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IDEXX: Contributing to something bigger

Sage Veterinary Imaging (SVI) has added Marina Mavromatis, DVM, DACVR, to its team of veterinary radiologists.

Mavromatis expressed the caseload, complexity, and diversity of cases at SVI is an ideal fit for her. "Dr Sage is on the cutting edge. She has a vision for her practice to always push to a higher level of veterinary radiology.” She added, "Through vet school and my internship, I was constantly drawn to the diagnostic aspects of cases. I enjoy collaborating with other clinicians and specialists. It helps me keep a pulse on advancements across the veterinary field."

What’s more Mavromatis will partake in the SVI residency programt, training and mentoring diagnostic imaging interns and residents. According to the release, SVI provides 1 of about 25 residency programs certified by the American College of Veterinary Radiology (ACVR).

A graduate of North Carolina State University and Cummings School of Veterinary Medicine at Tufts, Mavromatis achieved her DVM and completed her diagnostic imaging residency. Before being on the SVI team, Mavromatis was a practicing radiologist in the Philadelphia area.

Sage Veterinary Imaging welcomes Dr. Marina Mavromatis. News release. Sage Veterinary Imaging. December 7, 2022. Accessed December 7, 2022. https://www.prnewswire.com/news-releases/sage-veterinary-imaging-welcomes-dr-marina-mavromatis-301696322.html

Articles

Will offer veterinary radiology services and participate in the SVI residency program 

Dr Marina Mavromatis joins Sage Veterinary Imaging

Mast cell tumors occur due to an uncontrolled proliferation of malignant mast cells in various organs. Mainly seen in middle aged to older dogs, the approach to this cancer can often be challenging and confusing. Most patients present with a single cutaneous mass; however, this tumor can often have a variable appearance such as ulceration, inflammation, bruising in the form of petechiae and ecchymosis or edema, each of which can be minor or extensive. Some patients may have multiple masses all of which can have varied appearances also.

The history presented by owners also varies and may include a lump which has been present for a long time with no change, or recently it may have changed. A mast cell tumor is always suspected with any lump reported to be increasing and decreasing in size over time. Other patients may have a history of mast cell tumors. And others may have a large region of edema, wheal formation or bruising with no obvious mass.

Given that these cells exfoliate easily, an aspirate is usually all that is required to confirm diagnosis. Aggressive and repeated sampling is not necessary. Staining with inhouse Diff-Quik is usually sufficient to confirm a mast cell tumor, revealing a round cell with the characteristic purple cytoplasmic granules. Occasionally a round cell with a “fried egg” appearance is noted with no granules, this sample will need to be sent to the pathologist for additional staining, such as with Wright-Giemsa or toluidine blue stain. After aspiration, the mass should be re-evaluated given that these tumors tend to bleed easily and for a prolonged period. Degranulation may also occur resulting in the mass increasing in size. The erythema and wheal formation (Darier’s sign) and prolonged bleeding are also used to confirm your diagnosis.

After cytological confirmation, the next consideration is if staging is necessary. Typically, if the mass is in a location which carries a favorable prognosis and, in a location, considered easy to remove, then surgical removal is recommended. Various studies have confirmed that mast cell tumors in different locations are of different prognostic value. Anatomical locations which may carry a poor prognosis include perineal-perianal region, head and neck, inguinal area, scrotum, digit, and axilla.

 Once the tumor is removed further staging and treatment is dependent on the histopathology results and the grade. If a mass is difficult to remove (eg, due to location or size), if a patient has a history of mast cell tumors or if the mass is in a location associated with a negative prognosis, then staging tests are recommended. Staging tests involve chest radiographs and an abdominal ultrasound. Aspirate of the local draining lymph node is recommended. Willmann 

 has described the spread of mast cell tumors to regional lymph nodes (stage 2), then to the spleen and liver (stage 3) and then to other visceral organs and occasionally to the bone marrow (stage 4). Pulmonary metastatic disease is exceedingly rare. Staging tests are also recommended if the patient is clinically unwell, e.g., lethargic or vomiting or if the patient has had a history of mast cell tumors. It is never wrong to stage a patient.

