Is It Who Pulls The Trigger?April 6, 2012 (Note: Due to the recent disturbing report of Nick Santinos’ suicide after euthanizing his pit bull, Rocco, I have reissued this blog from last year…) You may have heard it before, the reasoning that guns do not kill people, the people who pull the trigger do the killing. That’s pretty black and white in this instance…a gun sitting in a drawer or under a pillow isn’t going to go hurt someone on purpose; it’s not a living thing with thoughts, actions, and reactions. So what about a parallel, but altogether different, issue of banned dog breeds? Yes, we all know that it’s becoming more commonplace for laws to be discussed and passed that ban certain dog breeds of notably bad reputations, such as pit bulls. On the one hand, you may know a person or family member who has suffered due to a dog attack. On the other hand, I have never met a more loyal group of dog lovers than owners of pit bulls, and they would never trade their breed for any other! They argue that like guns, it’s the people who own the dogs that are calling the shots and have the responsibility …
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Pelvic Limb Lameness: Palpate Early And OftenApril 5, 2012 Contrary to popular perception, not all pelvic limb lameness in dogs is joint-related, i.e., a “bad hip” or a “blown cruciate.” Definitive diagnosis is crucial, especially before pursuing surgery for the presumptive problem.1-5 Advanced imaging can help, as can arthroscopy, but neither method reveals soft tissue pain as a common source of the tension and altered gait in dogs. Only hands-on touch and informed palpation can “image” this source of discomfort and possible precursor to cruciate rupture. In light of this uncertainty of why a dog unweights a limb or displays caudal end weakness,6 clients who call a referral center for an evaluation are surprised when the receptionist asks them to set aside a surgery date.7 Even with a busy cutting schedule, why wouldn’t an orthopedic practice consider conservative care first? Tragically, some caregivers have complained of having to choose between only two options: costly reconstructive surgery or euthanasia. These caregivers are browbeaten into believing that if they refuse surgery, their dogs will without question suffer painful debilitation from arthritis.8 Is there not a kinder, gentler way? Different Viewpoints …
The Case Of The ‘Tummy Tuck’ I Just Couldn’t Get PastMarch 21, 2012 If I hadn’t seen it for myself, I wouldn’t have believed it. A pre-vet student who works for me finally wore me down and convinced me to Google it. That’s when I settled in with my morning coffee to watch a 30-minute video on the merits and how-tos of “tummy tucking” for cats. Tummy-tucking? Seriously? Apparently. And it was awful (as you might have expected it would be). In this case, undertaken in a mobile surgical unit on what appeared to be a middle-aged domesticated shorthair female with an average-sized “belly pooch,” the cat was subjected to a 30-minute procedure dedicated to removing as much subcutaneous fat as possible. Horrible. More so when you consider that one of the major complications with liposuction (done in humans with “lipo-wands” designed for the task) is the potential destruction of blood supply to the overlying skin and, therefore, full-thickness skin necrosis. This complication is rare when the procedure is performed correctly, seeing these wands are specifically designed to leave major vessels intact. But in the cat and dog (distinct from humans) the blood supply to the overlying skin is even more tenuous. While humans have multiple musculocutaneous vessels scattered …
For ToboMarch 21, 2012 Like many service members returning from war, Army Capt. Sam Wilson brought back from Iraq mental images and experiences that made home life a struggle. The love of his wife and pets helped ease his transition, but still there were flashes of anger that sent him searching for solutions. One solution was named Tobo. The German shepherd came into his life after his wife, Kris, suggested he answer an ad in the paper. “I think she just knew I needed that companionship,” recalled Wilson, now a statistician for a clinical research organization. “You know how you can have lots of pets but there’s always one that holds a special place for you? Tobo is that one for me.” So after watching Tobo, now 8, lose mobility and suffer through the pain of hip dysplasia, arthritic inflammation and degenerative joint disease, Wilson was excited to get a phone call last fall from the family’s veterinarian, Chuck Miller, DVM, a partner at Triangle Veterinary Hospital in Durham, N.C. Prime Candidate Dr. Miller, who in June will mark his 20th anniversary as a veterinarian by continuing to practice at a clinic that has been around since …
A Tetraplegic Recovers Without SurgeryMarch 6, 2012 Kelvin, a 50 pound, 4-year-old female spayed Husky mix was in bad shape. She presented with progressive weakness in all four limbs. Her recent history included a mild bout of diarrhea, which was (still) treated with 500 mg metronidazole BID. The day the dog was referred for an MRI, she was unable to walk on all four limbs. There was no obvious cervical spinal pain and she was tetraparetic (i.e. weak and unable to stand or walk). She appeared tense all over her body and “nervous” or “stressed out.” Blood work was unremarkable. The rest of the physical exam, including heart auscultation, was normal, except for obesity (body condition score of 5/5). A cervical spinal MRI was performed. The radiologist, who read the pictures in real time, deemed the scan normal. Therefore, an MRI of the brain was performed. It was normal, as well. The dog was referred to an internist. The diagnosis was central vestibular disease due to… metronidazole toxicity. Full disclosure: This patient was not mine, but I thought it was an interesting case that was well worth a quick review of metronidazole toxicity to avoid “getting caught.” The important thing to …
