Andy Roark DVM MS

Learn how to effectively support patients with hip dysplasia through conservative care as Dr. David Dycus joins Dr. Andy Roark on The Cone of Shame Podcast. In this episode, Dr. Dycus, founder of OrthoVet Consulting and Fusion Veterinary Orthopedics, shares his expertise on non-surgical approaches, from tailored exercise plans to lifestyle adjustments that maintain comfort and mobility. This practical discussion provides veterinary professionals and pet owners with essential tools to enhance quality of life for dogs of all ages dealing with hip dysplasia. Let’s get into this episode!

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

Dr. David Dycus: www.drdaviddycus.com

Dr. David Dycus on Instagram: https://www.instagram.com/ortho_vet/

Fusion Vet Ortho on Facebook: https://www.facebook.com/fusionvetortho

Dr. Know-It-All Card Game: https://drandyroark.com/in-the-know/

Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. David Dycus, a recognized leader in veterinary orthopedics, earned his veterinary degree from Mississippi State University and completed a residency and Master’s in surgery. Known for his expertise, Dr. Dycus has delivered over 250 lectures and taught 150+ labs worldwide, contributing extensively to veterinary literature, including co-editing the textbook Complications in Canine Cranial Cruciate Ligament Surgery. He was honored with the 2023 Veterinary Hero’s Award by DVM360 and is an orthopedic consultant for VIN. Dr. Dycus is the founder of Fusion Veterinary Orthopedics, where he specializes in joint replacement, fracture repair, and 3D implant printing, as well as Ortho Vet Consulting, a leading orthopedic coaching service.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark guys, I am back. Back again. Dr. Andy’s back with his friend, Dr. David Dycus. I promise I won’t ever do that again.

 Dr. David Dycus is back. He is talking about conservative management of hip dysplasia. We had an episode, uh, a couple weeks ago.

It was on surgical management of hip dysplasia. We talked through our surgical options and what they look like, and now we’re talking about when. Surgery is not an option or it’s not the right option right now.

What do we do? This is a lightning fast download of a ton of information that is really really good to have in your back pocket. It’s I don’t I just got a lot out of this. I took notes frantically throughout the whole episode. It’s really good stuff without further ado. Let’s get into it.

Kelsey Beth Carpenter: (singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark. 

Dr. Andy Roark: Welcome to the podcast, Dr. David Dycus thank you for being here.

Dr. David Dycus: Oh, thanks so much for having me. Absolutely.

Dr. Andy Roark: You were on just, not long ago. And, we were going through and talking about hip dysplasia and surgical options for hip dysplasia. And towards the end of the episode, you mentioned, you know, in some cases, we’re going to talk about conservative management of hip dysplasia.

And I thought, That’s something I am, I am really interested in. Uh, we had such a good conversation. anyone who hasn’t heard it should go back and listen. But I, I wanted to get into that with you. So for those of you who don’t know Dr. David Dycus you are the founder of OrthoVet Consulting.

You are the founder and owner of a brand new orthopedic hospital that is opening up in the Washington, D.C. area. It’s Fusion Veterinary Orthopedics. And, you are an instructor and a lecturer and genuinely a wonderful person. Yeah, thanks. Thanks for being here. First of all, and second of all Let’s start at a high level and kind of pick up where we left off.

we’ve got hip dysplasia, whether we’re talking about, a young puppy and we’re starting to see some pain when we’re stretching out their legs, and we talked about surgical interventions in that regard, all the way up to your older dog that’s coming in for sort of quality of life assessments and things like that.

Hip displacement is a, it’s a painful, it’s a painful process. Often, unfortunately, we are dealing with people who don’t have the resources to do surgery, or their pet may not be the best surgical candidate. Or, my impression is that sometimes we’re in this weird state where we say, we’ve got an issue here.

I don’t know that it’s a big enough issue to motivate the pet owner to buy into surgery, things like that. Help me, help me just at a high level. Let’s start to look at conservative management of hip dysplasia. What are our goals and what do we want to make sure that we avoid? What are our pitfalls?

Dr. David Dycus: So, you know, the goal of conservative management is several pronged. One is to improve comfort. Two is to improve hip range of motion. And three is to maintain high limb muscle strength. And so at the end of the day, we know that hip dysplasia is going to lead to hip arthritis. So a lot of our conservative aspects

are going to be very similar to some of the things that we do for arthritis in general, but then also we’re going to be specific to the hip. And so for the hip specifically, our whole goal of a patient with hip dysplasia is to maintain hip extension and do it comfortably. And at the same token, build up muscle strength.

And the overall goal would be to try to slow down minimized progression of arthritic changes. And so, the way I like to break it down to owners is the development of a home exercise program. And what i’m going to have them do and how and when is also going to be dependent upon the age of the dog and the pain level of the dog.

So let’s, let’s start with the five or six month old puppy that maybe the owners noticed a few things, you know, maybe they’re like, ah, he, he still plays like a puppy, but then he goes kind of off to the corner and lays down for a little while. I, you know, I, I maybe thought he was tired, but really it seems like maybe he’s self limiting a little bit.

And so we, we do our due diligence, we do our exam, maybe there’s a little bit of discomfort on, on hip extension, you know, we, we try to extend the hips and the dogs kind of pulling back a little bit from us and, and we say, you know, let’s just get some x rays, take a look at things and, and we take x rays and, and maybe there’s some mild arthritic changes, or maybe there’s just some hip laxity there and we say, okay, okay.

You know, we’ve got some mild changes in this very young puppy. What we’re going to have to do is establish our baseline management, as well as our home exercise program, that we’re going to want to plan on doing for life. And so what that’s going to be tailored around is going to be daily exercise. And maintenance of hip extension and hip strength.