Treatment with ancillary medications to decrease degranulation effects are recommended before treatment with surgery or radiation therapy. Antihistamines such as the H1 blocker diphenhydramine (2 mg/kg BID) and a H2 blocker famotidine (0.5-1 mg/kg SID) or the proton pump inhibitor omeprazole (0.5-1 mg/kg SID) are recommended.

Traditionally, treatment options include surgery, radiation therapy, chemotherapy, or a combination of these treatments. Most commonly surgery is the first line of treatment. Removal of any enlarged or concerning lymph nodes is recommended. Recently it has been recommended to remove any regional lymph node associated with mast cell tumors >3cm, given that at this size, metastatic disease was more likely.

 Prednisone and Chemotherapy can be used to cytoreduce a mass to make it more appealing for surgery. These tumors are radiation responsive and so radiation therapy can be used for bulky disease or to address microscopic disease post-surgery.

Newer therapies are also currently available and include Stelfonta, Vidium, and Torrigen. Stelfonta (tigilanol tiglate) is an intra-tumoral mast cell tumor treatment. Vidium involves genomic based-precision testing using next-generation sequencing to identify mutations in 120 relevant cancer genes and Torrigen produces an experimental Autologous prescription cancer immunotherapy vaccination.

Kathleen Tsimbas, BVSc received her veterinary school training at the University of Sydney, Australia. Before completing a rotating internship, specialty internship and residency at the University of Wisconsin in Madison. She is currently treating small animals at Advanced Veterinary Care in Salt Lake City, Utah.

Willmann M, Yuzbasiyan-Gurkan V, Marconato L, et al. Proposed Diagnostic Criteria and Classification of Canine Mast Cell Neoplasms: A Consensus Proposal. 

. 2021;8:755258. Published 2021 Dec 10. doi:10.3389/fvets.2021.755258

Ferrari R, Marconato L, Buracco P, et al. The impact of extirpation of non-palpable/normal-sized regional lymph nodes on staging of canine cutaneous mast cell tumours: A multicentric retrospective study. 

. 2018;16(4):505-510. doi:10.1111/vco.12408

Navigating an often difficult and confusing type of cancer

An approach to cutaneous mast cell tumors

 interview, Mariana Pardo, BVSc, MV, DACVECC, highlighted 2 invaluable pearls for making quick decisions during emergency fluid therapy. These include recognizing the difference between having hypovolemia and dehydration and reassessing vitals after bolus. 

The following is a partial transcript of the video.

 I think that the main thing that when it comes to emergency fluid therapy is recognizing shock, and how much fluids we need to give. 

Videos

In a dvm360® interview, San Diego Fetch faculty member and keynote speaker Dr Mariana Pardo outlines what to bear in mind when administering emergency fluid therapy

Quick decision-making during emergency fluid therapy

At the Fetch dvm360® Conference in San Diego, California, Matthew McGlasson, DVM, CVPM, chief medical officer at Noah's Ark Animal Clinics, explained how Basepaws canine and feline genetic testing kits offer a proactive approach to healthcare and are evolving veterinary medicine while addressing pet parents’ current needs. “You’re going to see a common theme throughout this presentation of moving from reactive medication to proactive medication,” he told attendees.

McGlasson first delved into how genetic testing can help strengthen the human-animal bond and how today’s pet parents are closer to their animals than ever before. In fact, the Human Animal Bond Research Institute revealed 95% of pet owners surveyed in the US consider their pets an important part of their family.

 Along with this, people are more than willing to spend money on their pets, with approximately $124 billion spent on pet products in 2021.

