This new resource offers veterinary professionals and students an opportunity to earn RACE-approved CE credit via a series of informative online webinars.

dvm360 launches online CE center amid pandemic

 Registration is now open for our November Fetch dvm360 virtual conference, which combines 3 of our exclusive annual live events: Fetch Indianapolis, Fetch San Diego, and the Atlantic Coast Veterinary Conference.

Registration for second virtual veterinary conference is now open

Dachshunds are the human equivalent to dwarfism, says neurologist and neurosurgeon Fred Wininger, VMD, MS, DACVIM (Neurology). “When we artificially bred dachshunds to have short little legs and a long back, we essentially artificially created a condition known as chondrodystrophy, which is Greek for ‘faulty cartilage.’” Where a Labrador retriever may have disk degeneration at age 8, 9, or 10, he explains, dachshunds have complete degeneration of their disks by the time they are 3 years old.

“It’s like they need another pair of legs in the middle of T12 and T13,” Christman joked. “Right,” Wininger agreed, “or more ribs.”

In this episode of the podcast, Dr. Wininger, who practices at Charlotte Animal Referral & Emergency Care in Charlotte, North Carolina, shares his knowledge about IVDD, including the differences between type 1 (degeneration of the inside of this disk predominantly) and type 2 (more of a slow protrusion or disk shifting that causes compression of the spinal cord). “Most dogs are probably somewhere on the spectrum of having a little bit of both,” he says.

Wininger also talks about type 3 herniation, also known as a missile disk or torpedo disk, which is now being seen due to the use of magnetic resonance imaging (MRI). In these dogs, he says, rather than a primary herniation or protrusion, a normal disk that is not that desiccated will rupture through, and actually not only bang the spinal cord but penetrate the spinal cord or hit it and then dissipate away. The new term is acute noncompressive disk herniation. “Those are dogs that get spinal cord injury in the absence of needing surgery.”

Regarding diagnostics, “The gold standard is always going to be an MRI,” Wininger says. “MRI is going to enable you to see not only the disk herniation and the rest of the spinal column, but it’s going to let you see the degree of the spinal cord compression.” Although computed tomography (CT) is not the first option, Wininger says there are some benefits to using this modality. CT is cost-effective, quick, and does not require the patient to be anesthetized like MRIs do.

They also discuss what types of herniation are considered a surgical emergency versus what can be treated with medical management, how the use of advanced imaging techniques has altered the typical treatment course, newer prevention options, and factors affecting patient recovery time. 

To learn more about managing IVDD in your patients, listen below.

Podcasts

In this episode of The Vet Blast Podcast, Dr. Christman is joined by Fred Wininger, VMD, MS, DACVIM (Neurology), who shares his extensive knowledge about intervertebral disk disease in dachshunds.

Episode 16: The latest on disk herniation in dachshunds

Veterinary physical rehabilitation is most effective when a multimodal approach is used. Arguably, the most important aspect of multimodal management for these patients is proper pain control. Rehabilitation will be counterproductive if the patient’s pain is not identified and managed appropriately.

 Localizing, assessing, and managing pain are imperative to improve patient comfort and compliance, both of which are paramount for successful rehabilitation.

Pain is a complex, often under-recognized phenomenon that includes both emotional and sensory components. Under the umbrella of pain lies nociception, which is the neural processing of a noxious stimulus. Nociception does not require consciousness. For example, a patient anesthetized with a hypnotic agent, such as propofol, will still exhibit a physiologic response to painful stimuli.

Pain is personal to every patient and, therefore, infinitely complicated. Our conscious perception of pain is subjective and “can be experienced even in the absence of obvious external noxious stimulation and…modified by behavioral experiences including fear, memory, and stress.”

