Successful veterinarians, like many business-minded health care professionals, seek to maximize opportunities and enhance the value of their practice. To do so, they require the resources and information that will enable them to provide high-quality care and build a thriving career. This can be challenging, especially in a rapidly changing and often volatile economy.

Much like other health care professions, veterinary medicine was greatly affected by the recession of 2008. However, recent reports indicate that as with the US economy, veterinary medicine is also rebounding. According to the American Veterinary Medical Association, over 100,000 veterinarians were in practice in the United States in 2014.

 As their numbers continue to increase, so, too, does the demand for educational resources and outlets for their voices to be heard.

is a new editorial offering from Michael J. Hennessy Associates, Inc, that publishes the latest news and expert commentary on current research related to veterinary medicine, including the diagnosis, treatment, and prevention of species-specific diseases; product information; client education; legal and regulatory updates; and news and trends. The audience for 

 consists of veterinarians, veterinary technicians, and assistants in the United States.

This premiere issue provides education from a board-certified veterinary pathologist on Lyme disease in dogs; a brief refresher on envenomations; a client education piece on allergies in pets as we move into spring; advice on how to handle commercial property leases from renowned veterinarian and attorney, Charlotte Lacroix, DVM, JD; and advice for individuals who are looking to provide mobile veterinary services, from a veterinarian who is in the field.

We are excited to bring you this latest offering and look forward to growing this new publication with you, our readers, at the forefront.

1. Market research statistics — US veterinarians – 2014. American Veterinary Medical Association website. www.avma.org/KB/Resources/Statistics/Pages/Market-research-statistics-US-veterinarians.aspx. Updated April 2015. Accessed February 1, 2016.

Articles

Letter from the Chairman

Making the Move into Veterinary Health Care

 Putney Carprofen Chewable Tablets are indicated in dogs for relief of pain and inflammation associated with osteoarthritis and for the control of postoperative pain associated with soft tissue and orthopedic surgeries.

 As with other nonsteroidal anti-inflammatory drugs (NSAIDs), signs of carprofen intolerance may include appetite loss, vomiting, and diarrhea, which could indicate side effects involving the digestive tract, liver, or kidneys. Some of these side effects, in rare situations, may be serious, resulting in hospitalization or even death. Pet owners should be advised to discontinue treatment if side effects occur and to contact their veterinarian. Concomitant use of Putney Carprofen Chewable Tablets with other anti-inflammatory drugs, such as other NSAIDs or corticosteroids, should be avoided because of the potential increase of adverse reactions. Please see the 

 for further safety and usage information.

Bitter-taste PetFlex "No-Chew" - Print Cohesive Bandage

 Although completely safe to use, the bitter taste of No Chew keeps animals from biting, tearing, and chewing the bandage. PetFlex is a flexible cohesive bandage with EasyTear technology. It is sweat- and water-resistant, durable, and will not constrict.

http://www.andoverhealthcare.com/animal/cohesive.html

This economical, portable scale with a 1-inch (25 mm) readout remote weight display and a platform measuring 36 W x 22 D x 2 H inches (90 W x 55 D x 5 H cm) is the ideal scale for medium to large animals. The VET330WH features built-in rechargeable battery power and comes with an AC adapter. The scale’s light weight combined with wheels and carrying handle make it ultraportable.

http://www.detecto.com/wp-content/uploads/2012/09/VET330WH_Veterinary_Scale_Bulletin.pdf

Millpledge Veterinary for Aniset Anti Kink IV Set (15 drops/ml)

The Aniset range of intravenous (IV) fluid administration sets and accessories represents the highest-quality, purpose-built veterinary IV set available on the market today. It offers the most versatility and flexibility compared with other sets and provides practitioners with peace of mind while the animal patient is in their care. The Aniset range of small-animal IV sets has been designed and calibrated to work on the Abbott/Hospira/Heska/Jorvet VetPro IV Pump fluid delivery settings and is IV infusion—pump compatible. The Animill IV sets and accessories are chemotherapeutic compatible. A primary anti-kink, auto-filling IV-giving set with break point and extension is included with each IV set.

 Laboratoire de Dermo-Cosmétique Animale for Bayer HealthCare LLC

 Recommended for use on noninfected elbow callouses, nasal planum (skin area around the nostrils), interdigital areas, and thickened foot pads. Contains ingredients to hydrate and helps support the management of excessive skin keratin production in canines and felines.

http://www.bayerdvm.com/show.aspx/pyoclean-wipes

VitusVet works with a practice's existing software to create a branded app that allows clients to have 24/7 access to the medically relevant parts of their record: subjective, objective, assessment, and plan (SOAP) notes, labwork, digital images, patient alerts, etc. In short, the kind of information that increasingly tech-savvy pet owners want but can't get in an emergency or when traveling. In addition to these major medical benefits, VitusVet brings in new clients and dramatically improves routine care compliance through the power of smartphone technology.