With pet owners having such a focus on their pets, veterinarians must ensure they are providing services that meet their needs. “What we used to provide 10, 20 years ago that just doesn't cut it anymore…so it's really up to us to deliver the care with the most up to date information that we have…what we're really coming to is early detection,” said McGlasson. This is where genetic testing comes into play.

Basepaws offers affordable, easy-to-use genomic testing kits for veterinarians that provide a comprehensive, predictive picture of a pet’s current health, and more importantly, risk factors for future conditions. You set up an account in its veterinary portal, then simply use the swab provided in the kit to swab a pet’s cheek, place it in an envelope, and drop it in the mail for the team to perform lab work. They will notify you of the pet’s breed[s] and any genetic markers indicating a pet is at risk for a certain disease via the portal within 4 to 6 weeks. “Some of the things we're going to be checking for [through the test include] bleeding disorders, fatal disease, dental disease, neurologic disorders, metabolic disorders, heart disease, kidney disease. Obviously, the specific diabetic cardiomyopathy marker, polycystic kidney disease in some of our cats,” shared McGlasson.

The results will also include actionable next steps. “They give you diagnostic and treatment considerations like with this condition, you might want to consider doing this test, this test, and this test… you can interpret it and talk with your client about it and let them know next steps.” He highlighted an example, “If you have a cat that's high risk for hypertrophic cardiomyopathy, I would definitely want to see that cat more than once a year. And these candidates are happy to bring their cat in to be checked every 4 months, every 6 months. I would send this cat to a cardiologist…and depending on what's found with the cardiologist, starting medication early may be appropriate.”

McGlasson advised to do genetic testing as early as possible, during puppy and kitten wellness visits so pet owners can take preemptive approaches that will lead to big changes down the road. These tests offer the epitome of individualized care, according to him.

McGlasson said what fuels his passion for veterinary medicine is the human-animal bond, and concluded by stating that “[Genetic testing] could be really life changing. It seems like the future is here…If we're talking about the human-animal bond, the goal is to keep these pets with their clients longer, so this is how we're going to do it.”

McGlasson M. How genetic testing can benefit your patients and your practice. Presented at: Fetch dvm360® Conference; San Diego, California. December 2-4, 2022.

HABRI benchmark survey of US pet owners. Human Animal Bond Research Institute. 2021. Accessed December 6, 2022. https://habri.org/pet-owners-survey

Pet industry market size, trends & ownership statistics. American Pet Products Association. Accessed December 6, 2022. https://www.americanpetproducts.org/press_industrytrends.asp

Dr Matthew McGlasson describes Basepaws' genetic testing kits and the role they play in offering today’s pet parents the individualized care they seek for their beloved animals 

The future is now with genetic testing

With the holiday season just weeks away, households across the world are preparing to host family, make delicious dinners, and decorate their homes. However, within the holiday cheer lurks foods and decorations that can be harmful to pets. On this episode of The Vet Blast Podcast, Renee Schmid, DVM, DABT, DABVT, discloses the risks that pets face this holiday season, plus what happens when a pet ingests a toxin. 

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

: Mistletoe [and] ivy those types of products are usually not a big deal. One of the things we do see though is there are some places that when they are making wreaths, instead of using evergreens they are using Yew plants, and so Yews are something that can cause some pretty significant issues in dogs and cats [such as] cardiac and heart issues. So something to be aware of if you are getting a wreath from a local area. 

Podcasts

As we approach the holiday season, Renee Schmid, DVM, DABT, DABVT, breaks down what foods and plants are a risk to your patients, plus the following steps after a suspected poisoning

Holiday toxins 101

At the Fetch DVM360® Conference in San Diego, held December 2-4, 2022, David Dycus, DVM, MS, CCRP, DACVS-SA, Nexus Veterinary Bone & Joint Center at Nexus Veterinary Specialists, spoke about extracorporeal shockwave therapy (ESWT) as a part of a multimodal plan—including a comprehensive rehabilitation program, post-surgery, and more—to manage musculoskeletal conditions such as osteoarthritis (OA), tendinopathies, and pain management.