Understanding the uniqueness of each patient’s pain enhances the practitioner’s ability to assess the animal accurately and guide treatment. It is important to recognize that pain is multi-dimensional, encompassing not only 

Physiologic and psychological outcomes of pain

Uncontrolled pain has myriad, often unrecognized consequences, the full breadth of which are outside the scope of this article. This article focuses on the deleterious effects of neurologic and musculoskeletal pain, specifically pain leading to full or partial disuse of the limbs. One of the most common manifestations of pain seen in rehabilitation medicine is lameness, and this aversion or inability to use a limb at full function can lead quickly to multisystem changes (

Changes to muscle secondary to disuse can often be appreciated easily on physical exam or even visualized from a distance. Muscle atrophy occurs quickly and is easily palpable; type 1 muscle fibers, which are important for maintaining posture, are most at risk. Decreased strength and loss of muscle force can also be appreciated.

 The latter is suspected to be secondary to a cellular component and not entirely explained by the atrophy itself.

 Flexibility deficits can occur if muscles are immobilized in a shortened position, resulting in decreased muscle fiber length.

 Altered biomechanics can cause a sustained low-level muscle contraction, which is thought to promote the formation of myofascial trigger points.

When tendons and ligaments are insufficiently loaded their mechanical integrity declines, with bony insertions particularly affected.

 A decrease in stiffness (the tissue’s ability to resist deformation) occurs. There is also a decrease in maximum failure load, which is the point at which a force can cause complete breakdown of the tissue. Although tendons and ligaments are both at risk for similar detrimental effects, tendons are less severely affected.

When bones are deprived of stress, their mass, density, and stiffness decrease.

 Increased bone resorption causes bone atrophy. The distal-most weight-bearing bones are at the highest risk for bone loss.

The articular cartilage will atrophy and/or experience degenerative changes when deprived of stress or immobilized. In addition, synovial fluid production decreases, resulting in impaired nutrient delivery to the cartilage. Production of proteoglycans, a component of synovial fluid that aids cartilage lubrication, also decreases, potentially reducing cartilage stiffness. The joint capsule itself is also harmed by disuse. Contracture can occur causing increased intra-articular pressure and decreased passive range of motion.

The experience of pain is stressful and affects not only a focal area but the entire body. The biologic stress response has many systemic effects, including hematologic, immunologic, and metabolic changes.

 Significant pain that is left untreated can lead to central sensitization, a dysfunction in the ability of the central nervous system to process pain that can be refractory to many common analgesics. The behavioral and emotional effects of pain should not be overlooked. Clients may notice a variety of behavioral changes in their pet, including becoming more withdrawn, anxious, aggressive, or submissive.

Because the behaviors associated with pain can be nebulous, veterinary professionals must continually develop and sharpen their ability to interpret nonverbal pain cues in their patients. A seemingly innocuous observation from a client, such as reclusiveness, can sometimes signal a subclinical problem.

The patient should be assessed with a thorough examination that includes observing the patient both in motion and at rest. Look for abnormal weight distribution, lameness, difficulty with postural transitions, or the inability to relax. Does the patient have an altered or exaggerated response to palpation? Are they tense or guarding when a specific area is examined? Is there evidence of excessive grooming or a cessation of grooming?

While some pets vocalize when a focal source of pain is discovered, others show their discomfort more subtly. In my experience, patients undergoing a painful examination may exhibit stress behaviors, such as a change in pupil size, lip licking, or yawning. Grimace scales, which use facial expressions, orbital tightening, and ear position as indicators, have been developed for measuring pain in several species.

The client should be interviewed about their pet’s behavior at home, such as difficulty eliminating, changes in food or water consumption, changes in demeanor or family interactions, and other alterations to their activities of daily living.

Because pain is considered the fourth vital sign (behind heart rate, respiratory rate, and body temperature), the American Animal Hospital Association advocates for pain scoring to be routine and ubiquitous.

 Although there is no one-size-fits-all pain assessment tool, several standardized subjective and objective tools are available.

 Scoring systems vary widely depending on how the data are obtained (visual vs numeric), the patient’s species, or the type of pain experienced (adaptive vs maladaptive).

