Ultrasound and telemedicineMay 27, 2019Don't just send him an ultrasound image and think he'll do business with you. "I will not read ultrasound images unless I've taught the person through doing the ultrasound," said Anthony J. Fischetti, DVM, MS, DACVR, department head of diagnostic imaging at the Animal Medical Center in New York, and president of Veterinary Ultrasound Society of the American College of Veterinary Radiologists (ACVR). "If I'm just reading still images from someone I haven't trained, I won't read them. I won't take their money, I won't try to make a diagnosis, and I kind of wish my colleagues would do the same," Dr. Fischetti said. Why? There's just too much to get wrong, he said. "You can make so many things look abnormal with ultrasound if you don't know the orientation of the probe or how the image was made," Fischetti said. In human medicine, often a relationship is already developed between those performing the ultrasound and the radiologist, so there's a level of trust and comfort. "We're just not there with veterinary medicine yet, and I'm personally against most telemedicine ultrasound," Fischetti said. Building relationships to improve trust and communication is also of utmost importance for Nathan C. Nelson, …
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Gathering vital patient information with ultrasoundMay 27, 2019Anthony J. Fischetti, DVM, MS, DACVR, department head of diagnostic imaging at the Animal Medical Center in New York, had just finished his shift. It had been an odd day; two dogs that had turned yellow had been brought into the clinic. The first patient, an older dog, had a tumor at the entrance of the gall bladder into the intestines—a common bile duct obstruction. The second patient had collapsed, experiencing diarrhea and vomiting. "I used the ultrasound to diagnose that it wasn't the liver," said Dr. Fischetti. "It turned out the dog was hemolyzing." An old, corroded coin in the dog's stomach was causing zinc toxicity. Thanks to the ultrasound images, the endoscopist retrieved the coin and the dog improved. Fischetti, who also is president of Veterinary Ultrasound Society of the American College of Veterinary Radiologists (ACVR), as well as other experts, say ultrasound is a safe and simple way to get more information on ailing patients. "I think the real value of ultrasound is its noninvasive nature," said Nathan C. Nelson, DVM, MS, DACVR, a clinical associate professor of radiology at the North Carolina State University College of Veterinary Medicine. Why use ultrasound? Key considerations for adding …
Four bold questions about hand asepsisMay 24, 2019Hand asepsis is one of the most critical components of surgical asepsis to lower the risk of nosocomial diseases. In this column, we answer four critical and bold questions related to hand asepsis. Could you lose your driver's license by scrubbing in? With the emergence of alcohol-based hand-rub solutions (ABHRS), you may be concerned that with repeated use, you could have enough alcohol in your bloodstream to lose your driver's license. Alcohol is indeed absorbed through the skin, and you inhale plenty of it while scrubbing (or "rubbing"). So could a breathalyzer test be positive? A 2006 Australian study1 looked at 20 health-care workers and their use of ABHRS repeatedly over a short period of time: 30 applications in an hour! Then serum and breath ethanol and isopropanol absorption were assessed. Traces of ethanol were detectable in the breath of 30 percent of subjects at one to two minutes after application and in the serum of 10 percent of them at five to seven minutes postexposure. Serum isopropanol levels were undetectable at all time points. Even though ethanol did have a positive result, whether through cutaneous absorption or inhalation of fumes, neither level would be considered positive during a police-issued …
Cone-beam computed tomography in dentistry and oral surgeryMay 24, 2019Computed tomography (CT) has revolutionized our ability to detect subtle hard and soft tissue abnormalities of the maxillofacial region. Cone-beam computed tomography (CBCT) is creating much buzz amongst veterinary dentists when it comes to dental/maxillofacial diagnostic tools. What is the difference between CBCT and conventional CT? Rather than a collection of thin, closely spaced slices obtained with a fan-shaped beam of conventional CT, CBCT has both an X-ray generator and detector that rotates around the patient, capturing data with a cone-shaped beam. Both modalities can be used to create very helpful 3-D reconstructions of the areas of interest, although CBCT provides increased detail of dentoalveolar structures. One veterinary study compared CBCT's diagnostic image quality with that of 64-multidetector row CT sagittal slices. Four blinded evaluators compared CBCT and 64-multidetector row CT images. Trabecular bone, enamel, dentin, pulp cavity, periodontal ligament space, lamina dura and "overall impression" were scored. Images captured with CBCT were found to be significantly superior in image quality when compared to images acquired with 64-multidetector CT in all categories.1 Inka, the jaguar My first experience with CBCT was with a patient from the Elmwood Park Zoo in Norristown, Pa. Inka is a five-year-old jaguar that fractured …
Tailoring vaccine protocols to benefit the patient and practiceMay 22, 2019More and more pet owners are starting to question veterinarians and their staff about the need for vaccinating their pets due to misinformation on the internet, as well as sensationalized stories about pets who may, or may not, have experienced a vaccine reaction. Those in opposition of vaccines are passionate about their views, while those in favor are equally vehement on the subject. Is one side right and the other wrong, or is there common ground to be found? Likely a little of both. Not all is yet known about the immune system, and there is still research that needs to be done. As such, recommendations offered today are based on current information, with the full knowledge they could change in the future. Not what they used to be Vaccines were developed to help prevent infectious disease, which they do, and vaccine technology has advanced tremendously since the inception of vaccinology. Vaccine opponents often argue ingredients such as adjuvants (e.g. aluminum, mercury, formaldehyde, and foreign proteins) are reasons to not vaccinate, as they can be the cause of adverse advents. This was true in the past; however, many vaccines have been "purified" over the years through the removal of …
