During this dvm360® interview, Janice Huntingford, DVM, DACVSMR, CVA, CVPP, CCRT, owner/medical director at Essex Animal Hospital Canine Rehab and Fitness, shared common signs dogs display with a ruptured cranial cruciate ligament so you can more easily diagnose these patients. 

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

Janice Huntingford, DVM, DACVSMR, CVA, CVPP, CCRT

: When dogs rupture their cranial cruciate ligament, what most people see is that they are quite lame and they may be toe touching or they may hold their leg up, you know entirely. They might be painful at their pelvis.

Videos

In this interview at the Fetch dvm360® conference in Charlotte, North Carolina, Janice Huntingford, DVM, DACVSMR, CVA, CVPP, CCRT, outlines signs of a ruptured CCL to bear in mind.

Signs of ruptured cranial cruciate ligament

In a dvm360® interview, Sonja Olson, DVM, book author at Heartstorming Wellness, explained the role you want to play in your veterinary career is influenced by mentors and experiences along the way that help you better understand yourself. 

: [It] depends on when you ask that question. That's the thing is that we only know what we know right now. And as you go through your life, you are going to be exposed to so many things in your life and people that will influence your understanding of yourself and how you're showing up and where you want to go.

During an interview at the Fetch dvm360® conference in Charlotte, North Carolina, Sonja Olson, DVM, reveals her answer to this question, noting the factors that may impact it throughout your life 

How do you know who you want to become in your career? 

Since 2000, Banfield Pet Hospital has tracked data on pet care visits and recently announced it has reached 150 million pet visits.

"The human-animal bond has grown ever stronger, with over 23 million households welcoming a pet since the start of the pandemic. Our hospitals and Associates have done an incredible job, stepping up to provide care to pets and their owners," said Brian Garish, president of Banfield Pet Hospital, in a company release.

Banfield also announced they are on target to reach another milestone: 300 million heartworm preventatives delivered since the data tracking started in 2000.

 According to the release, data collected by Banfield found that there was a 46% drop in dogs diagnosed with parasites, which emphasizes the importance of preventative care.

Banfield in its stride to create a better veterinary space has implemented innovative ways for veterinary professionals to provide better patient care. The company is elevating the roles of its certified veterinary technicians (CVT) in how they support veterinarians and clients by doctor-directed and supervised appointments with already existing Banfield patients. Clients also have access to virtual care through Banfield Vet Chats.

The company hopes by the end of 2023, it will have increased its number of stand-alone hospitals, offering Banfield veterinary professionals the chance to provide care for approximately 225,000 more pets.

Banfield Pet Hospital Delivers 150 Millionth Pet Visit During National Pet Month. Banfield Pet Hospital. May 12, 2022. Accessed May 17, 2022. https://www.prnewswire.com/news-releases/banfield-pet-hospital-delivers-150-millionth-pet-visit-during-national-pet-month-301546243.html

Articles

In tandem with National Pet Month, Banfield Pet Hospital announces this milestone

Banfield celebrates 150 million pet visits 

What does it take to land a job in the veterinary profession today? Pamelar Hale, DVM, MBA, and Ryan Hart examine the industry landscape and provide tips for those looking for their first job or those in search of greener pastures. 

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

: What's important, too, is remember doing an interview, whether it's zoom by phone in person, it's a two-way street. So, you want them to know about you [and] your interests, so have questions prepared for them. Will you be able to explore exotic animal medicine? [Do] you have a special interest in behavior, therapies, will you be able to do more of that . . . Remember, it's a family. You are actually joining a family. It may be part of a group; it may be solo-owned practice; but it's a group of people that work together that jell and mesh and form a family. 

Podcasts

Pamelar Hale, DVM, MBA, and Ryan Hart let new graduates and job-seekers know what to expect when interviewing at a veterinary hospital on The Vet Blast Podcast. 

Veterinary recruiting in the age of Zoom interviews

Heartworm disease is a threat to canines and felines in all 50 states. Although the disease can be fatal, preventives are widely available and highly effective. 

Resistant strains of heartworm are present in the United States. Protecting patients from infection with resistant strains and minimizing the continued development of resistance requires veterinarians to evaluate current prevention strategies and work to maximize adherence with both prevention and treatment protocols.

Dirofilaria immitis is the nematode parasite that causes heartworm disease. Microfilaria are ingested by mosquitoes during a blood meal from an infected dog. They undergo several molts into the infective third-stage larvae (L3) within the intermediate host. Within days of entering the host, L3 molt to fourth-stage larvae (L4), which migrate through the host’s body toward the circulatory system. Within 45 to 65 days, the L4 begin their final molt to the juvenile or immature adult stage.

Within 90 to 120 days following infection, all immature adult worms reach the pulmonary vasculature, where they will continue to develop into mature adult worms that will reproduce. Between 6 and 9 months following infection, the dog will develop patent infection with circulating microfilaria, which creates a reservoir for infection.

