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Long-Term Follow-Up of Aged Cats Fed Different Sodium Content Diets 

Sodium restriction or the addition of sodium to feline diets is a controversial issue in veterinary medicine. There is an argument for and against sodium in various disease states in humans, but it is unclear what dietary sodium level should be recommended for cats. Sodium restriction has been historically advocated for cats in some disease states (particularly cardiovascular and renal), but these recommendations were derived from human medicine. To date, no study has confirmed the benefit of this sort of dietary intervention in cats. 

This session reviewed the literature on the effects of sodium in feline diets. Additionally, the results of a recent prospective blinded and controlled study examining the health effects of different dietary sodium levels in cats was presented. Diets containing higher sodium levels reliably increased water intake and urine volume and/or dilution. This is potentially beneficial in treating cats with feline lower urinary tract disease (FLUTD), and a study demonstrated its therapeutic effect on cats with struvite urolithiasis. Blood pressure and hypertension have not been shown to be salt-sensitive in cats, and dietary sodium level does not have an effect on bone mass. The previous literature is inconclusive regarding adverse renal effects of high dietary sodium. The prospective study presented by the author suggests that increased sodium intake does not cause harmful effects on renal function, blood pressure, and cardiac structure and function. More research is needed in larger populations to confirm and better understand the apparent lack of sodium sensitivity in cats.—Reynolds BS

The Healthcare Community’s Role In Safe & Effective Animal-Assisted Therapy 

Animal-assisted activities (AAA) and animal- assisted therapy (AAT) are the 2 main categories of animal-assisted interventions. Development of an animal visitation or an animal therapy program involves a series of questions, concerns, and logistical challenges that must be addressed. Some of these issues include: location for visits, personnel involvement, infection and allergy control, cleaning protocols, and the health and safety of the humans and animals involved with the program. Participating animals should be over 1 year of age (although age requirements can vary by organization) and well-socialized and -trained. Additionally, animals should be comfortable with crowds of people, friendly, able to stay engaged, able to cope with stressful situations, nonaggressive, comfortable being touched, controllable, predictable, reliable, and in good health. The handler should also be friendly, considerate, caring, self-aware, and knowledgeable about the animal’s behavior and the place they are visiting. Formal programs that set standards for both quality and safety of the experience improve likelihood of success. Veterinarians can facilitate their clients’ participation by referring them to reputable organizations engaged in AAA or AAT and by ensuring that the animals are healthy. Additionally, more research is needed on the benefits of animal visitation and methods for enhancing the safety of all involved.—Freeman LM, Olsen CW

Forecasting of Heartworm Prevalence & the Impact of Prevention 

The Companion Animal Parasite Council (CAPC) has collected a large pool of data from 2011-2014 on the number of antigen positive tests for heartworm that were reported nationwide from IDEXX Laboratories and ANTECH Diagnostics. The data have been formatted into interactive maps, which can be found on the CAPC website. The maps provide an easily interpretable source of information for veterinarians and pet owners regarding heartworm risk and prevalence in dogs that visit veterinarians. 

The goal of the maps is to help answer 3 questions: 1) What is the chance a dog taken to a  practice in a given area will test positive for heartworm?; 2) Can we predict annual trends for a given area based on certain environmental factors?; and 3) Will it be possible to examine the effects of intervention on reducing heartworm prevalence? An equation was applied to the basic prevalence maps taking into account factors such as climate conditions, socioeconomic conditions, local topography, and vector (mosquito) presence. It was subsequently possible to examine what would happen when there are changes to one or more of those factors. CAPC is working toward being able to predict or forecast trends in heartworm disease. Additionally, the organization is working toward being able to assess the impact of prevention and intervention programs on overall disease prevalence.—Bowman DD

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Decision-Making in Urinary Tract Infection & Bacteriuria

Bacteriuria may or may not be an indicator of infectious urinary tract disease. Determining when it is clinically significant is crucial in deciding whether or not to treat, thereby lessening cost, side effects of treatment, and the risk of antibiotic resistance. In human medicine, asymptomatic bateriuria (ASB) is easier to diagnose and quantify. In veterinary medicine, the variety of urine-collection methods and the inability of animals to communicate possible subtle symptoms of urinary tract disease, make subclinical bacteriuria (SB) a more appropriate term. Though the broad studies examining ASB in humans are lacking in veterinary medicine, some research has found varying percentages of bacteriuria in pets with obesity, diabetes mellitus, hyperadrenocorticism, or postsurgery (orthopedic) or cyclosporine treatment. Most had no apparent clinical signs. In humans, preemptive treatment of ASB does not seem to eliminate bacteriuria in the long term and may even predispose to a future urinary tract infection (UTI) because of the creation of a more easily colonizable urinary mucosal surface. Preliminary studies indicate that untreated SB does not lead to UTIs in healthy female dogs. SB should spur more comprehensive diagnostic testing to determine the possible cause. Ultimately, the combination of a comprehensive history, clinical signs, and cytology is needed to determine the clinical relevance of bacteriuria. The author concluded that better research is required to provide guidance on the optimal approach to treating urinary tract disease in animals.—Weese JS