Cracking Fevers Of Unknown OriginFebruary 13, 2012 Fever can indicate infectious, inflammatory, immune-mediated or neoplastic disease. Typically, a physical examination and medical history lead a practitioner to a fever’s cause. Or the fever resolves serendipitously or in response to antibiotic therapy. But in some cases, the underlying cause of the fever is not readily apparent. These patients are said to have a fever of unknown origin (FUO). In 1961, the acronym FUO was coined by medical doctors Robert Petersdorf and Paul Beeson and defined as a temperature greater than 101 degrees Fahrenheit on several occasions, illness for more than three weeks and failure to reach a diagnosis despite one week of inpatient investigation. According to the Merck Veterinary Manual and veterinary specialists, this syndrome has no recognized definition in veterinary medicine, making its prevalence difficult to determine. “FUO is common in both species [canine and feline], although underlying causes can be quite different,” says Craig Webb, DVM, Dipl. ACVIM, Ph.D., MS. “Unfortunately, these cases often require that we try to rule out almost everything,” continues Webb, an associate professor of internal medicine at Colorado State University’s College of Veterinary Medicine and Biomedical Sciences. “So after the history and physical examination we …
With Thyroid Replacement, Consistency MattersJanuary 30, 2012 Everyone is aware of the economic challenges facing veterinary practices today: Visits to the veterinarian are down, and clients are getting concerned about some pet care costs. Some are even selecting alternate resources, including online pharmacies, and requesting prescriptions to have medications filled at human pharmacies at a lower cost. Practice managers or buyers might try to economize by going for the least expensive option when purchasing medications to stock for the clinic pharmacy, to help offset some of these concerns. Medically speaking, if veterinarians are dispensing human generic products in certain categories, there may not be a big difference in the actual product, but this is not the case for every prescription. Educate your staff and clients about when quality and consistency count, such as with thyroid replacement therapy. Overall, some aspects of hypothyroidism in dogs are fairly straightforward and simple. Most cases arise from irreversible acquired thyroid gland disease, due to either immune-mediated lymphoid thyroiditis (a heritable trait) or idiopathic follicular atrophy (normal thyroid tissue is replaced by connective and adipose tissue). In the immune-mediated form, there is a chronic, progressive lymphocytic destruction of the thyroid gland with a slow onset. Auto antibodies …
Considerations For Canine Rehab ProtocolsJanuary 30, 2012 The young and burgeoning field of canine rehabilitation is changing the way dogs recover from injury and surgery, with rehabilitation centers springing up across the country. The outmoded approaches of yesteryear, wherein animals were kept inactive through cage confinement or unmitigated pain, are disappearing in favor of more enlightened approaches adopted in human rehabilitation decades ago. Veterinarians now look for more than just a good surgical outcome, seeking earlier return of neuromuscular control and function through active engagement of both the patient and client. Rehabilitation procedures typically practiced on dogs include underwater or land-based treadmill exercise, passive range of motion and stretching movements, electrical stimulation, therapeutic ultrasound, proprioceptive training techniques, massage or other manual therapy maneuvers, swimming and more, depending on the inclinations and training of available therapists. What Studies Show Although evidence is emerging in both human and veterinary physical therapy, human physical therapists and canine rehabilitators alike readily acknowledge the dearth of high-quality, randomized, controlled and sufficiently powered trials, individually evaluating each component of a multifaceted rehab protocol. Such studies would lend insight into the relative value of each modality and provide answers to persistent questions concerning rehabilitation. For example, some studies …
The Epulis: What’s In A Name?January 25, 2012 Practitioners and technicians in general practice are on the front line of diagnosis. Early detection of oral tumors improves outcome. Gingival masses may result from neoplastic, hyperplastic, inflammatory or infectious causes. Any mass arising from the gingiva may be correctly referred to as an “epulis” (plural is “epulides”). However, the term “epulis” has been adapted in veterinary nomenclature to describe specific gingival tumors arising from periodontal ligament cells, including acanthomatous, fibromatous and ossifying epulides. In recent years, the nomenclature for these odontogenic tumors has changed. Fibromatous and ossifying epulides are now often referred to under the same heading of “peripheral odontogenic fibromas.” Based on histological appearance, acanthomatous epulis is now referred to as “canine acanthomatous ameloblastoma.” This article describes a clinically rational approach to gingival masses noted during conscious oral examination. 1. Start with a thorough oral examination On conscious oral examination, look for clues of whether the gingival mass is neoplastic, hyperplastic, benign or malignant. Is it well-circumscribed? Is there evidence of mobile or displaced teeth in the area? Mobile teeth are more commonly seen with malignant neoplasms due to aggressive root resorption, whereas benign neoplasms cause slow movement of teeth …
How To Test, Interpret Thyroid FunctionJanuary 16, 2012 Hypothyroidism is the most common endocrine disorder of dogs. More than 80 percent of cases result from autoimmune thyroiditis, the heritable autoimmune disease that progressively destroys the thyroid gland. Classical clinical signs of hypothyroidism only appear once more than 70 percent of the gland is destroyed. Accurate diagnosis may be difficult because thyroid dysfunction produces a wide range of clinical signs, many of which are subtle and mimic those of other causes. Hyperthyroidism is a common endocrine disorder of older cats. Diagnosis can be confounded by concurrent kidney, gastrointestinal and liver disease, as total T4 concentration can be suppressed into the normal reference range. To facilitate diagnosis of thyroid disorders, veterinarians need to routinely employ more complete thyroid profiles, and there is a need to balance affordability with accuracy. Testing Overview Total T4: Measures bound (> 99 percent) and unbound (< 1 percent) circulating T4. While T4 is the most widely used initial screening test for thyroid disorders, relying on this test alone is a primary reason for the misdiagnosis of canine and feline thyroid disorders. T4 concentration is affected by non-thyroidal illness (NTI) and certain medications (e.g. phenobarbital, corticosteroids and sulfonamides), …
