Repairing Fractures: Are You A Carpenter Or A Gardener?June 29, 2012 When we repair a fracture there are two basic approaches, which intuitively may seem mutually exclusive. The traditional approach is to “put the pieces back together” at all costs by focusing on the mechanical aspect. The carpenter-minded surgeon wants to reconstruct the bone so that it looks as close to the original bone as possible on postoperative radiographs. By ensuring anatomic reconstruction of the bony column with a variety of internal implants (plates, screws, pins, cerclage wires), we can provide instant mechanical support, which allows the patient to use the leg. This mindset is commonly used to repair simple transverse or oblique fractures, for example of the radius or tibia. Barely being able to see the fracture line on the postop films often gives the surgeon an instant high. The carpenter knows that clients don’t always understand the concept of confinement, and that a pet comprehends it even less. So the stronger the repair, the better the carpenter sleeps at night. There are clear disadvantages to this approach in some cases, classically in highly comminuted fractures. Meticulous reconstruction of each fragment to recreate the bony column leads to: • Opening up the fracture site and …
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Digital Dental DifferenceJune 29, 2012 As veterinary dentistry continues to advance, practitioners are increasingly looking for ways to boost the level of services they offer and better their bottom lines. Dental radiography can play a valuable role. Jan Bellows, DVM, Dipl. AVDC, Dipl. ABVP, of All Pets Dental Clinic in Weston, Fla., says dental X-ray systems should be a required tool for veterinarians who do any dentistry. Yet he estimates that only 10 to 15 percent of practitioners are using such systems. An abscessed molar in a Dachshund. “In time, if we look into a crystal ball, this will become the standard of care,” he says. The value of dental X-rays in maintaining a pet’s oral health is undisputed. John Lewis, VMD, FAVD, Dipl. AVDC, assistant professor of dentistry and oral surgery at the University of Pennsylvania, says multiple studies have shown that dental X-rays reveal significantly more pathology than thorough oral exams alone. “It gives you a look at the other 50 percent of the tooth that exists below the gum line,” he says. “X-rays help pick up subtle problems due to bone loss and periodontal disease. And with cats, you need dental X-rays to …
Proper Periodontal Care Good For Patient, PracticeJune 27, 2012Introduction Periodontal disease is a very common problem in veterinary patients. It has numerous severe local and systemic ramifications, but outward clinical signs occur only very late in the disease course. This means that it is significantly underdiagnosed, and even when recognized and treatment is recommended, clients can be reluctant to comply as they do not perceive the significance of the problem. Regardless, proper and prompt therapy of periodontal disease is beneficial for the health of the patient as well as financially for the practice. Incidence and Pathogenesis Periodontal disease is the No. 1 diagnosed medical problem in small animal veterinary patients. In fact, by 2 years of age, 80 percent of dogs and 70 percent of cats have some form of periodontal disease.1 Small and toy breed dogs are particularly susceptible. As shocking as these numbers are, they likely underestimate the true incidence of disease. This is because they are based on the diagnosis of gingivitis via a color change (inflammation) of the gingiva, or “marginal gingivitis.” While erythema and edema of the gingiva are reliable signs of disease, it is now known that increased gingival bleeding on probing or …
CO2 Laser Beneficial In Oncologic SurgeryJune 26, 2012 Cancer is one of the most common causes for mortality in companion animals, affecting one in two pets over the age of 10. Surgery is still the most effective modality for the treatment of cancer, because it can often provide an immediate cure or palliation of pain, with minimal and temporary side effects. Laser techniques in oncologic surgery have become effective alternatives to radical tumor resection and to palliative tumor treatment methods.1 CO2 and Nd:YAG laser excision has been shown to provide almost a 50 percent improvement in the control of local disease in vivo compared with scalpel resection in rodent mammary gland tumors and human oral mucosal lesions.2-5 Lasers provide light with the necessary wavelength at the intensity sufficient for photodynamic therapy (PDT) for treating cancerous and non-cancerous lesions.6,7 Hemangiopericytoma Intra-Op The carbon dioxide (CO2) surgical laser operates at a wavelength that is highly absorbed by water, therefore making it the most versatile and commonly used surgical laser available in veterinary medicine today. Despite the incredible development and advances that lasers have undergone in human surgical and therapeutic applications, lasers …
Let There Be Light: Why Laser Therapy Is Evidence-based MedicineJune 26, 2012 For those who view drugs and surgery as mainstay treatments, laser therapy may seem odd. Nothing is injected, swallowed or even tangible, yet proponents claim that light can help tissue heal and injured nerves regrow. Here are 10 common criticisms heard around the virtual veterinary water cooler and evidence-based responses. 1. “Some studies show that laser therapy does not work.” True. A number of negative studies on laser therapy have appeared in the medical literature over decades of research. However, several parameters influence outcomes, including wavelength, fluence, irradiance, treatment repetition and timing, as well as pulsing.1 Ineffective doses and lack of laser output testing further muddy the interpretation of outcomes in laser research.2 In order to identify and prevent more methodological flaws in laser research, the World Association for Laser Therapy publishes standards for the design and conduct of clinical studies,3 systematic reviews and meta-analyses.4 2. “Most laser research is of too poor quality to allow interpretation of effectiveness.” False. Several systematic reviews and meta-analyses (i.e., high grade evidence) have found in favor of laser therapy for various conditions. These include neck pain,
