Cerclage Wire for Rostral Mandibular InstabilityMay 6, 2015Originally published in the April 2015 issue of Veterinary Practice News Last month we discussed iatrogenic mandibular fractures of the rostral mandible, specifically the iatrogenic parasymphyseal fracture. One of the repair techniques for this fracture, and for traumatic symphyseal separation, is use of a cerclage wire placed behind the canine teeth. Though most practitioners are familiar with this seemingly basic procedure, there are subtle nuances of placement that will help your patients thrive following placement of the cerclage. No. 1. Not every patient with instability requires placement of a cerclage wire Some animals, especially brachycephalic small-breed dogs and some cats, may have significant symphyseal laxity as an incidental finding on anesthetized oral examination. If the patient is not showing signs of discomfort or jaw locking, symphyseal laxity is not likely causing any problems. In cases with no recent history of trauma, placement of a cerclage wire will likely not allow for a long-term decrease in laxity without a more invasive procedure such as symphysiodesis (cutting into the fibrous joint of the symphysis and encouraging scar tissue formation), and this is often not necessary. No. 2. Step-by-step: placement Before placing a cerclage wire, the intraoral soft tissues dorsal to the …
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Why the Basics Still Apply to Canine Skin AllergiesMay 4, 2015Originally published in the April 2014 issue of Veterinary Practice News Prevention, diagnosis and good management are still the most important elements of treating a dog with allergic skin disease, experts say, despite the presence of a potentially game-changing medication. “Apoquel has helped a lot of dogs, but you still need to implement good parasite control, including flea prevention, and you still need to ID the potentially underlying adverse reactions,” said Jeanne B. Budgin, DVM, Dipl. ACVD, president of the American Academy of Veterinary Dermatology. “In my opinion, Apoquel is not a replacement for diagnostics directed at identifying the cause of allergic skin disease,” Dr. Budgin said. Apoquel soared in popularity upon its release in January 2014. Many practitioners experienced a shortage of the drug when manufacturer Zoetis of Florham Park, N.J., ran low on supplies and faced production issues. Shortage Dr. Budgin, who works at Animal Specialty Center in Yonkers, N.Y., said she hasn’t experienced the shortage. She said she’s been able to keep patients that were started on Apoquel on the treatment. For others, the shortage has been an issue. One such affected practitioner is Christine Zewe, DVM, a resident in dermatology at Cummings School of Veterinary Medicine …
Survey: Clients Want to Know About ParasitesApril 30, 2015Originally published in the March 2015 issue of Veterinary Practice News Tens of thousands of dollars in additional revenue may be a series of phone calls away for U.S. veterinary hospitals. The Companion Animal Parasite Council and Bayer Animal Health in January released the results of a survey that found that 90 percent of U.S. pet owners want to hear about local spikes in pests such as disease-carrying ticks and heartworm-transmitting mosquitoes. Pet owners are willing to open their wallets, too, with 89 percent saying they likely would schedule an appointment to get their pet tested if a heightened parasite risk was communicated. The survey’s sponsors forecast that a two-doctor practice that informed clients about urgent parasitic risks in their home county and delivered related services could generate from $163,000 to $789,000 a year in extra revenue, depending on the level of pet owner response. “It’s amazing what some fairly simple changes can do financially for our profession,” said Karen E. Felsted, MS, DVM, CPA, CVPM, founder of president of PantheraT, a practice consulting firm in Dallas. She is the former CEO of the National Commission on Veterinary Economic Issues. Dr. Felsted was joined by CAPC leaders Susan E. Little, …