Management of Feline Inflammatory Airway Diseases

Inflammatory airway diseases in cats are among the most common respiratory disorders seen in practice. This review primarily covered noninfectious causes of inflammatory airway disease, notably asthma and chronic bronchitis. Traditionally, management of these diseases has focused on environmental modulation, glucocorticoids, and bronchodilators.

Glucocorticoids are the mainstay of treatment, as inflammation can predispose to airway hyperresponsiveness and remodeling. Oral prednisolone is typically chosen first because of its high bioavailabilty. Bronchodilators (eg, albuterol) are typically reserved for rescue therapy for cats experiencing acute bronchospasm. Chronic use of bronchodilators can paradoxically exacerbate airway inflammation and hyperresponsiveness. 

Additional therapeutics assessed in feline asthma treatment include dietary omega-3 fatty acids and luteolin, which may prophylactically decrease airway reactivity but do not decrease eosinophilic airway inflammation. Allergen-specific immunotherapy, which modulates T-cell activity and may dampen eosinophilic inflammation, is being investigated for feline asthma treatment. Both subcutaneous and topical mucosal delivery routes have displayed efficacy and minimal side effects. Systemic corticosteroids may alter the beneficial effects of immunotherapies.

Continued research on these immunotherapies is needed. Cyclosporine also works to alter T-cell activity, blunt airway hyperresponsiveness, and remodeling. However, studies found that it failed to inhibit an early phase response to allergen challenges. Because of this, its associated side effects, and the needed for therapeutic monitoring, cyclosporine should only be considered for refractory cases. The benefits of stem cell therapy are also currently being assessed, but further studies will be necessary.—Reinero C

Ethical Considerations in Maintaining Paralyzed Pets

Spinal cord injury, spinal neoplasia, degenerative myelopathy, and other conditions can cause a pet to become paralyzed. Whether to treat and maintain these pets can be a difficult ethical dilemma for veterinarians and owners.

A methodized system of analyzing ethical issues and factors affecting patients and owners can help clinicians formulate a practical plan to manage the situation. The bioethical concerns of autonomy, non-maleficence, beneficence, and justice should be weighed carefully in the patient-owner interaction. Ethical issues must be differentiated from true ethical dilemmas, in which both options are undesirable. An animal’s welfare and quality of life (QOL) are the main considerations when faced with a clinical-ethical dilemma, taking into account factors such as size of the pet, age, breed, species, attitude, primary pathology, severity of the paralysis, fecal and urinary continence, concurrent medical problems, changes in lifestyle, and ability of the owner to manage them physically and financially. If the decision to treat instead of euthanize has been made, taking appropriate steps to properly manage the patient is important to decrease the risk of complications (eg, UTIs, decubital ulcers). Owner education and consent are paramount. It should also be noted that QOL, its perceptions, and decisions about it can change over time. A clear, disciplined analysis of the above can clarify this difficult decision-making process.—Kenny PJ

Developing a Successful Social Media Marketing Strategy

Social media provides an effective form of marketing to both existing and prospective clients. It offers the advantage of a constant presence, which can stimulate reminders and increase compliance with pet owners, who are easily able to find your practice information.

It is best not to use social media as a place to sell to clients in “their” space. Rather, contact should include a mention of a service that you wish to market, a fun and engaging fact, and a social component. Training a few team members in social media marketing is essential to ensure messages are on-point and appropriate. Outsourcing social media marketing may not maximize its value and may decrease the validity of the honest engagements with your clients. Two postings per week provide a good start, with 3-5 postings per week being a realistic goal. Facebook is a common form of social media with many users connecting multiple times per day. Twitter can be easily linked to Facebook as you gain followers and develop Twitter talk. Pinterest is too new to be an effective channel for veterinary practice marketing. Google+ is new but may be very useful in the future as it connects a social network associated with the world’s largest search engine.

