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 …
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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."
10 golden rules of cancer surgeryFebruary 20, 2019Surgery plays a critical role in the management of cancer. One significant advantage of surgery is a chance at an immediate cure—after a single session. No other treatment modality can offer that. Here are 10 rules that must be followed to ensure the best possible surgical outcome. Do the math: Surgery is only 10 percent of the entire story. What follows mainly pertains to skin masses, but it applies to any tumor, even intrathoracic or intra-abdominal. 1) Client communication Whenever a mass is discovered, it is important to take the time to prepare the client for the worst, while hoping for the best. Don't sugarcoat things. Don't make assumptions. Don't claim to have microscopic vision. Don't overpromise. Remember, for example, that a mast cell tumor is called "the great imitator" for a reason. It can feel like anything, including a lipoma. 2) Preop workup Even though we typically say you can't diagnose cancer by looking at blood work, it will occasionally show abnormalities, such as infection, hypercalcemia, or increased liver values. Staging the patient (i.e. determining the extent of the disease) is a mandatory part of the preop workup. Before surgery is ever considered, perform three views of the thorax …
Is there a gold-standard test for adverse food reactions?February 14, 2019Some of the most common conditions seen in small-animal practice are gastrointestinal complaints, such as vomiting and diarrhea, and skin problems, including pruritis.1 Among the many differential diagnoses for these symptoms are adverse food reactions (AFRs).
Before you change the diet…February 7, 2019Naughty Girl is a healthy six-month old terrier puppy who is being fed a complete and balanced commercial growth food. She lives with Bad Boy, a four-year old beagle-spaniel cross who is fed an adult maintenance dog food. Bad Boy is brought to your clinic for a two-day history of vomiting and acting sluggish (or punky). Your physical exam reveals some pain on abdominal palpation and a lab test for canine pancreas-specific lipase is "abnormal," suggesting an elevated lipase level. Your suspicion of pancreatitis is high and, after rehydrating the dog with fluids, you send him home on a fat-restricted therapeutic diet. Is a diet change warranted in this situation? Nutrition textbooks and veterinary nutritionists refer to dietary fat as a "nutrient of concern" or "key nutritional factor" when talking about nutritional management for patients with pancreatitis. However, before automatically switching a patient's diet, conduct a thorough nutritional assessment to get the whole picture of what's happening in the home environment. Performing a nutritional assessment involves collecting information about the patient, the diet, and feeding management (Baldwin, et. al. 2010). This is not a process that involves extra time or work—a nutritional assessment begins with routine information collected about …
How endodontic and restorative crown therapy can help grow your practiceFebruary 6, 2019With today's specializations, the general practitioner can find it a challenge to treat all aspects of a pet's health. Areas like dermatology, behavior, and especially dentistry have seen a dramatic reduction in the general veterinary practice. Referral to specialists is becoming more and more the option and for good reason. By the very nature of their work, specialists have an increased knowledge in their particular field, making referral to them a wise choice, particularly when the referring veterinarian has little to no experience with a specific discipline. That being said, there is room for these specialized disciplines in a general practice. This is especially true when a practice has a veterinary technician specialist (VTS) credentialed in that specialty, and when appropriate time and effort is given to learning it, performing its procedures correctly, and most importantly, relaying that expertise to the client. Endodontic therapy (i.e. root canal therapy) and crown restorations are two disciplines that can be incorporated into the general practice, if only in a limited way and usually at a much lower cost than a referral practice. Single-rooted teeth, such as canine teeth and incisors, can be good candidates for root canal therapy. When adequately learned, endodontic …
GI issues tricky to diagnose, treatFebruary 6, 2019From intestinal parasites to irritable bowel disease (IBD), dietary indiscretion to food allergies, gastrointestinal issues are among the most common problems veterinarians see. While they might seem straightforward, they can be difficult to diagnose and treat for a number of reasons. Chronic diarrhea and vomiting may not be brought to your attention until it has been going on for a while without improving or begins to worsen in severity. And, of course, diarrhea and vomiting can be seen with diseases unrelated to the GI tract. Once the GI tract is pinpointed as the source of the problem, the signs can still have many potential causes. Radiographs show only faint shadows of the intestines, making interpretation difficult. Gastrointestinal problems can resolve on their own in three to five days, but when they don't, additional diagnostics, therapeutic trials, and medication can be the next step. Fortunately for pets, owners, and veterinarians, more companies are beginning to develop drugs and run clinical trials specifically for cats and dogs with GI disease, says M. Katherine Tolbert, DVM, PhD, DACVIM, clinical associate professor of medicine at Texas A&M University College of Veterinary Medicine & Biomedical Sciences. "There are a lot of new drugs that …
Understanding congestive heart failureFebruary 5, 2019Congestive heart failure (CHF) is described by medical professionals as more of a syndrome than a disease. Yet, when pet owners are often attuned to "disease," how can veterinarians best convey what CHF really is to their clients? "Congestive heart failure can result from a variety of different types of underlying heart disease," says Emily Karlin, DVM, Dipl. (cardiology), clinical instructor at Cummings School of Veterinary Medicine at Tufts University. "When we say CHF, we generally are referring to fluid buildup somewhere it should not be, as a result of heart dysfunction. We can see left-sided CHF (fluid buildup in the lungs—pulmonary edema), resulting in cough or trouble breathing, or right-sided CHF (fluid buildup in the abdomen or around the lungs—ascites or pleural effusion), resulting in abdominal distension or trouble breathing. Basically, CHF is a potential outcome of having heart disease." Recognizing signs and symptoms When it comes to differentiating CHF from heart disease, paying attention to clinical signs and symptoms is key. "Asymptomatic, or occult, heart disease is often detected based on physical exam abnormalities—such as a heart murmur, cardiac gallop, or arrhythmia—or sometimes by echocardiographic screening, but the animal is feeling well at home with no clinical …