But in a five or six old month puppy, we can’t force exercise on them. We can’t expect them to do some of these things. So it’s all about building the skillset and the training for what’s to come. The first part of that is the daily exercise, which is daily leash walking. And I’m sure many of us, owners every day that both the owner and the dog have no idea how to walk on a leash.

The owner doesn’t know how to walk their dog in a leash and the dog has no idea how to walk on a leash and that’s because they were never appropriately taught. And so if we have the five or six month old puppy, we don’t have to put a timeframe on the walking. We just need to get used to leash training. So the dog’s not pulling the dog’s walking beside you.

And at that point, we’re usually letting the dog kind of dictate, you know, the stop and go, the sniff, how long, but maybe we would keep it short, 10 or 15 minute segments, no real more than that. But getting the dog used to, if we’re in a city, most of the time you get to a city block, you have the dog stop and sit and wait until it’s okay to cross.

You know, we need to start working on those basic commands. But, when they, when they get back from a walk, we have to talk about establishing our home exercise program. And when they’re older, that’s going to usually be done two to three times a week following a walk. And our focus there is going to be trying to do some things to work on hip extension and hip strength.

And so what I’ll have them do is what are called sit to stands. And so in that case, it’s, it’s where we have them sit, but we want a nice square sit and then we’ll have them stand up and then we’ll have them sit and then we’ll have them stand up and, you know, after every two or three sits, we can give them a little treat.

But for a puppy, what we don’t want to do is say, okay, we’ve got to knock out 10 sit to stand exercises. What we need to do is say. Here’s how we train to sit square from the get go. And you know, this is the sit command. And then I’m going to give you a command to stand up and take a few steps towards me, and then I’m going to give you a command to sit.

So it’s all about learning. And then after our sit to stand, we are going to do, what are called either our paws up or our dancing exercises. And I think for a poppy, this is important because most of the time we want to train them not to jump up on people. So we need to make this a learn command that they can jump up when they’re giving the command to do that.

Because dancing exercises are essentially where you would pick the dog’s front feet into the air, so they’re standing up on their back legs. And then you would take a few steps backwards, so the dog’s taking a few steps forward. And then you would put the front legs down and then you would pick the front legs up and you would have them walk towards you.

And that really helps work on hip extension. Now the name dancing is really a bad name because it makes you think you’re going to pick them up and you’re going to walk backwards and then you’re going to walk forwards and you’re going to walk backwards. So you’re dancing, right? But if we make a dog, stand up on their back legs and step backwards.

That’s the most advanced form of the exercise to create hip extension. And so most dogs are not ready to do that. So we start with, standing up and we take a step back. So the dog’s taking a step forward and only when the dog is like mastered that, do we start allowing them to do it backwards, but some dogs might be really small or maybe that You know, they’re just not ready to get all the way up on their back paws.

So then what we can do is use either a small chair or a small elevated surface that we can put their front paws on just to hold there. And then over time we can slide it to get them to take a few steps. And then as they get stronger, as hip extension improves, we can kind of go higher and higher. And then after dancing exercises, either they can do some makeshift cavalettis or walking over obstacles of different things.

You could go in your garage, you can take your tools, your gardening tools, right? And you can throw them all on the floor. So now they’ve got to step over things or, you could put some couch cushions down if it’s a, if it’s a small breed dog or, Or, you know, maybe an air mattress, just anything that’s going to start working on some of the core stabilizing muscles as far as, uh, uneven terrain of having to pick the legs up and improve range of motion.

Um, but in a poppy, it’s all going to be about learning these things and getting the owner used to it, because the other thing that we should mention that I think is very important is before they take them on a walk or the worst thing we want to do to any dog, whether it’s a puppy, whether it’s a young adult, or whether it’s an adult, is allow them to be laying in the bed.

They hop up, throw on the leash, and go out the door for a walk. We want there to be a period of a warm up. So that means if you’re going to go walking, get your dog up, get him moving around the house for a few minutes, just to get moving. And then, perhaps you get them on the leash and, and you do, you know, a little bit of walking before you go on your walk.

Because when we’re walking, it’s not, let’s go sniff and sniff and sniff, it’s, it’s let’s walk. It is the period to get the heart rate up for an extended period of time. So we need to do a warm up. You know, you or I, we would not, You know, be sitting on the couch watching TV and then all of a sudden hop up and take off out the front door and go for a run.

You know, you’re gonna get up, you’re gonna, you know, do some moving, you’re gonna get yourself warmed up. Same thing, you know, we sometimes forget some of the common sense things that we do for ourselves should also apply to our pets. 

Dr. Andy Roark: Especially if you’ve got bad hips. You know, like, especially if you’ve got bad hips. I think about, well, I hop up and just go walk, and I go, well, yeah, but Andy, you don’t have arthritic hips, you don’t have, you know, hip dysplasia. That’s sort of the point of what we’re talking about. Uh, now that I am a bit older and think something is always achy, like, yeah, I, I get loose before I do a lot of things, uh, that I used to just hop up and charge right out with.

So it, at first when you said that, I was like, we’re going to warm up to go for a walk. Uh, it totally makes sense.

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Dr. David Dycus: And the other big thing is after the walk, Or after the walk and the exercises, because walks need to be daily exercises, usually like two to three times a week. But when all that’s done, there also has to be a cool down period. You know, the last thing we want them to do is be all warmed up and then they go run and jump in their dog bed and lay down.

So what we will do is say, okay, now’s going to be a great time to do some range of motion exercises. So, you know, flexion and extension exercises of the back legs like they’re riding a bicycle. Okay. But then on the hip extension, we actually are doing a stretch. We’re actually holding it. So we’ll take it out to extension to where we start to feel the tension or what the animal will tolerate.