It is best practice to choose a single pain scoring system for use throughout your hospital. The chosen system should be convenient and uncomplicated, with good inter-rater reliability. An ideal pain scale is multidimensional, includes several aspects of pain intensity and pain-related disability,

 and evaluates the animal during activities of daily living. Using a clinically tested and validated scoring system strengthens confidence in the results. For rehab patients, I find it helpful to have the client also complete the same questionnaire for comparison, with both completed at regular, predetermined intervals. This allows for examination of the owner’s impressions in the home environment and can further guide treatment decisions.

Pain in veterinary patients can be difficult to assess. Because unabated pain can have insidious consequences, we must be vigilant pain investigators before beginning a rehabilitation program. Using standardized pain assessment and scoring methods allows the practitioner to devise.a pain management program that can improve the patient’s physiologic and psychological health and thus improve compliance with the rehabilitation program leading to a more successful outcome. 

Ashleigh V. Fairfield, LVT, CCRP, VTS (Physical Rehabilitation), works at Veterinary Surgical Centers in Virginia.

1. Fox SM, Downing R. Rehabilitating the painful patient: pain management in physical rehabilitation. In: 

Canine Rehabilitation and Physical Therapy

2. Matthews K, Kronen P, Lascelles D, et al. Global Pain Council Guidelines. World Small Animal Veterinary Association. https://wsava.org/global-guidelines/global-pain-council-guidelines/. Published 2014. Accessed August 6, 2020.

3. Reid J, Scott M, Nolan A, Wiseman-Orr L. Pain assessment in animals.

4. Millis DL. Responses of musculoskeletal tissues to disuse and remobilization. In: 

5. Wall R. Introduction to myofascial trigger points in dogs. 

. 2014;29(2):43-48. doi: 0.1053/j.tcam.2013.11.001

8. Epstein M, Rodan I, Griffenhagen G, et al. 2015 AAHA/AAFP pain management guidelines for dogs and cats. American Animal Hospital Association. https://www.aaha.org/aaha-guidelines/pain-management-config/pain-management-intro/. Published 2015. Accessed August 6, 2020.

9. Karas,A. Pain, anxiety, or dysphoria—how to tell? A video assessment lab. In: 

Articles

A look at the causes and effects of pain, and how to assess your patients before beginning rehab.


The importance of pain assessment in rehabilitation patients

 for recent graduates and other veterinary professionals. The event—sponsored by VCA, Mount Laurel Animal Hospital, Veterinary Innovative Partners, and Western Veterinary Partners—offered both networking opportunities and a chance to learn more about challenges facing the profession. If you missed out on this great opportunity, you can still access the event by clicking 

Last month, dvm360 hosted a virtual recruitment fair for recent graduates and other veterinary professionals on the hunt for a new job. If you missed it, don’t worry—you can still register and access the event on demand. 

Did you miss our recent recruiting event?

We have all heard the STAT triage call to the lobby for the “panting” cat, or spoken on the phone with a panicked owner whose French bulldog is wheezing uncontrollably after playing fetch outside in the heat. Streamlining nursing care for patients in respiratory distress is critical to improving 

. Preparation, triage, assessment, and establishing a treatment plan based on the clinical signs can increase the odds that the patient will be discharged safely from the hospital.

Preparation, triage, and initial assessment.

The minute a technician hears that a respiratory emergency is presenting to the hospital, it is time to get ready. Vascular access supplies, a way to evaluate and secure the airway (ie, appropriately sized endotracheal tubes, laryngoscope), and a plan to provide supplemental oxygen should be in place before the patient enters the treatment area.

Immediate nursing care steps should include the following:

Evaluate the patient’s airway and intubate, if needed.

Perform an initial assessment by obtaining the patient’s baseline temperature, respiratory rate and effort, heart rate, pulse oximetry parameters (if the patient allows), mucous membrane color, capillary refill time, mentation, and posture.

Begin active cooling therapy depending on patient temperature.

A thorough patient history can change the treatment plan significantly. Asking guiding questions will greatly aid in the ability to gather a more complete clinical picture:

Did the respiratory signs come on abruptly, or has the animal been declining over time?

