;66(12):2705-2714. doi: 10.1093/jac/dkr367

Yoo JH, Yoon JW, Lee SY, Park HM. High prevalence of fluoroquinolone- and methicillin-resistant Staphylococcus pseudintermedius isolates from canine pyoderma and otitis externa in veterinary teaching hospital. 

Hassanzadeh S, Ganjloo S, Pourmand MR, Mashhadi R, Ghazvini K. Epidemiology of efflux pumps genes mediating resistance among 

2020;139:103850. doi: 10.1016/j.micpath.2019.103850

Ihrke PJ, Papich MG, DeManuelle TC. The use of fluoroquinolones in veterinary dermatology. 

Wang ZX, Kim SH. Effect of photobiomodulation therapy (660 nm) on wound healing of rat skin infected by 

Staphylococcus. Photobiomodul Photomed Laser Surg. 

2020;38(7):419-424. doi: 10.1089/photob.2019.4754

Mahmoud BH, Hexsel CL, Hamzavi IH, Lim HW. Effects of visible light on the skin. 

2008;84(2):450-462. doi: 10.1111/j.1751-1097.2007.00286.x

Zein R, Selting W, Hamblin MR. Review of light parameters and photobiomodulation efficacy: dive into complexity. 

2018;23(12):1-17. doi: 10.1117/1.JBO.23.12.120901

Wang Y, Huang YY, Wang Y, Lyu P, Hamblin MR. Photobiomodulation (blue and green light) encourages osteoblastic-differentiation of human adipose-derived stem cells: role of intracellular calcium and light-gated ion channels. 

Serrage H, Heiskanen V, Palin WM, et al. Under the spotlight: mechanisms of photobiomodulation concentrating on blue and green light. 

2019;18(8):1877-1909. doi: 10.1039/c9pp00089e

de Sousa NTA, Santos MF, Gomes RC, Brandino HE, Martinez R, de Jesus Guirro RR. Blue laser inhibits bacterial growth of 

Staphylococcus aureus, Escherichia coli, 

Pseudomonas aeruginosa. Photomed Laser Surg. 

2015;33(5):278-282. doi: 10.1089/pho.2014.3854

Wang Y, Huang YY, Wang Y, Lyu P, Hamblin MR. Red (660 nm) or near-infrared (810 nm) photobiomodulation stimulates, while blue (415 nm), green (540 nm) light inhibits proliferation in human adipose-derived stem cells. 

2017;7(1):7781. doi: 10.1038/s41598-017-07525-w

Fekrazad R, Sarrafzadeh A, Kalhori KAM, Khan I, Arany PR, Giubellino A. Improved wound remodeling correlates with modulated TGF-beta expression in skin diabetic wounds following combined red and infrared photobiomodulation treatments. 

2018;94(4):775-779. doi: 10.1111/php.12914

Fekrazad R, Asefi S, Allahdadi M, Kalhori KAM. Effect of photobiomodulation on mesenchymal stem cells. 

2016;34(11):533-542. doi: 10.1089/pho.2015.4029

Khan I, Arany PR. Photobiomodulation therapy promotes expansion of epithelial colony forming units. 

2016;34(11):550-555. doi: 10.1089/pho.2015.4054

Marchegiani A, Spaterna A, Cerquetella M. Current applications and future perspectives of fluorescence light energy biomodulation in veterinary medicine. 

Scapagnini G, Marchegiani A, Rossi G, et al. Management of all three phases of wound healing through the induction of fluorescence biomodulation using fluorescence light energy. SPIE Proceedings Volume 10863, Photonic Diagnosis and Treatment of Infections and Inflammatory Diseases II; 108630W (2019).

Marchegiani A, Fruganti A, Cerquetella M, Tambella AM, Laus F, Spaterna A. Klox fluorescence biomodulation system (KFBS), an alternative approach for the treatment of superficial pyoderma in dogs: preliminary results. 

Marchegiani A, Fruganti A, Spaterna A, Cerquetella M, Tambella AM, Paterson S. The effectiveness of fluorescent light energy as adjunct therapy in canine deep pyoderma: a randomized clinical trial. 

2021;2021:6643416. doi: 10.1155/2021/6643416

Marchegiani A, Tambella AM, Fruganti A, Spaterna A, Cerquetella M, Paterson S. Management of canine perianal fistula with fluorescence light energy: preliminary findings. 

2020;31(6):460-e122. doi: 10.1111/vde.12890

Marchegiani A, Spaterna A, Cerquetella M, Tambella AM, Fruganti A, Paterson S. Fluorescence biomodulation in the management of canine interdigital pyoderma cases: a prospective, single-blinded, randomized and controlled clinical study. 

