For Chand Khanna, DVM, PhD, DACVIM (ONC), DACVP (HON), chief science officer of Ethos Veterinary Health, it was during his doctoral program where he truly understood the key role veterinarians play in studying complex medical conditions like osteosarcoma. Ever since, it has been his mission to help strengthen communication between fellow oncology specialists, primary-veterinarians, and pet owners.

In this latest episode of The Vet Blast Podcast, Khanna briefly touches on a few osteosarcoma innovations and explains to Dr. Christman how three-way communication has evolved due to increasing technological advancements.

Instead of communicating via multiple faxes like in the past, Khanna says specialists can now conveniently and easily text back and forth between primary care veterinarians and clients to discuss cancer treatment options. He also uses Instagram to further enhance this three-way communication. These innovations are helping to build better relationships between primary care veterinarians and specialists, says Khanna, adding that this improving bond is so important during these unprecedented times when making tough treatment decisions is especially hard.

Christman agrees, noting that telehealth has significantly enhanced communication between veterinarians, specialists, and pet owners during COVID-19.

“This is a byproduct of the pandemic that is going to allow us to deliver broader care,” Khanna responds, explaining that it has created awareness of the many tools available to improve this three-way communication.

“We want to reassure the client that we are a trusted team working together for the benefit of the pet.”

Listen below to learn more about the veterinary triangle of communication.

Podcasts

On this episode of The Vet Blast Podcast, Dr. Adam Christman talks with veterinary oncologist Chand Khanna, DVM, PhD, about osteosarcoma research updates, plus how technology has improved three-way communication between veterinarians, oncology specialists, and clients.

Episode 24: Understanding the veterinary triangle of communication

The recent widespread increase in veterinary school applicants has offered a glimmer of hope to an often-times undervalued profession known for high burnout and turnover rates.

During the 2020-2021 cycle, the number of applicants at veterinary medical colleges rose to a whopping 19% year-over-year—79% started and completed the application process through the Veterinary Medical College Application Service, according to the Association of American Veterinary Medical Colleges (AAVMC).

Preliminary data reveal a surge of 10,273 applicants in comparison with 8,645 last year. In fact, over the past few years, the number of applicants rose by 6 to 7%, tripling the annual year-over-year growth rate, according to this 

Currently, there is no clear explanation for this surge in applicants because of several potential influences, including 

, which has increased awareness about the 

vital role veterinary professionals play in zoonotic disease research

, treatment, and vaccination development. Additionally, the pandemic has 

—shut-down orders have allowed pets and their owners to spend more quality time together. It has also resulted in busier clinical practices and a rise in animal shelter adoption rates.

If you want to learn more about these numbers, hold tight. The AAVMC says it will release final information soon.

Articles

The application submission rate jumped to 79% during the 2020-2021 school year, significantly surpassing the historically averaged rate of 72%-73%.


Veterinary medical college applicant rates rise by 19%

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/

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 

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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.