The Scoop, March 2024

AAHA Director Gregory Carastro, LVT, CVBL, touts the benefits of the Fear Free practice. The AAHA Community responds to a request for resources to help boost confidence in veterinary assistants. This month’s Scoop news articles include: AAHA Names First Veterinary Technician of the Year; North Carolina Requires Veterinarians Declare Gabapentin Use; Humans May Have Influenced Evolution of Dogs’ Eye Color; Study Evaluates Cannabis Product Use in US Cats and Dogs; and more!

View from the Board

The Fear-Free Initiative

Fear-Free veterinary techniques are a relatively new approach to caring for patients and clients in the veterinary field that have gained exceptional traction within the hospital setting.

Fear Free techniques are a set of techniques that have been developed as a part of a certification for veterinarians, veterinary technicians, veterinary assistants, kennel technicians, groomers, dog trainers, and pet owners.

This certification is offered directly through Fear Free, LLC, which is based in Denver, Colorado, and was founded in 2016. This initiative strives to further increase the understanding of animals’ emotional well-being, as well as reduce the amount of fear, anxiety, and stress in our companion animals.

Fear Free provides online and in-person education to veterinary professionals, the pet professional community, and pet owners. These courses are developed and written by well-respected veterinary professionals, including boarded veterinary behaviorists, boarded veterinary anesthesiologists, pain experts, boarded veterinary internists, behavioral certified veterinary technicians, experts in shelter medicine, among others. There are tens of thousands of Fear Free-certified veterinary and animal professionals that can be found throughout the United States and in more than 30 countries worldwide.

There has been some new research put forth within the veterinary profession to determine how this initiative has positively impacted client and patient stress levels. This research investigates the perspectives of veterinarians and clients on the effectiveness of these practices, and the competitive advantage of having a Fear Free-certified practice.

Clients who are bringing their pets into Fear Free clinics are quickly realizing that their pets’ visit doesn’t have to be traumatic for either them or their pet. The veterinary profession is changing as a result of this new certification, and as research has indicated, it is changing for the better.

Depending on the volume of team members a practice is certifying, practice owners can pay anywhere from $70 to $279 per person to have their staff certified in these practices. Veterinary practice owners commonly invest resources in various tools, treats, cleaners, diffusers, and even clinic renovations to help with client and patient flow. This is certainly another valuable program to consider.

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Gregory Carastro, LVT, CVBL is a director on the AAHA board. He is hospital administrator and director of human resources at the Veterinary Medical Center of Long Island. He has over 20 years of experience as a licensed veterinary technician and hospital administrator in the Long Island veterinary community.


Humans May Have Influenced Evolution of Dogs’ Eye Color

Images of wolves and domestic dogs showing difference in eye colorExamples of facial (eye) morphology in wolves and dogs. The eyes (iris color) of domestic dogs appear to be darker than those of wolves.

A study by scientists in Japan found that dark eyes are more common in domesticated dogs than in wolves, and that humans perceive dogs with dark eyes as being more friendly.

The researchers report that dark eyes may subsequently have been favored by humans, possibly unconsciously, during domestication from wolves to dogs. “I speculate that lighter irises have some evolutionary advantage for wolves, but domestication has lost this selective pressure and darker eyes have emerged in some primitive dogs,” said Akitsugu Konno, the first author of the research, from Teikyo University of Science. Their study is published in the journal Royal Society Open Science.

The researchers compared iris color in 22 images of grey wolves of various coat colors and from different locations and images of 81 domestic dogs, finding that the latter tended to have darker and more reddish eyes. They found that dogs with dark eyes were rated higher for friendliness than light-eyed dogs and deemed more easy-going, sociable and dependent, and less aggressive, intelligent, and mature. “We speculate that a darker iris makes it more difficult to distinguish the size of the pupil and thus gives the illusion of a large pupil, which is associated with our perception of being more infant-like,” Konno said in the publication.

