
The restrictions of having a valid veterinarian-client-patient-relationship (VCPR) significantly impact how we're going to be able to deliver telemedicine services, says practice manager Bash Halow, LVT, CVPM. That’s why he offers telemedicine as a free service to get clients in the door for an in-person visit.

“I’ve decided to introduce telemedicine as a not-charged-for service at our practices, as an introduction to talk to clients—in general terms—about what’s going on with their pet and using that to bring them in for the exam we need,” he said in an interview with dvm360.

A valid VCPR includes a physical exam, and for good reason, says Halow, adding that using telemedicine as a replacement for that hands-on exam is very risky.

Watch the video below to learn more about how (and why) Halow uses telemedicine at the practices he manages.

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Veterinary practice manager Bash Halow offers strategies on how to use telemedicine as a way to fortify the veterinarian-client-patient relationship.

Scared to use telemedicine at your veterinary practice? Don't be

The American Association of Feline Practitioners (AAFP) is inviting the veterinary community to attend its first-ever 

, which will focus primarily on feline anesthesia and behavior.

The e-conference will be held Monday, April 6 from 11:00 a.m. to 4:30 p.m. EDT to accommodate busy veterinary professionals who may be unable to leave their practice.

Despite the online-only format, the conference will still offer the same real-time experiences found at a traditional conference, including networking, Q&As and engaging discussions with other attendees, all made possible through a chat functionality. Attendees will also earn four RACE-approved CE credits.

The first half of the virtual conference will be led by Sheilah Robertson, BVMS (Hons), PhD, DAVCAA, DECVAA, DACAW, DECAWBM (WSEL), CVA, MRCVS, senior medical director for Lap of Love Veterinary Hospice—a network of over 100 veterinarians that specialize in end-of-life care and in-home euthanasia.

The schedule for Dr. Robertson’s talk is as follows:

11:00 a.m.—Anesthesia for Senior & Super-Senior Cats

12:00 p.m.—Anesthesia and Analgesia: Real World, Real Cases

The second half of the conference will be led by Sarah Heath, BVSc, DECAWBM, CCAB, MRCVS, a veterinary specialist in behavioral medicine and an external lecturer in small animal behavioral medicine at Liverpool University.

The schedule for Dr. Heath’s lectures is as follows:

2:00 p.m.—Inter-Cat Tension in Multi-Cat Households

3:00 p.m.—Behavioral Considerations in Feline Obesity & Weight Loss

This virtual conference, hosted by the American Association of Feline Practitioners, will allow veterinary professionals to participate from the comfort of their desks or on the go.



AAFP to hold inaugural e-conference in April 

Hey, veterinary professionals. We know you’re busy. That’s why we’ve made it even easier for you to get the latest veterinary news.

Click the video below to view the top 3 stories of the week in 60 seconds:

Last week, Antech Diagnostics announced the development of the 

first diagnostic test for canine inflammatory bowel disease.

The Purina Institute has announced the imminent launch of 

 the first and only cat food that can reduce allergens in cat hair and dander.

 explains how hypothermia occurs, the negative effects it has on the body, 

 how to prevent it during anesthetic events.

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Want to be in the know? Check out the veterinary news highlights from this week.

News in a minute: First canine IBD blood test, game-changing feline diet, hypothermia doodle

Research shows that loneliness and social isolation can induce negative health effects that rival those of obesity and smoking. In a 

 from global health insurer Cigna, nearly half of Americans reported feeling alone, isolated or left out at least some of the time. An argument can be made that today’s so-called “loneliness epidemic” is a serious threat to public health.

But Mars Petcare and the Human Animal Bond Research Institute (HABRI) believe that help for many people who feel alone, socially disconnected or isolated can come in the four-legged form through human-animal interaction (HAI) and pet ownership.

Consortium on Social Isolation in Companion Animals

Recognizing the potential of companion animals to make a real difference in human mental health, in 2018 the retail giant and the nonprofit collaborated with practitioners and researchers from human and animal health care to form the Consortium on Social Isolation and Companion Animals, with four overarching goals:

Identify the potential of HAI to assuage social isolation in people.

Pinpoint hurdles that some individuals may face in realizing the benefits of HAI.

