Clinical Updates
Clinical Updates
UC DAVIS LEADS THE WAY IN ADVANCING CLINICAL CARE AS ONE OF THE LARGEST AND MOST COMPREHENSIVE VETERINARY HOSPITALS IN THE WORLD.
Neurology Upgrades Diagnostic Equipment
A 15-year-old multifunctional diagnostic tool for neurologists was recently replaced thanks to donor funds designated for equipment upgrades. The electrodiagnostic machine, used daily by the Neurology/Neurosurgery Service, evaluates the peripheral nervous system and assesses certain aspects of the central nervous system. Its use varies from hearing assessment to testing muscle and nerve function.
The new machine’s technology upgrades allow for advanced software interface with medical records reporting, faster diagnosis, and other electrophysiology features still being investigated by the neurology team.
Specific advantages of the new machine include: testing brain abnormalities that may affect hearing signals; determining if more aggressive intervention is needed to address degenerative nerve disease; more advanced testing of optical nerve pathways; and testing of inflammatory changes in the muscle where the immune system is attacking muscle fibers.
Replacement of the existing equipment was necessary as it is also being used for research projects, including a novel treatment for spina bifida (which is leading to advancements in treating humans with the disease), and major research projects funded by the National Institutes of Health.
Clinical Trials Offer New Options
The Veterinary Center for Clinical Trials (VCCT) offers one of the most robust programs in the country, conducting more than 50 trials at any given time. Trials range from genetic discoveries of equine eye diseases and oncology options for cancer patients, to minimally-invasive surgical techniques for dogs and stem cell treatments for ligament injuries. Most clinical trials cover dogs, cats, and horses and can range in length from years to just a few weeks. Thousands of animals have benefitted from clinical trials conducted by VCCT since its inception in 2013. Recent trials include:
New Form of Insulin for Diabetic Pets
More than 150,000 cats and 80,000 dogs a year are diagnosed with diabetes in the U.S. Their owners face a treatment regimen of twice-a-day injections for the rest of their pets’ lives, an onerous and expensive task. Thanks to recently completed clinical trials, these pet owners will have a much easier treatment option in the future. Drs. Sean Hulsebosch and Chen Gilor, along with technicians Jully Pires and Mike Bannasch, completed trials on five cats and five dogs of once-a-week insulin therapies, reducing an owner’s injection responsibility from 14 shots per week to one. All of the ten animals responded favorably to the single injection of a long-acting protein. Following similar results at multiple trial sites nationwide, the drug’s manufacturer recently signed an agreement with a pharmaceutical company to commercialize the drugs, expecting marketability in a few years. Teddy, a 13-year-old male border terrier, was diagnosed with diabetes in 2019. Outside of the two months he was enrolled in the trial, he has received twice-a-day injections since his diagnosis 27 months ago.
Novel Drug to Treat Feline Heart Disease
Lizard, a 6-year-old male tabby cat, was the first patient enrolled in a clinical trial earlier this year investigating a new drug to treat hypertrophic cardiomyopathy (HCM), a heart disease that affects 1 in 7 cats. Dr. Joshua Stern is leading the trial of rapamycin, which has been shown to reverse HCM in rodents and people. This currently enrolling study is the first to evaluate rapamycin’s potential in cats, and is the first novel drug study developed in many years specifically for cats with HCM.
Analysis of Chronic Pain Associated With Ligament Injuries
Dr. Denis Marcellin-Little is evaluating whether the B cell lymphocyte (a white blood cell) plays a role in the development of chronic pain in dogs with an injury to their cranial cruciate ligament (CCL). Dogs in the study have ruptured their CCL and are candidates for a tibial plateau leveling osteotomy surgery on that joint. Part of the trial involves evaluating the dog’s gait and stride pattern on new equipment in the school’s Clare Giannini Hoffman Performance Laboratory. The canine force plates and associated multi-camera video setup allow for in-depth analysis and kinematic studies.
Hospital to Update Imaging Equipment
New Fluoroscopy Unit
The hospital recently secured a $500,000 donation to purchase a new fluoroscopy unit to replace the current 15-year-old machine. As machines reach that age, it becomes difficult to continue service contracts with manufacturers. Replacement parts become unavailable and outdated software is no longer compatible with the hospital’s electronic medical records or file-sharing systems. Fluoroscopy is an imaging technique that uses x-rays to film breathing and swallowing in real-time. A normal x-ray offers a snapshot in time, which is useful for static problems like broken bones or an enlarged heart. However, for dynamic processes like swallowing and breathing, it is often critical to evaluate the motions in real-time.
“There are major advantages of fluoroscopy as a real-time imaging modality,” said Dr. Allison Zwingenberger, director of imaging services. “You can watch a swallow as it happens or see an animal’s breathing movements. This allows veterinarians to see injuries to the esophagus or trachea that will not appear on an x-ray.” An additional advantage to this daily use machine is its capability as a fluoroscopy/x-ray combination. This will allow the machine to also be used to ease the busy backlog of radiology cases.
New Ultrasound Machine
The hospital will also soon be upgrading to a new ultrasound machine, replacing a 10-year-old piece of equipment. The new unit will improve large dog imaging, as the technology behind the electronics and algorithms that display the image has advanced. The newer machines improved probes and its ability to image deeper into the body – often needed with larger dogs – will produce improved image quality.
Ultrasound is a primary imaging tool to detect most abdominal issues, including gastrointestinal obstructions, cancerous growths, and fluid accumulation. It is also routinely used as a guidance tool to place a needle for a biopsy sample retrieval or to retrieve foxtails.
Unrestricted hospital donor funds allowed the hospital to make this much-needed upgrade.
Behavior Service Shifts to All Virtual Appointments
Over the years, clients have asked the Behavior Service to make house calls. Scheduling logistics and student teaching prevented that, but now thanks to virtual appointments, some benefits of house calls are being realized.
The service adapted to several different scenarios throughout the pandemic to stay open, from outdoor appointments to distanced appointments in larger indoor spaces. They finally decided on virtual appointments as the best alternative, and it’s been working well for all involved – pets, clients, clinicians, and students.
Because California law requires an in-person relationship to be established before any virtual appointment, a pre-appointment screening does need to take place at the hospital. But once that’s performed, the benefits of virtual appointments can begin.
“Seeing patients in their home environment – albeit on-screen – offers a completely different experience than seeing them at the hospital,” said Dr. Melissa Bain. “We can now see the layout of their home, which helps to identify potential pitfalls.”
Bain and Service Chief Dr. Liz Stelow generally never saw their patients’ poor behavior in the examination room, so transitioning to virtual appointments was helpful.
“If a client comes to us because their dog is biting, we don’t need to see the biting,” said Stelow. “We believe them. Virtual appointments still allow us to listen to our clients’ concerns and ask the questions necessary to properly assess patients.”
Additionally, virtual appointments allow for more family members, referring veterinarians, or trainers to be part of the visit, either together or from different locales. Virtual visits also keep animals safe in their home environment, especially beneficial for dogs being treated for anxiety.
Even the students benefit by allowing them to still participate if they ever needed to be quarantined, to communicate in real-time via chat during a student’s patient workup, and to create a less stressful, flexible schedule.