And we hold it for 10 or 15 seconds. So that’s a stretch. And that needs to be part of our, our cool down process. And so in the very young puppy, that’s just getting the dog used to that relaxing moment to lie down, to allow the owners to manipulate their back legs, touch their toes, extend their hips, it gets them used to what’s to come.

And then, because they have a condition that could go on to develop arthritic changes, we have to focus on weight control. You know, we need them to stay as lean as possible. And, you know, I tell them, listen, when you’re taking your dog out walking, I want your neighbors and your family to kind of talk about you behind your back, because they think your dog’s too skinny, because if that’s occurring, your dog’s at the appropriate size.

And so we’ve got to do that. I am also a big fan of Omega 3 fatty acids or fish oil supplementation. And then also, you know, the same thing from the OA standpoint, uh, different joint supplementations I’ll recommend. We also have to think about lifestyle changes. You know, we probably don’t want to take this dog that has uncomfortable hips and then go outside and play fetch over and over and over again.

You know, when we talk about daily exercise, owners usually think that that’s opening the back door and letting them run along the fence line in the backyard, which the owners like, because it requires like no effort on their part, but then when we tell them, listen, actually, daily exercise is walking.

Now they get kind of sad because now they’re like, crap. I have to be involved. Um, but you know that the running in that defense line is what I call daily playtime and and they can still do that but maybe we limit how often and how long just because you know dogs love to speed up slow down and twist and turn but the worst thing for their tendons and their joints is to speed up slow down and twist and turn So we don’t want to do things that are gonna actually cause joint pain, but if we get to the dog that is now maybe three or four and really hasn’t had any issues.

But now they’re coming into you because the owner has noticed either some offloading or an acute lameness or a mobility related issue. If it’s, if it’s the offloading or the acute lameness, number one, we need to rule out everything else before we blame it on the hips. You know, it really doesn’t matter how bad the hips look on a, on a radiograph.

There’s probably cruciate pathology. So make sure you rule out cruciate pathology first. But in that situation, I’m going to say, okay, you know what? We’re probably having a little bit of a flare up. So how are we going to get the flare up under control? Well, the first thing we’re going to do is we’re going to reach for pharmaceuticals.

So I’m going to put them on an inset. for, you know, probably 30 days, sometimes up to three months. You know, I think we underutilized duration of insets for joint pain vastly. So I tend to use them longer. we’re going to rest, you know, we’re not going to push a lot of exercise until they get a little more comfortable.

Uh, and I might even recommend they do a two or four or six week course of formal physical therapy just to help get the comfort under control because what we tend to always forget about is we look at a radiograph and think bone on bone, but we ignore all the soft tissues. And so not only is there joint pain, but there is soft tissue pain surrounding the joints of the muscles as well as the compensatory changes.

And so these dogs can become like tight walk, walking rubber bands that just improving tissue, distance ability and flexibility can go long ways to improving joint comfort. And, after we start making some headway with rehab, with our pharmaceuticals, then we’re going to ease into our warm up, our daily walks.

And my goal is to try to work up to at least 20 minutes on level flat ground twice a day. I know that’s asking for a lot. But once we kind of get to that 20 minute mark on level ground, then I want the owners to start doing things in their walks that are going to encourage hip extension. And the common sense of you would be like, okay, have a walk up a hill.

Well, walking up a hill doesn’t really increase hip extension very well, but walking upstairs does. So we’ll start the process of walking up an incline, but once we’re further along and joint comfort is improved, then we’ll start incorporating stair ascent. And, you know, that doesn’t mean taking them off the leash and letting them race up and down the stairs.

That means you’re controlled walking up the stairs, because that’ll actually improve hip extension by about 10 degrees. So we’ll, we’ll incorporate stair ascent, we’ll incorporate uneven terrain, so trails, tall grass, sand. You know, if they’re in the city, that can sometimes be, as long as it’s safe, can sometimes be, uh, walking on the sidewalk, you step off the sidewalk for a few steps.

You step back on the sidewalk and kind of do some modified cavalettis there. Just anything that’s going to start challenging some of those smaller core stabilizing muscles. And then when they get back from the walk, if it’s a day, we’re going to do our home exercises. Then we immediately go into our sit to stands, our dancing, our, you know, cavalettis, and then we go into our cool down with our range of motion and.

Uh, exercises and stretching. If it’s a day where we’re not doing our home exercises, then we go straight into our, our cool down process of our stretching and passive range of motion. And, and, you know, once we get that flare up under control, then we’re going to stay with that baseline management of our daily exercise plan, our weight control, our omega 3 fatty acids, and our other joint supplements.

But then we also need to counsel owners on paying very close attention for mobility related issues that might arise, because it’s going to happen. They’re going to have other flare ups. If that dog is doing great, and then two weeks later comes back into another flare up, and so we get them out of that, and two weeks later comes into another flare up, then we’re going to start saying, okay.

It might be that either we need to change our approach to how we’re getting this flare up under control, or it might be that we’re just not going to be able to get it under control enough and we have to start thinking about surgical intervention. But then if we’ve got the, say, nine year old German Shepherd that the hips can barely move, those are going to require a bit more work on the front end before we can get to kind of that home exercise plan.

So those are going to be the dogs where I’m going to come in with an NSAID probably for four months, and they’re going to be in a rehab program for probably six to eight weeks. We might throw in other drugs like amantadine or pregabalin. I might even consider injecting the joint with something. And then if we’re able to improve their function, because in those cases, if the hip extension is permanently reduced.

