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Ectoparasites, such as fleas, ticks, and mosquitoes, often dominate our discussions about parasite control with both colleagues and clients. While these external parasites can cause a host of conditions in companion animals—and controlling them is certainly important—a deeper problem hiding within is often overlooked: gastrointestinal endoparasites. 

These parasites, including hookworms, roundworms, whipworms, and tapeworms, not only cause gastrointestinal signs of vomiting, diarrhea, and anorexia in our canine patients,

 they can also lead to severe medical conditions in their owners when they serve as an aberrant host.

 For many pet owners, the mere sight of a roundworm in the pet’s stool or tapeworm proglottids on the pet’s rear end can lead to panicked phone calls to the veterinarian, isolation of the pet from family members, and a decrease in the overall quality of the human animal bond in that household until the matter is resolved. Considering these factors, it becomes clear that the need for proper detection of intestinal parasites—and treatment of the diseases they cause—are as important as ever.

The prevalence of endoparasites varies significantly both across the country and from study to study. A review of recently published studies shows a nematode prevalence ranging from about 6% to almost 30%.

Despite current veterinary protocols, a study analyzing data from the Companion Animal Parasite Council (CAPC) website even shows an increasing trend in positive fecal samples for hookworms and roundworms across the country.

 One recent study analyzing over 3000 fecal samples from dogs at nearly 300 dog parks across the United States found parasites in over 85% of locations and in 20% of samples tested.

Keep in mind that all prevalence studies are affected by a wide range of factors. Data will vary quite a bit based on seasonality, testing methods, age of the patient, sample size, and geographic region.

The most common tool in the veterinary arsenal to detect intestinal parasites is fecal flotation. Although this simple test can be found in most veterinary practices, it is easy to miss key steps in the testing process that ensure accurate results. A wide variety of flotation solutions are available, but the most common and useful are zinc sulfate and Sheather’s sugar solution. Both offer pros and cons that should be considered for individual veterinary practices.

The Kansas State Veterinary Diagnostic Laboratory offers a succinct and useful summary of these options as well as tips on how to perform the best flotation possible.

The summary’s authors, Kansas State University parasitologists Mike Dryden, DVM, MS, PhD, and Brian Herrin, DVM, PhD, also explain the benefits of centrifugation in fecal flotation, which significantly increases the accuracy of these tests.

Passive fecal floats are no longer considered appropriate tests.

 Many national veterinary laboratories now offer antigen testing in combination with fecal flotation. Detecting small traces of proteins enables diagnosis of infections during the prepatent period—before eggs are being shed—in parasites with intermittent shedding as well as in cases with low worm burden.

Given the variation in both parasite prevalence and the availability and methods of testing for them, we must consider occult infections and false-negative results when making recommendations for our patients. Although most veterinarians feel comfortable diagnosing and treating common intestinal parasites, research suggests that these parasites are actually underdiagnosed in veterinary medicine.

In fact, a recent study showed that fecal flotations have missed up to 96% of Dipylidium caninum and over 30% of Trichuris vulpis.

The rate of false-negative results is less dramatic for other parasites that shed eggs more reliably, but even with centrifugation and antigen testing Toxocara canis was missed in over 20% of cases in this study.

That our best testing methods have been shown to leave us with a significant level of undiagnosed parasites, we must consider other options to protect our patients.

There are several steps veterinarians can take to reduce the number of undiagnosed cases of intestinal parasitism in our patients and to protect those that do fall through the cracks. All fecal samples should be run as a combination of both microscopic examination by flotation and fecal antigen testing in order to reduce false-negative results on these samples.

 CAPC recommends a testing frequency of every 6 months.

 This allows us to catch these infections and treat them sooner and increases the likelihood of finding occult infection.

Perhaps the biggest difference we can make is to reinforce our recommendations for monthly ectoparasite and endoparasite prevention for our patients. Even at relatively high-risk locations, such as dog parks, samples from dogs that are on monthly prevention are significantly less likely to test positive for parasites.

 CAPC states it perfectly: “To help protect the unique relationship of dogs and cats and their human family, our recently announced guidelines lead with the recommendation that all family pets be treated year-round with broad-spectrum heartworm anthelmintics that also protect against intestinal nematodes.”

Many readily available products protect against a range of intestinal parasites seen in our patients. Products containing milbemycin, as opposed to ivermectin with pyrantel, will provide the best whipworm prevention, and those that contain praziquantel have the added benefit of protecting against tapeworms, which are among the most commonly underdiagnosed parasites. By recommending year-round monthly protection with products that include protection and treatment for common intestinal parasites, including tapeworms and whipworms, we can ensure that all of our patients maintain optimal health and a close bond with their human caretakers

Dr. Calabro practices small animal medicine at Brick Town Veterinary Hospital in Brick, New Jersey. His special interests include endocrine pathologies and feline medicine.

One Health: Zoonotic diseases. Centers for Disease Control and Prevention. Updated July 14, 2017. Accessed August 19, 2020. www.cdc.gov/ onehealth/basics/zoonotic-diseases.html.

CAPC guidelines: Intestinal parasites. Companion Animal Parasite Council. https://capcvet.org/ guidelines/. Accessed August 19, 2020.