The researchers add that the association of dark eyes with immaturity could influence humans to protect and care for such canines, although the study found eye color was not itself directly related to whether participants wanted to interact with or keep the dog. They report that “overall, dogs with dark eyes may have evolved the trait largely as means to send a nonthreatening gaze signal to humans.”

Photo credit: Photo courtesy of Akitsugu Konno


Study Evaluates Cannabis Product Use in US Cats and Dogs

Researcher Trina Hazza, DVM, DACVIM (Oncology), CVCH, conducted an online survey of 1,238 pet owners about their motivations for and perceptions of cannabis-derived product use in their pets. The results are published in Clinician’s Brief.

Hazza reports that approximately 30% of respondents had given cannabis or cannabidiol (CBD) to their pets (dogs, 75.8%; cats, 22.2%), most commonly in treat/chew and oil-based tincture forms, for anxiety (67.4%), joint pain/inflammation/aging (23%), cancer/nausea/vomiting (2.5%), seizures (2.5%), skin/allergy (1.7%), general health, and other conditions.

A majority of owners (64.9%) perceived some improvement in their pet’s condition; 11.5% did not notice any improvement; and 23.6% were unsure. Frequency and duration of cannabis or CBD administration were significantly related to perceived efficacy. Most owners (45.3%) reported no adverse effects, while 24.2% reported sleepiness and/or lethargy.

Photo credit: Beate Allerton/iStock via Getty Images Plus


QUOTE OF THE MONTH

“Worry often gives a small thing a big shadow.”

—Swedish Proverb

Cats Can Play Fetch, Too

A team of researchers recently published a study that found that some cats can and do play fetch, although it depended on the feline’s individual traits and the bond shared with their owner. The study was published in Scientific Reports.

Jemma Forman, a PhD student at the University of Sussex and an author of the study, said in an interview that her team believes it is the most extensive conducted to date on this specific behavior among cats. The study was based on a survey of the owners of 1,154 cats who played fetch on every continent except Antarctica. The authors found that 94% of the domesticated cats surveyed were not trained to play fetch but did so spontaneously. Most owners first noticed their cats fetching within the animal’s first year of life, with owners most frequently reporting seven months as the age cats began fetching.

In the survey, cats were found to fetch a variety of objects, though feline-specific toys, spherical objects, and cosmetics were the most commonly retrieved. Other owners reported their cats playing fetch with scraps, ring-shaped objects, and clothing items.

The authors also found that cats initiated fetching sessions more frequently than their owners, demonstrating their agency and an independent propensity to play. About 48% of the cats in the study tended to initiate fetch play, compared with 22% of pets whose owners reported initiating more often. The remainder of the cats initiated sessions about equally with their owners, according to the study.

While many cats do fetch, Forman suggested that more research was needed to determine how common it was. A cat’s breed was not a barrier to its ability to fetch, the study found, although Siamese cats were particularly well represented in the sample.

Photo credit: YURY KISIALIOU/iStock via Getty Images Plus


AAHA Community

Looking for resources to share with fearful assistants

Does anyone have any good resources or training practices to help a relatively new veterinary assistant feel more confident with patient handling? She is already Fear Free certified but has had a couple of minor scratches that have raised her level of concern. She is a great employee, and we need to boost her confidence. Any thoughts/tips/tricks are greatly appreciated!

A:

I suggest enrolling her in a course covering body language of cats and dogs from a reputable animal behavioral specialist.

A:

Part of our training includes required viewing of Sophia Yin’s Low Stress Handling DVD. There is also a book of the same title that includes the disc in paper copies. I would also suggest giving them hands-on training by one of your staff who is very knowledgeable in the space.

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Offer your fear training suggestions at community.aaha.org.

For help, email community@aaha.org.


New Heart Procedure at WSU Offers Hope for Dogs

Spike, a French bulldog, was born with pulmonic stenosis, a deadly heart defect that has become increasingly common in French bulldogs, one of the most popular dog breeds in the United States. Spike was one of the first two dogs at Washington State University’s (WSU) Veterinary Teaching Hospital to undergo a pulmonary valve stent implantation, a procedure that the hospital reports is performed at only a handful of facilities in the country.