How to Avoid the Iatrogenic Jaw FractureApril 13, 2015Originally published in the March 2015 issue of Veterinary Practice News? Not a subscriber? Subscribe today! If you extract enough firmly rooted mandibular canine teeth in your lifetime, basic anatomy suggests that you may find yourself to be the creator of an iatrogenic jaw fracture. The root of the mandibular canine tooth of dogs and cats makes up a large portion of the rostral mandible and it is nearly twice as long as the crown of the tooth. Bone is very thin between the lingual surface of the root and the caudal symphysis. Photos © 2014 John R. Lewis, NorthStar VETS. Radiograph of an iatrogenic jaw fracture that occurred during attempted extraction of the left mandibular canine tooth in a cat. Iatrogenic jaw fractures that occur during canine tooth extraction tend to be parasymphyseal fractures rather than symphyseal separations. Forces required to deliver this tooth root may also, in some cases, be sufficient to result in fracture of the bone. Here are some tips that I’ve learned on how to avoid iatrogenic fracture. Dental Rads Take dental radiographs and adjust your therapeutic approach accordingly. Dental radiographs are important from both diagnostic and therapeutic …
10 Tips for Veterinary Surgery LoversApril 7, 2015Originally published in the March 2015 issue of Veterinary Practice News You don’t have time to make every mistake in your career, especially in surgery: A mistake could cause significant harm to a pet, get you in a sticky situation or cost your patient his life. These suggestions are meant to start a reflection, not to offend anyone. They apply to new grads as well as seasoned surgery lovers. 1) Make it Big “Big surgeons make big incisions.” Unless you are performing minimally invasive surgery, don’t make mini-laparotomies. Sure, you can remove a spleen or a gastric foreign body through a short incision. However, stopping there would be a disservice to your patient; that’s only half of your job. The other half is to perform a thorough laparotomy, from the liver to the bladder. 2) Perfect Your Suture Pet owners will never appreciate how flawless a surgery you performed on Kiki. The only thing they see, and they may see for the next 10 years, is your skin suture. So work hard at crafting the prettiest skin suture possible. Learn how to close dead space. Strive to appose skin spots neatly. Strive to get rid of dog ears. Figure out where you …
Find Out Why Once Every Three Years is the Trend in VaccinationsApril 2, 2015Originally published in the March 2015 issue of Veterinary Practice News After speaking with hundreds of practicing veterinarians over the past two years about vaccines and vaccination protocols, Richard Ford, DVM, has found that practitioners are slowly trending away from all vaccines to all pets every year. “I believe it is fair to say that some trends are emerging,” said Dr. Ford, a co-author on both the American Animal Hospital Association canine vaccination task force and the American Association of Feline Practitioners feline vaccination advisory panel. He has noted a growing the tendency to incorporate triennial boosters for core vaccines in dogs (distemper, parvovirus, adenovirus-2) and cats (panleukopenia, herpesvirus, calicivirus). “In speaking with vaccine sales representatives from around the country, I would estimate about half of the practices today routinely incorporate the three-year recommendation for core vaccines,” Ford said. Ford sees this largely as a good thing. “The science is abundantly clear on this point,” Ford said. “While some vaccines must be administered annually to sustain a reasonable level of protective immunity, others – namely the core vaccines – provide years of protective immunity in the majority of dogs/cats that are vaccinated. There is simply no medical …
Why Feline Kidney Insufficiency is Still Tricky to TreatMarch 13, 2015Gary Norsworthy, DVM, Dipl. ABVP (Feline), owner of Alamo Feline Health Center in San Antonio, believes veterinarians should be careful when using the term “kidney failure” in talking to cat owners. To determine kidney function, creatinine and BUN (blood urea nitrogen) tests are conducted. Kidney failure occurs in a dog in which the creatinine value from blood tests is over 2.5 mg/dl, giving a dog a month or two to live. A creatinine number over 2.4 signals kidney trouble for a cat, yet actual kidney failure for a cat doesn’t start until that number reaches 5.0 or 5.5 mg/dl, Dr. Norsworthy said. Poor word choice can come into play when a veterinarian gets blood test results back with a creatinine value over 2.4 for a cat, he said. “Many cats are diagnosed with kidney failure that don’t have failure,” he said. Insufficiency Norsworthy said that in such cases he advises practitioners to use the term “kidney insufficiency,” a phrase he considers more accurate to describe cats in this range. “That’s an important distinction,” he said. “If you use the term ‘failure,’ owners wonder if their cat’s about to die. So cats often get euthanized when they shouldn’t.” With proper …