Propose best practices and practical solutions to address those hurdles.

Last year, the consortium convened experts in public health, research, psychology, gerontology and veterinary medicine for the first-ever Summit on Social Isolation and Companion Animals to tackle these goals, particularly as they relate to older adults and the mentally impaired.

 released this week by the consortium underscores the importance of social interaction in mental health and presents the results of a 2,000-person survey of both pet owners and non–pet owners throughout the United States. What they found may not be surprising to veterinary professionals:

80% of pet owners say their pet makes them feel less lonely.

54% of pet owners say their pet helps them connect with other people.

85% of all respondents believe that interaction with companion animals can help combat loneliness.

76% of all respondents agree that interacting with animals can alleviate social isolation.

“Pet ownership produces better heart health, and we have evidence that it improves mental health, but there’s an epidemic of loneliness in our society,” HABRI Executive Director Steven Feldman told 

. “We wanted to take a hard look at how having a pet and HAI can impact such a big societal challenge.”

From the Summit came three primary recommendations to ensure that animals are taken into consideration when addressing the loneliness epidemic.

Research is needed to help qualify best practices for whom and under what circumstances companion animals may be effective to help alleviate loneliness.

“We are working to facilitate and increase the amount of research in this area,” Angela Hughes, DVM, PhD, senior manager of Global Scientific Advocacy Relations at Mars Petcare, told 

, “because we understand that not every situation is going to be a perfect one for pet interaction.”

Instead of considering whether there is a pet in the home, future HAI research should take into account the quality of pet–human interaction and the degree to which individuals are attached to their pets. Future research should also evaluate the practice of animal-assisted intervention (AAI) to create evidence-based protocols that can be shared with all programs.

 Many barriers prevent older adults and the mentally impaired from participating in HAI. According to Feldman, this is an area where veterinarians play an important role.

“One of the barriers is making sure that as people age, they can keep their pets,” he says. “Veterinarians with older clients can help those clients keep their pets healthy as they age even as they move into continuing care facilities.”

But it’s also vital to recognize when pet ownership may 

be the solution. “Do they not have the ability to personally care for a pet?” Dr. Hughes asks. “Maybe an interaction with a therapy animal would be more beneficial instead of them being responsible for that pet all the time.”

Amplify uptake of ‘gold standard’ programs.

 The third recommendation is to support and help advance best practices in HAI. When it comes to therapy animals, for example, what are best practices to keep these pets healthy and make sure their welfare is looked after?

“Perhaps a doctor can prescribe a pet to a client who is suffering from social isolation and loneliness,” Dr. Hughes explains. “But we have to ask what’s the right pet and the right situation? We’re trying to help provide good guidelines and best practices.”

This report is just a starting point to help establish the role of pets and companion animals in helping to alleviate social isolation around the world. While some hurdles were identified at the summit, and best practices were proposed to help address these hurdles, researchers acknowledge that much more work remains.

Over the next five years, HABRI and Mars Petcare have committed to working to achieve these three goals in an effort to spark real change in society.

“Ultimately, we believe in the power of pets to help solve this pressing epidemic of loneliness and solution isolation,” Dr. Hughes says. “That’s why we feel like this roadmap is going to facilitate the role of HAI and pet ownership in addressing it.”

A new report from Mars and the Human Animal Bond Research Institute explains how interaction with animals can help many people feel less alone and socially isolated, and provides recommendations for keeping companion animals safe and healthy in the process.

Combatting the ‘loneliness epidemic,’ one pet at a time

Zoetis has acquired Ethos Diagnostic Science, a veterinary reference lab business unit of Ethos Veterinary Health, with a goal of enhancing its growing reference laboratory footprint. According to a 

, the acquisition will allow Zoetis to offer comprehensive and enhanced value to veterinarians throughout the country.

“We are thrilled to add the Ethos Diagnostic Science labs to our expanding diagnostics presence in the U.S., and we look forward to working with their dedicated, trusted, board-certified pathologists and laboratory technicians,” says Lisa Lee, Zoetis senior vice president and head of global diagnostics, in the release.

Ethos Diagnostic Science currently has laboratory locations in Boston, Denver and San Diego, where clinical teams perform testing for all veterinary species in hematology, clinical chemistry, urinalysis, microbiology, parasitology, endocrinology, serology, cytology and histology.