Do you give daily, weekly, or monthly medications?

Does the pet have any previously diagnosed conditions or illnesses?

Has the patient had anesthesia or sedation recently?

Is there any chance of toxicity or trauma?

Does the animal frequently get tired after exercising or in the heat?

Answers to these questions will assist the practitioner or veterinary team in determining whether the patient is suffering from upper airway, lower airway, pulmonary parenchymal, or pleural space disease.

An immediate treatment step for patients in respiratory distress is to provide supplemental oxygen. This can be accomplished in a number of ways, including via oxygen cage, face mask, or nasal oxygen cannula. The goal of supplemental oxygen therapy is to increase the percentage of oxygen in the air the patient is breathing (FiO2, 

Increasing the FiO2 around the patient can rarely be accomplished by providing “flow-by” oxygen via anesthetic machine tubing because oxygen disperses too quickly in open space (

). If an oxygen cage is not available, and the patient is stressed by placement of a face mask or nasal cannula, anxiolytic therapy should be considered to facilitate appropriate supplementation. It is important to note that nasal oxygen cannulas are irrelevant in brachycephalic breeds due to their abnormal facial anatomy.

The upper airway consists of the larynx, trachea, and nasopharynx. Brachycephalic airway obstruction occurs in both dogs and cats. The most commonly affected canine breeds include bulldogs, boxers, pugs, Cavalier King Charles spaniels, shih tzus, and mastiffs. Among cats, Persians and British shorthair are the breeds frequently affected. Other upper airway diseases include laryngeal paralysis (seen more often in geriatric Labrador and golden retrievers, and hypothyroid dogs), tracheal collapse (Yorkshire terriers and Chihuahuas), and nasopharyngeal polyps (juvenile cats).

The most noticeable clinical signs of upper airway disease are loud and stridorous inspiratory effort, and cyanosis. These patients often require anxiolytic therapy to facilitate appropriate nursing care (

). Sedation with butorphanol, acepromazine, or dexmedetomidine (

) can allow the patient to become relaxed enough to tolerate a face mask, intravenous catheter placement, and cooling therapy, if indicated.

Patients with upper airway disease, specifically brachycephalic breeds, often present with hyperthermia, and active cooling must be initiated if the animal’s temperature exceeds 105 °F(personal communication, Dickerson N, University of California, San Francisco, 2020). Active cooling is achieved by maximizing heat dissipation mechanisms and can be accomplished by dousing the entire body with tepid water, increasing air circulation over the body with fans to improve evaporation, and intravenous fluid therapy.

 Care must be taken when initiating active cooling, and it should be stopped once the patient’s temperature has dropped to 103 °F, as body temperature will continue to drop and patients may become hypothermic.

Depending on patient history, glucocorticoids such as dexamethasone sodium phosphate (0.1-0.25 mg/kg via slow IV) may be administered at the discretion of the veterinarian to reduce laryngeal swelling.

Careful handling and reducing stress are critical to providing appropriate nursing care to the patient in respiratory distress. It is important to monitor carefully for adverse effects of anxiolytic medications as patients can become oversedated and occlude their own airway if not watched closely. Pulse oximetry (with the probe on the lip, toe, vulva, or prepuce), electrocardiography, and blood pressure (oscillometric or Doppler) should be monitored as soon as the patient is tolerant.

Lower airway disease involves expiratory airway obstruction. Patients presenting with lower airway obstruction are able to move air into their trachea and lungs, but have constriction or obstruction when trying to exhale, resulting in expiratory effort.

Lower airway diseases include feline asthma (common in Siamese cats) and canine chronic bronchitis (in Northern breed dogs, such as the Siberian husky, Alaskan malamute, and samoyed); lower airway disease can also result from acute anaphylaxis. Clinical signs include coughing, wheezing, and gagging in dogs, and an abdominal “push” on expiration in cats.

Pulmonary parenchymal disease is marked by decreased pulmonary compliance, meaning the lungs cannot expand properly. Pulmonary parenchymal diseases affect the terminal and respiratory bronchioles, interstitium, alveoli, and vasculature.