Little ES, Johnson EM, Lewis D, et al. Prevalence of intestinal parasites in pet dogs in the United States. Vet Parasitol. 2009;166(1-2):144-152.

Savadelis MD, Evans CC, Mabry KH, et al. Canine gastrointestinal nematode transmission potential in municipal dog parks in the southeast United States. Vet Parasitol Reg Stud Rep. 2019;18:100324.

Drake J, Carey T. Seasonality and changing prevalence of common canine gastrointestinal nematodes in the USA. Parasit. Vectors. 2019;12:430. doi: 10.1186/s13071-019-3701-7

Stafford K, Kollasch, TM, Duncan, KT, et al. Detection of gastrointestinal parasitism at recreational canine sites in the USA: the DOGPARCS study. Parasit Vectors. 2020;13:275. doi:10.1186/ s13071-020-04147-6

Understanding the maps: Key factors that influence the results. Companion Animal Parasite Council. Accessed August 29, 2020. https://capcvet.org/ articles/understanding-the-maps-key-factors-thatinfluence-the-results/

Herrin B, Dryden M. Steps to Increase the value of fecal diagnostics. Kansas State Veterinary Diagnostic Laboratory. www.ksvdl.org/resources/ news/diagnostic_insights_for_technicians/ december2017/fecal_diagnostics.html. Accessed August 19, 2020.

Fecal Dx antigen testing—find parasite infections the microscope misses. Idexx Laboratories. Published March 2017. Accessed August 19, 2020. www.idexx.com/en/veterinary/reference-laboratories/ fecal-dx-antigen-test/fecal-study/

Adolph C, Barnett S, Beall M, et al. Diagnostic strategies to reveal covert infections with intestinal helminths in dogs. Vet Parasitol. 2017;247:108- 121. doi: 10.1016/j.vetpar.2017.10.002 11. The bond cats, dogs and their owners shouldn’t share. Companion Animal Parasite Council. Accessed September 10, 2020. https://capcvet.org/articles/thebond-casts-dogs-and-their-owners-shouldnt-share/

The bond cats, dogs and their owners shouldn’t share. Companion Animal Parasite Council. Accessed September 10, 2020. https://capcvet.org/articles/thebond-casts-dogs-and-their-owners-shouldnt-share/

Articles

A look at endoparasite prevalence, how to get the best results from fecal testing, and how anthelmintics can help protect our patients (Sponsored by Elanco Animal Health). 

Intestinal parasites: screening & prevention best practices

Proper eyelid anatomy is essential for protecting the globe, as well as for distributing the tear film on the ocular surface. However, many dog breeds suffer from inherited eyelid abnormalities that affect their function. This article discusses surgical correction of some of the more common disorders of this critical organ.

Entropion, or inward rolling of the eyelid margin, causes eyelashes and facial hair to contact the conjunctiva and cornea (

), leading to conjunctivitis, keratitis, and possible ulceration. There are 3 types of entropion: conformational (caused by anatomic abnormalities of the eyelids themselves) spastic (caused by marked contraction of the orbicularis oculi muscle), and cicatricial (caused by scarring from an injury or previous surgery).

Conformational entropion is by far the most common presentation. It usually affects both eyes, and more commonly the lower eyelid. Severe cases may involve the entire lid, but typically just a portion of the margin is affected. In brachycephalic dogs, conformational entropion is more notable at the medial lower eyelid, whereas in large, broad-skulled dogs it often affects the lateral part of the lower eyelid and the lateral canthus. Upper eyelid involvement is usually seen in dogs with very heavy brows, such as bloodhounds, Shar-Peis (

), and chow chows. Conformational entropion is believed to be inherited in a large number of dog breeds, including the chow chow, English bulldog, Irish setter, Labrador and golden retrievers, Saint Bernard, Shar-Pei, Rottweiler, Great Dane, and Chesapeake Bay retriever.

Although conformational entropion may manifest soon after eye opening, it often does not become clinically evident until later in life as the skull and associated facial skin gain their adult conformation. Conversely, maturation may also be associated with reduction or sometimes even resolution of entropion. For these reasons, surgeons should use temporary tacking and postpone definitive surgery until facial maturity is achieved, although such a delay is not advisable in severe cases.

The surgical method chosen to correct entropion depends on the patient’s breed and facial maturity, mechanism and severity of the condition, and position of the eyelid abnormality. Of these, mechanism is perhaps the most important, as the entropion may be caused by excessively long or short eyelids, excessive facial skin, an overly tight or misdirected canthal ligament, or a painful process causing spastic entropion. Regardless of the technique chosen, accurately assess the extent of skin resection before sedation, premedication, or anesthesia induction. Consider use of a dermatologic marker pen. Always apply topical anesthesia to eliminate other causes of spastic entropion before deciding on the extent of surgical resection. Keep in mind that the goal is to correct for the conformational or anatomic component only, not the spastic component. Correction of the conformational component will also alleviate the spastic component.