Product Focus

According to the American Veterinary Medical Association, there were over 65,000 veterinarians in private clinical practice in 2014.

 As a veterinarian in private practice, chances are, unless you own your own facility, you will need to sign a commercial lease for your veterinary practice. Here are some tips to help you successfully negotiate commercial leases for your veterinarian practice.

A careful examination of the premises includes inspecting the heating, ventilation, and air conditioning, and the electrical and plumbing systems—although even careful due diligence may not reveal hidden defects, such as an ineffective heating system (when checked in August), a flawed air conditioner (checked in February), or roof leaks during heavy rains. Do not assume that everything the landlord tells you about the premises is 100% accurate; requesting the right to have a private inspection conducted makes good sense.

A typical veterinary practice lease ranges between 10 and 25 years. Therefore, when you find a suitable facility, prepare and invest for a long-term relationship. Ask the landlord for options to renew the contract when the lease is up and make sure you are clear about when you must give notice to renew. (Remember: there are also benefits to long-term relationships for your lessor, given the costs associated with finding new lessees and negotiating commercial leases.)

Actual rent payments are usually the sum of the two types: 

 is what tenants pay to occupy the premises and can be determined in several ways. Be aware of comparing rentals based on dollars per square feet, as “square feet” can be defined in more than one way. Landlords can quote a dollar/square foot rent using “rentable square feet,” but because only a portion of space is actually usable by the tenant, true rent is higher. Base rent can also be based on a percentage of the tenant’s gross revenues, but this will complicate contracts as both parties need to determine how gross revenues will be calculated and how disagreements will be resolved.

Similar to a housing lease, commercial property leases typically include annual rent increases. If a tenant has a 10-year lease with a $60,000 flat annual rent, the cost would be $600,000 over the lease term. However, with a 3% escalation clause, the total rent paid will be $687,832.76, an increase of approximately $87,833.

 are also part of most commercial leases. These cover amounts outside of the base rent, such as the security deposit (often 1-3 months’ rent) and reimbursing the landlord for property taxes on a monthly or quarterly basis.

In multitenant facilities, landlords are responsible for common area maintenance (CAM), which includes sidewalks, stairways between tenant premises, parking lots, outdoor maintenance, etc. There is no commonly accepted definition of CAM, however, so it is open to negotiation. However defined, the landlord will look to pass on CAM expenses while you will want to negotiate to minimize them. As a lessee, be aware of the phrase, “Including but not limited to” as this allows the landlord to add new expense categories under CAM that tenants cannot typically audit. Single tenant leases, fortunately, are more straightforward with most expenses paid directly by the tenant. Keep in mind that structural repairs are usually listed as a landlord expense.

Tenants must maintain general liability insurance and casualty insurance covering their furnishings, equipment, and other property. In addition, tenants may be required to keep business interruption insurance sufficient to pay the rent for a year (or more). Tenants must also maintain fire and other casualty insurance on the facility itself in single-tenant facilities, whereas multiple-tenant facility landlords insure themselves and pass costs to tenants via CAM.

If premises are destroyed or damaged by fire or other casualty, the landlord will need to use insurance proceeds to repair the facility within an established deadline. If the deadline cannot be met, the lease can be terminated. A critical issue to discuss and negotiate before signing a lease is whether or not the tenant can terminate the lease in this instance or if only the landlord can do so. Be sure to negotiate these terms.

The landlord’s prior consent is typically required prior to making improvements to the property. Critical issue: for example, as the tenant, if you add additional islands for animal examinations, can you remove them when the lease ends or must they remain? Again, negotiate wisely.

Most lease agreements state that tenants cannot assign their lease, or sublet the space, without the landlord’s consent; however, tenants can try to prohibit unreasonable withholding or delaying consent. Tenants should negotiate with the landlord to get more freedom to assign the lease if they are selling the practice.

Property leases usually require tenants to hold landlords harmless from injury or damage suffered from acts and omissions of tenants—or from the premises being defective. Savvy tenants (with leverage) will try to stipulate that the disclaimer does not apply when the landlord was negligent. For example, if the landlord knew of a weakness in the flooring but did not disclose that fact, and then a floorboard gives way, injuring someone, you have a much more difficult situation on your hands if your lease gives the landlord blanket immunity when injuries occur. Although proving negligence comes with its own challenges, it makes sense to request that the landlord be responsible for situations arising from their own neglect.