Heartworm  prevention and the role of adherence 

The American Heartworm Society (AHS) recommends that dogs receive year-round heartworm prevention regardless of where they reside.

 All available FDA-approved heartworm prevention products are members of the macrocyclic lactone (ML) drug class. MLs are safe for all breeds, even those with MDR mutations, at prescribed doses.

 These drugs are highly efficacious against L3 and early L4 stages (< 30 days old).

Most FDA-approved preventive products are available in topical or oral forms for dogs and cats. These products rely on pulse administration of a low dose of ML once every 30 days, which works to kill larval heartworms that have been transmitted to the patient in the preceding month. The drug is eliminated from the body within a few days of administration, making timely dosing essential. Because L4s can molt into the juvenile stage in 45 days and late-stage L4, juvenile, and adult heartworms are less susceptible to MLs, a single missed dose of these preventive may result in infection.

Adherence is the largest barrier to effective heartworm prevention. When evaluating adherence with monthly preventive products, several factors need to be evaluated. These include the following:

Were the appropriate number of doses purchased by the client for a given period?

Was the product purchased/administered appropriate for the weight of the patient at the time of administration?

Was the product administered at appropriate intervals? 

For oral products, did the patient ingest the full dose? 

For topical products, was it applied to the skin in an effective manner?

Many of these factors are difficult to evaluate on a wide-scale basis to assess adherence, but several studies have evaluated purchase adherence. Data show that approximately two-thirds of US dogs do not receive any heartworm prevention.

 On average, only 8.6 doses are purchased per patient annually, falling short of the recommended 12 doses per year.

 In a study evaluating lack of efficacy claims, where a patient said to be on heartworm prevention tested antigen positive, 80.7% of cases were found to have insufficient heartworm prevention purchased.

An alternative prevention strategy for dogs is the use of injectable products administered in the veterinary clinic. Two long-acting injectable products are available, providing protection for either 6 or 12 months with a single injection. These products rely on the continuous release of moxidectin to eliminate larval heartworms. Purchase adherence with injectable heartworm preventives has been found to be superior to monthly products.

 Additionally, administration of the product in the veterinary office removes concerns that the patient was dosed appropriately.

Suspicion of heartworm resistance to MLs has been reported for over 20 years and has more recently been confirmed in the United States.

 Resistant strains appear to be most prevalent in states along the lower half of the Mississippi River.

 The full distribution of these strains has yet to be evaluated and ongoing research is needed to further identify resistance.

 is difficult and requires experimentally infecting a naïve dog with a suspected resistant strain following administration of an ML and monitoring for development of infection.

 Genetic analysis of resistant strains is ongoing to better understand mechanisms of resistance.

 Despite the identification of single nucleotide polymorphisms (SNPs) in some strains of ML-resistant 

, genotyping is not practical to use in the clinic to identify cases of resistant disease.

When a patient on preventives develops a heartworm infection, resistance should not be immediately assumed. Adherence in purchasing and administering appropriate preventives should be evaluated closely. An algorithm that can be used in the clinic to investigate potential resistance was developed by investigators.

 The algorithm relies on use of a microfilarial suppression test. A reduction in microfilaria by more than 90% indicates that resistance is unlikely.

Although resistant strains exist, it is important to note that in most cases, MLs are still reliable preventives.

Combating resistance will require maximizing the dosage and formulation of available MLs into highly effective preventives as well as maximizing adherence in administering existing preventives.

Variability in the efficacy of MLs exists and is related to the inherent properties of each drug. For instance, moxidectin is more lipophilic, has a higher potency, and has a longer half-life than other MLs.

Recent literature has demonstrated that moxidectin has higher efficacy than other MLs against resistant strains of D immitis, especially in sustained-release, pet parent-administered products.

 Thus, especially in areas with higher concerns for resistance, moxidectin-containing products may offer superior protection.

In practice, veterinarians can combat resistance by educating clients on the importance of year-round prevention, annual testing, and appropriate treatment for infected dogs. Recommendations for combating resistance in practice include the following:

Begin heartworm prevention in puppies by 8 weeks of age and continue year-round.

Consider the use of long-acting injectable preventives to improve adherence.

 An added advantage of these products is that all available injectable preventives for 

Include mosquito repellent products and environmental control of mosquitoes in your prevention strategy, especially in endemic areas, to minimize transmission.

Doxycycline can be administered to patients with resistant 

 At 10 mg/kg twice daily, doxycycline kills the symbiotic bacteria 

 is unable to produce viable microfilaria. Additionally, microfilaria exposed to doxycycline are unable to develop into infective larval stages when ingested by mosquitos.

Follow AHS guidelines for adulticidal therapy using melarsomine. The use of “slow-kill” methods for heartworm disease that rely on MLs is not recommended. Prolonged use of MLs in adult worms may select for resistant subpopulations and create a reservoir for resistant infection.