The majority of simple, breed-related entropion cases can be addressed using the Hotz-Celsus procedure. For this technique, make the initial incision parallel to the eyelid margin at the haired-nonhaired junction while protecting the ocular surface with a lid plate (

). Avoid placing this incision too far from the eyelid margin. This is a common error that causes a significant loss of “mechanical advantage” and achieves less eversion. The length of this first incision is dictated by the length (extent) of inverted eyelid. First, apply gentle pressure with the thumb at the point of entropion to roll out the eyelid until the eyelid margin (meibomian gland orifices) can be seen along the whole length; this will assist with outlining the full lateral and medial extent of entropion. Other clues are provided by the pale discoloration, blepharedema, and alopecia that occur secondary to rubbing of eyelid skin against the cornea.

Next, make a curvilinear incision joining the 2 ends of this first incision. The real art of entropion surgery is in deciding on the amount of tissue to resect (ie, the distance between the first and second incisions). This was predetermined during the examination of the awake patient (using topical anesthetic) and can be confirmed during surgery by applying the same clues used to determine the length of the first incision. The most important point is to ensure that the widest tissue resection is planned for the most inverted section of the eyelid, even if this creates an asymmetric area of resected tissue.

Undercorrection with the need for a second operation is preferable to overcorrection, which may cause cicatricial ectropion.

Do not remove the orbicularis oculi muscle; doing so increases hemorrhage, operating time, postoperative edema, and infection risk.

Use 5-0 or smaller suture material with swaged-on, cutting suture needles to suture the 2 incision lines to each other.

Place multiple, closely spaced sutures of small “bites” with the goal of excellent apposition. Sutures will not be under great forces postoperatively.

Use an Elizabethan collar until at least 2 to 3 days 

Provide adequate postoperative analgesia for the first 7 to 10 days.

Delay any decision regarding a second operation for at least 4 to 6 weeks.

A number of patients will benefit from some form of temporary relief of entropion until permanent blepharoplasty is performed. This has traditionally been achieved with a series of temporary tacking sutures placed so as to evert the eyelid (

). Temporary tacking procedures may be considered to treat entropion in the following patients:

Patients with an underlying treatable cause (eg, keratoconjunctivitis sicca, corneal ulcer) should be tacked while that cause is corrected or controlled.

Immature patients. Because entropion may progress or resolve with maturity in some animals, permanent surgical correction is best delayed until facial maturity is reached.

Patients with a temporary cause of entropion, such as transient enophthalmos caused by dehydration or lack of orbital fat, as seen in neonatal animals, especially foals and lambs.

Surgical staples have been used recently in place of sutures for temporary tacking because they are quicker, less traumatic, less irritating, persist in the tissue longer than sutures, and can usually be applied without general anesthesia. Animals may be sedated, but do not infuse local anesthetic into the eyelids. This disrupts the eyelid anatomy and hinders corrective tacking. Place as many staples as necessary to evert the affected eyelid margin (and canthus in some patients). Each staple should be perpendicular to the eyelid margin. Leave the staples or sutures in place for as long as necessary. In some animals, tacking may have to be repeated several times until facial maturity is reached and permanent corrective surgery can be performed.

Upper eyelid entropion is seen most commonly in dogs with excessive brow tissue, such as chow chows, Shar-Peis, basset hounds, and bloodhounds. In these patients it is usually the upper eyelashes that irritate the cornea because of ptosis of the heavy upper eyelid and the consequent “flat” angle at which these lashes approach the cornea. As such, standard entropion procedures such as the Hotz-Celsus technique may not alleviate the problem. Rather, these dogs usually require correction using the Stades technique.

To start the Stades technique, resect a large, approximately semicircular or crescent-shaped piece of tissue from the dermal side of the upper eyelid (including the cilia themselves, avoiding the Meibomian glands). Then, bring down the dorsal wound border toward (but not meeting) the wound nearer the eyelid margin. Suture to leave an exposed strip of subcutis about 3- to 4-mm wide. This tissue is left to heal by second intention such that the contraction and cicatrization during this process further everts the upper eyelid and forms a relatively hair-free margin. Severe cases may benefit from highly involved stellate rhytidectomy procedures (skin fold resections from the top of the head) to alleviate the heavy skin that contributes to the upper eyelid ptosis.

Like entropion, ectropion (eversion of the eyelid) almost always affects the lower lid only. Clinically significant ectropion is less common than entropion. The most common type is conformational or breed-related ectropion. The condition is seen in dogs with loose facial skin, such as retrievers, Saint Bernards, bloodhounds, and cocker spaniels. It can cause secondary lagophthalmos, keratitis, or conjunctivitis.

Depending on the severity of the ectropion, it can be resolved using one of two techniques: wedge resection or V-to-Y blepharoplasty.

When ectropion is secondary to mild euryblepharon (elongated eyelids), shorten the lower eyelid by resecting a full-thickness wedge from the lateral end of the lower eyelid (

). Then, use a standard 2-layer closure to perfectly appose the sides of the eyelid margin.

