10 Ways To Improve Post-Op CareMay 30, 2014Just because a patient is out of the operating room doesn’t mean we’re out of the woods. In fact, most deaths occur after, not during surgery: 50 percent of canine and 60 percent of feline deaths occur in the postop period. It is important to avoid becoming complacent, despite the busyness of the day. Here are 10 steps to improve the care given to your postop patients. 1. Extubation The proper time to extubate is often based on a widespread misconception, sometimes called the “two swallow” rule. This is a very unfortunate urban legend that can lead patients to serious trouble. “Two swallows” may not mean that the patient is alert enough to continue swallowing and breathing efficiently on its own. The more appropriate time to extubate is when a patient is alert, preferably has lifted its head up at least once, and begins to chew. The next challenge it to pull the tube before the patient chews it in half. Ideally, each patient recovering from anesthesia and/or surgery should be under direct supervision of a technician until extubation. We still need to remain alert afterward: Being extubated doesn’t mean that recovery is over. It is just one step of …
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Dog And Cat Allergies DemystifiedMarch 19, 2014 Natures Variety - Dog and Cat Allergies Demystified brightcove.createExperiences(); 1/3/2012 12:49 PM
Additive Manufacturing—or 3D Printing—helps Create new Knee Joint for a CatMarch 13, 2014 For quite some time, Mr. Cyrano L. Catte II, an orange and white cat, had the perfect life. He had a nice home in Upperville, Va., more than adequate food and owners who loved him very much. Then, in 2012 at age of 9, he got bone cancer in his left hind leg. Cyrano’s owners spared no expense or effort. They took him to the University of Colorado, where he became the first cat to receive stereotactic radiation (focused beams aimed at the tumor) therapy. Two sets of radiation cured his cancer—full remission—but one of the side effects was bone deterioration of his distal femur and some on the upper end of the tibia, as well. The normal procedure for such a condition would be to amputate the leg. In Cyrano’s case, that was not recommended: He weighed 26 pounds and movement on three legs would be difficult. One potential alternative would be total knee arthroplasty (TKA), complete replacement of the cat’s knee (stifle) with an artificial one. To explore this option—a first in the U.S. for cats—Cyrano’s intrepid owners took him to the veterinary facility at North Carolina State University in Raleigh. Once …
Non-Healing Facial Wounds: A Tale of Two TerriersMarch 13, 2014Endodontic disease has long been known as a common cause of a non-healing facial wound.1 The most common manifestation of this is the slab fracture of the maxillary fourth premolar tooth, which often results in pulp exposure, endodontic infection and a draining cutaneous tract below the medial canthus of the ipsilateral eye. This column compares two persistent cases I’ve seen recently that presented with similar problems but different etiologies. Jasper the Westie Case No. 1: Jasper, a 5-year-old male neutered West Highland white terrier, was presented to me with a three-month history of a non-healing wound beneath his left eye. The wound resolved when the primary care veterinarian placed Jasper on antibiotics, but recurred once antibiotics were discontinued. One year earlier, Jasper had received a dental cleaning and extraction of the left maxillary first molar due to severe periodontal disease. Jasper was presented to me for evaluation of any other dental issues that might be causing the non-healing sinus tract and scabbing beneath the left ventral eyelid. On conscious examination, Jasper was reluctant to allow for a good evaluation of the left maxillary quadrant, but I determined that the left maxillary fourth premolar (tooth 208) was present and did …
A Disaster Turns Into A Happy StoryMarch 13, 2014 Daisy, a 9-year-old diabetic miniature Schnauzer was diagnosed with a mucocele. Four months prior, Daisy had been seen for a splenic mass. We performed a c. Sadly, the biopsy revealed malignant histiocytosis. She recovered well from this procedure, but never 100 percent, according to the owner. She returned for an abdominal ultrasound after the referring veterinarian noticed an enlarged liver on palpation. In addition, the owner complained of Daisy's abdominal discomfort, decreased appetite and abnormal demeanor. Ultrasound confirmed hepatomegaly. The gallbladder was mildly distended and a small amount of free fluid was noticed around the liver. Blood work was supportive of liver disease with gallbladder involvement. Among others, she had an elevated bilirubin and high liver enzymes: alkaline phosphatase (alk. phos.), gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Exploratory surgery was recommended for what was considered by the ultrasonographer to be an early mucocele. A standard laparotomy and cholecystectomy were performed. Patency of the common bile duct was reestablished through a duodenotomy. All other abdominal organs appeared within normal limits. After lavage of the abdomen, closure was standard. Daisy recovered uneventfully and went home the next day. It was that simple. Overall …