Macrocyclic lactone drug resistance has been observed in some strains of 

, but the mechanisms of resistance, prevalence of resistant strains, and their distribution are still being investigated. As all available FDA-approved heartworm preventives rely on MLs, it is imperative that veterinarians work with clients to combat resistance through improving adherence in preventive administration and follow AHS guidelines when presented with a heartworm-positive patient.

Kate Boatright, VMD is a 2013 graduate of the University of Pennsylvania School of Veterinary Medicine, is a practicing veterinarian and freelance speaker. She is passionate about mentorship, education, and addressing common sources of stress for veterinary teams and recent graduates. Outside clinical practice, Boatright is actively involved in organized veterinary medicine at the local, state, and national levels.

American Heartworm Society. Current canine guidelines for prevention, diagnosis, and management of heartworm infection in dogs. Revised 2018. Accessed April 16, 2022. https://www.heartwormsociety.org/veterinary-resources/american-heartworm-society-guidelines 

Drake J, Wiseman S. Increasing incidence of 

 in dogs in USA with focus on the southeast region 2013-2016. 

2018;11(1):39. doi:10.1186/s13071-018-2631-0

Atkins CE, Murray MJ, Olavessen LJ, Burton KW, Marshall JW, and Brooks CC. Heartworm ‘lack of effectiveness’ claims in the Mississippi delta: computerized analysis of owner compliance. 

 2014;206(1-2):106-113. doi:10.1016/j.vetpar.2014.08.013

Mwacalimba K, Amodie D, Swisher L, et al. Pharmacoeconomic analysis of heartworm preventive compliance and revenue in veterinary practices in the United States. 

 2021;8:602622. https://doi.org/10.3389/fvets.2021.602622.

Prichard RK. Macrocyclic lactone resistance in 

: risks for prevention of heartworm disease. 

 2021;51(13-14):1121-1132. doi:10.1016/j.ijpara.2021.08.006

Moorhead AR, Evans CC, Kaplan RM. A diagnostic algorithm for evaluating cases of potential macrocyclic lactone-resistant heartworm. 

 2017;10(suppl 2):109-113. doi:10.1186/s13071-017-2441-9

American Heartworm Society. Resistance statement. Accessed April 17, 2022. https://www.heartwormsociety.org/images/Resistance_Statement_20200716.pdf

Prichard RK and Geary TG. Perspectives on the utility of moxidectin for the control of parasitic nematodes in the face of developing anthelminthic resistance. 

 2019;10:69-83. doi:10.1016/j.ijpddr.2019.06.002

Savadelis MD, McTier ML, Kryda K, Maeder SJ, Woods DJ. Moxidectin: heartworm disease prevention in dogs in the face of emerging macrocyclic lactone resistance. 

 2022;15(1):82. doi:10.1186/s13071-021-05104-7

Prevention strategies can help protect dogs from infection with resistant strains

Maximizing adherence to minimize heartworm resistance

Whistle—a pet technology healthcare service company—has launched its data-driven AI-enabled device that promotes preventative care called Whistle Health. 

By collecting data from over 100,000 pets worldwide over 4 years, Whistle created AI that translates the dog's every movement into a personalized and holistic wellness index, offering pet parents constant insight surrounding their pet’s health.

“Think of Whistle Health as your daily digital companion for your dog—a smart device that provides your pet with a voice, helping you understand them like never before,” said Kate Balingit, general manager at Whistle, in an organizational release.

“Whistle Health doesn’t just detect issues, it also connects pet parents to an entire ecosystem of pet pros for data-driven, personalized care, helping their pets live their happiest and healthiest lives," she continued.

According to the release, Whistle Health uses trillions of clinical insights and data points to track health behaviors such as drinking, eating, scratching, sleeping, licking, fitness, and activity.

 When Whistle Health is coupled with the Whistle app, the device can detect and alert pet parents of any potential health issues (eg, excessive scratching or changes in eating). Pet parents can then be connected to a veterinarian through Whistle’s Ask a Vet.

“It’s hugely impactful when pet parents are able to bring in tracking data collected from a device like Whistle Health—being able to use actual data to inform a treatment plan means veterinary professionals can provide more individualized and tailored care to our patients,” expressed Aletha Carson, DVM, senior manager, data and clinical research.

“Whistle Health is an incredible tool that every veterinarian should incorporate into their care," she added. 

Unveiling next generation of pet care technology with Whistle™ Health. Whistle. May 17, 2022. Accessed May 17, 2022. https://www.businesswire.com/news/home/20220517005049/en/Unveiling-Next-Generation-of-Pet-Care-Technology-with-Whistle%E2%84%A2-Health

Pet technology healthcare service company is rolling out a canine AI smart device

SAP Partners