The Changing World Of Veterinary Anesthesia Guidelines And MonitoringMay 2, 2012 UPDATE: AAHA released its anesthesia guidelines in early November. The American Animal Hospital Association is poised to release the first-of-its-kind small animal anesthesia guidelines. A task force comprising six board-certified veterinary anesthesiologists and a certified technician specializing in anesthesia created the approximately 10-page document in an 11-month timeframe. The AAHA guidelines is an all-inclusive, easily digestible document created for use by the entire veterinary team. With expanding anesthesia capabilities for the profession, Jason Merrihew, associate public relations manager at AAHA, says the association recognized the need to develop guidelines for veterinary professionals. He attributes the multitude of factors to consider when sedating or anesthetizing a healthy dog or cat, as well as the pet with one or more medical conditions a leading incentive. “AAHA’s guidelines include information on pre-anesthesia bloodwork, examination, equipment, staffing recommendations, monitoring from induction through recovery, pain management, drug choices, drug combinations, what drugs to use according to patients’ age, body type and temperament,” says Richard Bednarski, DVM, Dipl. ACVA, associate professor (anesthesia) at The Ohio State University in Columbus and chair for AAHA anesthesia guidelines. “These guidelines differ from the American College of Veterinary Anesthesiologists’ (ACVA) anesthesia monitoring guidelines because their …
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Keeping Hospice In Veterinary HandsMay 2, 2012 Our focus with this article is on people who compulsively collect old or sick animals and proclaim themselves operators of pet hospice homes or sanctuaries. Unfortunately, most of these self-proclaimed hospice workers use little to no veterinary medical supervision. Their collected animals suffer to death without proper pain management, comfort care or the human-animal bond. They might have started out as good Samaritans, working alone or with a group, rescuing animals and keeping a few, then a few more. Over time, they develop a strong urge to “save” more old and sick animals that were “abandoned.” That urge develops into a compulsive disorder. They collect more and more old, sick and special-needs animals. When their animals die, they exhibit tearful distress, blind denial or experience a pathological enlightenment. Their compulsiveness to collect more animals winds up harming their animals, themselves, their neighbors and their communities. A certain percentage of compulsive collectors of sick and old animals can maintain their operations for a time. But eventually many find themselves overworked, in debt, depressed and overwhelmed. The tipping point is when they acquire more animals than they can properly care for and house. Another tipping point into …
The Problematic Deciduous Canine ToothMay 1, 2012 I received a call from a referring veterinarian. He saw on his appointment book that a puppy was scheduled to have its four firmly rooted persistent deciduous canine teeth extracted. His 30-plus years of experience led him to conclude that firmly rooted deciduous canine teeth were among the most challenging extractions to perform. I agreed wholeheartedly. Looking for Answers What causes persistent deciduous teeth? To answer, we need to know what causes deciduous teeth to be normally shed. Resorption of permanent teeth is a pathological condition, but resorption of the deciduous tooth root is considered to be a physiologic process in which osteoclasts, osteoblasts and tooth-resorbing cells called odontoclasts work in concert to allow for resorption of the deciduous tooth root as the permanent tooth root moves into the area the deciduous root once occupied. As a result, the deciduous crown is shed. In cases where no permanent tooth is present, or if the permanent tooth is not in the correct location, the physiologic resorption of the deciduous tooth root does not occur at its regular time, and it may take years for the deciduous tooth root to resorb. Note that I used …
The Benefit Of Low Fat Pet Food In Dogs With GI DiseaseApril 27, 2012 Lipids are water-insoluble molecules that have many crucial functions in dogs. There are a variety of different lipids, but the only lipids that are routinely quantified in dogs are triglycerides and cholesterol. Hyperlipidemia refers to a state of abnormally increased blood concentrations of triglycerides, cholesterol or both. One indication for low-fat dietary intake in dogs with gastrointestinal disease is the management of dogs with hypertriglyceridemia with GI disease presumed to be due to or related to hypertriglyceridemia. The second indication is a group of dogs that have a normal serum triglyceride concentration, but have GI disorders resulting in difficulty to digest and/or absorb normal amounts of fat in pet food or dogs with lymphatic abnormalities. Hypertriglyceridemia is very common in dogs.1 In one recent study, 611 routine chemistry profiles in dogs performed at a private veterinary laboratory in Italy were evaluated and 33 dogs (5.4 percent) showed hypertriglyceridemia.1 Certain breeds have been identified as being much more commonly affected by hypertriglyceridemia. In a recent study of 192 healthy miniature schnauzers, 63 (32.8 percent) had hypertriglyceridemia.2 Definitive differentiation between primary or secondary hypertriglyceridemia is sometimes difficult, but is based on …
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 …
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 …