Commercial leases usually include lengthy provisions defining default triggers, notice requirements, and remedies. It is important to understand that lease termination and eviction do not suspend the tenant’s obligation to pay rent and CAM for the remaining term of the lease. The tenant’s obligation is reduced if the landlord re-rents the premises to a new tenant, but the landlord is not required to do so. That is, the landlord must make a reasonable effort to find a new tenant to rent the space, but if they cannot, or the space is rented for less than originally agreed in the original lease, the original tenant may still be obligated for the difference. Tenants should try to negotiate the insertion of a general clause into the lease requiring the landlord to mitigate damages.

Many leases stipulate that a guarantor’s bankruptcy triggers a tenant default under the lease, which then allows landlords to evict tenants. Tenants may want to try to soften this provision.

Dr. Charlotte Lacroix owns and manages Veterinary Business Advisors, Inc., a consulting firm which advises veterinarians and attorneys nationwide on veterinary business and legal issues. Dr. Lacroix received her doctorate in veterinary medicine in 1988 from the University of California at Davis. After completing a large animal internship at the University of Guelph (Ontario, Canada), she worked for several years at an equine medical and surgical referral practice serving northern New Jersey’s large equine community. In pursuit of her goal to make greater contributions to the veterinary profession, Dr. Lacroix attended law school and received her juris doctor from the University of Pennsylvania Law School. She is licensed to practice law in Pennsylvania and New Jersey. Dr. Lacroix is a regular contributor to 

Market research statistics - U.S. Veterinarians — 2014. American Veterinary Medical Association website. https://avma.org/KB/Resources/Statistics/Pages/Market-research-statistics-US-veterinarians.aspx. Updated April 2015.

Legal Focus

Charlotte Lacroix, DVM, JD provides tips to help you successfully negotiate commercial leases for your veterinarian practice.

Tips for Successfully Negotiating a Commercial Lease

With an estimated 26,000 veterinary practices in the United States in 2014,

 the veterinarian industry is growing and mobile veterinary practices are on the rise. Although house calls are certainly nothing new to veterinary medicine, utilizing a mobile veterinary practice for more than large animals and livestock is a new direction and one that some veterinarians may want to consider. To learn more about mobile veterinary practices, 

 interviewed Carmine Esposito, DVM, founder and owner of Progressive Mobile Veterinary Services, located in Clinton, New Jersey.

Q: Why did you pursue a career in veterinary medicine?

Like most veterinarians, it was a calling first recognized as a childhood dream. I always had a passion for nature, science, and animals. I remember reading James Herriot’s 

. The stories of a country veterinarian resonated with my passion for animals and my rural upbringing. These stories made me dream of one day being a country veterinarian. As it would come to pass, I pursued pharmacy instead of veterinary medicine; however, after working 7 years as a pharmacist, I finally decided to follow my calling.

I am reminded every day of why I wanted to become a veterinarian. I knew that pharmacy was not the field for me when I felt burdened with monotony, boredom, and the lack of patient appreciation for my efforts to help them feel better. Veterinary medicine, however, is the complete opposite. As most veterinarians know, unlike our human counterparts who care for one species, veterinarians must help and heal multiple species of animals, and aside from helping all of these different species, veterinarians are expected to wear many hats: as the general practitioner, surgeon, pharmacist, dentist, cardiologist, dermatologist, husbandry consultant, public health consultant, etc. The list of roles the veterinarian must assume is almost endless. I find this to be an exceptionally rewarding experience, and this inherent diversity of patients, procedures, and clients energizes me every day. The appreciation I see in my patients’ eyes when I help them feel better and their human parents’ gratitude is the proverbial icing on the cake. I am honored to be the “other” family doctor.

Q: What prompted you to start a mobile veterinary practice?

There are many reasons I decided to become a mobile veterinarian, but ultimately, it was because I wanted a better experience for my patients, clients, and myself. The more traditional practices I worked at prior to going mobile were busy, hectic, loud, and often inconvenient for the pet owners. Appointments were scheduled every 15 to 20 minutes. This relatively short appointment time made it difficult to develop a great connection with my patients and their owner. Due to scheduling constraints, I often saw sick patients several days or weeks after their owner had noticed the illness. I also observed patients so nervous from the car ride and/or the office that they would vomit, have diarrhea, or bite people due to fear. As I witnessed these scenarios repeat themselves, I thought there must be a better option.

