And that little girl grew up to be …

I was very pleased when I received my copy of the January 1, 2015, issue of JAVMA and couldn't help but smile when I saw the cover art, “The Kiss.” Not only is the painting absolutely adorable, but it also serves as a gesture that can go a long way to increase feelings of inclusion in a profession that is perceived as (and is) seriously lacking in diversity. Thank you; it was a great way to start off the New Year!

Bettye K. Walters, dvm

Columbia, Md

Don't get mad; get evenhanded

I am deeply troubled by the profession's response to the ABC News 20/20 segment that aired in late 2013 on upselling of veterinary services^1,2 and, more recently, to the Reuters news story on conflicts of interest between the veterinary profession and the pharmaceutical industry.^3,4 I don't believe the response will get the results we want to achieve.

In both cases, the response was to vigorously defend the profession, but the concern behind each story was not, in my opinion, addressed. I believe we would position ourselves better if we ignored the perceived attack and instead acknowledged and addressed the concern. By defending ourselves, we may feel better in the moment, but we do not achieve the goal of reducing the concern.

Thus, I would suggest that when similar situations arise in the future, we identify and acknowledge the underlying concern, discuss ways that animal owners can reduce their concerns, and discuss what individual veterinarians and the AVMA are doing to reduce the potential for problems related to the concern.

For example, in the case of the 20/20 segment on upselling in the veterinary profession, we might have responded by acknowledging that while there may be unethical individuals in any group of professionals, the vast majority of veterinarians are doing their best to recommend what each pet needs to become or remain healthy. We further could have suggested things pet owners can do to create a trusting relationship with their veterinarian and then indicated what individual veterinarians and the AVMA are doing to minimize these problems. Although the response did that to some extent, the message was potentially obscured by defensive comments.

In the case of the Reuters story about conflict of interest, we might have acknowledged that conflicts of interest are inherent in the veterinary profession⁵ and pointed out that veterinarians who are aware of the potential for bias are working hard to ensure it does not affect their decisions. We then could have suggested things that animal owners can do to ensure they trust their own veterinarians, described ways that individual veterinarians are working to reduce the impact of bias in their own practices, and described what the AVMA is doing to address the issue of conflicts of interest.

In short, I would suggest that in response to future perceived attacks on the profession, we leave out any defensive posturing and instead acknowledge and address the underlying concern. By doing so, we will come out looking better, and by showing integrity and taking the high road, we will help animal owners retain their trust in our profession.

Carin Smith, dvm

Smith Veterinary Consulting Peshastin, Wash

Mindfulness for veterinarians

A recent JAVMA News story¹ on the connection between moral stress and compassion fatigue recommended that veterinarians consider meditation as a way to protect against compassion fatigue and suggested that those who want information on meditation techniques without a religious component search for information on mindfulness-based stress reduction (MBSR). A variety of MBSR resources are available online, but readers may be interested to know that MBSR training specifically focused for veterinary personnel is available through VIN. I have participated in this program and feel that it has made me a more relaxed person and better clinician.

The class “Brilliant Sanity: How Mindfulness Meditation Can Make You More Effective and Happier” will be offered again this year, beginning in early April, and includes online mindfulness meditation sessions and optional live retreats.

Patricia Joy Shea, dvm

Eugene, Ore

Age-related changes of the eye in dogs

I enjoyed reading the two recent Reference Point articles “Common physical and functional changes associated with aging in dogs”¹ and “Defining healthy aging in older dogs and differentiating healthy aging from disease.”²

In the sections related to the special senses in both articles, aging changes of the lens and retina are discussed as well as the predisposition of older dogs to refractory ulcers, corneal dystrophies, and corneal mineralization. However, I believe two other important age-related ocular changes should be mentioned.

One is corneal edema associated with endothelial degeneration. This condition is frequently mistaken for corneal edema associated with glaucoma. Edema due to endothelial degeneration is frequently associated with bulla formation and recurrent ulceration.

