The 3 Surgical Options For C-SectionsSeptember 23, 2013 We continue describing our 10 steps for a happy C-section. [See Part 1, "The art and science of a safe C-section,” in the July issue.] This month, in the second of three parts, we focus on anesthesia and surgery. Our goals: safety and speed. 5. Anesthesia Melissa Goodman, DVM, board-qualified in the American College of Theriogenologists at Veterinary Reproductive Services in West Chester, Pa., skips premedication, and prefers masking patients down. She uses the smallest possible dose of propofol only if needed, e.g. in brachycephalic and fractious patients. When giving drugs to the dam, you are indirectly giving them to the babies. Many drugs are rapidly carried through the placental barrier and consequently affect the offspring. This may make resuscitation efforts more difficult. For example, acepromazine, ketamine and atropine can flow through the placenta, so they should be avoided. Glycopyrrolate, if needed, is a better choice than atropine. Choosing an anesthesia protocol that is safe for a caesarean patient is tricky at best. Because hypoxia is a concern for the patient and the neonates, pre-oxygenation for five to 10 minutes is an important precaution. Patients are then intubated and placed on isoflurane or …
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Surgical Insights: Care Of Neonates After A C-sectionSeptember 23, 2013 While rubbing babies and clearing their airways, we also should strive to prevent the three "hypos" in neonates: hypothermia, hypotension and hypoxia. We conclude our three-part article on C-sections with resuscitation and care of the neonates. It is time to change a few old habits and to embrace more modern techniques. Part 1 is here; Part 2 is here. 7. Resuscitation While rubbing babies and clearing their airways, we also should strive to prevent the three "hypos” in neonates: hypothermia, hypotension and hypoxia. Hypoxia is a constant battle during a C-section. The amniotic sac should be removed as soon as possible, and the mouth and airway must be cleared with a bulb syringe. "Don’t use too much suction,” reminds Margret Casal, DrMedVet, PhD, Dipl. European College of Animal Reproduction, University of Pennsylvania School of Veterinary Medicine, "as it could damage the delicate tissue of the pharynx and larynx.” Alternatively, a mucus suction device for human babies can be used, e.g., the poetically called "snotsucker nasal aspirator.” Hypothermia can be prevented by using warm towels straight out of the dryer, or a …
Facing Up To The Past After An Accidental SurgerySeptember 10, 2013 Declawing cats is my least-favorite elective surgery, but because my employer offers it, I long ago made up my mind to become very good at it and use the maximum possible pain medication that would be safe for the patient. Since our practice has an age and weight limit on declaw surgery, many patients present for simultaneous spay and declaw procedures. Two years ago, I accidentally declawed an 8-month-old, 5-pound kitten that was at the clinic for only a spay. When I began entering the surgeries into the computer, the surgery consent form stared back at me with the simple word SPAY. I gasped. No amount of squinting at the line or fiddling with the paper’s angle would change the fact: I made a mistake, the claws were in the wastebasket, and I had to cowgirl up and eat a slice of humble pie. Taking a deep breath, I called the client and put my cards on the table. I apologized, explained our pain management protocol and told her I would send home a bag of special cat litter used for declaw patients, all at my expense. Lucretia (not her real name) took the news …
The Mystery Is Solved!August 27, 2013 In my last blog, you heard about my Mickey, who was sickey. Well, the mystery has been solved! The abdominal ultrasound discovered an unsuspected culprit in the demise of his personality and comfort: pancreatitis. Wow, I didn’t see that coming! Considered acute, the poor guy must have been suffering with discomfort for several months; we know how painful pancreatitis can be for humans, and so we assume the same for animals. But in cats especially, it’s a difficult thing to detect. My main experience with pancreatitis comes from my years working in internal medicine and critical care, where our odds of pulling a dog through were pretty high, and our odds of pulling a cat through were dismal. Mickey’s hope rested on the fact that at least he was still nibbling food, and not consistently vomiting so we had a chance to turn things around. He has been responding to medical treatment thus far (famotidine and cerenia for nausea, and gabapentin for pain) and is finally showing some of his old personality! Such a relief … but it was so aggravating to have taken so long to identify the …
On Handling Outsized Risks From Bite-Sized PatientsAugust 22, 2013 Recently two of my clients found themselves heading to their nearby urgent care facility after their own pets bit them. Both clients openly acknowledged they'd disregarded my counsel, happily paid their bills, and promptly sought medical attention. At the risk of courting your derision along with your sympathy, I'll confess: Recently two of my clients found themselves heading to their nearby urgent care facility after their own pets bit them ... in my exam room! Bad, I know. What's worse is that I was physically present to witness both events. Though I'd urged each of these clients to keep their hands well away from their anxious pets—in the second case, imploring a client not to attempt clipping her own terrified cat's claws—they'd apparently felt compelled to ignore their pets' warning signs (along with my advice). The good news? Both clients openly acknowledged they'd disregarded my counsel, happily paid their bills, and promptly sought medical attention. I then made note of the events in their medical records, flagged the files for future reference ("Never allow this client to handle her own pets—no matter what she says!"), and called the following …