“We’re very proud of Ethos Diagnostic Science and our lab teams who have demonstrated our core value of innovation and provided invaluable service to our clinical teams, pet families at Ethos Veterinary Health and veterinary teams of our lab customers,” says Brian Cassell, DVM, Ethos Veterinary Health’s chief strategy officer.

Zoetis expects the global veterinary diagnostics category to continue to grow faster than the animal health industry overall. According to the company, this growth is driven by pet owners’ increasing interest in rising medicalization rates, standards of veterinary care and the convenience of in-clinic testing.

“With the addition of Ethos’ labs in San Diego, Denver and Boston, we continue to build a more holistic diagnostics portfolio at Zoetis,” Lee says, “and together we can provide veterinarians with even more valuable service and accurate insights that inform the care they provide to animals.”

The animal health company continues to grow its presence in the diagnostic category, which is estimated to exceed $4 billion. 

Zoetis acquires Ethos Diagnostic Science 

Antibiotics are often prescribed for dogs with gastrointestinal (GI) signs. In fact, three studies surveying veterinary prescribing habits in the U.K. showed that antimicrobials were prescribed as first-choice therapy in 50% or more of dogs presenting with acute diarrhea.

While antibiotics can certainly be beneficial or even lifesaving for some dogs with GI disease, for others these drugs are unnecessary and may even be harmful.

. As antimicrobial resistance becomes an ever-pressing concern in modern human medicine, there has been a growing movement in veterinary medicine to promote appropriate and judicious use of antibiotics.

 Oral administration of antibiotics may lead to the rapid development of resistant strains in the GI tract; cross-resistance to other antimicrobial agents can also occur.

 Opinions vary about the short- and long-term effects of antibiotics on the microbiome, which plays an important role in health and immunity, but it’s clear that concern is warranted (Figure 1). In one study, metronidazole was shown to cause a transient decrease in pathogenic bacteria and an increase in beneficial bacteria,

 but a different study showed that the fecal dysbiosis index was significantly increased in healthy dogs receiving metronidazole, indicating significant alterations in the microbiome structure and diversity, with some changes remaining up to 4 weeks after the completion of antibiotic administration.

(The fecal dysbiosis index is a polymerase chain reaction [PCR] assay that quantifies the abundances of various bacterial groups, with values < 0 indicating a normal fecal microbiota and values > 0 indicating dysbiosis.)

Fenbendazole has no significant effects on the microbiome of healthy dogs,

 but tylosin, another commonly prescribed medication for GI disease, can have prolonged effects.

 In one study, healthy dogs receiving standard doses of oral tylosin had significantly increased fecal dysbiosis indices, persisting for at least 2 months in some dogs.

 Although none of the dogs in these studies had (or developed) GI signs, the effects of antibiotics on the microbiome warrant further investigation.

While we know antibiotic use affects the microbiome, we do not know the potential long-term consequences. Links have been found in humans between antibiotic exposure early in life and the development of various diseases, such as inflammatory bowel disease and allergies.

Thus, it is reasonable to be concerned that antibiotic use in our own patients—especially young, growing dogs—might suffer similar consequences.

 in dogs has many possible causes, but a primary bacterial etiology is uncommon. Although diarrhea is often self-limiting, antibiotics are sometimes prescribed by practitioners in an effort to expedite recovery.

Studies evaluating whether antibiotics have a discernible effect on time to resolution of diarrhea in dogs have had mixed results. One study failed to identify a significant difference in time to recovery in dogs treated with metronidazole compared with placebo,

 and another found that metronidazole hastened resolution of diarrhea by about 1.5 days (both groups in this study recovered quickly).

 A large, retrospective observational study found that dietary modification and nutraceuticals (which included probiotics) were positively associated with resolution of acute diarrhea, but no such association was found with pharmaceutical agents (including antibiotics).

