A Tetraplegic Recovers Without SurgeryMarch 6, 2012 Kelvin, a 50 pound, 4-year-old female spayed Husky mix was in bad shape. She presented with progressive weakness in all four limbs. Her recent history included a mild bout of diarrhea, which was (still) treated with 500 mg metronidazole BID. The day the dog was referred for an MRI, she was unable to walk on all four limbs. There was no obvious cervical spinal pain and she was tetraparetic (i.e. weak and unable to stand or walk). She appeared tense all over her body and “nervous” or “stressed out.” Blood work was unremarkable. The rest of the physical exam, including heart auscultation, was normal, except for obesity (body condition score of 5/5). A cervical spinal MRI was performed. The radiologist, who read the pictures in real time, deemed the scan normal. Therefore, an MRI of the brain was performed. It was normal, as well. The dog was referred to an internist. The diagnosis was central vestibular disease due to… metronidazole toxicity. Full disclosure: This patient was not mine, but I thought it was an interesting case that was well worth a quick review of metronidazole toxicity to avoid “getting caught.” The important thing to …
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Cracking Fevers Of Unknown OriginFebruary 13, 2012 Fever can indicate infectious, inflammatory, immune-mediated or neoplastic disease. Typically, a physical examination and medical history lead a practitioner to a fever’s cause. Or the fever resolves serendipitously or in response to antibiotic therapy. But in some cases, the underlying cause of the fever is not readily apparent. These patients are said to have a fever of unknown origin (FUO). In 1961, the acronym FUO was coined by medical doctors Robert Petersdorf and Paul Beeson and defined as a temperature greater than 101 degrees Fahrenheit on several occasions, illness for more than three weeks and failure to reach a diagnosis despite one week of inpatient investigation. According to the Merck Veterinary Manual and veterinary specialists, this syndrome has no recognized definition in veterinary medicine, making its prevalence difficult to determine. “FUO is common in both species [canine and feline], although underlying causes can be quite different,” says Craig Webb, DVM, Dipl. ACVIM, Ph.D., MS. “Unfortunately, these cases often require that we try to rule out almost everything,” continues Webb, an associate professor of internal medicine at Colorado State University’s College of Veterinary Medicine and Biomedical Sciences. “So after the history and physical examination we …
The Bossy Cat And Owner-Directed AggressionFebruary 8, 2012 Owner-directed aggression in dogs has been written and talked about at length, but feline owner-directed aggression has received less attention. In dogs, “conflict aggression” has replaced “dominance aggression” as a more accurate description of the behavior’s motivation. The change occurred because pundits no longer accept the premise that the relationship between dogs and their owners is governed by pack mentality, as neither dogs in the wild nor, as it turns out, wolves seem to organize themselves along these lines. With this in mind, it seems ludicrous to discuss dominance or status-related aggression in cats, as they do not organize themselves into packs and should have no biological drive to establish themselves in any kind of order. But is it so ludicrous to consider that there may sometimes be a particularly bossy cat that calls the shots with others in a household? I think not. One social arrangement of cats has been described as a “despotic hierarchy,” a system in which one cat assumes control over all others who, barring the odd pariah, live peaceably as subordinates. Another more fluid, social situation between house cats involves a sort of time share arrangement in which one cat may …
Considerations For Canine Rehab ProtocolsJanuary 30, 2012 The young and burgeoning field of canine rehabilitation is changing the way dogs recover from injury and surgery, with rehabilitation centers springing up across the country. The outmoded approaches of yesteryear, wherein animals were kept inactive through cage confinement or unmitigated pain, are disappearing in favor of more enlightened approaches adopted in human rehabilitation decades ago. Veterinarians now look for more than just a good surgical outcome, seeking earlier return of neuromuscular control and function through active engagement of both the patient and client. Rehabilitation procedures typically practiced on dogs include underwater or land-based treadmill exercise, passive range of motion and stretching movements, electrical stimulation, therapeutic ultrasound, proprioceptive training techniques, massage or other manual therapy maneuvers, swimming and more, depending on the inclinations and training of available therapists. What Studies Show Although evidence is emerging in both human and veterinary physical therapy, human physical therapists and canine rehabilitators alike readily acknowledge the dearth of high-quality, randomized, controlled and sufficiently powered trials, individually evaluating each component of a multifaceted rehab protocol. Such studies would lend insight into the relative value of each modality and provide answers to persistent questions concerning rehabilitation. For example, some studies …
The Epulis: What’s In A Name?January 25, 2012 Practitioners and technicians in general practice are on the front line of diagnosis. Early detection of oral tumors improves outcome. Gingival masses may result from neoplastic, hyperplastic, inflammatory or infectious causes. Any mass arising from the gingiva may be correctly referred to as an “epulis” (plural is “epulides”). However, the term “epulis” has been adapted in veterinary nomenclature to describe specific gingival tumors arising from periodontal ligament cells, including acanthomatous, fibromatous and ossifying epulides. In recent years, the nomenclature for these odontogenic tumors has changed. Fibromatous and ossifying epulides are now often referred to under the same heading of “peripheral odontogenic fibromas.” Based on histological appearance, acanthomatous epulis is now referred to as “canine acanthomatous ameloblastoma.” This article describes a clinically rational approach to gingival masses noted during conscious oral examination. 1. Start with a thorough oral examination On conscious oral examination, look for clues of whether the gingival mass is neoplastic, hyperplastic, benign or malignant. Is it well-circumscribed? Is there evidence of mobile or displaced teeth in the area? Mobile teeth are more commonly seen with malignant neoplasms due to aggressive root resorption, whereas benign neoplasms cause slow movement of teeth …