The other is atrophy of the pupillary sphincter muscle. Because the muscles in the two eyes rarely atrophy at the same rate, this commonly leads to anisocoria. Age-related anisocoria can be mistaken for neurologic disease. With advanced pupillary sphincter muscle atrophy, the dog may appear to have blepharospasm owing to the need to squint in bright light to control the amount of light entering the eye.

Hopefully, these articles will assist practitioners in differentiating between normal and abnormal age-related changes.

Nancy M. Bromberg, vmd, ms

VCA SouthPaws Veterinary Specialists & Emergency Center Fairfax, Va

The authors respond:

On behalf of the authors, I want to say that we are delighted that you enjoyed reading the two recent Reference Point articles. Although these articles were intended to describe what is known about normal aging changes in dogs that do not diminish quality of life, rather than aging-associated diseases that do affect quality of life, I appreciate the suggestion of adding in two other relatively common age-related ocular changes—corneal endothelial degeneration and iris atrophy.

The first, corneal endothelial degeneration, is due to the gradual age-related degenerative loss of corneal endothelial cells. Because it can be hard to distinguish from corneal edema associated with pathological conditions such as glaucoma and anterior uveitis, it would be prudent to refer affected patients for evaluation by a veterinary ophthalmologist, in that such conditions can lead to permanent blindness without appropriate treatment. In addition, as you wrote, endothelial degeneration is associated with bulla formation and recurrent ulceration. The bullae are often difficult to see without magnification, and mismanagement can predispose to secondary infected ulcers.

The second, atrophy of the pupillary sphincter muscle or iris atrophy, may result in poor pupillary light responses, photophobia, and anisocoria. Although this is a relatively benign aging issue, it should be distinguished from other conditions that can cause similar signs, including neurologic disease, glaucoma, and anterior lens luxation.

In our articles, it was impossible to include a list of all diseases associated with aging. We hope, however, that general practitioners and specialists will use these articles as a supplement to their own knowledge and experiences.

Carmen M. H. Colitz, dvm, phd

Animal HealthQuest Solutions LLC All Animal Eye Care Inc Jupiter, Fla

Approach to treatment of aural hematomas

I am writing to comment on the recent JAVMA article¹ describing the use of Jackson-Pratt drains to treat aural hematomas in dogs. In the article, the author reports that a variety of medical and surgical treatments have been described for the management of aural hematomas. One method that is not discussed is that of simply allowing the hematoma to resorb on its own. In my first 10 years of practice, I treated aural hematomas surgically. However, some owners declined surgery because of cost, and in those cases, the hematoma resolved without intervention within 2 months. I have not treated an aural hematoma surgically in 20 years but do treat any underlying ear disease that might be present. In my experience, surgical intervention is not indicated for most aural hematomas. However, if there was no improvement after 2 to 3 months, I would consider inserting drains at that time.

Rocky Deutsch, dvm

Signal Hill Animal Clinic Manassas, Va

The author responds:

I am pleased that my report has generated interest in a condition that many veterinarians commonly see in practice. My purpose was to describe a simple, affordable method to manage large aural hematomas in dogs. In four of the five dogs included in the report, the long-term cosmetic and functional results were such that the appearance of the affected ear was comparable to that of the unaffected ear. In one dog, disparate swelling of the delaminated pinnal cartilage resulted in a small fold in the ear after successful drainage. Moreover, the pain, bandage care, and scarring associated with incisional drainage were avoided with this technique.

It is my experience that excessive scar tissue deposition and deformation of the ear are common in dogs with chronic aural hematomas. Owners who prefer to avoid these changes to the pinna typically opt to have the hematoma drained early in the course of this condition. It must also be noted that many dogs are bothered by the mere presence of a large aural hematoma, exclusive of any underlying otitis externa. To date, timely management of aural hematomas has resulted in patients that were free from signs of discomfort and were tolerant of the drainage apparatus during the course of treatment.

Michael M. Pavletic, dvm

Angell Animal Medical Center Boston, Mass