I researched many options and learned that the permits, zoning, time, and cost involved in opening another veterinary office would handcuff me to the same impersonal and anxiety-inducing appointments that I wanted to avoid. Ultimately, the desire to be the other family doctor who helps and heals in the comfort of your home appealed to me. Across my professions, first as a pharmacist and now as a veterinarian, I always desired a connection with my patients. Going to the patient’s home allows me the opportunity to make that connection and the visit is much more enjoyable for everyone involved. Appointments are typically 45 minutes with minimal stress on patient and owner.

My typical house call can involve many services, such as wellness exams, vaccinations, sick pet exams, deworming, microchipping, ophthalmic exams with glaucoma testing, tear production test, corneal ulcer testing, abdominal ultrasounds, electrocardiogram, echocardiograms, blood pressure screenings, diagnostic laboratory testing (bloodwork, fine needle aspirates, biopsies, skin scrapes, etc), pharmacy services, electronic medical records, health certificates, hospice care, euthanasia, and cremation services. In addition to these services, many mobile veterinarians decide to purchase full-service “hospitals” on wheels. These mobile hospitals would allow for additional services such as x-rays, surgery, and dental procedures. The average cost for a full-service hospital on wheels is $225,000. Currently, I refer my patients requiring x-rays, surgery, and dental procedures to local veterinary offices and in return, many of these local offices refer their clients requiring a house call to my mobile practice. My goal is to purchase a full-service hospital on wheels in the near future.

I have found the mobile practice to be especially helpful for:

No need to load all the cats and dogs in the car at the same time

No need to make multiple appointments and trips to the vet’s office for all the pets

No need to get a sitter for the kids or take time off of work to get to the vet

Birds and reptile transportation during cold weather

Cats unable to be placed in carrier or car

Breeders or clients with young or immunocompromised patients

Provides an opportunity to minimize these patients exposure to potential infectious diseases 

Q: What challenges do you face as a mobile veterinarian?

By far, the biggest challenge I face is the amount of time spent driving and the resulting inefficiency from being on the road most of the time. This time is unproductive and often translates into very long days where I can only see a few clients. Most days are scheduled for 5 to 6 appointments knowing that an unexpected appointment or two will pop up. The typical day is 7 to 8 appointments, which requires approximately 10 hours on the road followed by 3 to 4 hours of paper work once home. For every hour I spend with a client, there is at least 30 minutes of paper work to be completed at the end of the day. To help overcome this challenge, I have hired staff to work remotely on scheduling, billing, ordering supplies, and updating the patient’s electronic medical records.

There is an additional challenge of finding clients that are willing to pay a little more for this individualized convenient attention. While most clients recognize the convenience of the mobile service, they do not realize the time and cost associated with such a service. The gas, wear and tear on the vehicle, lack of ability to see 30 patients a day (as a traditional practice can do), etc, all add up. I have embraced this lack of understanding as an opportunity to educate my clients. Each one of my appointments requires approximately 2 hours of time (including driving, time at the patient’s home, and paperwork). This amount of time is about 6 times the time allotted at a veterinary office. The average cost of the house call is $50 more than a comparable office visit. My clients and I feel this is a bargain for the more personable, convenient, and less stressful house call. Not everyone who contacts the mobile practice feels this way, however, and so educating clients on all that goes into the mobile veterinary service is the key.

Another big challenge I face is finding a balance between work and personal life. A mobile veterinary practice is designed to be convenient for clients and, therefore, I am always extremely busy at times when my clients are available, such as nights, weekends, and very early mornings.

Q: What advice do you have for anyone considering starting a mobile veterinary practice?

Starting a mobile veterinary practice has been the best decision I have made. It builds the type of relationships with your patients and clients that you could only dream of in an office environment. There are challenges which must be considered before jumping in though: you must love being on the road and you have to be accepting of the long hours that are not convenient for you, but convenient for your clients. If you already have a practice, you should consider your current patients and clients and whether or not they will continue to utilize your services as a mobile veterinarian. Would they be willing to pay the additional cost of a visit?

If you think this is the type of practice for you, I also suggest reaching out to a local mobile veterinarian and asking to ride along for a few days. In addition, I recommend getting involved in the mobile/house call associations. You should also think about the type of services you would like to offer. Is your geographic area a good market for these types of mobile services? There are many services you can provide with basic equipment; however, x-ray, surgery, and dental procedures will require a more substantial investment in equipment. Mobile truck vendors, such as Laboit Specialty Vehicles Inc, have been a tremendous resource.

Q: What are your hopes for the future of veterinary medicine?

