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October 2009 Letters to the Editor
Blood Pressure Story Didn’t Go Far Enough
Editor:
I want to applaud the efforts of Veterinary Practice News at highlighting a routine diagnostic service that you and I take for granted when we visit our family doctor—the blood pressure check [“Pressure’s On to Monitor Blood Pressure,” September 2009].
While we have seen a real upswing in the upper-echelon general practices, there is still a long way to go before it becomes adopted as a standard of practice industry-wide. A major obstacle has been the reluctance of academia and media to openly discuss and differentiate brands versus methods in this debate, sacrificing truth and practicality for a desired perception of neutrality.
I had hoped the article would convey that blood pressure monitors with veterinary-specific algorithms are gaining more exposure and acceptance, and as a result, routine diagnostic blood pressure checks are increasing.
Readers may be confused between Doppler and oscillometric methods, with the hope that a new, untested brand of oscillometric device holds some promise for accuracy and reliability that heretofore has not been achieved. This is simply untrue, as evidenced by the thousands of our customers worldwide, including all-feline practices and every single U.S. veterinary school, who have been successfully monitoring blood pressure in dogs and cats, anesthetized and awake, since 2001.
The main obstacle to widespread adoption of routine blood pressure checks can be reduced to these factors:
- The absolute inefficiency of using Doppler, and the horrible experience that practitioners have had attempting to use human hand-me-down blood pressure technology on pets, especially on cats.
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- The negative perception that has been projected on the entire category.
Ever since my father brought Johnson & Johnson’s Dinamap to veterinary medicine 20 years ago, I have tracked the evolution of the technology, and the poor publicity that oscillometric devices have received since the very first studies were done comparing indirect readings to the true gold standard of direct arterial pressure. That is why I made certain to point out that not all oscillometric monitors are the same.
As recently as 2005, a study published by leading members of the American College of Veterinary Internal Medicine concluded that Doppler was more reliable than oscillometric. Read the fine print and footnotes and you will find that the study was performed in 1999 using a Dinamap oscillometric monitor that was designed for humans more than 20 years previously. Unfortunately, articles and studies like that perpetuate the myth that Doppler is better than oscillometric. As Dr. Anthony Carr noted in the article, oscillometric devices are far more efficient and practical than Doppler.
The good news is that veterinary-specific solutions are available today that are not only validated by published studies for use with dogs and cats, but also have an established track record and are backed by strong companies committed to efficient veterinary patient care.
Andrew Schultz Jr.
Director of Veterinary Monitoring & Critical Care for Sharn Veterinary, a division of Midmark Corp.,
Tampa, Fla
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Give petMAP a Try
Editor:
I was delighted to see the article “Pressure’s On to Monitor Blood Pressure” [September 2009]. I was surprised and disappointed to not read about the petMAP unit by CardioCommand Inc.
I have been monitoring blood pressure in my patients for many years, at first utilizing the Critikon Dinamap and then the Parks Medical Doppler. Those methods proved either to be inaccurate and/or cumbersome. I believe for those reasons many of us have not and in some cases still aren’t monitoring blood pressure regularly.
I was excited, though skeptical, when I first tried the petMAP over five years ago. At first, we were doing simultaneous readings using my Doppler unit to determine its accuracy. Not only did we find the petMAP to be as accurate, it was immensely easier to use. It is especially nice in smaller patients.
Since that time, we have been using the petMAP exclusively, and it has made reliable monitoring more comfortable and efficient for our patients and staff. As we all know, the easier something is to use, the more it will be used, and that is to the benefit of all of our patients.
It is my hope that future articles pertaining to blood pressure monitoring will mention the petMAP so my fellow practioners can try one out for themselves.
William Stearman, DVM
Coppell, Texas
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Oh, Man
Editor:
The July 2009 issue of Veterinary Practice News put a few knots in this grumpy old conservative’s shorts.
First, we’re all aware that Reality Check columnist Patty Khuly is quite intelligent and attractive, and I can understand that she might want to promote herself. Seems to me she’s missing out on a much broader audience by not trying to step into the national arena, much as Marty Becker did.
Although it sounds like Dr. Khuly’s May 2009 column [“On Becoming a Food Animal Vet in Modern America”] generated some buzz, it also left a large number of readers abandoning the column by mid-mire, not giving a hoot about whatever she was rambling on about.
In July’s follow-up [“Food Animal Vets Not Short on Ideas”], the reader is treated to not one but two pictures of Dr. Khuly and 34 “I,” “me” and “my” references. Many of “us” simply don’t care.
Regarding the July ditty “ ‘Problem’ Visits Hamper Communication,” I was tickled by the fifth paragraph: “A paternal style during problem appointments carries the potential for negative consequences.” Jane Shaw, director of the Argus Institute, then says, “We know that paternalism is not an effective approach for gaining results.”
I was really starting to rue being a 54-year-old male practitioner at that point and decided to Google the Argus Institute. I was soooo surprised to see the entire staff of the Argus Institute was female!
Kurt E. Blaicher, DVM, Dipl. ABVP
Plainfield, N.J.
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Origins of Ear Cropping
Editor:
In the discussion of ear cropping [“Docking and Cropping on Chopping Block,” September 2009], we all seem to ignore the fact that there are no wild canids in nature whose ears do not stand up; this after thousands of years of evolution. Floppy ears are the result of hundreds of years of breeding by mankind in order to get results for whatever dog traits the breeders were looking for.
Sherbyn Ostrich, VMD
Past president of the American Veterinary Medical Assn.
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October 2009 Letters to the Editor
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