Given that there is minimal (if any) proven benefit of antibiotic use in dogs with uncomplicated acute diarrhea, there is no basis to support the routine prescription and use of antibiotics in these cases.

has a tropism for rapidly dividing cells, including those of the intestinal crypt epithelium, which leads to a severe enteritis. This, paired with the neutropenia that classically occurs with this disease, places patients at risk for bacterial and endotoxin translocation, which can result in bacteremia, systemic inflammatory response syndrome (SIRS) or multiorgan dysfunction. For this reason, broad-spectrum antibiotics are warranted in neutropenic patients suffering from canine parvovirus infection.

Typically, a beta-lactam antibiotic (ampicillin 22 mg/kg IV three times daily) is used, alone or in conjunction with enrofloxacin (5-10 mg/kg/day IV); see Table 1. Enrofloxacin may cause cartilage damage in young, growing animals, but this is rare with standard doses. Aminoglycosides can also be considered in well-hydrated dogs, but its use carries a risk of acute renal failure.

Table 1. Indications, antibiotic agents, and doses for treating GI disease in dogs

 (AHDS), formerly known as hemorrhagic gastroenteritis, is associated with a small intestinal overgrowth of 

although it should be noted that this organism is present consistently in the feces of healthy dogs. The netF toxin gene produced by 

 might play an important role in the pathogenesis of this disease. Although there is no significant difference in 

 encoding for the alpha toxin or enterotoxin between dogs with AHDS, parvovirus, or healthy controls, a significantly greater number of dogs with AHDS have the netF toxin gene.

 While the presence of netF gene in fecal samples supports 

–associated AHDS, there is no difference in outcome between netF-positive and netF-negative dogs. It should also be noted that there is a 10% to 12% prevalence of this gene in nonspecific diarrhea cases and healthy controls, and about 50% of dogs with AHDS are netF negative.

There is no significant difference in the recovery and outcome of dogs treated with or without amoxicillin/clavulanic acid,

 and in a study evaluating the effects of a probiotic on the clinical course of AHDS, dogs made a rapid recovery without antibiotics.

For this reason, unless evidence of sepsis exists (such as fever or toxic change of neutrophils on a leukogram), antimicrobials are unlikely to be necessary for the treatment of this syndrome.

Dogs with AHDS that do not receive antibiotics have a good prognosis and rapid recovery, despite roughly one-third of these patients meeting two or more SIRS criteria.

 This suggests that standard SIRS criteria alone may not be strict enough to guide appropriate use of antimicrobials.

(ARD) describes a chronic (> 3 weeks) enteropathy for which no underlying cause is found and which is completely responsive to antibiotic treatment. Classically, ARD is seen in young, large-breed dogs, with German shepherds being overrepresented. It is characterized by chronic intermittent diarrhea as well as weight loss, a variable appetite, and possible vomiting.

The diagnosis is based on a positive response to therapy, exclusion of other diseases (e.g. exocrine pancreatic insufficiency in a young German shepherd with weight loss and diarrhea) and a demonstration of disease relapse when antibiotics are withdrawn. Excluding other diseases is important as many of them may improve temporarily with antibiotics; thus a positive response to therapy does not negate the need for appropriate workup.

About two-thirds of dogs with chronic enteropathies have food-responsive enteropathies, with ARD and steroid-responsive diarrhea making up the remaining third.

 Dogs with food-responsive diarrhea have better outcomes than dogs with either ARD or steroid-responsive disease. Therefore, an antibiotic trial should be considered only after a strict diet trial (hydrolyzed protein or novel protein diet) for a minimum of 3 weeks with no response.

The antibiotics recommended for treatment of ARD are metronidazole (10-15 mg/kg PO twice daily) and tylosin (25 mg/kg PO once or twice daily). Some dogs respond specifically to tylosin,

 so it may make more sense to look to tylosin before metronidazole in an antibiotic trial for a chronic enteropathy. Response to therapy should be quick (within 2 weeks), and dogs with a positive response to tylosin at 25 mg/kg/day might respond to doses as low as 5 mg/kg/day.

 Thus, dose reduction can be considered following a positive response to the standard dose.

As noted earlier, ARD is definitely diagnosed when relapse occurs following antibiotic withdrawal and clinical signs resolve when the antibiotic is re-introduced.

 That said, not all dogs require lifelong therapy and periodic withdrawal of antibiotics should be attempted to determine whether ongoing therapy is necessary.

 is characterized histologically by granulomatous inflammation with periodic acid-Schiff–positive macrophages. This disease classically is seen in young boxer dogs or French bulldogs.

