Experts weigh in on ear examsMay 7, 2019Ears. They're the bane of veterinarians and clients alike, not to mention the dogs and cats who must contend with itchy or painful ear conditions caused by environmental and food allergies, bacteria and yeast overgrowth, mites, foreign bodies, trauma, tumors, or polyps. Ear problems can spring from many different sources. That makes it essential to conduct a thorough exam, be familiar with some of the other disorders that can lead to ear problems, and know what to ask owners to bring out clues to the cause. Itch triggers Allergies are probably the number one cause of ear inflammation. Once ears become inflamed, secondary infections caused by overgrowth of normal populations of bacteria or yeast in the ear typically follow. The result is exudate, pain, and worsening inflammation. Young animals in multipet households or hoarding situations may pass ear mites (Otodectes cynotis) back and forth, especially if they aren't on a monthly preventive, are fed a poor diet, or are sick. Demodex canis is another mite that can affect young or old animals who are immune-suppressed. Less commonly, endocrine diseases (e.g. Cushing's or hypothyroidism), as well as certain autoimmune disorders, can cause ear problems. Take hypothyroidism. "Those dogs commonly will have …
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New CAPC study shows Lyme disease is spreadingMay 7, 2019Research from the Companion Animal Parasite Council (CAPC) indicates seroprevalence of Lyme disease in dogs is not only increasing in the Northeast, where it is considered endemic, but also spreading into areas that were previously thought to not be at risk for this serious, zoonotic tick-borne disease. ("Seroprevalence" in this case refers to the prevalence of dogs exposed to Borrelia burgdorferi, the pathogen responsible for causing Lyme disease in the U.S. based on serologic tests—hereafter referred to as "prevalence.") Study results were published in the December 2018 issue of Environmetrics, the official journal of The International Environmetrics Society (TIES). This milestone study, titled "A Large-scale Spatio-temporal Binomial Regression Model for Estimating Seroprevalence Trends," suggests canine prevalence rates for Lyme disease are rising and that those rates are increasing most in areas where the pathogen has recently encroached. Specifically, exposure in dogs to B. burgdorferi is rising in states not traditionally considered to be areas of high Lyme risk. Significant increases in the percentage of dogs testing positive for exposure have also been seen in areas that have not yet reported significant human incidence. These findings suggest canine Lyme prevalence could serve as an early warning system for changes in …
Getting to the root of pyodermaMay 7, 2019Scaling, hair loss, papules, pustules, and epidermal collarettes. All are clinical signs pointing toward canine pyoderma. The culprit may seem clear at first glance; however, veterinarians must look at the bigger picture to address the underlining issue. It's important to first understand the meaning of pyoderma, particularly regarding the depth of infection, says Elizabeth Layne, DVM, Dipl. ACVD, clinical instructor at the University of Wisconsin-Madison, School of Veterinary Medicine. The most common form of pyoderma is superficial bacterial folliculitis, a bacterial infection of the upper part of the hair follicle, caused by Staphylococcus pseudintermedius. Deep bacterial infections (presented as swelling, nodular lesions, and oozing draining tracts) can occur, but that is a different diagnostic and therapeutic approach, Dr. Layne adds. Superficial bacterial pyoderma is almost always secondary to some kind of skin abnormality, such as atopic dermatitis. Other skin diseases (e.g. flea allergy dermatitis, sebaceous adenitis, or primary seborrhea) can also result in superficial pyoderma, Layne notes. Systemic illness or immune compromise may lead to superficial bacterial pyoderma as well. Since pyoderma commonly masks another condition, a vicious treatment cycle can ensue if the underlining problem isn't identified. "Veterinarians often recognize the signs of infection and treat with antibiotics …
Taking ECGs to the next levelMay 6, 2019The ECG has been a routine test in veterinary practice for decades, and is commonly used for diagnostic purposes, as well as an anesthesia and critical-care monitoring tool. Although the principles of ECG diagnosis remain the same, the ways in which an electrocardiogram can be recorded have changed in recent years. Some of the changes in technology now allow general practices to have access to services that were previously only provided by specialty clinics. Some of the newer technologies also allow screening ECGs to be obtained easier and faster than their conventional counterparts. Why get an ECG? When obtaining a "standardized" ECG, we generally have been taught to use alligator clips and to place the patient in right lateral recumbency. This, of course, requires time and generally two people: one to restrain the animal and the other to run the machine. Further, this technique generally is not amenable to exam room use. A newer option is to consider using a direct chest lead. To decide which technique is best for a particular clinic, it is important to know what ECGs can be used for. The simplest and most important feature of an ECG is it allows a definitive rhythm diagnosis …
Surgical endodontics: When all else fails...May 6, 2019In my previous two columns, we looked at conventional (orthograde) root canal therapy, along with vital pulp therapy. This time, we will discuss surgical (retrograde) endodontics. In instances where orthograde root canal therapy has failed, a decision needs to be made to either perform a second orthograde root canal therapy or to proceed to the next step: surgical endodontics. Extraction would be a third option for a failed root canal procedure if the owner no longer chooses to salvage the endodontically diseased tooth. Besides its use as a treatment when orthograde root canal therapy fails, retrograde root canal therapy may be the chosen course of action when an instrument breaks off while performing an orthograde procedure. Instruments most likely to break off in the canal include Lentulo spiral paste fillers, barbed broaches, and rotary files. Sometimes the detached instrument portion can be entombed in endodontic filling material during orthograde obturation, but if not, a retrograde procedure may be warranted. The procedure What is surgical root canal therapy? A surgical approach is made over the apical portion of the root, and bone is carefully removed to expose the root area (Figure 1). The apical 4 mm of the root is surgically …
