How To Avoid UTI FrustrationJanuary 30, 2013 Surgery lovers, like most practitioners, are regularly faced with urinary tract infections in animals with bladder stones or redundant vulvar folds, spinal patients, diabetics or patients with plain bad luck. But what is the best way to treat these infections in 2013? Ask three colleagues how they treat a UTI, and you will likely hear three answers. To be fair, current guidelines to treat UTIs can sometimes seem nebulous. There are multiple factors to consider. Fortunately for us, the International Society for Companion Animal Infectious Diseases recently locked up a team of specialists in a conference room and told them they would not be allowed to eat and drink until they come up with guidelines to help the rest of the profession. Thanks to the courage, altruism and wisdom of our colleagues—specialists in infectious diseases, internal medicine, microbiology and pharmacology (from the human and veterinary fields)—we now can refer to their excellent UTI guidelines. They were recently published in Veterinary Medicine International, a journal available to all veterinarians.* What follows is not an exhaustive summary of the article, but a review of some important points, especially as they relate to …
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‘Chiropractic Functional Neurology’: Not Veterinary MedicineJanuary 28, 2013 The One Medicine movement is beginning to blur the boundaries between human and animal health. In many ways, encouraging collaboration among physicians, dentists, veterinarians and public health officials will benefit all parties. However, veterinarians must remain vigilant to ensure that practices adopted from human alternative medicine are rational, ethical and scientifically based. Consumers count on veterinarians and regulatory agencies to protect them from fraud and safeguard their animals’ health and well being. Consider the case of homeopathy. As the FDA stated, "Homeopathy is an alternative therapeutic modality developed in the late 1700s by a German physician for use in humans. Homeopathic medicine is considered an unconventional form of veterinary practice. ... There are currently no FDA-approved homeopathic drugs for veterinary use.”1 Homeopathic veterinarians prescribe what are essentially sugar pills, with little proof that they differ from placebos. Their academy publishes standards of practice advising against medications (e.g., analgesics, chemotherapy, cardiac drugs, etc.) as well as conventional therapy, including surgery for skin lesions.2 The British Medical Association has denounced homeopathy, maintaining that taxpayers should not have to financially support unscientific practices as part of the National Health Service.
Canine Vaccines: The Best Current ThinkingJanuary 24, 2013 Before the American Animal Hospital Association published the first canine vaccine guidelines in 2003, veterinarians had only manufacturers’ recommendations for guidance. This posed a problem when veterinarians grew increasingly concerned with over-vaccination and a link between certain vaccines and sarcoma development in cats became apparent. Experts and academics have collaborated on the topic three times since the release of the initial canine vaccine guidelines, helping veterinarians create a rational vaccine program to include in their patient wellness protocols. “Years ago, the profession was heavily marketed through the need for annual vaccinations,” says Robert Franklin, DVM, Dipl. ACVIM, of Oregon Veterinary Specialty Hospital in Beaverton, Ore. “Now we educate owners about the total wellness needs of their pets. Vaccines are an important preventive in a wellness program, but are just part of it.” Without discussing specific brands, the AAHA guidelines cite the duration of immunity (DOI) of core vaccines. The task force deems these vaccines as highly effective, having a potency of five years to lifetime. However, the task force has agreed that core vaccines should be given every three years. Members of the American Animal Hospital Association Canine Vaccination Task Force • Link V. Welborn, DVM, …
Telemedicine Is Better, Faster, NowJanuary 24, 2013 Better, faster, now. Those words best describe the goals of the rapidly growing telemedicine industry, a frontier that technology is opening up to any area of medicine that enables practitioners to use an image to help them treat their patients. Advances in technology and the ability of people and businesses to handle increasingly more bandwidth have enabled service providers to expand their offerings, giving veterinarians in many cases almost real-time consultation opportunities with specialists. It’s that increasing broadband speed that is expanding telemedicine beyond its core service of teleradiology and into areas like tele-endoscopy, tele-ultrasound, tele-arthroscopy and teledentistry, said Jim Waldsmith, DVM, president of Vetel Diagnostics in San Luis Obispo, Calif. “That is opening up the role of a consultant to anything that makes an image,” said Dr. Waldsmith, who also serves as a staff veterinarian at The Equine Center in San Luis Obispo. A Growing Market According to BCC Research, the telehealth market globally is expected to double to more than $27 billion by 2016, and while a large portion of that will be driven by home health and disease management monitoring, experts see the veterinary telemedicine market growing in step with …
John Harvey, DVM: Following His BlissNovember 28, 2012 John Harvey, DVM, Ph.D., Dipl. ACVP (clinical pathology), says he is following his bliss as executive associate dean and professor of hematology at the University of Florida College of Veterinary Medicine in Gainesville. Dr. Harvey is referring to a quote in Joseph Campbell’s book “The Power of Myth”: “If you follow your bliss, you put yourself on a kind of track that has been there all the while, waiting for you, and the life that you ought to be living is the one you are living. Wherever you are—if you are following your bliss, you are enjoying that refreshment, that life within you, all the time.” “For me, that’s been veterinary academic hematology,” he says. “I didn’t know it starting out. Things just sort of happened along the road, but that’s the way it ended up.” Harvey, a member of the UF veterinary college faculty since 1974, spends most of his time with university administration duties but he continues to teach and conduct research. His research interests include erythrocyte metabolism of domestic animals, Heinz body hemolytic anemias, serum haptoglobin alterations in disease states, iron deficiency anemia, methemoglobinemias, myeloproliferative and lymphoproliferative disorders, developmental hematology and iron …