 Examples include pneumonia (aspiration or bacterial), cardiogenic pulmonary edema, non-cardiogenic pulmonary edema (secondary to choking or near-drowning, electrical cord bites, snake bites, sepsis, upper airway obstruction, and adult respiratory distress syndrome),

 and pulmonary contusions from trauma such as being hit by a car.

In addition to inspiratory and expiratory effort, clinical signs include crackles and wheezes on thoracic auscultation.

 Treatments include diuretics (cardiogenic and noncardiogenic pulmonary edema), antibiotic therapy and hydration (pneumonia), and supplemental oxygen. Nebulization could be a useful treatment tool in patients with pneumonia.

Patients with pleural space disease typically present with rapid, shallow breathing because of the lung’s limited ability to expand and ventilate. These patients are working 

to breathe. If the pleural space is filled with air, neoplastic tissue, fluid, or other organs (eg, diaphragmatic hernia), the lungs have less room to expand normally. Common disease processes that result in pleural space disease include pleural effusion (secondary to heart failure or neoplasia), pneumothorax (secondary to infection, foreign material, or trauma), and hemothorax.

Thoracentesis to remove air or fluid from the pleural cavity can almost immediately alleviate clinical signs in these patients; in some cases a chest tube can be placed to facilitate drainage procedures. Once the animal is stable, it is typically placed in an oxygen kennel while a diagnostic plan is being determined. Diagnostics can include TFAST (quick thoracic ultrasound), thoracic radiography, advanced imaging (computed tomography, echocardiography), and cytology of any aspirated fluid.

Technicians play a crucial role in the initial evaluation and treatment of patients in respiratory distress. Careful preparation, providing initial treatments, evaluating clinical signs, and obtaining a careful patient history can significantly improve outcomes for these patients.

Jordan Sanchez, RVT, has been in working veterinary medicine for nearly a decade, practicing in shelter medicine, field medicine, and specialty anesthesia. She currently works as an anesthesia technician in Portland, Oregon, and plans to pursue veterinary technician specialty certification in anesthesia and analgesia.

Sumner C, Rozanski E. Management of respiratory emergencies in small animals.

 2013;43:799-815. doi:10.1016/j.cvsm.2013.03.005

Sharp CR. Approach to respiratory distress in dogs and cats

Todays Veterinary Practice.https://todaysveterinarypractice.com/approach-to-respiratory-distress-in-dogs-and-cats. Accessed September 20, 2020.

Hemmelgarn C, Gannon K. Heatstroke: Clinical signs, treatment and prognosis.VetLearn.com. http://vetfolio-vetstreet.s3.amazonaws.com/94/d5ef00bd5e11e28e71005056ad4736/file/PV2013_Hemmelgarn2_CE.pdf. 2013. Accessed September 20, 2020.

Hackett T. (2009). Pulmonary parenchymal disease. dvm360. https://www.dvm360.com/view/pulmonary-parenchymal-disease-proceeding. Accessed April 24, 2020.

Veterinary teams must be prepared to provide immediate triage and assessment for patients that are having difficulty breathing. 

Improving outcomes for patients in respiratory distress

Taking care of patients may be your top priority—and rightly so—but we live in a world where people spend quite a bit of time online. That means your online presence is almost as important as your physical facility. Through your practice website, online reviews, and social media, your online presence should highlight what makes your clinic unique and demonstrate to existing and future customers how your practice will meet their pets’ needs. And you need to do this with friendliness, consistency, and the human touch.

A well-designed website will attract new customers, provide in-depth information about pet care, and make it easy to connect with existing and prospective clients alike. Companies report that improving the online customer experience increases loyalty, boosts revenue, and saves the business money,

 and 73% of consumers say a positive experience with a business is key in influencing their brand loyalties.