 Patients usually present with a combination of colitis, hematochezia and weight loss.

With the use of fluorescence in situ hybridization (FISH; Figure 2), mucosally invasive 

 was identified as the likely cause of this disease. Long-term remission is associated with eradication of the bacteria.

Typically, it is treated with a long course of fluoroquinolones, such as enrofloxacin (5-10 mg/kg/day for six to eight weeks). This disease has been identified in a variety of other breeds and even in cats, with reported remission with fluoroquinolone therapy.

 to fluoroquinolones has been demonstrated. Therefore, bacterial culture and sensitivity testing of the tissue is recommended. Due to the potential for the development of antimicrobial resistance, empiric therapy for this disease is not recommended.

(and/or their toxins) are often detected today using fecal PCR panels, which allow for the identification of organisms such as 

Clostridium difficile, C. perfringens, Campylobacter 

 regarding enteropathogenic bacteria offers a more detailed discussion on this topic.

As these organisms can be found in both healthy animals and in those with diarrhea, interpretation of the results of these panels can be confusing. For some organisms, identification of enterotoxin genes may be more helpful. Enterotoxin genes are produced by both 

 and are found more frequently in dogs with diarrhea than in those without.

Clinically, many of these cases will present as self-limiting diarrhea that does not require antimicrobial therapy. In fact, overuse of antibiotics in these scenarios may promote drug-resistant organisms.

Conversely, if a patient presents with systemic signs of illness (e.g. fever, toxic changes or a degenerative left shift) and is diagnosed with an enteropathogenic bacteria, appropriate antibiotic therapy may be warranted.

 spp., antimicrobial therapy is not indicated in nonclinical or mildly affected dogs. This recommendation remains the same even with an immunocompromised owner. In this case, appropriate husbandry and hygiene become the more important aspects of management.

Despite the frequency of antibiotic use for GI disease in dogs, there are relatively few indications for prescribing antimicrobials in this context (Table 2). Overuse could result in antimicrobial resistance and may have long-reaching effects on the host microbiome. Therefore, in the absence of evidence to support their use, antibiotics should be avoided in systemically healthy animals. For systemically ill animals, clinical judgment should be used until more specific criteria are developed.

Table 2. When to use (or avoid) antibiotics

1. German AJ, Halladay LJ, Noble PJ. First-choice therapy for dogs presenting with diarrhoea in clinical practice. 

2. Jones PH, Dawson S, Gaskell RM, et al. Surveillance of diarrhoea in small animal practice through the Small Animal Veterinary Surveillance Network (SAVSNET). 

3. Singleton DA, Noble PJM, Sanchez-Vizcaino F, et al. Pharmaceutical prescription in canine acute diarrhoea: a longitudinal electronic health record analysis of first opinion veterinary practices. 

4. Lappin MR, Blondeau J, Boothe D, et al. Antimicrobial use guidelines for treatment of respiratory tract disease in dogs and cats: Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases. 

5. Weese JS, Blondeau J, Boothe D, et al. International Society for Companion Animal Infectious Diseases (ISCAID) guidelines for the diagnosis and management of bacterial urinary tract infections in dogs and cats.

6. Marks SL, Rankin SC, Byrne BA, et al. Enteropathogenic bacteria in dogs and cats: diagnosis, epidemiology, treatment, and control. 

7. Schmidt VM, Pinchbeck G, McIntyre KM, et al. Routine antibiotic therapy in dogs increases the detection of antimicrobial-resistant faecal 

8. Igarashi H, Maeda S, Ohno K, et al. Effect of oral administration of metronidazole or prednisolone on fecal microbiota in dogs. 

9. Suchodolski JS, Olson E, Honneffer J, et al. Effects of hydrolyzed protein and metronidazole on the fecal microbiome and metabolome in healthy dogs. 

10. Fujishiro MA, Lidbury JA, Pilla R, et al. Evaluation of the effects of anthelmintic administration on the fecal microbiome of healthy dogs with and without subclinical Giardia spp. and Cryptosporidium canis infections. 