How To Test, Interpret Thyroid FunctionJanuary 16, 2012 Hypothyroidism is the most common endocrine disorder of dogs. More than 80 percent of cases result from autoimmune thyroiditis, the heritable autoimmune disease that progressively destroys the thyroid gland. Classical clinical signs of hypothyroidism only appear once more than 70 percent of the gland is destroyed. Accurate diagnosis may be difficult because thyroid dysfunction produces a wide range of clinical signs, many of which are subtle and mimic those of other causes. Hyperthyroidism is a common endocrine disorder of older cats. Diagnosis can be confounded by concurrent kidney, gastrointestinal and liver disease, as total T4 concentration can be suppressed into the normal reference range. To facilitate diagnosis of thyroid disorders, veterinarians need to routinely employ more complete thyroid profiles, and there is a need to balance affordability with accuracy. Testing Overview Total T4: Measures bound (> 99 percent) and unbound (< 1 percent) circulating T4. While T4 is the most widely used initial screening test for thyroid disorders, relying on this test alone is a primary reason for the misdiagnosis of canine and feline thyroid disorders. T4 concentration is affected by non-thyroidal illness (NTI) and certain medications (e.g. phenobarbital, corticosteroids and sulfonamides), …
Is Early Neutering Hurting Pets?January 16, 2012Early neutering has become the norm in the U.S. Some states are asking voters to pass initiatives requiring citizens to sterilize their pets no later than puberty. Overpopulation is the driver. But what if large-scale studies found that early neutering jeopardizes the health of our pets? What if we found enough epidemiological evidence that early neutering of pet dogs may open them to orthopedic, behavioral, immunologic and oncologic issues? A veterinarian who treats canine athletes has raised questions about early neutering. In an opinion article, Christine Zink, DVM, Ph.D., Dipl. ACVP, weighs the advantages and disadvantages of early versus late neutering when considering the performance and health of canine athletes. The article, “Early Spay-Neuter Considerations for the Canine Athlete: One Veterinarian’s Opinion,” appears on Dr. Zink’s website. Click here to review the thought-provoking article and to look at the references. Zink assembled 18 references to support her article. Some show that dogs spayed or neutered early are taller than dogs spayed at an older age. Zink notes that sex hormones have a role in bone density. She concludes that the structural and physiological differences in dogs neutered early may be the reason veterinarians are seeing a …
Gentle Man, Strong LeaderJanuary 6, 2012 For Roy Smith, DVM, it was always about the cats. Ever since he was a 14-year-old aspiring veterinarian, Dr. Smith knew he wanted to open a feline-only practice that allowed him to treat his preferred species. Fifty years later, his dream has been fulfilled—and then some. Smith owns and operates Central Texas Cat Hospital in Round Rock, Texas, and is the president-elect of the American Association of Feline Practitioners. “I love our profession and think it’s the greatest one in the world,” he says, emphasizing his dedication to both his clients and the veterinary community. “We have a lot of challenges coming our way right now to keep it that way, and it’s what keeps me going. There are a lot of good people helping out, and I want to do the same for the veterinarians coming along. Pass it on. It’s what keeps me going.” Roy Smith, DVM, with Howie, the stray cat who was discovered near a trash bin with a mangled eye and in a coma. Smith nursed him back to health. The formerly feral cat now calls Central Texas Cat Hospital home. His efforts caught the attention of the …
Supplement Can Bolster Pets’ Anxiety TreatmentJanuary 5, 2012When it comes to pets, fears, anxieties and phobias are more common than most people realize. In people—at least some of them—logic and reasoning can be used to help that person understand that an object, noise or event is not as scary as it may seem. But for pets, their perception is their reality. No amount of discussion or psychotherapy can change their minds about a situation that seems threatening or dangerous to them. In a national online survey about anxiety in pets, nearly 40 percent of pet owners who responded say they have at least one pet that experiences anxiety.1 Possible contributing factors to anxious behavior may be a lack of proper socialization, some traumatic event, genetic predisposition, and even cognitive decline. As an animal ages, hearing and sight may be compromised, and with confusion or even discomfort from arthritis, that can result in a more stressed or anxious pet. Nearly a third of the owners who responded to the online survey say their pets’ fears and anxieties are “extremely or very” problematic, while 44 percent say it is “somewhat” problematic. And 70 percent say the anxiety their pet experiences occurs “fairly often” or “frequently.” It …
Let’s Regard End Of Life As A Distinct StageJanuary 4, 2012 While I discussed end of life (EoL) care with Dr. Don DeForge on Connecticut radio, an exciting idea flashed through my mind. We were finishing a 45-minute discussion when I said, “It is time for us to declare, once and for all, that end of life is a distinctly new stage of life. Veterinarians were taught to support four main stages of life. We were not educated to focus our professional attention and develop the skills and expertise for the very important and inevitable ‘End of Life Stage.’ “We need to provide more EoL services because society’s human-animal bond demands more care in this area despite the recession and fewer office visits.” The main life stages we are educated to support are: • Puppy and kitten stage • Adult stage • Senior stage • Geriatric stage I propose a fifth life stage, the End of Life Stage. It is the only life stage that can occur during the other stages. With luck, EoL may not impose itself on the kitten and puppy stage, but sometimes it does. Let’s start thinking about EoL as an inevitable life stage that deserves more focus and expertise in management. …
