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 …
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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), …
Is Early Neutering Hurting Pets?January 16, 2012Early neutering has become the norm in the U.S. Some states are asking voters to pass initiatives requiring citizens to sterilize their pets no later than puberty. Overpopulation is the driver. But what if large-scale studies found that early neutering jeopardizes the health of our pets? What if we found enough epidemiological evidence that early neutering of pet dogs may open them to orthopedic, behavioral, immunologic and oncologic issues? A veterinarian who treats canine athletes has raised questions about early neutering. In an opinion article, Christine Zink, DVM, Ph.D., Dipl. ACVP, weighs the advantages and disadvantages of early versus late neutering when considering the performance and health of canine athletes. The article, “Early Spay-Neuter Considerations for the Canine Athlete: One Veterinarian’s Opinion,” appears on Dr. Zink’s website. Click here to review the thought-provoking article and to look at the references. Zink assembled 18 references to support her article. Some show that dogs spayed or neutered early are taller than dogs spayed at an older age. Zink notes that sex hormones have a role in bone density. She concludes that the structural and physiological differences in dogs neutered early may be the reason veterinarians are seeing a …
Supplement Can Bolster Pets’ Anxiety TreatmentJanuary 5, 2012When it comes to pets, fears, anxieties and phobias are more common than most people realize. In people—at least some of them—logic and reasoning can be used to help that person understand that an object, noise or event is not as scary as it may seem. But for pets, their perception is their reality. No amount of discussion or psychotherapy can change their minds about a situation that seems threatening or dangerous to them. In a national online survey about anxiety in pets, nearly 40 percent of pet owners who responded say they have at least one pet that experiences anxiety.1 Possible contributing factors to anxious behavior may be a lack of proper socialization, some traumatic event, genetic predisposition, and even cognitive decline. As an animal ages, hearing and sight may be compromised, and with confusion or even discomfort from arthritis, that can result in a more stressed or anxious pet. Nearly a third of the owners who responded to the online survey say their pets’ fears and anxieties are “extremely or very” problematic, while 44 percent say it is “somewhat” problematic. And 70 percent say the anxiety their pet experiences occurs “fairly often” or “frequently.” It …
Let’s Regard End Of Life As A Distinct StageJanuary 4, 2012 While I discussed end of life (EoL) care with Dr. Don DeForge on Connecticut radio, an exciting idea flashed through my mind. We were finishing a 45-minute discussion when I said, “It is time for us to declare, once and for all, that end of life is a distinctly new stage of life. Veterinarians were taught to support four main stages of life. We were not educated to focus our professional attention and develop the skills and expertise for the very important and inevitable ‘End of Life Stage.’ “We need to provide more EoL services because society’s human-animal bond demands more care in this area despite the recession and fewer office visits.” The main life stages we are educated to support are: • Puppy and kitten stage • Adult stage • Senior stage • Geriatric stage I propose a fifth life stage, the End of Life Stage. It is the only life stage that can occur during the other stages. With luck, EoL may not impose itself on the kitten and puppy stage, but sometimes it does. Let’s start thinking about EoL as an inevitable life stage that deserves more focus and expertise in management. …
Brave New World In Veterinary MedicineNovember 30, 2011 North Carolina State University is the only university in the country to offer autologous bone marrow transplants (BMT) for dogs with lymphoma—one of the most common canine cancers. Steven Suter, VMD, MS, Ph.D., Dipl. ACVIM (Oncology), an assistant professor of oncology at North Carolina State University, has been performing the transplants since October 2008. He says that a 40-50 percent cure rate is reported in humans with B-cell lymphoma using the same procedure, although the canine data is still tentative. “When do you say a dog is cured?” Dr. Suter asks. “For people it is five years out [after the transplant procedure]. For dogs I estimate we can say two years after treatment is a success. In the first group of 24 dogs with B-cell lymphoma that we treated, eight are long-term survivors.” Suter started providing this service with the hope that the procedure could be perfected and performed in the specialty clinical setting. Since the inception of the project, Suter has continued to modify the protocol. Apply: The rehydrated graft is applied into a surgery site. If a surgery site is not very vascular, pre-mixing with patient blood is advised. “We …
Nutrition And Advanced Diagnostics Can Combat Parasite Plagues, Other GI ConditionsNovember 9, 2011 Primary care veterinarians and internal medicine specialists alike say gastrointestinal (GI) disease comprises up to 25 percent of their caseloads. Diagnosing and treating the array of chronic cases can be complex. With new pet foods created to prevent or maintain certain GI conditions, new in-house testing and diagnostic tools, more patients and clients can eliminate acute disease or minimize symptom flare ups in maintaining chronic cases. “Parasites, digestive disturbances and food allergies are the most commonly seen GI issues,” says Cade Wilson, DVM, of Carter County Animal Hospital P.C. Ardmore, Okla. “But giardia, GI cancer, GDV are other conditions that require more work to treat. Giardia could be difficult to identify before the new SNAP giardia test was developed and chronic conditions require diagnostic tools or surgery to identify.” Richard E. Goldstein, DVM, Dipl. ACVIM, Dipl. ECVIM, associate professor of small animal medicine at Cornell University, says SNAP tests such as the giardia and pancreatitis tests have brought testing in-house, minimizing missed disorders/diagnosis and expediting treatment. “It takes less than 10 minutes to get a result from SNAP tests,” Dr. Goldstein says. “The shelf life is good and they’re economical. They’ve improved patient care for …