Three Techniques to Treat Toe FracturesJanuary 22, 2014 Although metacarpal and metatarsal fractures are fairly common injuries in cats and dogs, the best way to treat is somewhat controversial. Incomplete or complete fractures of one or two metacarpal/metatarsal bones can be treated with external coaptation. The splint should immobilize the carpus/tarsus completely to be effective. Generally, external coaptation requires six to 12 weeks to achieve bony union. Splints should be changed at least weekly to decrease the risk of pressure sores in an at-risk area because of the lack of soft tissue coverage. If three or four metacarpal/tarsal bones are fractured and displacement is present, external coaptation may be a poor choice. When multiple bones are fractured, the splint cannot maintain reduction properly, and while union may occur, the recovery will be prolonged and deformity is likely. Surgery is considered a better choice in such cases. Indications for surgery Internal fixation is used for simple or comminuted metacarpal/metatarsal bone fractures or in patients with three or four fractured bones. In multiple bone fractures, the fixation can be used for all fractured bones or for metacarpal/metatarsal bones 3 and 4 only, i.e. weight-bearing toes. Options for fixation include plating or wiring (rarely performed), …
More "Zebras": Mandibular SwellingsDecember 17, 2013 My November and December columns focused on zebras. Not the actual animals, but rather the zebra diagnosis, that rare clinical presentation that may mimic a more common abnormality. I finished my November column by asking readers to share with me any zebras they have encountered. Linda Molesworth, VMD, of Huntingtown, Md., sees a zebra more frequently than most of us, because she is the proud owner of Zena (see photo above). Let’s continue to discuss dental/orofacial zebra diagnoses, in the context of mandibular swellings in dogs. Signalment—age, breed and sex—may be a very important component of the information gathered when creating a list of differential diagnoses. Take the example of a patient that presents for a ventral mandibular swelling. Many a mandibular swelling has been caused by a nonvital tooth with endodontic infection, often as a result of a tooth fracture, or extension of periodontal disease to the level where it can invade the endodontic system of a tooth. However, numerous other possible causes exist. If unilateral mandibular swelling is seen in a 14-year-old dog, the nonzebra diagnosis of neoplasia would come to mind. However, if nonpainful swellings were occurring in both mandibles of a …
Wellness Plans Allow Vet Clients To Budget For Pets’ Preventive CareDecember 3, 2013 In the minds of most veterinarians there’s a plan for just about every pet they see to ensure that pet’s immediate and long-term medical needs. But the reality, according to proponents of wellness plans, is that those details too often go unrelated to pet owners. "We really do have a full-year plan for their pets in our head,” said Carol McConnell, DVM, MBA, chief veterinary medical officer with Veterinary Pet Insurance of Brea, Calif. "When a pet comes in you look at the age, where they live, and other factors, and you formulate a plan.” It’s a detailed plan, Dr. McConnell said, adding, "But we’re clearly not good an explaining it to clients.” VPI in January launched a wellness service for veterinarians to offer clients called "Preventive & Wellness Services, which McConnell pronounces as "paws.” "We are basically positing ourselves as a silent partner with veterinarians,” McConnell said. She said the service is proving popular, with between 2,000 and 3,000 plans across the U.S. in place through more than 100 practices. Jeffrey S. Klausner, DVM, MS, Dipl. ACVIM, senior vice president and …
Veterinary Nutrition And You: Redefining The Future Of Pet FoodDecember 3, 2013 I’ve been to AVMA, NAVC, CVC and ACVIM and, after attending at least five of each of the above conferences over the past 15 years, I can attest that they’ve all got loads to offer. But that’s not to say there aren’t other international-level conferences worth your while. Take WINSS, for example. The Waltham International Nutritional Sciences Symposium is arguably the world’s premier pet nutrition conference. Yet until Mars invited me to attend this year’s October meeting in Portland, Ore., I’d never thought to venture outside the confines of my own customary conference rotation. Which would’ve been a shame. Not only would I have lost out on some killer doughnuts (Portland’s VooDoo Doughnuts fries up the finest), this meeting established that attending smaller symposia treating niche-ier topics can prove even more rewarding than the usual suspects. After all, there’s nothing quite so stimulating as some crisp non-tropical air, a fistful of fried dough, a huge conference hall teeming with veterinary nutritionists and three days chock-a-block with talks, presentations, hot topic sessions and even a bit of entertaining dissent. Most exciting of all, however, was not the banter that arose after one speaker attempted to dispel …
Dissecting The Cat-Dog Healthcare DisparityNovember 14, 2013 Unless you’ve been hiding under a rock lately, you’ve doubtless borne witness to the latest round of handwringing within our national community. This time it’s to do with our nation’s most populous but least served companion animal species: the cat. Though statistics tracking both canine and feline hospital visits reveal a significant downward direction, cats are far less likely to receive the routine treatment we’ve collectively determined they deserve. Yes, it seems that some cat lovers don’t care for their feline pets to the same tune they do their dogs. So say those of us who observe the differences between how people treat their own beloved cats and dogs on a daily basis. And so say our collegial powers that be. A Look at Numbers Because of this, Bayer Healthcare and the American Association of Feline Practitioners teamed up to confirm our suspicions with the Veterinary Care Usage Study III: Feline Fidings. Here’s a quick summary of the basic findings I received firsthand at a lunchtime panel discussion-style press event at the American Veterinary Medical Association conference in Chicago this past summer: * 52 percent of cats hadn’t seen a veterinarian within the past …