We can’t expect it to ever become normal. The question is, can we improve it a little bit? Can we improve just 10 or 15 degrees of hip extension and improve comfort? And if we’re able to improve comfort and it might be at that point, they’re now reliant on a daily anti-inflammatory, or Uh, we have to think about our exercise plans.

Maybe this dog can only tolerate up to 10 or 15 minute walks. Maybe they’re not going to be able to tolerate doing stair work. They’re not going to be able to tolerate doing dancing exercises. So we’ll start to tailor what they can do to the individual dog. But then I’m also going to recommend that they do maintenance rehab probably every four to six weeks, because what’s going to happen

is once they get them loosened up and more comfortable, then they’re going to go out and they’re going to do some things, but they’re going to slowly start compensating again. They’re going to slowly start getting tighter and tighter again. And when they do that, uh, what’s going to happen is they’re going to start right back into a flare up again.

And so we go into maintenance rehab. But those patients too, if we’re not able to get. comfort under control pretty quickly, we might start recommending something like a, uh, a total hip replacement. I would not put a, I don’t know that I would do an FHO in those guys because you’re going to make them even more cripple.

And you know, yes, you might resolve some of the pain, but you’ve made hip function worse. I would rather get pain under control and other mains than doing an FHO.

Dr. Andy Roark: Yeah. When you talk about, you know, going for, for walks and you talk about 20 minutes and then some pets may not be able to go that long. Is the, is the, is the guide for you if we go out and we’re walking 20 minutes and then we start to see some discomfort, we’re starting to see limping, things like that.

Is that what you’re looking for to tell the pet owner to, we’re going to adjust down? Yeah. So how do you set that? And my follow up question is going to be, I know that pet owners are going to come and they’re going to say. Twenty minutes was great. And so now we’re doing thirty minutes. And to me, it does make some sense of, if I want to try to maintain musculature, then building musculature is the first step to maintaining musculature.

I would like to see more muscle in those hips, I think. When do we go up and when do we go down on the duration of the exercise and the walking and stuff that we’re doing?

Dr. David Dycus: Yeah, if it’s one that we’re working up to the 20 minute mark, generally speaking, as long as they’re comfortable, I will tell them we can add about five minutes a week. So add one to two minutes every few days, and you slowly work it up. Um, if it’s a dog that they’re trying to slowly work it up, but then the dog is now starting to trail behind them, um, or More importantly, they went that longer distance and they came back and then the dog now looks more stiff and sore, like they’ve gone, they’ve lied down, they get up and they’re like, Whoa, they look like they way overdid it.

That means we probably pushed it too far too soon. But if it’s one of those that every time we try to increase a little bit and then it’s like, Oh, this happens every time. And they’ve got horrendous hips. It might be, listen, 15 minutes is as far as we’re going to be able to get comfortably because if we go beyond that, they’re going to have to pay the price for it.

And so the general rule is no more than five minutes a week. not adding more than a minute or two every, every few days. and so we don’t want to jump from 10 minutes to 20 minutes the next week. We want to gradually work, work into it and kind of see how the dog’s doing. If you add time and you notice a difference, back, back down and try to ramp back up over a longer period of time.

If you don’t notice a difference, kind of keep working it up until you hit that point where you say, listen, my dog could probably walk for four days straight without an issue, but I only have 35 minutes that I can dedicate. Then 35 minutes it is. but a lot of dogs don’t have the, the, the conditioning, the endurance or the muscular strength to, go right out on a 20 minute walk if they’re not used to walking.

Dr. Andy Roark: Dr. David Dycus thank you so much for being here. Where can people find you online? Where can they keep up with your exploits?

Dr. David Dycus: Absolutely. So for you on social media, Instagram is ortho underscore vet and Facebook is Dr. David Dycus um, my website is drdavidDycus.Com and then for the hospital, Instagram and Facebook are both Fusion vet ortho.

Dr. Andy Roark: Thanks for being here. Gang, thanks for tuning in, everybody. Take care of yourselves.

Dr. David Dycus: Thank you.

Dr. Andy Roark: And that’s what we got. Thanks again to Dr. David Dycus for being here. Dr. David Dycus, I love saying Dr. David Dycus. I think that’s a great, that’s a great name that rolls off the tongue. Uh, he’s also an amazing guest on the podcast. I promise I’m not having him on the podcast just cause I like saying Dr. David Dycus, but it doesn’t hurt. Anyway, guys, thanks again for being here. I hope you enjoyed it. Take care of yourselves, everybody. I’ll talk to you later on.

Dr. Jane Sykes joins us as we dive into the 2023 ACVIM Consensus Statement on leptospirosis. In this episode, Dr. Andy Roark is joined by Dr. Jane Sykes, a renowned small animal internist at UC Davis College of Veterinary Medicine and editor of Greene’s Infectious Diseases of the Dog and Cat. Dr. Sykes emphasizes the growing importance of leptospirosis vaccination for all dogs, including those in urban areas. Dr. Sykes provides insights into recent advances in leptospirosis diagnostics, prevention, and the disease’s zoonotic potential, explaining how the updated consensus reflects new knowledge and data on this pathogen. She highlights critical details, such as new safety guidelines for veterinary staff when handling suspect cases and ways to improve accuracy in diagnosing leptospirosis. Dr. Sykes also shares her personal experiences with leptospirosis, underlining the importance of awareness, timely diagnosis, and vaccination for better patient and staff safety. This episode is packed with valuable information for veterinary professionals who want to keep their practices informed and up to date on infectious disease protocols.