Considering that 93% of people have left a website because it didn’t display properly on their mobile device,

 and 53% of visitors will abandon a website if it takes more than 3 seconds to load,

 ensuring mobile friendliness is critical. So, put in maximum effort to create an enjoyable, effective online user experience by making sure your website is informative, easy to navigate, and loads quickly on any device. Also, take time to ensure that your website mirrors your practice’s look and feel.

Some potential clients focus on the veterinarian’s professional training, while others will want to know about the practice’s pet care philosophy. Including this information on your clinic’s website in a way that shows the expertise and dedication of your team gives customers a better idea of how you run your practice.

Considering that 90% of consumers read online reviews before patronizing a business and customers are willing to spend 31% more at a business with excellent reviews,

 earning those positive reviews is critical to your practice’s success. On the other hand, negative reviews can severely impact your bottom line: Businesses risk losing as many as 22% of customers with just a single negative review.

The best approach to earning a good online reputation is 2 pronged: Ask satisfied clients to provide a positive review of your practice on Google or Yelp, and provide a professional and polite response when the inevitable bad review pops up. It’s best to 

 by phone or see if you can meet them in person to try to resolve the perceived issue.

Social media plays a vital role in client engagement. Research shows that 90.4% of millennials, 77.5% of gen Xers, and 48.2% of baby boomers are active social media users.

While social media is an easy way to promote your practice, it’s important to note that it’s not a substitute for advertising. Think of social media as a way to develop a 2-way communication channel between you and your clients. The main goal of social media is to encourage clients to share their positive experiences, thus attracting potential new clients.

To give your practice a leg up on the competition, you need to make sure that your online presence is as robust as possible. Once you achieve that, you can sit back and watch a stream of new customers flood through your door.

Sudhir Bhatti is the co-founder and CEO of 

, a technology company created to help healthcare practices become modern and efficient and grow online by delivering a patient-first experience.

1. New research from Dimension Data reveals uncomfortable CX truths [press release]. Cision PR Newswire. April 4, 2017. Accessed September 14, 2020. 

https://www.prnewswire.com/news-releases/new-research-from-dimension-data-reveals-uncomfortable-cx-truths-300433878.html

2. Clarke D, Kinghorn R. Experience is everything. Get it right. pwc. 2018. Accessed September 14, 2020. 

https://www.pwc.com/us/en/advisory-services/publications/consumer-intelligence-series/pwc-consumer-intelligence-series-customer-experience.pdf

3. Köhler H. Essential web design stats for 2020 [new research]. HubSpot. Updated February 18, 2020.Accessed September 14, 2020. 

https://blog.hubspot.com/marketing/web-design-stats-for-2020

4. Grey B. 41 Website speed statistics important to Google. May 26, 2020. Accessed September 14, 2020. 

https://www.officialbryangrey.com/website-load-time-statistics/

5. Saleh H. The importance of online customer reviews. invesp. Accessed September 14, 2020. 

https://www.invespcro.com/blog/the-importance-of-online-customer-reviews-infographic/

6. Hinckley S. New study: data reveals 67% of consumers are influenced by online reviews. Moz. September 2, 2015. Accessed September 14, 2020. 

https://moz.com/blog/new-data-reveals-67-of-consumers-are-influenced-by-online-reviews

7. US social media users, by generation, 2019 (% of population). eMarketer. August 1, 2018. Accessed September 14, 2020. 

https://www.emarketer.com/chart/226029/us-social-media-users-by-generation-2019-of-population

To stand out from the crowd, veterinary practices must take advantage of every online opportunity to showcase their offerings and exceptional service.

How your online presence can make your practice shine

 (MRSP) have been raising eyebrows and anxiety levels for years. Drug-resistant 

infections aren’t just affecting dogs and cats. Horses, cattle, pigs, and even exotic species also get them. According to Alison Diesel, DVM, DACVD, clinical associate professor of dermatology at Texas A&M University College of Veterinary Medicine and Biological Sciences, these infections aren’t going away anytime soon. In fact, research shows they are on the rise.