I currently see a huge disparity between the level of medical care pet owners want for their pets and the level they can afford. This is not anyone’s fault, but a sign of the changing attitude people have about pets. Pets are now seen as family members and, as such, owners expect that they will receive the same medical care a child or an aging parent would receive. Veterinarians are trained to provide this level of care and have the desire to do so, but often pet owners decline the service because of inability to afford the cost. The cost is due to the price of equipment and cost of education required to perform these procedures and tests. I hope that someday soon, veterinarians can effectively educate clients on the cost of such procedures and work with clients to develop a medical system that will provide the client with the means to reimburse veterinarians for their expertise and training, and pay for required equipment to allow all of our 4-legged, feathered, and scaled family members access to the best possible health care.

Dr. Carmine Esposito, DVM, PharmD is the founder and owner of Progressive Mobile Veterinary Services, located in Clinton, NJ. Dr. Esposito earned his Doctorate in Pharmacy from the University of the Sciences in Philadelphia. Dr. Esposito practiced pharmacy for seven years before pursuing his dream of becoming a veterinarian. In 2010, he graduated Magna Cum Laude from St. George’s University School of Veterinary Medicine after completing his clinical year at North Carolina State University Teaching Hospital. His vast knowledge of pharmacology and physiology, in both veterinary and human medicine, allows him to easily explain and discuss diseases and treatments with pet owners. He strives to provide pet owners with a better understanding of their pets’ medical conditions. 

Downing J. Veterinary private-practice sector makes modest rebound. Veterinary Information News website. 

. Published May 13, 2014. Accessed January 13, 2016.

Business Focus

To learn more about mobile veterinary practices, American Veterinarian interviewed Carmine Esposito, DVM, founder and owner of Progressive Mobile Veterinary Services, located in Clinton, New Jersey.

An Inside Look into Mobile Veterinary Practices

Lyme disease (borreliosis) is among the most frequently diagnosed, zoonotic, tick-borne diseases worldwide

 and continues to receive intense attention in small animal medicine since canine disease was first reported in the early 1980s.

 In animals, clinical Lyme disease occurs primarily in dogs

 and is most prevalent in New England and along the East Coast, as well in the upper Midwestern and West Coast states (including California).

In North America, the disease is caused by the spirochetal bacterium 

 (the blacklegged tick) is the main vector in eastern and central North America, while 

the western blacklegged tick) is the main vector west of the Rocky Mountains.

Infection of dogs is more common in areas with endemic populations of ticks and where acaricide use is nonroutine; however, infection is rare in dogs in nonendemic areas without a travel history to an endemic area.

 Typically, ticks must attach and feed for 24 to 48 hours before 

Clinical Signs and Disease Manifestations

In dogs, clinical Lyme disease is a less common outcome of infection than in humans, and only about 5% of dogs develop clinical signs of Lyme disease when exposed to 

Clinical disease usually presents with acute signs such as fever, lethargy, anorexia, depression, lameness, joint swelling, polyarthritis, and/or lymphadenopathy, as well as neuroborreliosis in chronic cases.

 Although uncommon, nephropathy can also occur in advanced stages of the disease.

 infection detect the presence of either the organism itself or antibodies to it:

 from tissue or blood is the definitive method for diagnosis of 

this test has low sensitivity, requires incubation periods of up to 6 to 8 weeks, and is usually limited to research settings.

 Detection of the organism by polymerase chain reaction or cytology is also difficult.

In contrast, serological assays for detection of 

 antibodies are highly sensitive and specific, and are widely used in clinical practice to identify

-specific antibodies has typically involved a 2-step procedure of a quantitative nonspecific enzyme-linked immunosorbent assay (ELISA) followed by qualitative specific Western blotting. Because the nonspecific ELISA measures antibodies to the whole organism and cannot differentiate between antibodies from natural exposure to the organism and vaccination, it produces positive results in both cases and is therefore followed by a confirmatory Western blot test.

However, more recent confirmatory tests have also emerged, in particular based on C6 detection. Both qualitative (in-clinic test kits) and quantitative (performed in reference laboratories) versions of the C6 test are available. C6 is a peptide associated with the variable region of 

but only in live organisms, and is immunodominant in dogs infected with 

is expressed when the organism is transmitted to the dog, but is not expressed in the tick, in tissue culture, or in Lyme disease vaccines. Antibodies against C6 are therefore highly specific for 

 and indicate natural exposure. C6 antibody responses occur 3 to 5 weeks after infection and decline following treatment of dogs with clinical Lyme disease.

The qualitative in-clinic test is therefore useful for screening for 

 infection, either as part of a screening program for dogs without clinical signs or when Lyme disease is suspected; a positive result indicates active infection with the organism. The quantitative C6 test is effective in measuring response to antibiotic therapy in dogs with Lyme disease, as decreasing levels of the C6 antibody indicate infection control.