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

Updated ACVIM Consensus Statement on Leptospirosis in Dogs: https://onlinelibrary.wiley.com/doi/10.1111/jvim.16903

CDC Leptospirosis in Animals: https://www.cdc.gov/leptospirosis/pets/index.html

Uncharted’s Practice Owner Summit: https://unchartedvet.com/practice-owner-summit-2024/

Dr. Know-It-All Card Game: https://drandyroark.com/in-the-know/

Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Jane Sykes is a powerhouse in veterinary medicine and infectious disease research! A professor at UC Davis with board certification in Small Animal Internal Medicine, she holds degrees in veterinary science, a PhD, an MBA, and a public health certification. Renowned for her work on infectious diseases in pets, Dr. Sykes has published extensively and earned numerous awards for her research on zoonotic diseases. Her passion for teaching and her impressive expertise make her a top voice in veterinary health and public safety—so prepare to be inspired and informed as we dive into her world!

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a super important one for you today. I am here with Dr. Jane Sykes and we are talking about the 2023 updated ACVIM consensus statement on lepto sclerosis in dogs. Guys, this rattled cages at my vet clinic.

The recommendation outta this consensus statement is that. All dogs should be recommended for leptospirosis. That means an initial vaccine, a booster, and an annual vaccine thereafter. And the recommendation here is that all boarding facilities and dog daycares should also be requiring leptospirosis vaccines in dogs.

We talk about why that is. We talk about what the differences, what the changes were for the 2010 consensus statement to the 2023. it’s a fascinating conversation. Dr. Sykes is amazing. Anyway this is big. It’s changed the way we’re doing stuff at our vet practice. it’s big for staff awareness and keeping our team safe.

I hope you’re gonna love this episode Let’s get into it 

Kelsey Beth Carpenter: (singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark. 

Dr. Andy Roark: Welcome to the podcast. Dr. Jane Sykes, thank you so much for being here.

Dr. Jane Sykes: Thank you for having me. I’m excited to be 

Dr. Andy Roark: here. 

It is, it is an absolute pleasure and honor to have you on the podcast. You are amazing. you are on the faculty at UC Davis College of Veterinary Medicine. You are a small animal internist. You have an MBA. You have a Master’s of Public Health. You are the editor of the 5th edition of Greens Infectious Diseases of Dogs and Cats. You are the chair of the 2020 Consensus Statement on Leptospirosis from ACVIM and the updated statement, which is what blew my doors off. And was the reason I reached out and was like, Hey, would you be willing to come and talk to me?

 You have an incredible resume. You have done really incredible things in your career. And you’re doing work that really matters and that’s really important. And so I was not kidding when I said, the 2023 updated ACVIM consensus statement on leptospirosis in dogs came out last year.

This has been a very popular piece. I saw, I think it was the most downloaded piece from ACVIM last year. And I, it was handed out at our vet practice because of some of the recommendations that were in it and specifically in the updated consistent consensus statement, the word that was sort of put forward was the recommendation of all dogs, small dogs, all dogs.

urban dogs being vaccinated for leptospirosis. It was recommended that all boarding and daycare facilities also require this vaccine. And that’s a massive shift from what a lot of vets have been saying. It’s a shift from what I’ve been saying. It is It also has ramifications for staff awareness and staff safety because you talk a bit more about the zoonotic potential of leptospirosis.

So let me just sort of stop here can you unpack that for me? Is that, is an accurate representation of what’s being recommended in the, in the consensus statement?

Dr. Jane Sykes: Yeah, I think you know, there’s been a lot of change since the original 2010 ACVIM consensus statement was published, and we tried to reflect that in this updated version of the consensus statement, it’s been a long time and we have new diagnostic tests. We have new understanding of the epidemiology of the disease.

We have new vaccines as well. And so, you know, we really wanted those things to be reflected in the statement. And we also really understand that we have a better understanding of how pathogenic lepidospires are transmitted in terms of environmental sources of the organism as well as animal to animal transmission.

So I do want to just, before I start talking about the consensus statement, a few acknowledgements and disclosures. First of all, I’m supported by a number of industry groups in terms of my research and speaking, including industry groups that make vaccines for lepto. But I’ve really been quite passionate about leptospirosis throughout my career.

I’ve seen. I’ve seen it in all places that I’ve worked and I’ve seen dogs dying from it. So I, you know, I believe when I’m recommending vaccination for leptospirosis, it’s because I truly believe in it. And my own dog is vaccinated for leptospirosis. So there’s that. And then I also want to say that I’m really speaking as the chair of the consensus statement.

It’s my opinions that I’m giving here, but there were several other panel members that were part of the consensus statement. And the way that we have done these consensus statements lately is to do what’s called the modified Delphi method. And so when we proposed the new updated consensus statement to the ACVIM Board of Regents, we then had a core panel and we identified a number of expert reviewers.

So the total number of people that were voting on statements in the consensus statement was 12. And so then we presented the consensus statement recommendations at the 2023 ACVIM forum last year. And then after we had presented the statement, we then posted, the document on the ACVIM listserv for comments.

And really, we had really positive feedback about. The recommendations that were made. It was pretty quick for it to go through to publication in the Journal of Veterinary Internal Medicine. And it, you will see if you do look at the document that for every statement there’s a level of agreement, which is the number of people that were in favor of the statement.

Sometimes voters didn’t vote if they didn’t feel like they, knew enough about the topic to vote. So there was some abstentions for some of the statements, but you can see that, for most of the statements, almost all panel members agreed with them.

Dr. Andy Roark: I’ll put a link to the statement in the show notes so people can see it. Was there something that in particular that came up that made you say, we need to revisit the 2010 statement? Was there anything that sort of drove that decision to go back? I know that there’s a threshold where you must have said, my position on this has changed or the information has reached a new level and it’s worth revisiting.