11. Suchodolski JS, Dowd SE, Westermarck E, et al. The effect of the macrolide antibiotic tylosin on microbial diversity in the canine small intestine as demonstrated by massive parallel 16S rRNA gene sequencing. 

12. Manchester AC, Webb CB, Blake AB, et al. Long-term impact of tylosin on fecal microbiota and fecal bile acids of healthy dogs. 

13. Kronman MP, Zaoutis TE, Haynes K, et al. Antibiotic exposure and IBD development among children: a population-based cohort study.

14. Ni J, Friedman H, Boyd BC, et al. Early antibiotic exposure and development of asthma and allergic rhinitis in childhood. 

15. Ungaro R, Bernstein CN, Gearry R, et al. Antibiotics associated with increased risk of new-onset Crohn's disease but not ulcerative colitis: a meta-analysis. 

16. Shmalberg J, Montalbano C, Morelli G, et al. A randomized double blinded placebo-controlled clinical trial of a probiotic or metronidazole for acute canine diarrhea. 

17. Langlois DK, Koenigshof AM, Mani R. Metronidazole treatment of acute diarrhea in dogs: A randomized double blinded placebo-controlled clinical trial. 

18. Unterer S, Busch K, Leipig M, et al. Endoscopically visualized lesions, histologic findings, and bacterial invasion in the gastrointestinal mucosa of dogs with acute hemorrhagic diarrhea syndrome. 

19. Sindern N, Suchodolski JS, Leutenegger CM, et al. Prevalence of

 netE and netF toxin genes in the feces of dogs with acute hemorrhagic diarrhea syndrome. 

20. Unterer S, Strohmeyer K, Kruse BD, et al. Treatment of aseptic dogs with hemorrhagic gastroenteritis with amoxicillin/clavulanic acid: a prospective blinded study. 

21. Ziese AL, Suchodolski JS, Hartmann K, et al. Effect of probiotic treatment on the clinical course, intestinal microbiome, and toxigenic Clostridium perfringens in dogs with acute hemorrhagic diarrhea. 

22. Moberg FS, Bjornvad CR, Lorentzen C, et al. Dogs with acute haemorrhagic diarrhoea syndrome not receiving antibiotics have a good prognosis despite initial high AHDS-score and systemic inflammation. Presented at the 29th European College of Veterinary Internal Medicine–Companion Animals Congress, September 2019.

23. Volkmann M, Steiner JM, Fosgate GT, et al. Chronic diarrhea in dogs - retrospective study in 136 cases. 

24. Allenspach K, Culverwell C, Chan D. Long-term outcome in dogs with chronic enteropathies: 203 cases. 

25. Westermarck E, Frias R, Skrzypczak T. Effect of diet and tylosin on chronic diarrhea in beagles. 

26. Kilpinen S, Spillmann T, Westermarck E. Efficacy of two low-dose oral tylosin regimens in controlling the relapse of diarrhea in dogs with tylosin-responsive diarrhea: a prospective, single-blinded, two-arm parallel, clinical field trial. 

27. Kilpinen S, Spillmann T, Syrja P, et al. Effect of tylosin on dogs with suspected tylosin-responsive diarrhea: a placebo-controlled, randomized, double-blinded, prospective clinical trial. 

28. Manchester AC, Hill S, Sabatino B, et al. Association between granulomatous colitis in French bulldogs and invasive 

 and response to fluoroquinolone antimicrobials. 

29. Mansfield CS, James FE, Craven M, et al. Remission of histiocytic ulcerative colitis in boxer dogs correlates with eradication of invasive intramucosal

30. Craven M, Mansfield CS, Simpson KW. Granulomatous colitis of boxer dogs. 

31. Leal RO, Simpson K, Fine M, et al. Granulomatous colitis: more than a canine disease? A case of Escherichia coli-associated granulomatous colitis in an adult cat. 

Drs. Grimes and Lidbury work in the Department of Small Animal Clinical Sciences at Texas A&M University. Dr. Lidbury is affiliated with the Gastrointestinal Laboratory, which offers the canine fecal dysbiosis index and fecal enteropathogen testing on a fee-for service basis.

Antimicrobials may be prescribed due to convenience, habit, or good intentions, but in the absence of evidence to support their use, they should be avoided in systemically healthy animals. Here’s why.