Initial reports dealt with drug-resistant 

 infections in humans. Yet Diesel warned, “We’ve been seeing an increasing number of these drug-resistant infections in our companion animals as well. These include methicillin-resistant 

, and other species.” During a session at the AVMA Virtual Convention in August, Diesel highlighted the need for clinicians to understand how to diagnose, manage, and help prevent these infections.

According to Diesel, there are several possible reasons for the rising number of cases, including more frequent culture testing and increased (or inappropriate) exposure to antibiotics. Diesel remarked that the strains of methicillin-resistant microbes being identified in humans are being detected in veterinary patients as well, so the increasing trend of MRSA in humans may be a factor in the rising numbers of veterinary cases of MRSP and MRSA.

Identifying drug-resistant pyoderma begins with the workup. However, Diesel cautioned that physical exam findings cannot tell a clinician whether an infection is drug-resistant. It is incorrect to assume that a more “virulent-looking” dermatitis is more likely to be caused by a drug-resistant pathogen, she said.

Staphylococcal bacteria are part of the normal skin and mucosal microflora in dogs, cats, and large animals. The most important skin pathogen in dogs is 

 (which is more traditionally a pathogen in humans), can also play a role in canine skin infections. Besides staphylococcal species, other microbes can have a role in canine and feline skin infections.

The diagnostic steps that focus on identifying the species of bacteria involved in the infection should not be dismissed. Papules, pustules, crusts, and epidermal collarettes are commonly featured in canine pyoderma. However, pustules are less common in cats. Papules and crusts may be identified in cats, but increased dander, exfoliative dermatitis, and scaling are more likely. Eosinophilic plaques and indolent ulcers can also be featured in feline pyoderma. Diesel reminded attendees that most veterinarians use glucocorticoids to treat eosinophilic plaques, granulomas, and indolent ulcers in cats, but these lesions may respond to antibiotics, too. “Consider treating with antimicrobials first, prior to reaching for those steroid medications.” She advised.

In addition to selecting an appropriate antibiotic for pyoderma, the dose and duration of treatment can both have important implications for treatment success. For calculating an antibiotic dosage to treat skin infections, Diesel advised, “Go big or go home. If you aim for the higher end of the dose range, you reduce the risk of developing resistance down the line.” This is important because some dogs that develop drug-resistant infections have previously received antibiotics near the low end of the dose range. Underdosing can increase the risk for developing a drug-resistant infection later.

Diesel also recommended treating superficial bacterial skin infections for 3 to 4 weeks initially. Deep bacterial pyoderma should be treated for a minimum of 6 to 8 weeks. “Ten to 14 days of antibiotics (for superficial pyoderma) is generally insufficient,” she said. “You kill off the majority of the organisms, but some remain, so the infection comes right back.”

Bacterial culture and susceptibility testing can be costly, so it’s understandable that some pet owners and veterinarians delay this step. However, postponing it for too long can lead to more serious problems in the future. Diesel recommended culture testing when empirical therapy doesn’t fix the problem. This includes patients presenting with lesions that don’t resolve, new lesions that appear 

 therapy, or lesions that recur after antibiotics are discontinued. Deep pyodermas should be cultured earlier in the process. The presence of nodules, draining tracts on the skin, and/or identifying rod-shaped bacteria on cytology are all good reasons for culture testing, Diesel said. “However, rods on a skin cytology tell me that I’m not dealing with a 

infection,” she added. “Identifying what that organism is will help guide my treatment recommendations for that patient.”

Ear infections warrant different considerations when it comes to culturing. Diesel cultures ears if a middle ear infection is suspected, in which case she obtains a culture sample from the tympanic bulla. In general, some veterinarians don’t culture pyoderma until 2, 3, or maybe even more different antibiotics have been tried, yet the infection is still unresolved. She noted that this sequential use of stronger and stronger antibiotics can lead to drug resistance. Instead, she urged attendees to culture earlier in the process. “If you put a dog on cephalexin, see the pet back in 3 weeks. If the infection is still unresolved, that’s the time to culture.” She also recommended culturing an intact pustule or 

 crust to obtain a good, representative sample. For deep infections, find an intact nodule and submit a small tissue/biopsy sample for culture testing.

