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 …
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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 …
What makes a good working dog?February 5, 2019The canine labor market is diverse and expansive. Assistance dogs may be trained to work with the visually or hearing impaired, or with people in wheelchairs. Detection dogs may be trained to sniff out explosives, narcotics, or bedbugs. Others even learn to jump out of helicopters on daring rescue missions. Despite the wide variety of working roles available for man's best friend, those jobs can be tough to fill, since not every dog will qualify. Even among those specifically bred to be assistance dogs, only about 50 percent starting a training program will successfully complete it, while the rest go on to be very well-trained family pets. As a result, the wait list for a trained assistance dog can be up to two years. Evan MacLean, PhD, director of the Arizona Canine Cognition Center at the University of Arizona (UA), is exploring ways to identify the best dogs for different jobs—before they start the long and expensive training process—by looking at their cognitive abilities. He is lead author of a study in Frontiers in Veterinary Science looking at whether canines' cognitive abilities can help predict their success as working dogs. While a dog's physical characteristics and temperament are often considered …
How 3-D printing benefits presurgical planning for angular limb deformityFebruary 4, 2019 The surgical treatment of limb deformities in dogs has historically been approached by taking preoperative measurements using radiographic orthogonal views. When calculations for the osteotomy location, hardware type, and size were determined, the information was transferred to the patient in the operating theatre. Although using this procedure can result in satisfactory outcomes, there are many cases involving severe deformities where preoperative planning can be very difficult. Having a 3-D model closely approximating the actual limb can significantly benefit the preoperative plan. Enter 3-D printing Three-dimensional printing (3DP) is proving to be a very useful technique in veterinary orthopedic applications, particularly as it relates to preoperative planning. Production of multiple models that are scaled on a one-to-one ratio to the patient can allow the surgeon to accurately plan surgical procedures. Using these techniques for preoperative planning can provide several benefits, including lessening time under anesthesia and lowering its associated risks, as well as decreasing surgical site infection. Although it is expensive, the cost of employing 3DP can be justified when considering the benefit of shorter surgeries, less anesthetic time, and facilitating more consistent results to avoid subsequent revision surgeries. In the majority of cases, the use of 3-D modeling is …
Dentistry—A discipline in need of changeFebruary 4, 2019I am writing this article as I travel home from Phoenix, after attending a successful Veterinary Dental Forum (VDF). This event is the official annual meeting of the American Veterinary Dental College (AVDC), Academy of Veterinary Dentistry (AVD), and the Foundation for Veterinary Dentistry (FVD). This year, VDF drew its largest crowd yet, partly due to general practitioners that are filling an educational void by attending lectures and wet labs in the various disciplines of dentistry and oral surgery. In this month's column, and in honor of National Pet Dental Health Month, I'd like to discuss a challenge for the veterinary profession, specifically dentistry training at the veterinary school level. It's not a new problem, and it doesn't exist at every school, but its significance is greater today than ever before, due to the changing needs of successful general practices. Decreasing significance The number of didactic teaching hours available within the veterinary curriculum is not getting any larger. In fact, teaching hours dedicated toward a specific topic are becoming more difficult to obtain due to new specialties, expanding knowledge base, and justifiable shifts in curricular focus to feed not only the IQ, but also the EQ. Ask any small-animal …
Compounded drugs—A literature updateJanuary 2, 2019In exciting times of new approved drug formulations for animal species, veterinarians face a myriad of challenges when balancing optimal treatment protocols and overall cost burden. Compounded drugs may offer an enticing alternative to an approved animal drug in terms of palatability and cost to the owner; however, the legal status of compounded drugs is often difficult to evaluate.