The V-to-Y (or Wharton-Jones) blepharoplasty procedure is used in moderate and severe cases of ectropion, and for cicatricial ectropion (

). Begin by outlining a triangular piece of skin with the base being parallel to the eyelid margin and sufficiently wide to encompass the section of everted eyelid. Do not make any incision at the base of the triangle. Rather, incise the skin along the two sides of the triangle, and elevate a V-shaped flap of skin between them toward the base. Excise all scar tissue beneath and surrounding this flap. Then, suture the incision beginning at the apex farthest from the eyelid margin; use simple interrupted sutures of 3-0 to 5-0 braided nylon or silk to form a vertical line perpendicular to the eyelid margin. This vertical portion forces the triangle and eyelid margin toward the globe. The length of the vertical portion depends on how much elevation or inversion of the eyelid margin is required to return it to its normal position. To allow for subsequent wound contraction, it should be about 2- to 3-mm longer than required. Finally, suture the remaining parts of the 2 incisions to the free edges of the flap so that the sutured skin forms a Y.

Lower medial entropion canthoplasty (brachycephalic syndrome)

A syndrome of eyelid, conjunctival, and corneal lesions is seen commonly in brachycephalic dogs. This so-called brachycephalic ocular syndrome consists of any combination of the following features:

Lagophthalmos or sleeping with the eyelids incompletely closed

Epiphora caused by kinking of the lower nasolacrimal canaliculi and puncta

Brachycephalic ocular syndrome is sometimes exacerbated by distichiasis and decreased tear production or quality. Medial canthoplasty neatly corrects many of the signs associated with this syndrome. It reduces the palpebral fissure size, removes the medial caruncle, and everts the lower medial entropion, thereby reducing corneal exposure, frictional irritation from trichiasis, and functional nasolacrimal apparatus obstruction.

Medial canthoplasty is recommended for dogs with this combination of signs, especially when the signs are associated with progressive corneal melanosis. It is also suitable for patients with shallow orbits, exposure, or strabismus following proptosis, especially when these are associated with secondary corneal lesions. When performing this procedure, be sure to avoid the lacrimal puncta, meticulously remove all hair follicles from the medial caruncle, carefully incise the eyelids, realign the eyelid margins perfectly, and provide appropriate postoperative management as for other eyelid procedures.

Full-thickness wedge resection is used to remove small eyelid tumors (

) or (as previously discussed) to shorten the eyelids from their lateral end when ectropion is due to euryblepharon. Always avoid the medial canthal area and nasolacrimal apparatus. Tumors larger than 25% of the eyelid length in cats and in mesaticephalic and dolichocephalic dogs, or more than 33% in brachycephalic dogs, should be removed using alternative surgical techniques. When performing a wedge resection, the height of the triangle should be approximately twice its base.Make the skin incision with a No. 15 Bard-Parker scalpel while supporting the eyelid with a Jaeger eyelid plate (see Figure 3).Cut the subcutis and conjunctiva with straight Mayo or Stevens tenotomy scissors, so that the tissue wedge is resected completely. Appose the lid margin using the 2-layered closure.

Ron Ofri, DVM, PhD, DECVO, is a professor of comparative ophthalmology at the Koret School of Veterinary Medicine at Hebrew University of Jerusalem in Rehovot, Israel.

Conditions in which the eyelid rubs against the eyeball, as well as drooping eyelids, can only be corrected surgically. Here’s a look at the appropriate procedures for various conditions.

Help with challenges in eyelid surgery

Human and veterinary insulins are categorized by their onset and duration of action, as well as by the protein source from which they are derived. Short-acting insulins are typically used in the veterinary hospital for intensive blood glucose (BG) control, whereas intermediate-and long-acting insulins are used both in hospital and at home for long-term, daily glycemic control. Based on protein source, insulins are human, human analogue (synthetic insulin that is altered from the natural form but retains biological function), bovine, or porcine. Porcine and canine insulins have an identical amino acid sequence, whereas bovine and feline insulins differ by a single amino acid.

Traditionally, veterinarians have managed diabetes in dogs and cats with a variety of veterinary and human insulins (

). Veterinary insulins include porcine lente and protamine zinc human recombinant insulin (PZI). Human insulins or insulin analogues include neutral protamine Hagedorn (NPH), glargine, detemir, and degludec. Pre-mixed combinations of short-acting lispro or aspart insulin with longer-acting protamine insulin are also available as intermediate-acting insulins.

The overall goals for the treatment of canine diabetes include resolving polyuria and polydipsia, maintaining ideal body weight, preventing diabetic ketoacidosis, decreasing the risk for urinary tract infections, and slowing the development of complications (eg, diabetic cataracts) through excellent glycemic control. Ideally, these goals are accomplished while avoiding clinical hypoglycemia. For dogs, the American Animal Hospital Association recommends the use of porcine lente, PZI, or NPH insulin, plus a complete and balanced diet that lacks simple carbohydrates.