Fluorescent bead-based multiplex assay of antibodies to 

 is a novel and highly sensitive approach for the simultaneous evaluation of antibodies to different 

 antigens as indicators of acute or chronic infection. These include outer-surface protein A (OspA), OspC, and OspF that are differentially expressed either in ticks (OspA) during transmission to the host (OspC) or later in the host (OspF). The OspC antibody response is therefore used to indicate early infection and OspF is used for chronic infection.

It is important to remember that serological test results can be used to document exposure to 

 but not to diagnose Lyme disease. Serological screening of healthy dogs for exposure to

 is therefore controversial because it can lead to overdiagnosis or overtreatment of Lyme disease, although most of these dogs will never develop clinical disease. The consensus opinion of the American College of Veterinary Internal Medicine (ACVIM) is that dogs with proteinuria in endemic areas should be screened for

 exposure with antibody tests. Although the treatment benefit of seropositive healthy dogs remains unknown, ACVIM also recommends that seropositive dogs should be screened for proteinuria and other co-infections and tick control should be initiated.

In conclusion, a presumptive diagnosis of Lyme disease in dogs must be based on clinical presentation, a history of tick exposure and/or Lyme disease risk, laboratory serological test results, elimination of differential diagnoses, and response to treatment.

Dr Parry graduated from the University of Liverpool, England in 1997 and is a board-certified veterinary pathologist. After 13 years working in academia, she founded Midwest Veterinary Pathology, LLC where she now works as a private consultant. She is passionate about veterinary education and serves on the Indiana Veterinary Medical Association

’s Continuing Education Committee. She regularly writes continuing education articles for veterinary organizations and journals, and has also served on the American College of Veterinary Pathologists

’ Examination Committee and Education Committee.

Berrada ZL, Telford III SR. Burden of tick-borne infections on American companion animals. 

. 2009;24(4):175-181. doi: 10.1053/j.tcam.2009.06.005.

Bouchard C, Leonard E, Koffi JK, et al. The increasing risk of Lyme disease in Canada. 

Krupka I, Straubinger RK. Lyme borreliosis in dogs and cats: background, diagnosis, treatment and prevention of infections with Borrelia burgdorferi sensu stricto. 

 2010;40(6):1103-1119. doi: 10.1016/j.cvsm.2010.07.011.

Lyme disease. Companion Animal Parasite Council website. http://www.capcvet.org/capc-recommendations/lyme-disease. Published June 2015. Accessed January 5, 2016.

Littman MP, Goldstein RE, Labato MA, Lappin MR, Moore GE. ACVIM Small Animal Consensus Statement on Lyme Disease in Dogs: Diagnosis, Treatment, and Prevention. 

Wagner B, Freer H, Rollins A, et al. Antibodies to 

 OspA, OspC, OspF, and C6 antigens as markers for early and late infection in Dogs. 

. 2012;19(4):527-535. doi: 10.1128/CVI.05653-11.

Medical Focus

Lyme disease is among the most frequently diagnosed, zoonotic, tick-borne diseases worldwide and continues to receive intense attention in small animal medicine since canine disease was first reported in the early 1980s.

Clinical Signs and Diagnosis of Lyme Disease in Dogs

Dogs and cats can be allergic to the same things that make people sneeze. Unlike allergies in humans, however, allergies in small animals are more likely to affect the skin and ears than the respiratory system.

 Symptoms of allergies in dogs and cats can include the following: 

Reddish-brown discoloration of the feet (from saliva staining)

Red skin, especially on the abdomen, legs, or armpits

The most common allergies in dogs and cats fall into 3 categories: atopy (allergy to substances in the environment), flea allergy, and food allergy. Some pets have allergies in more than one category.

Atopy is a hypersensitivity to environmental particles that are inhaled or absorbed through the skin.

 Atopy is often seasonal but can be year-round, depending on the cause. Skin testing, usually performed by a veterinary dermatologist, can identify the specific allergens that cause reactions in a pet with atopy. Triggers may include these common causes: 

Pollens, especially from trees and grasses

Atopy has a genetic component and is often seen in terriers and retrievers, although any dog can be affected. Animals with atopy typically start showing symptoms at a young age: under 3 years in dogs and under 5 years in cats.

 In dogs, licking the front feet is a classic sign of atopy. Cats with atopy, however, are often itchy around the head and neck and may develop small scabs anywhere on the body.

Animals with a flea allergy have an intensely itchy reaction to the bite of even a single flea. Because flea-allergic pets groom themselves excessively in response to the itching, few or no fleas may be visible on the skin. Flea allergy symptoms can be seasonal or year-round, depending on the climate; the peak is often in the late summer or fall.