Preplan your marketing by identifying your focus, pinpointing dates to post, and finding a few website references to link to your postings. Thirty minutes a week can be an effective time commitment to provide effective social media marketing.—Garcia E

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How I Use Motility Modifiers on the Clinic Floor

Disorders of gastric motility are common in cats and dogs but can be difficult to diagnose. Treatment is accomplished by changing the diet to small, frequent meals that are low in calories, fat, and protein, and through the judicious use of prokinetic drugs. Paralytic ileus is the most common indication for GI prokinetics. Pyloric diseases, pancreatitis, and uremic syndrome are other causes of ileus in small animals. Clinical signs (eg, nausea, vomiting, anorexia, cranial abdominal pain, abdominal distention, bloating) are associated with the underlying disease. Borborygmi are typically absent. GI obstruction should be ruled out before prokinetics are used. The literature is limited on prokinetics, so these proceedings reviewed prokinetics based on collective clinical experience.

Serotonergic drugs act on presynaptic 5-hydroxytryptamine (5-HT) receptors and stimulate smooth muscle cell contraction in the stomach and intestine. Metoclopramide works best by IV constant rate infusion (CRI). Cisapride, which has been withdrawn from the pharmaceutical market due to arrhythmogenic potential, is safe at standard doses in cats. Erythromycin is a motilin agonist. At a subantimicrobial dose, the drug stimulates gastric emptying in dogs. The H2-receptor antagonists, ranitidine and nizatidine, also act as anticholinesterase inhibitors, which increase contractility in smooth muscle cells. Mirtazapine, a central-acting alpha-2 receptor antagonist, administered at a high dose (45 mg/dog) was shown to accelerate gastric emptying and colonic transit time in healthy research dogs. Capsaicins may have stimulatory effects on GI motility. Current consensus is that a lidocaine CRI has no direct effect on GI motility.—Gaschen FP

Vaccination Against Canine Leptospirosis

Leptospirosis is a zoonotic disease affecting humans, dogs, cattle, pigs, sheep, and goats. Leptospires are obligate aerobic spirochete bacteria that, unlike other pathogenic spirochetes, contain lipopolysaccharides (LPS) in their outer membrane. Different serovars have antigenic diversity because of variations in LPS carbohydrate composition.

LPS is also thought to facilitate the long-term survival of the organism in the environment. Proteins present in the outer membranes are upregulated during infection. In reservoir hosts, Leptospira causes chronic, nearly subclinical disease whereas in incidental hosts illness may be mild or acute and life-threatening. Immunity to leptospires is thought to be solely or primarily humoral, conveyed via passive transfer of monoclonal antibodies directed against LPS.

Current licensed human vaccines are killed/inactivated whole cells or outer envelope fractions with reported efficacy of 60%-100%. Although there are almost 200 pathogenic serovars, the most commonly reported serovars in dogs are Canicola, Grippotyphosa, Icterohaemorrhagiae, and Pomona. These serovars are included in tetravalent vaccines for dogs. Infection in vaccinated dogs is most likely due to failure to give the initial 2-vaccination series, infection by a non-vaccinal serovar, or failure by the bacterin to invoke initial protective immunity. Canine leptospirosis vaccines have been implicated in type I hypersensitivity reactions, the likelihood of which may be lessened by recent attempts to reduce bovine serum albumin content in the vaccine.

Recombinant DNA techniques are currently being used, thus far unsuccessfully, to develop subunit vaccines against leptospirosis.—Moore GE

Clinical Application of Immunotherapeutics in Veterinary Oncology

These proceedings highlighted some of the current major advancements within the field of immunotherapeutics for treating canine cancer. In human medicine, rituximab—a monoclonal antibody that targets the CD20 antigen on the B-lymphocyte surface—has become a standard of care in cancer treatment. Studies and development of canine monoclonal antibodies for treatment of B- and T-cell lymphomas are underway.

Another drug in preclinical studies provides a DNA plasmid to tumor cells, which primes the immune system to attack the tumor. Additionally, a vaccine targeting telomerase reverse transcriptase is being studied in dogs with lymphoma. For canine osteosarcoma patients, a recombinant therapeutic vaccine has shown initial promise as an adjunct therapy.

An anti-EGFR monoclonal antibody drug developed from human colorectal carcinoma therapies appears to be taken up by canine mammary tissue and is under further investigation. For canine melanoma, a human chondroitin sulfate proteoglycan plasmid vaccine has been shown to elicit antibodies and may be associated with longer disease-free intervals and survival. The xenogeneic canine melanoma vaccine increased anti-tyrosinase antibodies and survival in vaccinated patients during initial studies. A later study reached a different conclusion, although study protocol may have influenced results.—Bergman PJ, Johannes CM

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