Vital pulp therapy in dogs and catsMarch 29, 2019Last month, we discussed the rationale behind and approach to conventional (orthograde) endodontic therapy. Orthograde root canal therapy removes the entire contents of the pulp chamber in the root canal system. Vital pulp therapy is a different kind of endodontic procedure, performed instead on teeth that have had recent pulp exposure. Determining whether it's best to perform vital pulp therapy or orthograde root canal therapy for an individual tooth is a judgment call. Most dentists gravitate toward orthograde root canal therapy whenever possible, since it involves removing the entire contents of the pulp and minimizes the likelihood of possible future pain and infection by not leaving to chance whether remaining pulp maintains its vitality. However, orthograde root canal therapy may not be an option for young teeth, as they lack a closed apex. In the past, it was a rule of thumb that vital pulp therapy be performed within 48 hours of pulp exposure in dogs older than 18 months of age and within two weeks in dogs younger than 18 months of age. However, the sooner vital pulp therapy is performed after pulp exposure, the better the chance of success. Therefore, even when a patient is younger than 18 …
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Seven options to provide life-saving oxygenMarch 28, 2019There is arguably nothing more heart-wrenching than a patient who is suffocating. How you handle these patients could be the difference between life and death. Some colleagues can be hesitant to admit these patients and may advise clients to take them to an emergency or referral facility that may be much farther away. It doesn't have to be that way. Short-term, there really is no risk to oxygen therapy. So even if the disease process were not oxygen-responsive, there is no harm in providing therapy while you figure things out, assess the severity of the disease, and obtain diagnostics. Providing oxygen is an easy way to buy time. Empower your nurses to start some sort of oxygen therapy when your patient is exhibiting any of the following situations: • dyspnea of any kind; • shortness of breath; • abnormal respiratory sounds; • cyanotic gums; • severe anemia or hemorrhage; • increased respiratory rate; • head trauma; and/or • lateral recumbency. Although arterial blood gas analysis would be the most accurate way to assess pulmonary function, it is rarely available in general practice. Pulse oximetry is a cheaper and more available option. You …
Stoner news: Struvite diets for cats and dogsMarch 28, 2019While struvite uroliths may in some cases require surgical intervention, the recommended standard of care by the American College of Veterinary Internal Medicine (ACVIM) is medical dissolution with a therapeutic diet formulated to alter urine acidity and encourage water consumption. Dietary dissolution of struvite stones is both effective and inexpensive. Therapeutic diets limit calculogenic compounds (e.g. phosphorus and magnesium) and acidify urine. That makes the urine a less welcoming environment for stone formation and dissolves stones that are present. Concerns medical dissolution places pets at risk of urethral obstruction are not borne out by the literature, according to the ACVIM consensus statement, published in the Journal of Veterinary Internal Medicine (JVIM) in 2016. Dietary management itself has changed as well. The shift from struvite-only dissolution or prevention diets to combination struvite dissolution/prevention and calcium oxalate prevention diets is the biggest change in management of these uroliths, says Cailin Heinze, VMD, Dipl. ACVN, assistant professor of nutrition at Cummings School of Veterinary Medicine at Tufts University. Causes differ Struvite uroliths occur in both dogs and cats, but have different causes. In dogs, struvite stones—the most common type seen—develop almost exclusively as a result of urinary tract infections (UTIs) caused by …
Asymptomatic bacteriuria—To treat or not to treat?March 28, 2019Veterinarians and pet owners are highly motivated to find discrete, fixable problems when pets are unwell. Owners want the reassurance and sense of control that comes with knowing what the problem is and taking action. Veterinarians want to help our patients, while also satisfying clients. Their expectation is that we offer some clear preventive or therapeutic intervention justifying their time and the expense of coming to see us, as well as reassure them about their pets' condition. Finally, our medical training often emphasizes diagnosis and treatment as the core responsibility for a doctor; the importance of knowing when not to take action is frequently underemphasized.1,2 Such inherent bias toward finding and treating problems creates discomfort and resistance when scientific evidence suggests we should avoid some tests or treatments. Though there is widespread awareness of the risks of overdiagnosis and overtreatment in human medicine, these are relatively new and controversial concepts in the veterinary field.3,4 My own efforts in this column and elsewhere to suggest we might sometimes do better not to run a test (e.g. pre-anesthetic bloodwork)5 or prescribe a treatment (e.g. lysine)6 have generated the kind of pushback often greeting such suggestions. Nevertheless, we have a responsibility to …
Laser therapy—Indications and contraindicationsMarch 27, 2019Photobiomodulation—a.k.a laser therapy—has become commonplace in veterinary medicine, with knowledge gained over the last eight to 10 years coming from evidence-based data and shared clinical experience. Achieving predictable and reproducible results with laser therapy is dependent on properly managed treatments, proper dosing, effective use of therapy laser hardware and software, and appropriate treatment technique.1 Low-level laser therapy (LLLT) applies low-level (low-power) lasers to the surface of or in orifices of the body. Whereas high-power lasers are used in laser medicine to cut or destroy tissue, application of low-power lasers is said to relieve pain or stimulate and enhance cell function. Laser therapy is a unique and extremely gentle form of treatment with the ability to stimulate tissue healing, virtually without side effects. It is very different from laser surgery, as it avoids heating the tissue, which can cause cell and tissue damage. As such, photobiomodulation is often called "cold laser" therapy.2 What's it for? Laser therapy has been postulated to exert three main effects: reduction of pain, modulation of inflammation, and acceleration of healing.3 The primary categories with the strongest support—largely via experimental studies—include its use in pain, wounds, musculoskeletal conditions, neurologic pathology, and in conjunction with complementary medicine techniques …