Pulmonic stenosis, one of the most common congenital heart defects in dogs, occurs when the pulmonary valve, which allows blood to flow from the heart to the lungs, narrows and causes the heart’s right ventricle to pump harder. Dogs such as Spike who have a severe form of stenosis often develop right-sided congestive heart failure and rarely live past 3–5 years of age.

The hospital reports that until recently, the only surgical option offered at WSU was balloon valvuloplasty, in which a catheter is used to guide a specialized balloon through a vein into the dog’s heart. There, the balloon is inflated and deflated, then removed to create a larger opening in the valve allowing blood to flow more easily.

WSU’s cardiology team received training for the stent procedure when they hosted Kursten Pierce, DVM, DAVCIM (Cardiology), a cardiologist at North Carolina State University. Pierce also oversaw the first procedure, which is similar to ballooning, except a small stent is left in the valve to ensure it remains open after the balloon is removed.

The hospital says that stenting is more effective for dogs with severe pulmonic stenosis and in breeds like French bulldogs who have smaller and narrower valves. It is also a secondary option for dogs with anatomy not suitable for ballooning and for those who have undergone ballooning but experienced restenosis.

Photo courtesy of College of Veterinary Medicine/Ted S. Warren


FDA Approves Calming Drug for Cats

The FDA has approved Bonqat, a pregabalin oral solution for reducing feline anxiety during transportation and veterinary visits. Pregabalin is used in human medicine to treat neural pain and as an anticonvulsant, and Bonqat is the first FDA-approved application in veterinary medicine.

The medication is administered orally as a single dose about 90 minutes before travel or a veterinary visit. A full dose is safe for two consecutive days. Bonqat is a DEA Schedule Class V drug with the potential for human abuse, so labeling includes information about drug abuse, addiction, and diversion. People exposed to the drug might experience dizziness, sleepiness, blurred vision, weakness, and dry mouth, possibly requiring medical attention.

Photo credit: Sudowoodo/iStock via Getty Images Plus


Canine Anti-Aging Drug Receives Conditional FDA Approval

The biotech company Loyal is working on a new drug, LOY-001, designed to extend the lifespan of large- and giant-breed dogs. The veterinarian-administered treatment has earned FDA approval for a reasonable expectation of effectiveness, which is part of the conditional approval application. Loyal CEO Celine Halioua said the “milestone is the result of years of careful work by the team.”

“Developing a treatment that will increase longevity by reducing age-associated disease is a new indication,” said animal drug development expert Linda Rhodes, in a Loyal press release. “No drug has ever been approved with such a claim, and being the first to bring a treatment for such a challenging indication will be truly historic.”

Loyal states that large dogs tend to live shorter lives than smaller dogs. They say that part of this lifespan disparity comes from the process of selective breeding that “created” these dog breeds. In large- and giant-breed dogs, breeding for size caused these dogs to have highly elevated levels of IGF-1, a hormone that drives cell growth. High IGF-1 effectively drives these dogs to grow large when they’re young, but high IGF-1 levels in adult dogs are believed to accelerate their aging and reduce their healthy lifespan.

“The extreme phenotypic variety found in dogs is not natural. It’s the result of intensive breeding by humans to create dogs that exceled at tasks such as herding, protection, and companionship,” said Brennen McKenzie, VMD, Loyal’s director of veterinary medicine.

The company says that LOY-001 is intended as a long-acting drug given to dogs every three to six months. If the FDA gives final approval, it should be available in 2026.

Photo credit: vauvau/iStock via Getty Images Plus


AAHA Names First Veterinary Technician of the Year

Susan Herbert, RVT, was chosen as the first-ever AAHA Veterinary Technician of the Year. Herbert has worked as a veterinary technician at AAHA-accredited Chestermere Veterinary Clinic in Alberta, Canada, for five-and-a-half years, but she’s been a vet tech for over 25 years.

She’s still invigorated by the role because she’s pursued her interests along the way. Now she feels grateful to be working at an AAHA-accredited, Fear Free-certified practice where the team shares her enthusiasm for helping clients prevent and work with behavior issues in pets.