But was, what, was there a moment that you said, yeah, we need to go back and look at this again?

Dr. Jane Sykes: I think we’d always wanted to do it. And I think we’d always received questions from people about when it was going to be updated given the new knowledge on the disease. And I think it was, really about a group of people that felt like it was the right time to do it based on everything that we knew about LEPTO and and a little bit was the right time as far as ACVIM was concerned in terms of their production of new consensus statements.

Dr. Andy Roark: Have you gotten any pushback on the new statement? Have there been people who said, Oh that’s Bobbycock. I don’t know. Whatever. Has anyone just said, that’s not that. Surely not that. This is over the top.

Dr. Jane Sykes: I’ve been involved in a lot of consensus statements over the years, including some really tough ones, like the antimicrobial is great antimicrobial guidelines, which were internet international guidelines and where you really don’t have a lot of evidence sometimes to make statements.

But the great thing about consensus statements that I’ve learned is that when you get feedback that, there’s not enough evidence to support that or what you’re saying, we don’t agree, is it usually stimulates people to go out and do research and then you get more information and you can do these revised statements and so that’s, that, that has been one thing that’s made me quite optimistic now about developing new consensus statements and guidelines documents, but I would have to say that this leptospirosis one was a relatively easy one in terms of all of the ones I’ve been involved with in terms of acceptance.

And there has been some questions surrounding the use of bleach in hospital environments given its corrosive nature and also concerns about people handling bleach. Bleach. So there was one recommendation in the statement about with there was a large volume of urine diluting it. If you had a bag full of urine diluting it one to one with bleach as being maybe the best way to inactivate leptospires in that situation.

But and concerns about the use of bleach in general. And so I think that’s really been the main one that’s come up. And I think any disinfectant is going to be active against leptospires. They are really fussy friable organisms in the environment. You know, I think if you used other hospital based disinfectant or accelerated hydrogen peroxide, that would just be fine.

Dr. Andy Roark: When. When we talk about, vaccination and, and a rise in prevalence in the condition, do you think that we’re missing these cases when they come into the clinic? Do you think that it’s common for vets to see leptospirosis dogs and not recognize what they are?

Dr. Jane Sykes: I think my feeling talking to veterinarians over the course of my career about, about lepto in big audiences and in small audiences is that we both see under diagnosis of leptospirosis and over diagnosis of leptospirosis. And certainly I’ve presented cases in front of veterinarians and they’ve come up to me and said, Oh my gosh, I am sure I saw a dog with leptospirosis recently based on that.

It was very, very similar to what you described and leptospirosis is really quite a pattern recognition disease, right? In fact, Adolf Weil, it’s kind of an interesting historical story because I love history of infectious diseases, but Adolf Weil who the, who discovered leptospirosis in people in the late 1800s, he recognized these people who had leptospirosis.

Really similar clinical signs. And he thought that there was something infectious that was causing their jaundiced. And that’s how leptospirosis in people got the name Weil’s disease. So he was actually practicing patent recognition back then. And now we have, you know, recently been developing things like machine learning algorithms.

Krystle Reagan, who’s on faculty here at UC Davis and was my infectious disease fellow, has been training a machine learning algorithm to recognize leptospirosis in dogs that can help us pick up these cases because they do often have this pattern of clinical laboratory abnormalities. it is under recognized in some practices, but in other situations, it’s overdiagnosed to, and that kind of reflects some of the challenges surrounding diagnostic testing for the disease.

One of the really cool things that I’m very proud of about the consensus statement is that it includes a case definition for leptospirosis, and believe it or not, this is the very first case definition for any companion animal infectious disease that’s ever been developed formally.

There is a table in the consensus statement that can guide veterinarians with the diagnosis by stating, you know, the findings that are needed to diagnose leptospirosis. And so we have, clinical criteria and we have laboratory criteria and the clinical criteria require that the dog has to have onset of systemic illness within the last two weeks.

So it’s not a chronic grumbling disease that we’re talking about. We get lots of questions about dogs with chronic PU/PDing lepto really, we think that leptospirosis in dogs is characterized by an acute onset of illness in the last two weeks. And we have supportive biochemical and CBC findings as well as imaging findings and then these specific laboratory diagnostic test findings to support the diagnosis.

Dr. Andy Roark: For those who don’t know a lot about leptospirosis, what are the waving flags that should get their attentions when cases come into their practice? So, if you’re a, you know, if you’re a, veterinary assistant or something and you come in and, you’re setting up a room, you’re taking a history, you know, things like that, what are the, what are the flags that our staff should be looking for?

It’s always, I always, I want to keep them safe and the easiest way for me to keep people safe is for them to be looking out for themselves at least partially. And so, what should they look for?

Dr. Jane Sykes: Yeah, so I think, first of all, if a dog has a history of being properly vaccinated with a 4-serovar vaccine for a lepto, it’s really unlikely that a dog will have leptospirosis. So leptospirosis should be suspected in dogs that have not been properly vaccinated for a lepto really have very few cases where breakthroughs have occurred in vaccinated dogs.

And so, you know, acute onset of clinical signs that usually nonspecific, right? Not eating, vomiting, diarrhea P U. P. D. Oftentimes early on in the course of illness. And one of the challenging things is in the first day or so of illness Those animals can have blood work. That looks pretty normal.

They might have a fever, but pretty normal blood work. And we do say in the consensus statement that whenever you see an animal that’s unvaccinated for lepto and has this sort of acute onset of a febrile illness, And really any dog can get lepto too. So it can be a small breed dog, a large breed dog, an indoor dog and outdoor dog.