Nationwide members paid $119 million to treat their dogs and catsMarch 21, 2019Nationwide members spent $119 million in 2018 to treat their dogs and cats. The pet health insurance company analyzed its database of more than 725,000 insured pets to determine the top 10 most common conditions that prompted veterinary visits. "Pet owners are encouraged to schedule regular medical checkups as recommended by their veterinarians to prevent many common, yet problematic medical conditions," says Nationwide vice president and chief veterinary officer, Carol McConnell, DVM, MBA. "Early detection can be key. The majority of medical conditions on the top 10 list can be successfully managed if treated promptly by a veterinarian." The following conditions affect dogs and cats the most, according to Nationwide: Dogs 1) skin allergies 2) ear infection 3) noncancerous skin mass 4) diarrhea/intestinal upset 5) skin infection 6) vomiting/upset stomach 7) arthritis 8) dental disease 9) anal gland inflammation 10) bladder urinary tract disease Cats 1) bladder/urinary tract disease 2) dental disease 3) chronic kidney disease 4) vomiting/upset stomach 5) diarrhea/intestinal upset 6) excessive thyroid hormone 7) upper respiratory infection 8) skin allergies 9) diabetes 10) heart valve malfunction
Talking the talk—What to say when clients prefer raw dietsMarch 21, 2019One only needs to pay attention to the news or trending items on Facebook to see the spate of pet food recalls happening in our country. And with an uptick of pet parents feeding their dogs raw or freeze-dried raw food, it is important veterinarians have honest and open conversations with their clients about concerns surrounding these diets. The following is American Veterinary Medical Association's (AVMA's) position statement on raw diets: "AVMA discourages the feeding to cats and dogs of any animal-source protein that has not first been subjected to a process to eliminate pathogens because of the risk of illness to cats and dogs, as well as humans." Katy Nelson, DVM, medical director of Pet Health for Stop Aging Now, agrees. "Cooking or pasteurization through the application of heat until the protein reaches an internal temperature adequate to destroy pathogenic organisms has been the traditional method used to eliminate pathogens in animal-source protein, although the AVMA recognizes that newer technologies and other methods, such as irradiation, are constantly being developed and implemented," Dr. Nelson says. "Most veterinarians are going to listen to the governing body of our profession, as well as the Centers for Disease Control (CDC) and …
Keep more flea and tick preventive purchases in-clinicMarch 20, 2019When pet owners needed to purchase parasite control products, they traditionally went to their local veterinarian. However, the influx of retail businesses (both online and brick and mortar) competing in this market has created a financial feasting frenzy on clinic profits. "We have moved from having a near monopoly on the sale of flea/tick products to the current situation where less than half of clients are now purchasing their flea/tick products from their veterinarian," says Lowell Ackerman, DVM, DACVD, an independent consultant, author, and lecturer. In most veterinary hospitals, pharmaceuticals represent 25 to 30 percent of revenue, according to Dr. Ackerman. As the bulk of that revenue comes from the sale of parasite control products, this "erosion" of sales is both significant and troubling. Reel 'em back in Reasons as to why pet owners have strayed beyond home base varies. Cost, convenience, and just not knowing the benefits of purchasing from their veterinarian are examples. When it comes to product pricing, veterinarians need to be competitive, but they don't need to be the low-price leader, according to Ackerman. "Clients see most noninjectable parasite control products as commodities, and it is easy for them to compare prices across different sources," …
DogsLife offers financial aid for canine cancer treatmentsMarch 20, 2019A new nonprofit is helping pet owners pay for canine cancer treatments by any board-certified veterinary oncologists in North Texas. The organization, DogsLife, selects recipients through an application and interview process involving the pet's owner and veterinarian, as well as the treating veterinary oncologist. The private charity is primarily supported by donations and all of the funds go directly to providing treatments to the dogs. Sir Desmond, a retired racing Greyhound, was diagnosed with osteosarcoma. As a result, the dog's veterinary oncologist recommended his leg be amputated. The price of surgery and chemotherapy was not in Sir Desmond's owner, Caitlin Schmidt's budget, so she applied for assistance from DogsLife. The charity covered half of the surgery and all of the chemotherapy costs. "I cannot really put into words what the phone call meant to me when I was told DogsLife was providing a grant to help pay for all the overages for Desmond's treatment that I simply could not afford," Schmidt says. "Desmond had his amputation surgery and is beginning his chemotherapy."
Trust, education can build vaccine complianceMarch 18, 2019Can people control their exposure to whatever virus du jour is making the rounds? No—and that's the point veterinarians should stress among vaccine-wary clients, says Tony Rumschlag, DVM, director of consulting veterinarians, companion animal at Elanco Animal Health. "We cannot in all circumstances control our pets' exposure to disease," he says. "We can help prevent disease in our beloved pets by simply following an appropriate vaccination protocol." As in human medicine, some veterinary clients are expressing concern over the necessity and safety of vaccines for companion animals. "Because some of the diseases we vaccinate against are not as prevalent as in the past, both on the human and animal side, people start to lose sight of the value of vaccines," Dr. Rumschlag explains. "When vaccination rates decrease, these diseases tend to reappear. And I understand how pet owners can forget the extent of parvo and distemper cases we saw in the 1980s and early '90s." Rumschlag says that while there is a lot of science backing the safety and value of vaccines, many of the concerns about them are based more on emotions. "Veterinarians who have treated dogs infected with preventable diseases, such as parvo and distemper, need to …