Interpreting the laboratory’s culture report isn’t always straightforward, either. If the culture report identifies “coagulase-positive” 

, that still doesn’t confirm whether the organism is 

. In that case, Diesel suggested, before you decide what to do, call the lab to ask if they can identify the species further. Clinicians may also have to ask the lab to test separately for susceptibility to specific antimicrobials, as some antibiotics aren’t included in standard susceptibility panels.

You’ve cultured a pustule and received a laboratory report that confirms a methicillin-resistant infection, so what’s the next step? A methicillin-resistant microbe will likely be resistant to beta-lactam antibiotics, notably penicillins, cephalosporins, and carbapenems. Not only are veterinarians seeing methicillin-resistant infections, they are also seeing multidrug-resistant infections that are resistant to beta-lactam antibiotics and other drug classes like fluoroquinolones. Most of the “reliable” oral antibiotics veterinarians normally choose empirically for pyoderma won’t work for these infections.

Fortunately, topical therapies fill that void. Diesel noted that her practice relies much more on topical therapy for these resistant infections. “For superficial 

 bacterial folliculitis, you can treat them 100% with topical therapy,” she advised. Diesel recommended bathing the pet every 1 to 2 days, or at least 3 times per week. Leave-on lotions, conditioners, or mousses may extend the time between baths, due to their residual effects. (Some of these leave-on products can also be used in between baths.) Chlorhexidine, benzoyl peroxide, Tris-EDTA, and sodium hypochlorite are topical ingredients that may be effective. Mupirocin, silver sulfadiazine, and even some natural-ingredient preparations can also be options. Owner compliance may be an issue (especially with cats), so if the owner is unwilling or unable to bathe the pet, another option, such as wipes or sprays, is needed.

According to Diesel, numerous studies have shown that MRSA is transmissible between humans and animals. She also cautioned attendees that “as veterinary professionals, our chance of being carriers for MRSA is about 4 times higher than in the general population. It’s even higher for large animal veterinarians.”

 is not considered a pathogen in humans. Reports of human infections are rare and usually occur following bite wounds or in people who are immunocompromised. Coagulase-negative 

 is being investigated, but its zoonotic potential is still in question. This organism has been isolated from pustules in cases of canine dermatitis. Diesel cautioned that over 90% of coagulase-negative 

 species are methicillin-resistant or multidrug-resistant, so this is something to keep in mind when counseling clients and determining treatment for patients.

Important preventive measures for veterinary professionals include using antimicrobials judiciously in patients and performing bacterial skin culture testing earlier instead of waiting, Diesel said. Additional recommendations for veterinary teams include the following:

Decontaminate surfaces such as exam tables and counters.

Isolate contaminated patients, and wear appropriate personal protective equipment when handling them.

It is also important to educate clients so they understand the zoonotic potential. For pets receiving antibiotic therapy, Diesel advised sharing the following recommendations with clients:

Minimize pet contact with young and immunocompromised people.

Administer the full antibiotic prescription.

Wear gloves when administering topical therapies.

Don’t allow the infected pet to sleep on the bed.

Discourage sharing towels and linens with pets.

Postpone social events/activities for the pet.

The role drug-resistant microbes play in veterinary medicine is an ongoing area of investigation. Diesel referred attendees to the consensus guidelines from the World Association for Veterinary Dermatology

for more information about diagnostic testing, patient management, and preventive measures.

Dr. Todd-Jenkins received her VMD degree from the University of Pennsylvania School of Veterinary Medicine. She is a medical writer and has remained in clinical practice for over 20 years. She is a member of the American Medical Writers Association and One Health Initiative.

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

Advice from a veterinary dermatologist for treating drug-resistant skin infections in your patients while protecting their owners and your staff from possible exposure. 

Featured Content

dvm360 launches online CE center amid pandemic

Registration for second virtual veterinary conference is now open