How to improve your surgical skillsMay 6, 2019What can you do to improve your surgical skills? Assuming your career path does not include a surgery internship or a residency and board certification, here are some tips to raise the surgical bar. Prerequisites Some traits are self-understanding. In order to perform surgery, you need to have dexterity and think in 3D. You'll also need the following: "Good hands"—no shaking allowed. A keen sense of observation. Observe the patient. Observe the tissue. Observe others perform surgery. Some will teach you what to do, while others will teach you what not to do. Use the correct suture material, the correct needle, and the correct size. Know and apply the seven principles of William Stewart Halsted, MD, our 19th-century forefather (see The basics of surgery). Speaking of forefathers… believe the sayings they crafted: "Measure twice, cut once." "If it's worth taking out, it's worth turning in" (i.e. masses belong in the lab, not the trash). "There are routine surgeries, but there is no routine anesthesia." "Dilution is the solution to pollution." It is critical to thoroughly understand anatomy, indications, and surgical approaches. Reading books to acquire a good understanding of anatomy and a great knowledge of approaches is a must. But …
Declawing cats may soon be illegal in New YorkMay 3, 2019Legislation is currently moving through New York's state assembly in an effort to ban the declawing of cats. Declawing is already banned in several cities in California, as well as many countries around the world, including Switzerland, Israel, and the U.K. If Bill A01303 is passed, it would make New York the first state to ban the practice. "Claws play an important role in various aspects of cats' lives. They use their nails to assist in climbing and maintaining balance, to help them fully stretch, to relieve stress through kneading, and to escape danger," reads a state assembly memorandum memo. The memo goes on to say, "When the claws are removed, the animal tends to shift its gait and where it places most of its weight, causing strain on its leg joints and spine, which can lead to early onset arthritis and prolonged back and joint pain." Should the bill pass, anyone who performs an onychectomy, a partial/complete phlangectomy, or a tendonectomy procedure on a cat faces a fine of up to $1,000. Declawing will be permitted when it is necessary for therapeutic purposes, including: an existing or recurring illness; infection; disease; injury; or an abnormal condition in the …
Is cranberry effective for treating UTIs?April 29, 2019Like most herbal remedies, cranberry has traditionally been employed for a wide variety of unrelated problems, ranging from diseases of the liver and stomach to blood disorders and even cancer.1 These days, however, it is pretty firmly established in the minds of pet owners—and many veterinary professionals—as useful for urinary tract infections (UTIs). It may be surprising, then, to learn there is little convincing evidence to support the effectiveness of cranberry in preventing or treating UTI. The question of whether cranberries, in some form, have value in treating or preventing UTIs is a pretty old one. In addition to historical claims among herbal medicine practitioners, there are scientific references on the subject going back to the 1960s.2 An early theoretical rationale for using cranberry to treat UTIs was it inhibited bacterial growth by acidifying the urine.3,4 However, later research has not substantiated this theory, and this rationale is no longer commonly used to explain the purported benefits of cranberry in preventing or treating a UTI.1,5 The more popular theory today is compounds in cranberry juice, particularly a group called proanthocyanidins, interfere with the attachment of some bacteria to the bladder mucosa, reducing colonization and the establishment of infection.6,7 This …
Dermatology and nutrition: Beyond food allergyApril 29, 2019 When dogs and cats present with skin disorders, the initial approach is to collect a history, do a physical exam, and then perform diagnostic tests to rule in or rule out common conditions. After establishing a tentative diagnosis, most veterinarians will next consider which medications are most appropriate (e.g. antibiotics, antifungals, parasiticides). It is not as common to consider diet and nutrition as part of the workup and treatment for dermatologic disorders, other than performing elimination diet trials for suspected cutaneous adverse food reaction (food allergy). However, the right diets, nutrients, and sometimes nutritional supplements can have a significant benefit in improving or resolving certain skin disorders. This article highlights some of the options for incorporating nutritional science into the management of dermatologic disorders. Cutaneous adverse food reaction The most common presentation for a dog or cat with cutaneous adverse food reaction (CAFR) is nonseasonal pruritus, although other syndromes such as otitis externa and gastrointestinal (GI) upset may occur.1,2 While some companies offer "food allergy testing" using serum, saliva, or even hair clippings, the only valid diagnostic test is an elimination diet trial. There are a number of veterinary therapeutic diets that can be used for diet trials and …
Why heartworm prevention begins in your practiceApril 24, 2019According to the American Heartworm Society (AMS), it is estimated more than one million dogs have heartworm disease. Spread by mosquitoes, heartworms live in the heart and pulmonary arteries of infected dogs and cats. Left untreated, the disease can lead to heart failure, as well as damage to other organs. To mark Heartworm Awareness Month, we asked Claire Walther, DVM, veterinary specialty operations at Zoetis Petcare, for her take on what veterinarians can do to better convey the need for heartworm prevention to pet owners. 1) What is the single biggest misconception among veterinarians regarding heartworm disease? Biologically, it is how missing one dose of a preventative medication can lead to the development of heartworm disease. We say it to our clients daily, but many of us couldn't explain why if a client asked. In my own practice, I struggled with the answer. Here is a 30-second sound bite I've used with my clients to help simplify what is a complex discussion. "Young heartworms are carried by infected mosquitoes, and it only takes one bite to transmit them to your dog.1 Once in your dog, the young heartworms live just underneath the skin for about a month—this …