Adding Grooming To Your Practice: What Now?August 22, 2013 You have decided to add grooming to your veterinary practice; smart move! A grooming service can provide additional conveniences for your pet families, while also putting another set of eyes and hands on your patients to detect potential health problems. If you have seen the potential, the decision may have been easy. But integrating the new service may not be as easy without keeping some things in mind. The Groomer It's not easy to find a good groomer. Looking through the "help wanted" ads in veterinary journals and websites, it seems everyone is always looking for groomers. "The hardest part is finding that right person who will work with the veterinary practice team to become an extension of the services it can provide," says Tim Thompson, DVM, partner and Medical Institute Director for VitalPet, a Texas-based group of veterinary hospitals where the mission is, "Quality medicine in a caring family environment." In his practice, the current groomer grew up in that family, previously working as a receptionist, and was sent to grooming school to come back and fulfill that position. She was already part of the team. One way to make sure …
How Techs Talk To Clients About Slimming Their Hefty Pets DownAugust 7, 2013Whether they think fat cats are cute, or that loving their dog means treats or human food, getting a pet’s weight down starts with communicating the dangers of obesity to clients, according to a handful of veterinary technicians who have tackled some difficult cases. Perhaps no fat pet has received as much recent publicity as Skinny, a 43-pound cat found in late 2012 in the Dallas area. Skinny ended up in the hands of the staff at East Lake Veterinary Hospital and Pam Nowell, RVT, who has a history of slimming down fat cats. It’s a story that Nowell likes to recount, especially to clients—to drive home just how damaging it can be when a pet is overfed. She and other techs cite overfeeding as a principal reason for pet obesity. "He was 43 pounds when we got him,” Nowell said. "He couldn’t even groom himself because he was so overweight.” Starting a Program The hospital put Skinny on Hill’s m/d pet food, and a volunteer from the local pet orphanage came in regularly to walk him. At first he could walk only about six steps before having to sit and catch his breath, and Skinny also …
Bond & BeyondJune 28, 2013 Dr. Alice Villalobos offers insights into timely issues affecting the human-animal bond, animal welfare and the relationships among pets, owners and veterinary practitioners. For Dr. Villalobos’ Quality of Life Scale, click here »
Weight-Loss Study Finds New Hill’s Food A SuccessJune 10, 2013 Veterinarians often find it challenging to discuss weight-loss options with owners of chubby pets. The new Hill’s therapeutic food is formulated with L-carnitine to help a pet burn excess body fat and spare lean muscle mass without depriving pets of needed daily caloric intake. With more than half of dogs and cats deemed overweight or obese, based on a 2011 survey by the Association for Pet Obesity Prevention, veterinarians often find it challenging to discuss weight-loss options with owners of chubby pets. Some owners become defensive while others might express frustration in not being able to prevent their pets from overeating. "Sadly, some owners brag that they have 25-pound cats, so we need to educate them about the role obesity plays in certain diseases like diabetes and arthritis,” says Amy Lowe, DVM, a veterinarian at the Bytown Cat Hospital in Ottawa, Ontario, Canada. Her clinic participated in a recent veterinarian-supervised blinded feeding trial involving 314 cats and dogs throughout the U.S. and Canada. Chubby pets were weighed, measured and exclusively fed the new Hill’s Prescription Diet Metabolic Advanced Weight Solution. Suzie struts her stuff before and after her weight-loss program. …
AAHA Updates Dental Guidelines For Dogs, CatsMay 21, 2013For The Education Center In 2004, an AAHA task force of boarded veterinary dentists, technicians and general practitioners authored the evidence-based AAHA Dental Care Guidelines for Dogs and Cats. Recently, AAHA assembled some of the original contributors and new, fresh eyes to create an updated report. The 2013 AAHA Dental Care Guidelines are available online at www.aahanet.org/Library/DentalCare.aspx. Figure 2. Stage 3 periodontal disease (5 mm pocket depth) diagnosed under general anesthesia Here are some of the important details in the guidelines that help veterinarians deliver consistent quality of dental care to their patients. The updated guidelines have been peer reviewed by the Journal of the American American Hospital Association and endorsed by the American Veterinary Dental College. Dental health care needs to be part of the preventive healthcare examination discussion. It should begin at the patient’s first appointment and continue throughout all subsequent exams. Semi-annual dental evaluation examinations are recommended. Figure 3. Surgical extraction of retained deciduous tooth Assessment by life stage introduced the concept of periodontal diseases—with its many appearances, compared to the catchall term "periodontal disease” (Figure 1). The professional