So the history may not always help you there. But if, if ever you see that it’s the recommendation is because lepto can progress to acute kidney injury pretty quickly within 24 to 48 hours. And those dogs can then. Maybe even need dialysis to save their lives. We recommend that clients be told that if their dog is not better in 24 hours, they should return for re examination.

And so having that high index of suspicion for the disease is really important. We even go so far as to, to recommend considering giving a short course of antimicrobials in those dogs because it could potentially protect them from developing A. K. I. And there is stewardship issues with that one.

But if you’re in a region where leptospirosis occurs, there’s maybe history that’s suggestive, lack of vaccination history. Then you might even want to think about giving a short course of doxycycline or amoxicillin.

 Hey there. Are you a veterinary practice owner? If so, I would love to work with you. Why don’t you come to the uncharted veterinary conference practice owner summit in Atlanta? It is December 5th through the 7th and it’s in Atlanta, Georgia. It will be me in the uncharted team working hands on with only practice owners. This is going to be a small boutique conference. It’s going to be a gathering we’re going to have about 60, 70 practice owners. Everybody there is going to be a practice owner or have been a recently retired practice owner. 

And we are going to be digging into how to make your business work for you instead of you constantly working so that your business can stay afloat. I know a lot of you are living in that place, in that Headspace. I’ve been there. We’re going to get out of there. We were going to make your business serve you, which is something that a lot of us are dream of it. 

So we’re going to get in there. And make it happen. Head over uncharted vet.com. I’ll put links in the show. Note directly to the event, learn more about the practice owners summit. You’re going to need to become an uncharted member to come. It is a hundred percent worth it. Anyway, I hope to see you guys there.

Dr. Andy Roark: Can you talk a little bit about the difficulty in diagnosing leptospirosis? I know that there’s, as you said, it can be challenging to get a formal diagnosis. Walk me through the process there. Have there been updates or changes in the recommended approach to diagnosing the condition?

Dr. Jane Sykes: Yeah. So we have both nonspecific diagnostic tests, right? So we, certainly as a pattern recognition disease, you could have supportive findings on blood work. So especially that combination of azotemia and a cholestatic liver enzyme increase. So it’s usually not liver failure that these dogs develop.

It’s a cholestatic liver injury. So if you saw really, really high ALT, for example, and evidence of hepatic failure, that would not be likely to be a lepto case. A lot of dogs with lepto are thrombocytopenic. A lot of them have glucose urea. They can be red flags in conjunction with the presence of azotemia.

So that’s, oftentimes we’re diagnosing it based on clinical suspicion, and we do recommend that if you suspect lepto that all dogs get thoracic radiographs because many dogs have evidence of this condition known as leptospiral pulmonary hemorrhage syndrome, which can be just a mild interstitial pattern initially on radiographs, but then can progress to more severe pulmonary infiltrates that are alveolar due to hemorrhage.

And so identifying those changes early can help increase the suspicion for a lepto and it also can make you more cautious with your fluid therapy. So there’s the combination of those findings, but then we have specific diagnostic tests for a lepto and the gold standard diagnostic tests that you may have heard of is a serial logic test called the microscopic agglutination test or the MAT test.

And this is when. Let’s say you went out and got leptospirosis tonight, right? So if you decided to go out and get lepto tonight you might go and eat a rat kidney because that’s a really good source of organisms. And so I’m just going to put you in the position of someone or a dog that develops leptospirosis.

And so let’s say you ate rodent tissue and then a week from today you got sick and you went to your doctor and you said, Oh, I got leptospirosis. I think I have leptospirosis because I ate this rodent kidney tissue, then they would take your blood and they would submit it for a leptospira PCR, but they would also submit it for this serologic test, the MAT test.

And so what this test is doing is looking for antibodies to different serovars. And at the CDC, their panels include 23 different serovars. So the point of doing that to the point of including all of those serovars is to try to maximize the chance of detecting an antibody response to a pathogenic cerebrum.

And so they’re going to do serial twofold dilutions of your serum, and they’re going to react them with each of those live leptospiral cerebrums, and they’re looking under a darkfield microscope for the title that causes 50 percent of the organisms to agglutinate. And that’s the title that’s reported out to the clinician.

So you may be familiar with the veterinary panels, which includes six or seven different serovars typically, and sometimes you see multiple positive titers to different serovars, and that’s because of cross reactivity among those serovars. The problem is that when dogs first come in sick with leptospirosis, this is an antibody test and lepto is an acute disease.

So oftentimes dogs do not have positive titers in that very early phase of illness. In fact, they can be completely negative and we expect that. And if you have a dog that’s been sick for two days and has high titers. They might be left over from previous exposure or from vaccination because most dogs that get exposed to lepto actually don’t get sick and then one to two weeks later is when you want to take your convalescent sample.

So your doctor would tell you to come back in one to two weeks and they would again repeat the test and you should see zero conversion over that time period. And so you’ll notice that I said that at the CDC, they use more than 20 different serovars, whereas veterinary panels often include six or seven different serovars and can understand that might be the case because it’s such a laborious test to actually perform, right?

It’s just, you can imagine trying to do that, and that’s why they tend to batch it. And it’s only done once a week. And so that’s one of the other problems with these diagnostic tests is that we often have to wait a long time to get those test results back. And the other thing I’ll say about that is because this is not a serovar test.

Right? It’s just a diagnostic test for leptospirosis. You can keep on adding more and more serovars and see higher and higher titers to other serovars that you add in. It’s really just trying to increase the chance of detecting a positive reaction. So there’s been lots of people looking at alternatives to the MAT test because it is so cumbersome to perform and we have to wait for those results.

And they’re often negative early on in the course of illness. And so now we have these point of care tests. And that was another reason for for, doing the updated consensus statement, because these point of care tests. are increasingly being used in practice environments. And so these point of care tests are also antibody tests.