All Bleeders Stop...EventuallyNovember 21, 2012 Dr. Emma was frantic. “Help! I’ve excised many masses over the years, but I’ve never seen one bleed like this.” I could hear her distress over the phone as her patient’s blood pressure dropped. After a little help, the dog eventually did fine, so this is a perfect opportunity to review our options for hemostasis. Here is a non-exhaustive list of techniques to stop bleeding. We will assume that our patient has normal clotting capabilities. Time. As the saying goes, “All bleeders stop...eventually.” This law has never failed in the history of mankind or petkind. Not even once. It’s just a matter of time. That said, we would rather keep bloodletting within reason. Time will allow small vessels to clot on their own. Direct pressure. A classic mistake is to apply too much pressure, especially under stress. Too much pressure completely occludes the blood vessel, which prevents platelets and clotting factors from reaching the bleeding site, and prevents formation of a fibrin clot. Appropriate pressure may be all you need if the blood vessels are small enough. How much pressure to apply is an art form, which is acquired with experience. …
A Special Touch For Dying AnimalsNovember 20, 2012 Touch. Careful, calming, confident touch soothes the mind and the body. Where has touch gone in modern medicine, especially for the terminally ill? What shifted the focus from “caring for the sick” to “treating disease”?1 Was it understaffing? Heightened technology? “Professional distancing”? Fortunately, hospice care has shifted the spotlight back on the patient, strengthening the family network and making it safe to share hopes and fears about death and dying. Massage is establishing a foothold as a critical piece of hospice. It has received widespread acclaim from staff, patients and families in the human hospice setting.2,3 Responding to a survey, one patient noted, “[Massage is] the only time I can relax completely” ... it “reduces spasms and makes me feel good.” Gaining Ground Massage is gaining recognition as a reliable way to reduce pain, medication requirements and isolation.4 End-of-life patients who regularly receive massage become more peaceful and comfortable.5,6 It alleviates constipation and encourages the elimination of metabolic end products from tissue.7,8 It also benefits circulation, relaxes muscle tension, settles the …
Neuromodulation For ConstipationOctober 31, 2012 Cats and humans share a common problem: constipation. Sedentary lifestyles, suboptimal fluid and fiber intake, and uncontrollable stress all contribute to digestive difficulties. Neither drugs nor surgery alleviate the ailment entirely. Each poses risks of future morbidity and continued distress of one sort or another.1,2 Even something as seemingly harmless as an herbal enema can deliver damaging consequences. A recently published case report recounts how a “natural” enema nearly killed a patient by causing massive rectal hemorrhage.3 At least humans can usually control the cleanliness and quality of the bathrooms they seek, the food they eat and the water they drink. Cats cannot. No one enjoys a dirty, smelly latrine; similarly, cats dial down their interest in eliminating when faced with a putrid litter box already overflowing with feces. Cats have specific preferences for low, sometimes clear glass bowls without the odor or taste of other cats’ mouths in the water or on the sides of the container. Add in the worry of being watched or ambushed while defecating, pain in the pelvis or spine,4 and the cacophony of household noise and agitation,5 …
6 Tips For Keeping Patients Safe Under AnesthesiaOctober 22, 2012Refining anesthesia protocols has been at the top of practitioners’ to-do lists since the American Animal Hospital Association released its anesthesia guidelines for dogs and cats. Patient safety is a primary goal in all anesthetic procedures, so to minimize risks, consider these tips for creating a successful outcome for patients undergoing anesthesia. 1. Pay particular attention to the induction and recovery phases, as these are the most critical, says the University of Georgia’s Jane Quandt, DVM, Dipl. ACVA, Dipl. ACVECC, of Athens, Ga. “Induction [is critical because] we are taking animals to the point of unconsciousness,” said Dr. Quandt. “And in recovery they regain consciousness and must cope with the demands of tissue trauma and going back to room air if they were on inhalant anesthesia.” She also notes that the recovery phase may be the most overlooked by general practitioners. “Recovery may be overlooked a bit because once [patients] are conscious we tend to move on to the next patient.” Daniel K. Edge, DVM, MBA, veterinary liaison manager for Abbott Animal Health in Abbott Park, Ill., agrees, and notes the findings of a 2006 study. “According to the Confidential Enquiry into Perioperative Small Animal Fatalities, 64 percent of …
Medical Errors And How To Avoid ThemOctober 22, 2012 A medical error is the ultimate taboo. It can bring feelings of shame, incompetence and humiliation. “How Doctors Think” is a fascinating book that investigates the thought process of physicians, through success and failure. Throughout the book, the author, Jerome Groopman, M.D., details different types of errors. Let’s go through a few and apply them to the field of veterinary medicine in general and surgery in particular. Anchoring Error Also called distorted pattern recognition, anchoring is “a shortcut in thinking, where a person doesn’t consider multiple possibilities but quickly and firmly latches on to a single one, sure that he has thrown his anchor down just where it needs to be.” This type of error occurs when we cherry pick symptoms to confirm our (biased) impression. For example, let’s consider a 6-year-old Labrador whose lameness has been getting progressively worse over the past three months. Of course, we suspect an ACL tear. The fact that he can “sit square” doesn’t seem to matter all of a sudden. The fact that he has no obvious effusion, no stifle pain and no clear drawer sign doesn’t matter either. It must still be a partial tear, we rationalize, …