Herbert is deeply concerned with the number of dogs and cats entering animal shelters due to behavior issues—a problem exacerbated by the pandemic. So she loves helping improve communication between people and their pets.

“Behavior is my passion,” she said. “It has been for the last few years, and it seems like a lot of people are getting on the bandwagon. So let’s hope that we can make some kind of a positive impact.”

In one instance of making a positive impact, a German shepherd named Gus learned to like coming to the practice thanks to three free “positive visits” (i.e., coming in for a warm welcome and dog treats, not procedures) before a vaccination appointment, which went great.

“The client thought it was fabulous,” she recalled. “He said it was like night and day from his previous practice. Hearing that from the clients makes you feel really good.”

So what’s the secret to longevity in such a rewarding but challenging profession, according to Herbert?

“We all talk about work–life balance, and that’s very important, I think. Finding something that you are still interested in (like behavior) in the field can make a huge difference,” she advised. “If you have a great team that’s behind you, and a great practice, that’s extremely helpful. But if you’re needing a change, with the market the way it is, there’s lots of room out there for it.”

Veterinary technicians are at the heart of any veterinary practice and deserve to be recognized and celebrated. This award recognizes the outstanding achievements of credentialed veterinary technicians and their key role in patient care. Learn more at aaha.org/vtoy. This award is possible thanks to the generous support of Zoetis.

Photo credit: Chainarong Prasertthai/iStock via Getty Images Plus, Photo courtesy of Clay Neddo


Diets Limiting Ingredients May Improve Dog GI Issues

Researchers at the Cornell University Department of Clinical Sciences in the College of Veterinary Medicine report that restricting the number of ingredients in the diet lessens signs of disease in dogs with persistent gastrointestinal (GI) diseases. They report that dogs with chronic enteropathy (CE) responded equally well to both the trial and control diets.

“Our findings question assumptions that have been made about the cause of food intolerance in dogs with CE, which was largely considered an adverse immune response to dietary antigens,” said Kenneth Simpson, BVM&S, PhD, DACVIM, DECVIM, professor of small animal medicine and co-author of the study, which was published in the Journal of Veterinary Internal Medicine.

For the study, dogs with CE were randomly assigned one of three diets with similar calorie and macronutrient profiles: two “hypoallergenic” diets and one with fewer ingredients compared to most commercial pet foods. To the researchers’ surprise, all dogs did better on their new diets—regardless of whether they were in the trial or control groups.

“Essentially, this group of dogs with low-grade, chronic enteropathy went into lasting remission with diet,” Simpson said, “and the responses were independent of the diet being hydrolyzed or not, and independent of the dog having been previously fed antigens that were considered a potential cause of adverse reactions.”


North Carolina Requires Veterinarians Declare Gabapentin Use

The AVMA reports that the state of North Carolina plans to make reporting mandatory for the usage of a medication frequently employed for pain management in animals, with implementation expected in approximately one year.

Governor Roy Cooper signed into law a new requirement to report the use of gabapentin despite it not being a scheduled drug. The law is part of his North Carolina Opioid and Substance Use Action Plan. For pharmacies, the law goes into effect March 1, 2024, with veterinarians being required to comply a year later.

Originally approved as an anti-seizure medication for humans, gabapentin is now being misused in combination with illicit opioids, ultimately leading to some states classifying gabapentin as a controlled medication. Because the US Food and Drug Administration (FDA) has not approved any label indications for gabapentin use in animals, the drug has been used in an extralabel manner to treat a spectrum of conditions in animals, including nerve pain and anxiety in dogs and cats, seizures in dogs, and feline hyperesthesia syndrome.

Per the new law, gabapentin will be reportable by veterinarians only if the amount dispensed exceeds a 48-hour supply, says Claire H. Holley, executive director of the North Carolina VMA.