They’re not organism detection tests. They’re just detecting antibodies. But we have two different platforms. We have the SNAP lepto test from IDEXX and we have the witness lepto from Zoetis. Now the witness lepto is an IgM based test, so it’s more likely to detect recent infection than the snap lepto, which is an IgM IgG based test.

But these tests still have limitations in that they can be negative early on in the course of illness. And they can be positive from previous exposure. That’s just a lot less likely to occur with the witness test than with the snap lepto. And so the studies that have been published now are showing that when the witness test is positive in association with clinical science it is really likely to truly be leptospirosis.

But we had a case recently come in this year that we did was sick just early on in the course of illness. We did the witness test. Witness test. It was negative, and I recommended to the resident that they did another witness test in 5 to 7 days. And so they repeated the point of care test, and it went from negative to positive.

So that’s, you know, one way that these tests can be used rapidly to detect zero conversion.

Dr. Andy Roark: That’s amazing. Given the zoonotic potential of this condition, Jane, if you owned a vet hospital, are there certain guidelines that you would put into place? What are the, what are the sort of the safety standards that that you would say, I want my staff to know these things just to keep everyone safe, knowing the prevalence of the condition?

Dr. Jane Sykes: Yeah. And so this, there’s actually been some interesting comments about zoonotic transmission in the updated consensus statement that I think are worth spending some time on. Because actually, you know, if anything, we’ve backed off on handling precautions a little bit. And we know that with lepto, we have reservoir hosts that are chronically infected with lepto and shed organisms typically in the absence of clinical signs.

And then we have incidental hosts like sick people. Dogs and humans with leptospirosis. And we know that actually incidental hosts, they have a lot of inflammation to the spirochete. And so they actually don’t shed very many organisms. Oftentimes it’s a lot about the inflammatory response, whereas it’s these reservoir hosts

that shed lots of organisms and are a much more important source of infection. So you’re actually more likely to get leptospirosis from handling a reservoir host, like large animal species that’s chronically shedding lepto, like horse or cattle, than you are even maybe working with a sick dog that truly has leptospirosis.

So we still, we’re not discounting the zoonotic disease potential there, but there’s been a few other studies looking at outbreaks of lepto in dogs and lepto in dogs and really there’s not a lot of evidence that transmission from sick dogs with lepto occurs. There was one particular study

regarding outbreak of leptospirosis that was occurring in the Phoenix area again, underscoring the fact like you’ve got an arid area and leptospirosis is still occurring. In fact, large numbers of cases in that region. So in this particular outbreak, the CDC got involved and they went and studied the outbreak and people who are in contact with the infected dog.

So they looked at nine dog owners and 109 animal caregivers and many of these people, especially the veterinary technicians were saying that they when any PPE they were splashed in the face with urine or had extensive blood contact when they were working with dogs that had to leptospirosis. And so they were looking to see if anybody got sick after those experiences, and they found seven people who got flu like illness afterwards, and they tested them for antibodies to lepto, and they were all zero negative. So the thought was, is that they actually had probably some other cause of their flu like signs. And so they concluded that the title of the paper is, despite high risk exposures, no evidence of zoonotic transmission during a canine outbreak of leptospirosis. And there’s been other studies looking at veterinarians who are in contact with dogs in lepto one in Italy, for example, that showed that really there wasn’t much evidence of zero conversion among those people.

So now instead of requiring, you know, handling precautions for all of those AKI dogs that we see, you know, we see a lot of dogs with renal disease, but only a small percentage of them actually have lepto, but we still end up handling a lot of animals as if they’re lepto precautions, but to reduce the impact of that and also environmental waste associated with those types of precautions.

Now, if you have a lepto suspect, we recommend using those precautions for 48 hours only. And after 48 hours of suitable antibiotic therapy, even either doxycycline or penicillin, that you can then lift those precautions. So these long hospitalizations with precautions no longer recommended.

Dr. Andy Roark: That’s reassuring. I, I appreciate it. It’s funny looking at the, you start to look at the symptoms that we might be looking for and I say, well, you know, when we have a vomiting diarrhea dog come in, should we be gloving up and treating this as a potential, you know, zoonotic condition?

And that’s very reassuring. That helps a lot. Dr. Jane Sykes. Thank you so much for being here. Thanks for talking about this with me. I really appreciate it I’ll put a link to the consensus statement in the show notes Where can people find you online? Do you have resources that you really recommend for people who are interested in this?

Dr. Jane Sykes: the nice thing is, is the JVIM consensus statements are all open access. So you can download them free and get all the information in the consensus statement. Also I think the other resources are the CDC websites on leptospirosis and their healthy pets, healthy people resources.

There’s information on leptospirosis there for animal owners that might be asking questions about it. Or if you do see a case and you want to give owners resources, I would refer them to the CDC resources.

Dr. Andy Roark: That’s absolutely wonderful. Thanks so much for being here. Gang, thanks for tuning in everybody. Take care of yourselves. We’ll see you later

 And that’s what I got for you guys.

I hope you enjoyed it. I hope you got a lot out of it I hope it sparked some kind of some discussion at your practice. Are you seeing leptospirosis dogs? I hate the idea that I might be seeing them and not recognizing them I also hate the idea that there’s a vaccine that can keep these dogs safe and I maybe we haven’t been recommending it as much as we should. Anyway, all you can do is learn and take in the new data that’s out there and keep adjusting what you do to get better that’s my takeaway from this This is a somehow I’m just really interested in and I think that we have the potential to do a lot of good here. Alright, guys, onward and upward take care of yourselves. I’ll talk to you later on.