Fluid Therapy Can Be Lifesaver If Done RightJanuary 17, 2011 Incorrectly determining that a patient is dehydrated when it is hypovolemic can cost the animal its life. This leads some professionals to stress the need for caution when prescribing fluids to small animals and for a possible review of a veterinarian’s fluid therapy protocol. “My primary concerns with the way fluids are administered to patients include incorrect volumes being given and improper selection of fluid type,” says Wayne E. Wingfield, DVM, Dipl. ACVS, Dipl. ACVECC, a professor emeritus of emergency and critical care medicine at Colorado State University. “Secondly, too much emphasis on use of subcutaneous fluids is given. Failure to properly assess electrolytes and lack of understanding of acid base in relation to electrolytes and fluid needs is also a problem,” says Dr. Wingfield, also a consultant for Abbott Animal Health. The lack of a step-by-step protocol for administering fluids is one reason missteps occur, says Elisa Mazzaferro, DVM, Ph.D., Dipl. ACVECC, of Wheat Ridge Animal Hospital in Wheat Ridge, Colo. “I see a lot of animals in need of fluid therapy, often referred to me by other practices,” Dr. Mazzaferro says. “Sometimes practices stabilize the animal before transferring it, other times they immediately …
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Dispelling Myths About CaOx UrolithsNovember 29, 2010 Therapeutic diets for dogs with urinary disease have simplified its management. Fearing that something “nonprescription” will upset the delicate balance between urinary solutes and their saturation, veterinarians may find themselves administering stern precautions to clients against feeding any “real” or human food, including fruits and vegetables. Certainly, preventing recurrence of calcium oxalate (CaOx) urolithiasis in stone-prone dogs can prove difficult, and some caregivers welcome the simplicity of feeding one food to their dog every day for life. They have no urge to dabble in homeopathics, experiment with herbs or turn to culinary solutions through homemade diets or plant-based embellishments. Others, however, search high and low for natural remedies and may seek help elsewhere if their veterinarian insists on commercial diets, given consumers’ persistent mistrust of the pet food industry since the Chinese melamine disaster.1 In the absence of a clinically proven medication or foolproof commercial diet, the drive for plant- or food-based options for CaOx stone prevention remains strong.2-3 As medical professionals know well, a one-size-fits-all approach to urolithiasis prevention rarely holds water. Metabolic abnormalities, foods and urinary tract health all influence lithogenesis, but stone type determines the specific treatment and prevention …
Diabetes Emergency Preparedness As Important As InsulinOctober 18, 2010 Owners often are shell-shocked when they hear their pet has diabetes. But a veterinarian’s optimistic attitude can help a client successfully manage the disease. “It’s usually a traumatic piece of information for an owner when a veterinarian tells them their pet has diabetes,” says Randy Lynn, DVM, a technical service veterinarian with Intervet Schering-Plough Animal Health of Summit, N.J. “If the owner is handling the news well, you can discuss the emergency situations that may occur in a diabetic animal. If you’re speaking to them and their eyes gloss over, you might want to send them home with written information, and then have the owner return in a day or two once they’ve processed everything. “It’s a delicate balance that the veterinarian has to weigh. If you tell them too much on day one, you could tip them over the edge.” Dr. Lynn says a diabetes diagnosis gives veterinarians a “chance to shine,” noting that owners will rely heavily on them for information on choosing insulin, injecting insulin and monitoring the animal. Besides hearing the diabetes news, distressed clients also have to be warned about hypoglycemia, the No. 1 emergency concern of veterinarians who …
Size Doesn’t MatterOctober 18, 2010 Trader, a 7-year-old male golden retriever, kept losing weight despite a normal appetite. Long story short: Abdominal palpation, radiographs and ultrasound suggested a very large abdominal mass, presumed to be splenic in origin. Trader is a golden, after all. Since thoracic radiographs were normal, Trader’s owners elected surgery. We removed a 14-pound multilobulated ugly-looking mass. It had numerous adhesions to the pancreas, the duodenum, the jejunum and the omentum. A few days after Trader went home, histopathology revealed a leiomyoma, a perfectly benign tumor of the smooth muscle. Collin, a 12-year-old male intact German shepherd, had a large ugly-looking paraprostatic mass. It was as large as his head! Its inner wall was lined with cartilage. It was partially resected, omentalized and biopsied. Histopathology revealed dystrophic ossification of a perfectly benign periprostatic cyst. Lady, a 9-year-old Labrador retriever, appeared lethargic and weak. She was diagnosed with hypoglycemia. What is your differential diagnosis? (See “Differential Diagnosis of Hypoglycemia” at VeterinaryPracticeNews.com/DDHypo.) Palpation and X-rays revealed a large mass in the cranial abdomen. Exploratory confirmed a soft-ball sized mass attached to the pylorus. The mass was excised, and histopathology revealed a leiomyoma. Lady made a full recovery, and is …
Laser Vs. Acupuncture And MassageOctober 18, 2010 Laser therapy, the new kid on the block for non-drug management of pain and a host of other problems, has spawned persistent questions about how it works and whether the benefits justify the financial investment. Now that evidence-based education is becoming available for laser therapy1, facts can begin to replace the hearsay and hype that make many of us uncomfortable. Practitioners want to know how laser stacks up against the old favorites: acupuncture and massage. Measuring all three side by side in clinical trials would provide the best insight, but only sporadic comparisons of this nature are found, mostly in human medical literature. 2-3 What are the differences in how the therapies work? Laser, acupuncture and massage share the common mechanism of neuromodulation. That is, each activates somatic afferent fibers in the periphery. Peripheral nerves then deliver impulses to the spinal cord and brain to help normalize central, autonomic and peripheral nervous system function. All three have the capacity to beneficially affect local tissue as well, promoting blood flow and reducing inflammation. The differences relate to how each accomplishes these changes. The light energy from laser’s photoirradiation leads …
