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 …
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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 …
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," …
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 …
Osteosarcoma: Beyond amputation and euthanasiaMarch 12, 2019When a patient is diagnosed with osteosarcoma, we tend to focus on three options: • the "gold standard," i.e. amputation with or without chemotherapy; • what many call palliative care, meaning pain medication and rest; or • euthanasia. But what if amputation is not an option? What if chemotherapy or radiation is out of the owner's financial capabilities? Or a couple of medications are not enough to numb the pain? What if visible metastasis to the lungs is already present? Bob Stein, DVM, pain management guru and founder of the Veterinary Anesthesia & Analgesia Support Group (www.vasg.org), recently shared another valid option.* "With my suggested approach, we can often provide quality of life to even large-breed dogs for six to 12 months and sometimes more than 20." Let's detail Dr. Stein's protocol. Pamidronate Pamidronate, a bisphosphonate, is an injectable drug that is inexpensive and easy to administer (ref: TM Fan et al. JVIM 2007). It helps to reduce pain (in 30 to 50 percent of patients), inhibit bone osteolysis, and has potential cancer-suppression effects by impeding proliferation and inducing apoptosis. The drug has a wide safety margin and can even be used on patients with renal or …
Getting to the bottom of root canal therapyMarch 8, 2019Anyone who has tried to extract a firmly rooted mandibular canine tooth in a dog or cat has likely muttered the phrase, "There's got to be a better way," (amongst other muttered phrases!) while performing the frustrating procedure. In some cases, there is indeed a better way. Although root canal therapy is not an option for every diseased tooth, it is an elegant way to treat dead teeth and teeth with pulp exposure. Terminology, development, and anatomy Endodontics refers to the study and treatment of the inside of the tooth (pulp) and periapical tissues, the latter of which are located around the tip (apex) of the tooth root. The pulp consists of nerves, blood vessels, lymphatics, and connective tissue. Pulp tissue is found in the pulp chamber of the crown and the root canal of the root. The pulp communicates with the periapical tissues through numerous small openings in the apex of the tooth root called the apical delta. Dental pulp is important for the development of the tooth in a young animal. Cells called odontoblasts continually produce dentin internally throughout the tooth's life. This makes the walls of the root and crown thicker. Recently erupted teeth have walls that …
Is banning "artificial" ingredients based on fear or science?March 1, 2019Since the late 1980s, individuals and organizations have been trying to warn the public about a deadly chemical known as dihydrogen monoxide (DHMO). Though widely used in the home and in commercial settings, including the health-care industry, this substance has been shown to cause severe lung damage and even death when inhaled in small quantities. Hundreds of thousands of people die annually from this cause.1 DHMO also can produce electrolyte disturbances and potentially fatal neurologic symptoms when taken orally, and it can cause severe burns and even explosions when heated.2 A number of surveys have found high levels of support for banning DHMO, and elected officials in several countries have explored taking such action, although DHMO remains ubiquitous.3,4 Given the obvious dangers of this chemical, why do public health agencies not take action to restrict it? It is possible that funding and political influence from industry impede regulatory action. However, it is more likely that governments have chosen not to ban DHMO because it is essential for life. Most people are surprised to learn this until they recognize the nontechnical name for this chemical—water. Is "chemical" a dirty word? The campaign against DHMO has been used as a humorous …
SAGE partners with San Francisco ophthalmology clinicsFebruary 26, 2019SAGE Veterinary Centers, a specialty and emergency veterinary organization, has added two new partner locations to expand its services and provide patients with better specialty care. The organization has partnered with Veterinary Vision, a provider of ophthalmology treatment in the San Francisco Bay area. Its clinics in San Carlos and San Francisco treat more than 3,100 patients and perform over 12,000 examinations annually. According to Veterinary Vision's Cynthia Cook, DVM, PhD, incorporating ophthalmology into the specialty services provided at SAGE Centers will allow optimized outcomes for ophthalmic emergencies, coordinate care for patients presenting with ocular manifestations of diseases affecting other organs, and coordinate complicated patient management with anesthesia and surgery departments when needed. "SAGE and Veterinary Vision are uniquely aligned in cultural values," said Gina Del Vecchio, SAGE chief executive officer. "People are our most important asset, and we are both delighted and honored to welcome the doctors and staff of Veterinary Vision into the SAGE family."