A stable routine for meals, snacks, and exercise is crucial for good glycemic control. Advise pet owners to avoid frequent changes in types and amount of food. Although the ideal diet for diabetic dogs has yet to be determined, recommendations include the following:

High-fiber, restricted-fat diets, which are high in complex carbohydrates (>45%)

Diets with moderate fiber and restricted carbohydrates (< 30% metabolizable energy [ME]), which are higher in fat and protein

High-fiber diets may help delay glucose absorption from the gastrointestinal tract and reduce postprandial hyperglycemia. A number of prescription canine diabetic diets with increased fiber are available, although most have carbohydrate levels less than 45% ME. If used with NPH insulin, these high-fiber diets may exacerbate postprandial hyperglycemia in some dogs because peak gastrointestinal glucose absorption occurs after peak insulin action. High-fiber, moderate-fat diets may cause significant weight loss in some diabetic dogs, and thus are not suitable for most lean or underweight dogs.

A variety of commercially available, nonprescription, grain-free diets are lower in carbohydrates and higher in protein and fat, but they have not yet been used in clinical trials with diabetic dogs. Dietary fat restriction (<30% ME) should be considered for diabetic dogs with concurrent chronic pancreatitis or persistent hypertriglyceridemia. It is generally recommended that insulin be given within 1 hour of a meal and, in most cases, for convenience, the meal and the insulin injection are given at the same time.

The primary goal of treatment in feline diabetes is to obtain remission (ie, maintenance of euglycemia without the need for insulin therapy or other hypoglycemic drugs). Remission is possible in about 80% of cats newly diagnosed with diabetes if normal or near-normal BG concentrations are achieved shortly after diagnosis. The probability of remission is increased when a low-carbohydrate (<15% ME), high-protein diet (Hill’s m/d, Purina DM, or others) is used in combination with a long-acting insulin such as glargine or detemir administered twice daily. Lower remission rates are reported using PZI or porcine lente insulin, or when a moderate-carbohydrate diet is fed. Rapid institution of excellent glycemic control, ideally in conjunction with home monitoring, contributes to remission, while institution of tight control (around 6 months or more) following diagnosis is associated with significantly lower remission rates (84% vs 34%).

Because remission often occurs between 4 and 8 weeks of therapy when cats are managed optimally, weight loss is not a major factor in achieving remission. However, weight management is critically important for maintaining remission. Eating does not need to be coordinated with insulin administration in cats, especially if a low-carbohydrate diet and long-acting insulin are used. The type and amount of food and snacks should be consistent each day; snacks must be low in carbohydrates.

It’s imperative to consider owner-derived clinical information in conjunction with history and physical exam. Monitor the patient’s water intake, urination, body weight, physical activity, and signs of clinical hypoglycemia. Urine glucose and ketone measurements may also be useful, but BG measurements are the most valuable, particularly when performed at home.

Fructosamine concentration can be useful if there is conflicting evidence for glycemic control (eg, the client reports good clinical control but in-clinic measurements indicate poor glycemic control). Fructosamine can also be useful when clinical information is inadequate or unreliable, or if the owner is unable to measure BG at home. Fructosamine concentrations are more useful for adjusting insulin in relatively stable diabetic cats that have been diabetic for months or years and are unlikely to go into remission. This is because insulin dose is adjusted less frequently in these animals, and knowledge of the average BG concentration over 2 to 3 weeks reflected by fructosamine is more relevant in these cats, but it is not useful for day-to-day insulin dose adjustments in newly diagnosed diabetic cats. Fructosamine concentration gives no information on nadir or pre-insulin BG, only mean BG over weeks.

Monitoring BG at home is invaluable for maximizing the probability of remission. Home BG measurements are typically more accurate because they avoid the spurious effects of patient stress.

 At-home monitoring for feline patients also provides more data on which to base insulin dose adjustments, enables accurate assessments for cats that are responding as expected, and is convenient for the owner.

Interest in measurement of hemoglobin A1c (HbA1c) has seemingly been renewed, possibly given the significance of type 2 diabetes in humans and much commercial advertising of new pharmaceuticals intended to lower the HbA1c of people with diabetes.

 Glycosylated hemoglobin is a hemoglobin product with a glucose molecule attached to its N-terminal amino acid valine. Glycosylation is irreversible and concentration of HbA1c within the circulation is approximately 2 to 3 months (the lifespan of a red blood cell). A dried blood spot test is currently offered (Baycom Diagnostics), yet published data on its performance remain unavailable.

As for cats, single sporadic BG measurements in dogs provide little useful clinical information for monitoring glycemic control. Instead, serial BG concentration curves that follow the same protocol as those obtained in hospital are required. Results must be related to the dog’s clinical signs; interpretation requires an understanding of the complex interactions involved in glucose homeostasis in diabetic dogs.

There is considerable day-to-day variability in BG measurements in diabetic dogs,

 and home-generated serial BG curves are as reliable as hospital-generated curves and have many of the same limitations.

For both dogs and cats, a practical approach incorporates knowledge of clinical signs to guide the timing of home-generated BG curves. If clinical signs are consistent with hypoglycemia occurrence at home, owners must be accustomed to measuring their dog’s BG concentration. This can confirm whether hypoglycemia is present and whether timely treatment is needed.

Samples can be obtained from the marginal vein of the lateral pinna, by collection of capillary blood, or by direct venipuncture. Once the owner becomes familiar with the technique, they usually require considerable practice collecting samples at home before they develop sufficient skill to generate a serial BG curve.