2019;30(5):371-e109. doi: 10.1111/vde.12785

Apostolopoulos N, Mayer U. Use of fluorescent light energy for the management of bacterial skin infection associated with canine calcinosis cutis lesions. 

2020;8(4). doi.org/10.1136/vetreccr-2020-0001285

Marchegiani A, Spaterna A, Piccionello AP, Meligrana M, Fruganti A, Tambella AM. Fluorescence biomodulation in the management of acute traumatic wounds in two aged dogs. 

2020;65:215-220. doi.org/10.17221/131/2019-VETMED

Salvaggio A, Magi GE, Rossi G, et al. Effect of the topical Klox fluorescence biomodulation system on the healing of canine surgical wounds. 

2020;49(4):719-727. doi: 10.1111/vsu.13415

Tambella AM, Attili AR, Beribe F, et al. Management of otitis externa with an led-illuminated gel: a randomized controlled clinical trial in dogs. 

2020;16(1):91. doi: 10.1186/s12917-020-02311-9

Articles

Phovia is highly effective for treating superficial and deep skin infections.

Managing superficial pyoderma with light therapy

Opy USA, Inc., (Opy), and its parent company Openpay Pty Ltd (Openpay), have expanded to the US with the launch of ezyVet—a next-generation, customizable cloud-based practice management software pivotal in managing day-to-day workflows for veterinarian clinics internationally.

, this expansion has extended Opy’s current global relationship with Openpay in Australia and the UK. At the beginning of October, ezyVet began offering Opy’s Buy Now, Pay Later (BNPL) products to its US clientele, providing pet owners with a differentiated, Buy Now, Pay Smarter payment option including affordable pricing for covering commonly expensive services (eg, neutering and spraying, annual examinations, emergency surgeries, and life-saving treatments).

“Owning a pet means that you have an extended member of your family, and it’s heartbreaking to think about how many pet owners need to make painful decisions simply because they cannot afford an expensive treatment,” said Brian Shinderman, CEO of Opy and chief strategy officer of Openpay, in the release. 

“Opy removes those barriers by providing flat, predictable payments, with costs lower than most competitors, and with more time to pay. We are hopeful that our offering with ezyVet will provide consumers with the resources needed to focus on what matters most–optimal care for their loved ones,” he added.

Additionally, the US debuts ezyVet as the first cloud-based software to launch BNPL in a transparent form within the veterinarian industry and introduces Opy as the first BNPL provider to be partnered into a cloud-based platform for veterinarian care.

“Opy’s differentiated BNPL product provides doctors and their teams access to offer longer payment terms for their clients, better enabling optimal care choices in an all-in-one solution, from check-in to check-out,” said Mike Kimbell, SVP, head of US healthcare for Opy.

“Our streamlined presence within ezyVet can help provide their client base with assistance when facing challenging financial decisions and in addition, help save veterinary staff valuable time and better expand upon client relationships,” he continued.

Beginning this month, ezyVet locations are set to go live in Ohio, Michigan, and Virginia.

Opy goes live in the US with ezyVet. News release. Opy. October 27, 2021. Accessed October 27, 2021. 

https://www.opy.com/us/news/opy-goes-live-in-the-us-with-ezyvet/

A differentiated longer, larger, lower cost, but pay-later solution is now available for US pet parents making critical medical decisions for their beloved companions.

Opy debuts in the US with ezyVet

Mast cell tumors (MCTs) are the most common type of skin tumor found in dogs and the second most common skin tumor in cats.

To help broaden your knowledge on this widespread epidemic in the veterinary sector,  we've selected 3 informative articles that are chock full of the latest diagnostic and treatment methods for patients with MCTs. 

From a specific beagle's experience with MCTs to data displaying the best treatment options for feline splenic MCTs—there’s something for everyone. Happy reading!

Clinical case study: Radiation therapy for facial mast cell tumor in a beagle

David Lurie, BVSc; DACVIM (Oncology); DACVR (Radiation Oncology), outlines each step of the process as this beagle undergoes radiation therapy for an MCT.

Treatment options for feline splenic mast cell tumors

This research highlights the role of chemotherapy and supportive care on splenic MCT outcomes in cats.

Take 5: Key points managing cutaneous mast cell tumors in dogs

Michael O. Childress, DVM, MS, DACVIM (Oncology), shares 5 critical points to be mindful of when deciding the most ideal course of therapy for canine cutaneous mast cell tumors.

Mast cell tumors. American College of Veterinary Surgeons. Accessed October 27, 2021. https://www.acvs.org/small-animal/mast-cell-tumors

These insightful articles highlight the modern diagnostic and treatment measures for feline and canine MCTs. 