Food allergies are less common than atopy but can cause similar symptoms in dogs and cats, although the symptoms are not seasonal. Pets can become allergic to any ingredient they have eaten in the past; common culprits are beef, chicken, eggs, and corn. The only way to diagnose a food allergy is by feeding an elimination (hypoallergenic or novel ingredient) diet and watching for symptoms to resolve. It is best to consult a veterinarian before planning a diet trial.

Dogs and cats with allergies commonly develop secondary skin infections caused by bacteria, yeast, or both. These infections can also be very itchy, and allergy treatment alone will not make a pet comfortable until a skin infection is under control. An ear infection is sometimes the only sign of an underlying allergy and may not be noticed by the owner. Signs of a skin infection can include the following: 

An allergy is a chronic condition that can get worse over time, so it’s best to seek veterinary care early. Any pet with itching or other symptoms that do not respond fairly quickly to home care should be seen by a veterinarian. Home care can include the following: 

Use flea control for all dogs and cats in the household (both indoors and outdoors). Depending on the climate, this could mean treating all year long. Prescription flea products have made flea control much easier than it once was; talk to your veterinarian.

Bathe your pet with a mild pet shampoo. This removes allergens from the coat and can provide some relief from itching. An oatmeal-based shampoo is often a good choice. Do not use OTC medicated shampoos without first consulting your veterinarian because some of them can irritate the skin.

If you know your pet’s allergy triggers (from skin testing, for instance), reduce exposure as much as possible. For example, vacuum often and use a HEPA filter if your dog or cat has a dust mite allergy. 

Your veterinarian may perform diagnostic tests to identify skin and ear infections and rule out diseases that mimic the symptoms of allergies. The treatment plan depends on the diagnosis and clinical signs and can vary over a pet’s lifetime. Treatments prescribed by your veterinarian may include the following: 

Medicated shampoos, conditioners, sprays, or other topical agents

Immune-modulating drugs, such as cyclosporine

Immunotherapy injections (allergy vaccines individualized for each patient)

Your pet might also benefit from referral to a veterinary dermatologist. Dermatologists can formulate allergy vaccines based on skin test results and also have access to new treatment options like monoclonal antibody therapy. An allergy is a lifelong condition that cannot necessarily be cured, but with your veterinarian’s help, it can usually be managed.

Dr. Laurie Anne Walden received her doctorate in veterinary medicine from North Carolina State University in 1994. After an internship at Auburn University College of Veterinary Medicine, she returned to North Carolina, where she has been in companion animal general practice for over 20 years. Dr. Walden is also a board-certified Editor in the Life Sciences and owner of Walden Medical Writing.

1. Allergies. Texas A&M Veterinary Medical Teaching Hospital website. 

www.vethospital.tamu.edu/small-animal-hospital/dermatology/allergies

www.merckvetmanual.com/pethealth/dog_disorders_and_diseases/skin_disorders_of_dogs/allergies_in_dogs.html

. Updated June 2011. Accessed January 9, 2016.

Small Animal Dermatology: A Color Atlas and Therapeutic Guide

4. Netherton S. Dogs’ itchiness may indicate atopic dermatitis. University of Illinois College of Veterinary Medicine website. 

www.vetmed.illinois.edu/pet_column/dogs-itchiness-may-indicate-atopic-dermatitis/

. Published October 28, 2013. Accessed January 9, 2016.

www.merckvetmanual.com/pethealth/cat_disorders_and_diseases/skin_disorders_of_cats/allergies_of_cats.html

. Updated July 2011. Accessed January 9, 2016.

Client Education

The most common allergies in dogs and cats fall into 3 categories: atopy (allergy to substances in the environment), flea allergy, and food allergy.

It's Spring and My Pet Itches! A Look at Seasonal Allergies

 in the United States are bitten by venomous snakes. Venomous snakes native to North America belong to 2 groups: crotalids and elapids. Crotalids, or pit vipers, include rattlesnakes (found throughout the United States), copperheads (in eastern states), and cottonmouths or water moccasins (in wetlands of the southeastern United States). The only elapid in the United States is the coral snake, which lives in wooded or marshy areas in the South.

Crotalid bites occur much more often than elapid bites.

 Bites from venomous snakes not native to the United States have also been reported in humans, including children; these bites are mostly by snakes kept in residences (not zoos).

 It is reasonable to assume that pets could also be bitten by non-native snakes for which antivenin is not readily available.

Fatalities are more common in dogs than in other animals,

 occurring in an estimated 1% to 30% of cases.