TKLs Studied In Mast Cell CancersOctober 5, 2010Oncologists foresee treatments from combined therapy research Only lymphoma is more common in dogs than malignant mast cell skin tumors, making MCTs of great interest to veterinary oncologists. Up to 80 percent of mast cell tumors are grade II but can act as grade I or grade III, experts say, citing the need for a better way to accurately diagnose and treat the cancer. Oncologists say being able to determine the path of a MCT earlier in treatment, along with a more clear-cut eradication method, would improve the odds for animal cancer patients. “If you ask 10 oncologists how to treat a grade II mast cell tumor, you’ll get 11 different answers, counting the indecisive one,” says Rance Gamblin, DVM, Dipl. ACVIM (oncology), of Metropolitan Veterinary Hospital in Akron, Ohio. “With the current understanding on mast cells, there isn’t one treatment plan that can work in each patient.” An added danger with MCTs is that they do not have a classic, easily identifiable appearance and can spread to additional skin sites, lymph nodes and the spleen, ultimately resulting in death. “In 10 to 15 percent of MCT cases, a tumor …
Urban Wildlife Raising Risk Of LeptoOctober 5, 2010 Leptospirosis is the most common zoonotic disease worldwide, but the U.S. Centers for Disease Control removed it from the reportable human diseases list in the 1990s because of a lull in diagnosed cases. According to those who research Leptospira interrogans, the bacteria that causes the disease, it now can be considered re-emerging. Leptospirosis has been diagnosed in more than 150 mammalian species. The leptospira bacteria is shed most commonly through urine and can be contracted through mucous membranes, abrasions and ingestion. Without mandated reporting on the human or animal side, attaching an accurate number to diagnosed cases is difficult, veterinarians say. But, based on veterinary diagnostic laboratory and practitioner reports, the disease’s prevalence is notable. Widespread in Nature “There’s good evidence to support an increase of diagnosed cases of leptospirosis in the U.S.,” says George E. Moore, DVM, Ph.D., Dipl. ACVIM, an associate professor of clinical epidemiology and director of the clinical trials group at Purdue University. “Wild animals have remained a reservoir for the disease, which then spreads to dogs and potentially people. Lack of predators and increased food supply in suburban areas makes wildlife concentrations eight to 10 times higher …
Ending Japan’s Permanent PetlessnessOctober 5, 2010 Last November, I spent a week in Japan presenting an oncology and end-of-life-care symposium for veterinary students at Nihon University in Tokyo. For three hours every day I taught and interacted with students, general practitioners and faculty. Dr. Tomoko Takahashi, head of oncology and radiation therapy services at the university, was my faculty host. Dr. Takahashi gave me an office in the teaching hospital to serve as my headquarters for the week. I set special hours for students to speak with me in private. The week started routinely. But when I lectured on end-of-life care, palliative therapy and pet hospice, which I call Pawspice, many students had teary eyes and used tissues to dab their faces as they took notes. It was obvious that a number of students were in emotional pain. I was surprised to see that Dr. Takahashi was filled with emotion as she interpreted certain aspects of attachment and grief management that are part of my lectures on palliative and Pawspice care. Starving for Information Students stayed and chatted with me at the end of the sessions. They told me they had never heard anyone discuss attachment and the human-animal bond and …
Treating Arthritis With Integrative MedicineSeptember 2, 2010 Arthritis generally is treated using NSAIDs, especially the newer COX-2 inhibitors, and often with the addition of tramadol if pain control is incomplete. But what can a practitioner do if liver and kidney function are compromised and tramadol is not enough? Glycosaminoglycans have become part of mainstream medicine, and the effectiveness of acupuncture is widely recognized. But these two treatments are just the beginning as far as other integrative methods are concerned. In addition, some clients are mistrustful of any drug, no matter how widely used, but for them there are options as well. Because complementary medicine acts in many different ways, rather than being various versions of the same basic action (as opposed to COX-2 inhibitors), practitioners often will find that using a number of different items works better than trying a single method. The use of supplements that decrease cartilage degradation, reduce inflammation and help with muscle spasms—rather than just looking to decrease joint pain—often give the best long-term effects. Add physical therapy to increase flexibility and muscle strength, and the maximum benefit will be given. Uneven Results Some studies of glucosamine and chondroitin in humans have cast doubt on their benefits …
Shedding Light On Surgical ExodonticsSeptember 1, 2010 Many indications exist for extraction of a firmly rooted tooth. These include endodontic disease (when root canal therapy is not economically feasible or medically desirable), tooth resorption and crowding of persistent deciduous and permanent teeth. Though tooth extractions occur daily in nearly every practice, many practitioners have not been taught how to effectively and efficiently extract firmly rooted teeth. Having the right tools makes all the difference. Exodontics is a fancy word for extraction of teeth. Considering how much work it is to remove a firmly rooted or ankylosed tooth, the procedure deserves a fancier word than “pulling”! This article will discuss the necessary armamentarium and things a practitioner should look for when making purchase decisions. Do you have a dental X-ray unit? Preoperative dental X-rays are a must for firmly rooted teeth. Anatomic variation in root shape, size, curvature and even number of roots makes taking a preoperative radiograph a good thing. Do you have a high speed/low-speed dental unit? Whether compressor-driven or nitrogen-driven, a high-speed unit is an important tool to remove bone on the buccal surface of firmly rooted teeth to create a window and to minimize forces necessary to …