Shockwave therapy has been used since the 1970s as a way of fragmenting uroliths so they could pass through the urinary system. Now it is used in other areas of the body for fragmentation.

The term shockwave is often misinterpreted, Dycus said, but it is simply a high-energy acoustic wave or impulse created by changes in pressure. The medical reasoning behind using shockwaves is to direct the sound energy into the tissue for a healing response. More specifically, ESWT is acoustic nonlinear waves of high pressure and velocity generated from outside the body. Cavitation that is produced in the tissues increases cellular permeability, produces free radicals, and generates anti-inflammatory cytokines and growth factors.

To produce shockwaves, 3 types of focused shockwave generators are used with varying focal volumes and energy levels:

Focusing energy allows for greater tissue penetration depth with a rapid decline of energy at the periphery, delivering an intense amount of energy to a small area. Radial pressure is an alternative to focused ESWT, as it creates pressure waves, rather than shockwaves, that are longer, slower, less intense, and shallower in penetration. Knowing the differences among shockwaves is important because their energy settings are not comparable.

Some of the well-demonstrated benefits of ESWT are faster healing and an increase in the quality of healing in the soft tissue and bone, chondrocytes protection, dissolved fibrous/calcification, and attracting bone marrow stem cells to the treatment site, and pain reduction.

“The literature [shows] evidence for bone healing and tendinopathies,” Dycus said. During his presentation, he reviewed studies on bone healing, tendinopathy, desmopathy, and OA.

“The production and release of various growth factors that are associated with bone healing, in particular, upregulating the family of bone morphogenic proteins (BMPs), is what really helps stimulate bone healing,” Dycus pointed out. Increases in BMPs that stimulate bone healing have been seen as early as four weeks after treatments. Further, shockwave therapy not only improves the biological side of healing but also increases bone mineral density—the quality and strength of the bone—citing an early 1994 study.

In the world of sports medicine, research shows that “shockwave therapy helps improve tendon and ligament healing through various biologic [responses],” Dycus said. “A rat model showed improved release of various growth factors for Achilles’ tendinopathy,

 and a rabbit model for patellar tendinopathy found it improved strength as well.

Further, in a study with client-owned dogs, post-tibial plateau leveling osteotomy (TPLO), the mean patellar ligament thickness was lower in the ESWT group compared to the control group.

ESWT has ample support for its use in animals as a means to manage, in conjunction with other therapies, tendinopathies, OA, and other conditions by targeting tissue to decrease inflammatory mediators and increase the release of growth factors to stimulate healing.

Dycus D. Shockwave Therapy for Orthopedic Management: What Do We Know? Presented at: Fetch dvm360® Conference; San Diego, California. December 2-4, 2022.

Johannes EJ, Kaulesar Sukul DM, Matura E. High-energy shock waves for the treatment of nonunions: an experiment on dogs. 

. 1994;57(2):246-252. doi:10.1006/jsre.1994.1139

Chen YJ, Wang CJ, Yang KD, et al. Extracorporeal shock waves promote healing of collagenase-induced Achilles tendinitis and increase TGF-beta1 and IGF-I expression. 

. 2004;22(4):854-861. doi:10.1016/j.orthres.2003.10.013

Hsu RW, Hsu WH, Tai CL, Lee KF. Effect of shock-wave therapy on patellar tendinopathy in a rabbit model. 

. 2004;22(1):221-227. doi:10.1016/S0736-0266(03)00138-

Gallagher A, Cross AR, Sepulveda G. The effect of shock wave therapy on patellar ligament desmitis after tibial plateau leveling osteotomy. 

. 2012;41(4):482-485. doi:10.1111/j.1532-950X.2012.00958.x

An examination of shockwave therapy and its clinical usages for various orthopedic conditions

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