Selecting an appropriate glucose monitor and obtaining reliable glucose readings are essential. Some monitors read whole blood concentration as opposed to serum or plasma values. This causes an “under-reading” effect, in which a true serum concentration of 65 mg/dl will be read out as 50 mg/dl.

 In addition, the distribution of glucose between red cells and plasma is different for cats and humans,

 so human-calibrated plasma monitors may be misleading. Owners should be encouraged to purchase a veterinary-specific BG meter. I recommend the AlphaTRAK (Merck), as this has been well validated.

David Bruyette, DVM, DACVIM, was medical director at VCA West Los Angeles Animal Hospital and is currently chief medical officer at Anivive Lifesciences. He is also CEO of Veterinary Diagnostic Investigation and Consultation, and editor of the just-released 

1. Behrend E, Holford A, Lathan P, Rucinsky R, Schulman R. 2018 AAHA diabetes management guidelines for dogs and cats. 

 2018;54(1):1-21. doi:10.5326/JAAHA-MS-6822

2. Rucinsky R, Cook A, Haley S, et al. AAHA diabetes management guidelines for dogs and cats. 

. 2010;46(3):215-224. doi:10.5326/0460215

3. Sparkes AH, Cannon M, Church D, et al. ISFM consensus guidelines on the practical management of diabetes mellitus in cats. 

. 2015;17(3):235-250. doi:10.1177/1098612X15571880

4. Zoran DL, Rand JS. The role of diet in the prevention and management of feline diabetes. 

 2013;43(2):233-243. doi:10.1016/j.cvsm.2012.11.004

5. Bloom CA, Rand J. Feline diabetes mellitus: clinical use of long-acting glargine and detemir. 

2014;16(3):205-215. doi:10.1177/1098612X14523187

6. Roomp K, Rand JS. Management of diabetic cats with long-acting insulin. 

 2013;43(2):251-266. doi:10.1016/j.cvsm.2012.12.005

7. Casella M, Wess G, Hassig M, et al. Home monitoring of blood glucose concentration by owners of diabetic dogs. 

 2003;44(7):298-305. doi:10.1111/j.1748-5827.2003.tb00158.x

8. Van de Maele I, Rogier N, Daminet S. Retrospective study of owners' perception on home monitoring of blood glucose in diabetic dogs and cats. 

9. Alt N, Kley S, Haessig M, et al. Day-to-day variability of blood glucose concentration curves generated at home in cats with diabetes mellitus. 

 2007;230(7):1011-1017. doi:10.2460/javma.230.7.1011

10. Kim NY, An J, Jeong JK, et al. Evaluation of a human glycated hemoglobin test in canine diabetes mellitus. 

2019;31(3):408-414. doi:10.1177/1040638719832071

11. Fleeman LM, Rand JS. Evaluation of day-to-day variability of serial blood glucose concentration curves in diabetic dogs. 

 2003;222(3):317-321. doi:10.2460/javma.2003.222.317

12. Cohen TA, Nelson RW, Kass PH, et al. Evaluation of six portable blood glucose meters for measuring blood glucose concentration in dogs. 

 2009;235(3):276-280. doi:10.2460/javma.235.3.276

Nearly all veterinary patients with diabetes are managed with a combination of insulin therapy, diet, and weight management. Here’s the latest.

Treating diabetes mellitus in cats and dogs: What are your goals?

When it comes to diagnosing dry eye, there are several nonspecific and specific signs to look for, says Ron Ofri, DVM, PhD, professor of comparative ophthalmology at the Koret School of Veterinary Medicine at Hebrew University of Jerusalem in Rehovot, Israel.

“You get secretion, you get conjunctiva, a little congestion, and corneal pigmentation vascularization,” says Ofri. “All of these are really nonspecific signs of inflammation.”

One specific sign of keratoconjunctivitis or dry eye, he says, is a dull-looking cornea. “You can really see that it is not as reflective.”

Dry eye also has a very typical history, he explains. For example, owners will often tell him that their dog had a history of inflammation and was prescribed eye drops, but as soon as treatment ended, the inflammation came back.

Ofri also emphasizes that any dogs presenting with red eyes, discharge, and any eye discomfort, should take a Schirmer Tear Test. This 2-minute test produces visual results that you can then share with their owners, he says.

In the video below, Ofri offers additional insight on how to diagnose dry eye in pets.

Videos

Veterinary ophthalmologist Dr. Ron Ofri explains how to identify signs of dry eye, plus how to best diagnose this uncomfortable condition.

Diagnosing dry eye in pets: ‘It’s a no-brainer’

We said goodbye to the last of their 2 Dachshunds today. I felt their tears as the black one fell asleep for the last time. Nearly a year of poor health was ending, and with it came the tender memories that would be too sensitive to touch for a while. Some people would say it was just a dog, but I beg to differ, and so would they. Those of us who are younger may be wise to see how the sunshine years hold a tribute to weenie dogs.

The dogs gave them something to care for—a living creature that still needed them for guidance and the basics of life. Yet bigger than that, it gave them meaning that carried over from years of raising children and grandchildren. You cannot just turn those emotions off as time changes its definition of wisdom and usefulness.