What You Need to Know About Jaw LockingMarch 13, 2015Originally published in the February 2015 issue of Veterinary Practice News Last month, we discussed differential diagnoses for cats that are unable to close their mouths. One possible cause for cats’ and dogs’ inability to close the mouth is open-mouth jaw locking, which is rare enough that you may not have learned of it in veterinary school. Photo © 2012, John R. Lewis, University of Pennsylvania Figure 1: Open-mouth jaw locking in a Persian cat. Note the mouth is locked open so wide that there is no contact between maxillary and mandibular teeth. The slight shift of the mandible to the right suggests locking is occurring on the right. Clinical Signs and Etiology In cases of open-mouth jaw locking (OMJL), cats and dogs present with the mouth wide open, and the lower jaw often has shifted to the side where the coronoid process (the tip of the ramus) is locking on the ventrolateral aspect of the zygomatic arch (Figure 1). On presentation, patients may be drooling, pawing at the face and vocalizing. The defining clinical trait that allows OMJL to be distinguished from other possible causes of inability to close the mouth on conscious examination is that …
Where do you Stand on the Antibiotics Debate?March 4, 2015Originally published in the February 2015 issue of Veterinary Practice News Choosing the right antibiotics—or whether to prescribe them—is far from a straightforward matter, and as concern grows over excessive antibiotics use, there’s a lot to consider. From the start, veterinarians are taught the correct use of antibiotics, which includes making a proper diagnosis, taking cultures and assessing sensitivities to choose the right antibiotic. It’s the next step in the process that becomes more difficult for veterinarians, said clinical pharmacist Sue Duran, RPh, MS, Ph.D., a fellow in the American Society of Health-System Pharmacists and the chairwoman of the board certification committee for the International College of Veterinary Pharmacy. “Both human and animal clinicians experience peer pressure from owners to prescribe antibiotics for their patients,” said Duran, a clinical pharmacist with the Auburn University College of Veterinary Medicine. J. Scott Weese, DVM, DVSc, Dipl. ACVIM, said pinning down the “whys” behind antibiotics overprescribing is difficult. “There are various reasons unnecessary prescribing can happen,” said Weese, an associate professor in the department of pathobiology at the University of Guelph’s Ontario Veterinary College in Canada. In some cases, antibiotics are used without a reasonable suspicion of a bacterial infection, such as …
More Options for Bad Joints in Aging PetsMarch 2, 2015Originally published in the February 2015 issue of Veterinary Practice News There’s no shortage of ways for a veterinarian to approach the treatment of joint problems in aging pets. For dogs in particular, a path taken from several fronts is recommended by Brenda S. Kennedy, DVM, MS, of Canine Companions for Independence. “A multimodal approach is necessary to reduce pain and minimize further degeneration in the joints,” Dr. Kennedy said. “This is especially true for senior pets, who are more likely to be in a more advanced stage of the disease process.” Kennedy was to speak in January at the North American Veterinary Community conference in Orlando, Fla. Her talk was titled “Canine Longevity: Strategies to Extend Healthspan.” The multimodal therapy she refers to can include the use of nonsteroidal anti-inflammatories (NSAIDs), analgesics such as tramadol, amantadine and gabapentin, or injectable polysulfated glycosaminiglycans like Adequan, or products like oral glucosamine, chondroitin, methylsulfonylmethane (MSM), as well as omega-3 fatty acids. Adjunct therapies like acupuncture and physical rehabilitation may also be beneficial, she added. Start With Diet, Exercise The basics of diet and exercise are a message that Kennedy and other experts drive home. “Maintenance of a lean body condition along with …