Is fear driving the anti-vaccine movement?May 22, 2019Vaccines are one of the most effective means for preventing disease ever developed and one of the great triumphs of scientific medicine. Widespread vaccination of children has dramatically reduced—and in some cases eliminated—infectious diseases that have plagued humanity for thousands of years. There is less research evidence for the impact of vaccination in companion animals, but there is ample reason to believe vaccines have been equally successful in dogs and cats.3–7 Any veterinarian old enough to remember the emergence of canine parvovirus (CPV) in the U.S. in the late 1970s, for example, would probably testify to the efficacy of vaccination in reducing the incidence of this disease.5–7 There also is compelling evidence showing the reduction of both canine and human rabies cases due to vaccination programs aimed at dogs.8–12 And similar to smallpox, the veterinary disease rinderpest was eradicated largely due to the use of an effective vaccine.13 Vaccines and autism Despite the evident success of vaccination in reducing morbidity and mortality, there has always been controversy about the practice.14 The introduction of widespread vaccination in children was initially met with resistance and legal challenges. There was fear about the safety of vaccines, as well as resistance rooted in …
Covetrus signs deal with Mars Petcare for exclusive dental health and medication productsMay 8, 2019Covetrus is now the exclusive supplier of Mars Petcare's Greenies Dental Treats and Pill Pockets. The deal allows veterinarians to purchase the products for both their in-clinic and ecommerce/auto-ship channels, helping to differentiate themselves from online competitors. "With our customer reach, differentiated go-to-market strategy, and our industry-leading service organization, Covetrus is uniquely suited to partner with Mars Petcare to drive increased adoption of dental health solutions and medication administration tools for our customers and their clients," says Matt Leonard, Covetrus's executive vice president, president of North America and global supply chain officer. "This new partnership highlights the opportunity we have at Covetrus to continuously help support veterinarians deliver cost-effective solutions and enhance their client experience." Both Greenies Dental Treats and Pill Pockets are designed to simplify oral care and medicating solutions for pet owners.
Experts weigh in on ear examsMay 7, 2019Ears. They're the bane of veterinarians and clients alike, not to mention the dogs and cats who must contend with itchy or painful ear conditions caused by environmental and food allergies, bacteria and yeast overgrowth, mites, foreign bodies, trauma, tumors, or polyps. Ear problems can spring from many different sources. That makes it essential to conduct a thorough exam, be familiar with some of the other disorders that can lead to ear problems, and know what to ask owners to bring out clues to the cause. Itch triggers Allergies are probably the number one cause of ear inflammation. Once ears become inflamed, secondary infections caused by overgrowth of normal populations of bacteria or yeast in the ear typically follow. The result is exudate, pain, and worsening inflammation. Young animals in multipet households or hoarding situations may pass ear mites (Otodectes cynotis) back and forth, especially if they aren't on a monthly preventive, are fed a poor diet, or are sick. Demodex canis is another mite that can affect young or old animals who are immune-suppressed. Less commonly, endocrine diseases (e.g. Cushing's or hypothyroidism), as well as certain autoimmune disorders, can cause ear problems. Take hypothyroidism. "Those dogs commonly will have …
New CAPC study shows Lyme disease is spreadingMay 7, 2019Research from the Companion Animal Parasite Council (CAPC) indicates seroprevalence of Lyme disease in dogs is not only increasing in the Northeast, where it is considered endemic, but also spreading into areas that were previously thought to not be at risk for this serious, zoonotic tick-borne disease. ("Seroprevalence" in this case refers to the prevalence of dogs exposed to Borrelia burgdorferi, the pathogen responsible for causing Lyme disease in the U.S. based on serologic tests—hereafter referred to as "prevalence.") Study results were published in the December 2018 issue of Environmetrics, the official journal of The International Environmetrics Society (TIES). This milestone study, titled "A Large-scale Spatio-temporal Binomial Regression Model for Estimating Seroprevalence Trends," suggests canine prevalence rates for Lyme disease are rising and that those rates are increasing most in areas where the pathogen has recently encroached. Specifically, exposure in dogs to B. burgdorferi is rising in states not traditionally considered to be areas of high Lyme risk. Significant increases in the percentage of dogs testing positive for exposure have also been seen in areas that have not yet reported significant human incidence. These findings suggest canine Lyme prevalence could serve as an early warning system for changes in …
Getting to the root of pyodermaMay 7, 2019Scaling, hair loss, papules, pustules, and epidermal collarettes. All are clinical signs pointing toward canine pyoderma. The culprit may seem clear at first glance; however, veterinarians must look at the bigger picture to address the underlining issue. It's important to first understand the meaning of pyoderma, particularly regarding the depth of infection, says Elizabeth Layne, DVM, Dipl. ACVD, clinical instructor at the University of Wisconsin-Madison, School of Veterinary Medicine. The most common form of pyoderma is superficial bacterial folliculitis, a bacterial infection of the upper part of the hair follicle, caused by Staphylococcus pseudintermedius. Deep bacterial infections (presented as swelling, nodular lesions, and oozing draining tracts) can occur, but that is a different diagnostic and therapeutic approach, Dr. Layne adds. Superficial bacterial pyoderma is almost always secondary to some kind of skin abnormality, such as atopic dermatitis. Other skin diseases (e.g. flea allergy dermatitis, sebaceous adenitis, or primary seborrhea) can also result in superficial pyoderma, Layne notes. Systemic illness or immune compromise may lead to superficial bacterial pyoderma as well. Since pyoderma commonly masks another condition, a vicious treatment cycle can ensue if the underlining problem isn't identified. "Veterinarians often recognize the signs of infection and treat with antibiotics …