The dogs gave them stories to share with one another as the retirement years set in. Adventures hung in the air for hours and those short legs carried a long back into the mischievousness of puppyhood. Each new trick was story material for the next phone call with family. Lap time was special, with not a bump or change in skin texture going unnoticed.

And what about the exercise? The black dog was paralyzed in the hindquarters for almost 11 months. Improvement was slow, but it was coming. The surgery had been a success, and a good prognosis depended on much physical therapy at home. Imagine that—11 months of walking and exercising and moving those legs and swimming that critter in the bathtub and carrying it outside and tucking it into bed. It makes you wonder who got the most exercise. It also makes you wonder whether you would have exercised at all.

No disappointment. This love is unconditional. So what if you go to bed at 8:30 PM? These dogs will be more than happy to stay right beside the bed until 5:00 am when you start the next day. So what if you keep the house at 88 °F year-round? They’ve never known any different. So what if you drive 25 miles per hour on the interstate? They just love going for rides. So what if you tell the same story over and over? They love it as much the last time as they did the first.

Inside of me is a huge tribute to weenie dogs. I’ve seen their effect. I’ve laughed at those stories. I’ve helped you notice every bump and change in skin texture. I’ve monitored that exercise program. And I’ve seen that love in your eyes as you held a precious friend in your lap.

If the world has collapsed and there is no love at all, there would still be the love of a dog. They just don’t know how to do otherwise.

The love of a dog is endless, even when it’s their time to go. After nearly a year of suffering, a couple says goodbye to their sweet Dachshund.

A tribute to weenie dogs

I am originally from the South (OK, Texas, but still…), and I grew up knowing that people with integrity put the safety of women and children first. For example, when a woman boards a full bus, a man likely gets up and offers his seat. If it’s raining, my husband drops me off at the restaurant door and then goes to park the car.

This practice applies not just in uncomfortable situations but unsafe circumstances as well. If the lawn mower is on its last legs and the blade may to break into smithereens and come flying out in all directions, then mom is certainly not allowed to mow the lawn. Dad cuts the grass until the mower is repaired or a new one purchased.

Now, let’s escalate these hypothetical situations further. If a shooter enters a room, some men will instinctively push any women and children behind them. But what if the man enters the room not with a gun but coughing, sniffling, and clearly suffering from a severe respiratory illness? There may be no bullets but, in 2020, this man is likely perceived as a clear and present threat to others.

The topic is currently being discussed around supper tables across the globe. What if a vaccine for SARS-CoV-2, the virus that causes coronavirus-19 disease (COVID-19)—a proverbial bullet-proof vest—becomes available? Who gets to be at the front of the line?

The idea of women and children first is believed to have been coined in 1852 when the British troop shipHMS Birkenhead sank off the coast of South Africa. Of the more than 634 men, women, and children on board, only 193 survived the disaster, including all of the women and children.

 This logic doesn’t really translate well to pandemics, emerging pathogens, and vaccine protocols, does it? The question remains: Who gets the vaccine first when it becomes available, and who gets it if the supply is limited? And who decides who is at the front of the line?

Unfortunately—or fortunately depending on your perspective—only 50% of Americans intend to get vaccinated for SARS-CoV-2 once a vaccine is available.

 Public misperception surrounding the need for and safety of vaccination is a real problem globally. In 2019, well before COVID-19 came along, the World Health Organization (WHO) listed vaccine hesitancy as 1 of the top 10 major global health threats.

 With a COVID-19 vaccine being developed and brought to market at “warp speed,” the unknowns about adverse effects and overall longevity of efficacy are likely to be a huge stumbling block to vaccine administration to the masses. So, the line may not be as long as some think, yet the public is still concerned with who gets to go first.

In 1964, the Advisory Committee on Immunization Practices (ACIP) was chartered to provide expert advice and recommendations for vaccine use in the civilian American population to the secretary of US Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC).

 Today, the ACIP remains a globally respected gold standard for guidance on childhood immunization schedules, efficacy monitoring (think rabies titers) and, of course, pandemic priority populations for vaccination.

The secretary of HHS appoints 15 voting members of the ACIP following an application process. According to the CDC, 14 of the members have expertise in vaccinology, immunology, pediatrics, internal medicine, nursing, family medicine, virology, public health, infectious diseases, and/or preventive medicine. One member is a consumer representative who provides perspectives on the social and community aspects of vaccination.

 All 15 serve as volunteers and are joined by 8 ex-officio committee members representing federal agencies with immunization program responsibilities as well as 30 more nonvoting members who act as liaisons from external organizations with immunization expertise, such as the American Medical Association and the American Academy of Pediatrics.

According to ACIP, when developing recommendations, the members use an explicit evidence-based method based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

 In April 2020, amid the expanding pandemic, the ACIP formed a 41-member COVID-19 working group charged with preparing for the introduction of safe and effective COVID-19 vaccines, reducing disease transmission and associated morbidity and mortality, helping to minimize disruptions to society and the economy, including health care capacity, and ensuring equity in vaccine allocation and distribution.