The Changing Face Of Diagnostic TestingJune 26, 2012 In the beginning, there were reference laboratories. Although turnaround took a while, they could always be counted on to provide accurate results. Today the diagnostic testing landscape has changed. Large reference labs such as Antech (Irvine, Calif.) and Idexx (Westbrook, Maine) still ply their trade, but the rise of in-house test kits and analyzers has introduced new testing alternatives to the veterinary industry. Idexx now provides clinic-based hardware as well as sendout services, and Antech has opted to remain with its traditional reference offerings. With the expansion of testing options, is the handwriting on the wall for the end of reference laboratories? Not at all, said Darin Nelson, Antech's senior vice president. "We have much higher-end, more expensive equipment than practitioners have in their clinics," Nelson said. "You get much more information, many more analyses and checks for more abnormalities than in-office analyzers or test kits can provide. "It's like comparing a Lamborghini to a Kia," Nelson said. "Many of the in-clinic hematology analyzers use an older technology called impedance that has problems with the small red blood cells that animals have, especially in differentiating them from platelets, such as the larger ones …
How To Make Anesthesia Safer, Part 2May 30, 2012 A recent white paper published by AAHA is dedicated to the art of anesthesia. The guidelines “are not meant to establish a universal anesthetic plan or legal standard of care,” explain the authors,* but they are an excellent review of common practices in 2012. Full disclosure: What follows is not a summary of the article, but the second part of our review of a few great points made by the authors. Click here to read Part 1. 13. Liver disease “Increases in the liver enzymes of an otherwise healthy patient are not an absolute reason to avoid anesthesia,” the authors write. With severe liver conditions, dextrose supplementation can fight hypoglycemia and fresh frozen plasma may be required with hypoproteinemia. Anesthetic drugs metabolized by the liver may lead to delayed recovery, so reversible drugs may be a better choice, such as opioids and alpha-2 agonists. 14. Ace Myth Acepromazine is often avoided in “seizure patients.” Yet, the authors write, “There is no evidence to show that ‘ace’ increases the risk of seizures in epileptic patients or patients with other seizure disorders.” 15. Anticholinergics “Indiscriminant …
CO2 Laser Surgery: Dermatologic ApplicationsMay 25, 2012 The carbon dioxide (CO2) surgical laser has many advantageous uses and is the primary laser in use today in veterinary dermatology.State-of-the-art CO2 lasers feature flexible fiber waveguide beam delivery with scalpel-like handpieces for surgical accuracy and precision. The surgeon can easily control the device for use in three ways: skin incision, lesion excision and ablation. It can be readily controlled for precise microsurgery or used for ablating larger lesions. Because its wavelength is highly absorbed by water, little to no collateral tissue damage occurs when this laser is used properly. The Animal Skin & Allergy Clinic in Lynnwood, Wash., has used the CO2 lasers made previously by Luxar and now by Aesculight (both of Seattle) for more than 20 years in our dermatology practice. These lasers feature precision and reliability that are indispensable for a surgeon, including: A) convenience and pinpoint precision of scalpel-like handpieces; B) calibration of the distal end laser power; C) ability to defocus the beam to switch between incising/excising and large-area ablation; D) rugged design thanks to all-metal laser tube technology (In the 22 years I have used these lasers, I have never had a breakdown. One time the tube had to be …
Eye Protection Is Paramount When Using Class IV Therapeutic LasersMay 23, 2012 An increasing number of veterinary practices are using class IV therapy lasers to help patients with conditions ranging from ear infections to anal glands, and acute injuries to chronic hip dysplasia. Laser therapy is a scientifically based modality1 that helps reduce pain and inflammation while increasing blood flow2 and enhancing the rate and quality of tissue healing.3 Lasers are classified by the potential for hazard to the eye, with class IV being the highest. There are complicated definitions for the specifications of each laser class,4 but generally a laser with power greater than half a watt is a class IV laser. Several companies market class IV therapy lasers in the veterinary industry. Misconceptions The therapy laser used to treat Tails the dachshund for intervertebral disc disease5 and the airborne military laser that shot down a ballistic missile6 are both class IV lasers, which has led to many misconceptions. Some report that the former can and will cause the same degree of thermal damage as a surgical or industrial laser. Class IV therapy lasers deliver more energy per …
Therapy Lasers: Too Good To Be True?May 23, 2012 First, I am particular about the terminology of laser therapy as there are many misperceptions and misrepresentations. After years of inferior products and exaggerated claims, we must be specific and accurate with our statements. So this is not a discussion of “light” therapy but “laser” therapy. More specifically, we are talking mainly about high power laser therapy. Although “cold” lasers or low level lasers work on the same principles, they often do not have enough power to elicit a measurable or consistent clinical response in deep musculoskeletal conditions. Newer high-powered Class IV therapy lasers were FDA cleared in the U.S. in 2005. Their use has grown dramatically in the past two years. The two key parameters that dictate the function or capability of any laser are wavelength and power. Laser therapy works by a wavelength-specific form of photobiomodulation. Laser light in the red and near-infrared range is absorbed by specific chromophores in the body (cytochrome C oxidase/hemoglobin/water) and this has a positive effect on specific biological reactions. This photochemical reaction increases blood flow to tissue, stimulates the release of O2 from the hemoglobin delivered and enhances the conversion of O2 to useful energy by cytochrome …