 Mortality after snakebite is low in cattle and horses because of their size, although bites to the head can result in swelling that leads to asphyxiation and death. Not all bites result in envenomation, however. Many are “dry bites,” with little or no venom delivered.

Snakebite is a medical emergency. Treatment at a veterinary hospital should not be delayed by attempts to provide first aid.

 First aid should consist of limiting the animal’s activity and transporting it as quickly as possible. Most field treatments are ineffective at best, and some can harm the patient. Cold packs, hot packs, incision and suction, and tourniquets should not be used.

 Because elapid venom can cause respiratory paralysis, animals bitten by coral snakes should be taken to a facility that can provide 24-hour monitoring and mechanical ventilation.

Crotalus adamanteus, “Eastern diamondback” rattlesnake

Crotalid bites typically cause local tissue necrosis with swelling, discoloration, and epidermal sloughing.

 Local reactions are generally more severe with rattlesnake bites than with copperhead or cottonmouth bites. Blood or serum may seep from bite wounds. However, fang marks do not necessarily indicate envenomation. A tissue reaction is usually seen within 10 minutes of moderate to severe envenomation. If no swelling has occurred within 1 hour and no systemic signs of envenomation are present, the bite was probably dry.

Systemic clinical signs include coagulopathy, petechiae, weakness, vomiting, diarrhea, hypotension, thrombocytopenia, pulmonary edema, cardiac arrhythmia, and shock.

Agkistrodon contortrix “Southern copperhead” snake

The venom of Mojave, timber, and canebrake rattlesnakes is primarily neurotoxic. Envenomation causes neurologic signs such as muscle fasciculations.

 It is possible for an animal to die from neurotoxic crotalid venom without showing any local tissue reaction.

Agkistrodon piscivorus leucostoma, “Western cottonmouth” snake

If a crotalid bite is not witnessed, it can be mistaken for other disorders. Differential diagnoses include trauma, abscess, bite wound from an animal other than a snake, spider bite, and allergic reaction to an insect bite.

The predominant signs of coral snake envenomation are neurologic, with minimal local swelling and pain. The onset of signs may be delayed for up to 18 hours. Signs include tetraparesis, weakness, ataxia, muscle fasciculations, tachypnea, shallow breathing, altered (quiet) mental state, hemolysis, anemia, and hemoglobinuria.

 Death, when it occurs, is usually caused by respiratory paralysis.

Puncture wounds from coral snakes may be difficult to find. Differential diagnoses for elapid envenomation include tick paralysis, botulism, and myasthenia gravis.

Diagnostic testing includes a complete blood count, coagulation profile, chemistry panel, and urinalysis. Anemia and thrombocytopenia can occur with both crotalid and elapid bites, and echinocytes may appear after rattlesnake and coral snake envenomation. Coagulation deficits may or may not be accompanied by thrombocytopenia. Rhabdomyolysis can cause an increase in serum creatine phosphokinase. Urinalysis may reveal hematuria, hemoglobinuria, or myoglobinuria. Pigmenturia indicates severe envenomation. Using a snakebite severity score is recommended to track the progression of signs and help decide whether antivenin is needed.

Snake envenomation patients should be observed for at least 8 hours.

 Treatment for crotalid envenomation can include intravenous crystalloids, opioid analgesics, and treatment of coagulopathy. Rapid-acting corticosteroids, antibiotics, and antivenin are used in some cases.

 The use of steroids is controversial, and nonsteroidal anti-inflammatory drugs should not be used if coagulopathy is present. Antivenin may be indicated if swelling progresses rapidly, if coagulopathy or thrombocytopenia is present, or if the patient has signs of neuromuscular toxicity or shock. Antivenin is often not needed for copperhead bites. Newer Fab antivenins have a lower risk of anaphylaxis but could be too expensive for veterinary patients.

Treatment for coral snake envenomation consists of intravenous fluids, anticonvulsants, and respiratory support.

 Patients should be monitored in the hospital for 48 hours, and mechanical ventilation may be needed for up to 72 hours.

 Coral snake antivenin is not currently available in the United States.

The prognosis for snakebite patients depends on the type of snake, degree of envenomation, size of the patient, location of the bite, and time before initiation of treatment. Severe crotalid envenomation can cause significant long-term effects secondary to tissue necrosis

 Elapid bites usually do not cause significant long-term sequelae in patients that survive.

Venomous snakes. Centers for Disease Control and Prevention website. 

. Updated July 24, 2015. Accessed January 5, 2016.

Overview of snakebite. Merck Veterinary Manual website. 

March 2016