However, a second group has been appointed by the National Academy of Medicine at the direction of top US health officials to develop a framework to determine priority for vaccination.

 While the appointment of 2 prestigious expert panels to assess vaccination priorities could prove problematic, it is good to remember that both entities serve only to make recommendations and to advise the HHS secretary. The task of true decision and execution, once a vaccine is available, rests with the Secretary alone.

Despite potential confusion over disparate recommendations, the ACIP working group recently made public early prioritization populations for SARS-CoV-2 vaccination. As reported, “…the work group has proposed that vaccine priority be given to health care personnel, essential workers, adults aged 65 years and older, long-term care facility residents, and persons with high-risk medical conditions.”

 This ranking of priority populations is much more sophisticated than women and children. It is based largely on likelihood of exposure, severity of illness, and the transmissibility characteristics of the virus itself.

It is prudent to remember that a vaccine is not yet available. Just as researchers are working at “warp speed” to develop a safe, effective vaccine, the virus itself continues to spread through community transmission with many recovering from the disease with immunity. It remains to be seen when the vaccine will be available and how many people in priority populations remain without naturally developed antibodies.

If all this sounds a little familiar, it should. The ACIP also determined priority vaccination populations during the (H1N1) 2009 pandemic. The CDC has extensive information available to the public related to pandemic influenza response and vaccine allocation. The CDC doesn’t play favorites with emerging pathogens, but influenza surely receives a large amount of respect and attention from public health officials, especially when compared with emerging coronaviruses. Mutagenicity, morbidity and mortality rates, transmissibility, and other factors combine to demand more attention for influenza than coronavirus. However, we can rest assured that once a SARS-CoV-2 vaccine is available, 50% of Americans will line up,

 according to population groups determined by unelected, appointed experts, for a dose of protection from COVID-19 while only about 38% of the population will get a seasonal flu shot that may provide cross-protective immunity to novel influenzas.

 How encouraging! Estimates indicate that for community immunity to SARS-CoV-2 to be reached, about 70% of the population must be immune, whether through vaccination or natural disease recovery.

 With approximately 5.5 million cases at the time of writing,

 the United States is about 324 million cases short of the 70% immunity target. Until the majority of us 

 trust in science and data, keep calm and mask on.

Jenifer Chatfield, DVM, DACZM, DACVPM, is board certified in zoological medicine and preventive medicine. She has been a practice owner, worked in zoos, and completed international fieldwork. Her peer-reviewed publications include pharmacokinetics, wild animal behavior, infectious disease, and assisted reproduction in endangered species. Chatfield loves French bulldogs, Himalayan cats, the dirtiest of vodka martinis, and basking in the sun on any Caribbean beach. Find more about her exploits and adventures at 

1. Johnson B. “Women and children first!” Historic UK. Accessed October 18, 2020. 

https://www.historic-uk.com/CultureUK/Women-Children-First/

2. Cornwall W. Just 50% of Americans plan to get a COVID-10 vaccine. Here’s how to win over the rest. American Association for the Advancement of Science.June 30, 2020. Accessed September 11, 2020. 

https://www.sciencemag.org/news/2020/06/just-50-americans-plan-get-covid-19-vaccine-here-s-how-win-over-rest

3. Ten threats to global health in 2019. World Health Organization. Accessed September 11, 2020. 

https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019

4. Smith JC, Hinman AR, Pickering LK. History and evolution of the advisory committee on immunization practices—United States, 1964-2014. 

5. About GRADE. Centers for Disease Control and Prevention. October 23, 2018. Accessed September 11, 2020. 

https://www.cdc.gov/vaccines/acip/recs/grade/about-grade.html

6. Coronavirus remains front and center at June ACIP meeting. The American Academy of Family Physicians. July 1, 2020.Accessed September 11, 2020. 

https://www.aafp.org/news/health-of-the-public/20200701acipjunemtg.html

7. Splete H. ACIP plans priority groups in advance of COVID-19 vaccine. MD Edge Hematology and Oncology. June 29, 2020. Accessed October 18, 2020. 

https://www.mdedge.com/hematology-oncology/article/224632/coronavirus-updates/acip-plans-priority-groups-advance-covid-19

8. Branswell H. Confusion spreads over system to determine priority access to Covid-19 vaccines. STAT. July 22, 2020. Accessed September 11, 2020.

https://www.statnews.com/2020/07/22/confusion-spreads-over-system-to-determine-priority-access-to-covid-19-vaccines/

9. Estimates of influenza vaccination coverage among adults—United States, 2017–18 flu season. Centers for Disease Control and Prevention. November 5, 2018. Accessed September 11, 2020. 

https://www.cdc.gov/flu/fluvaxview/coverage-1718estimates.htm

10. Herd immunity and COVID-19 (coronavirus): what you need to know.Mayo Clinic. June 6, 2020. Accessed September 11, 2020. 

https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/herd-immunity-and-coronavirus/art-20486808

11. United States COVID-19 cases and deaths by state

Centers for Disease Control and Prevention. October 18, 2020. Accessed September 11, 2020. 

A One Health expert outlines the many factors involved in determining who will receive a vaccine and urges us—for the time being—to keep calm and mask on.

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