Photo credit: lhfgraphics, Vladimir Molnar/iStock via Getty Images Plus, KrizzDaPaul/DigitalVision Vectors via Getty Images


White Feet Don’t Treat: Considerations for Dogs with MDR1 Mutations

As our understanding of genetics has grown, veterinarians have increasing opportunities to educate clients about potential breed-specific concerns and counsel on genetic testing opportunities. One notable genetic mutation that can lead to significant neurological toxicity and even death from certain drugs is the MDR1 mutation.

Veterinarians should be aware of which patients should be tested for this mutation and how to manage their medications.

Understanding the Genetics

The MDR1 gene (also known as the ABCB1 gene) encodes P-glycoprotein, a drug transporter located at the blood-brain barrier and other tissues that prevents certain drugs from entering the nervous system.1,2

Ivermectin sensitivity was observed in some collies, leading to researchers to investigate a possible genetic basis. A 4-base pair deletion was identified in the MDR1 gene by Katrina Mealey, DVM, PhD, DACVCP, DACVIM, and colleagues in 2001.1 This mutation causes protein synthesis to stop prematurely, leading to a nonfunctional drug transporter.1

Patients that are homozygous for this mutation are affected by sensitivity to multiple drugs. When exposed to these drugs, clinical signs can vary from weakness, ataxia, and tremors, to seizures, blindness, and death.

The mutation should be suspected in at-risk breeds and any patient that has a reaction to a drug known to be a substrate of P-glycoprotein. Additionally, these drugs have less biliary excretion, due to the presence of the P-glycoprotein molecule in the bile ducts, causing decreased clearance of some drugs.3

Knowing the MDR1 genotype of a patient allows veterinarians to adjust their treatment plans. A genetic test is available through Washington State University’s Program for Individualized Medicine (PRiME).4 Test kits can be ordered by clients or veterinarians, and samples can be obtained by cheek swab or blood draw.

Which patients are at risk?

The MDR1 mutation is often associated with herding breeds, such as collies, Australian shepherds, and Shetland sheepdogs. The mutation is most prevalent in collies (up to 70%).1,4 Up to 50% of other herding breeds will have the mutation.2,3

However, the mutation has also been identified in several other breeds, including German shepherd (10%), English shepherd (15%), Silken Windhound (30%), McNab (30%), and Long-Haired Whippet (65%).2,3 Testing should be considered for dogs of these breeds.

Up to 10% of mixed breed dogs can also be affected.3 It is important to note that even dogs that do not obviously look like herding breed mixes can be homozygous for the mutation.2 It may be prudent to discuss testing with owners of all mixed breed dogs prior to administering a medication known to be a P-glycoprotein substrate.

Cats can also have a mutation. First identified in 2015, this mutation is a nonsense mutation of the same gene.5 It is present in up to 4% of the feline population.3

Drugs of concern for MDR1 mutations

The MDR1 mutation was first discovered because of observed ivermectin sensitivities. Ivermectin and related drugs are safe at doses used for heartworm prevention but can become toxic at doses used to treat mange.3,6

Manufacturers of drugs containing alfaxolaner, fluralaner, ivermectin, milbemycin, moxidectin, sarolaner, and selamectin have tested these drugs for safety in patients with MDR1 mutations and are deemed safe at FDA-approved doses.3,5

A full list of drugs that can be problematic for patients with the MDR1 mutation is available through WSU’s PRiME.

These drugs include:

  • Certain anesthetic agents (butorphanol and acepromazine)
  • Antiemetics (maropitant, ondansetron)
  • Apomorphine
  • Grapiprant
  • Cyclosporine
  • Some chemotherapy agents3,6

Identification of these drugs comes from prospective studies, retrospective studies, case reports, and some anecdotal information.3 In cats, case reports of sensitivities to eprinomectin and ivermectin have been published.3

When possible, choosing an alternative drug to accomplish the same therapeutic effect is recommended in patients with known or suspected MDR1 mutations. When this is not possible, dosing recommendations for individual patients are available through a consultation with Washington State University College of Veterinary Medicine’s PRiME.

Photo credit: Anna-av/iStock via Getty Images Plus, ktsimage/iStock via Getty Images Plus

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