New Therapies Take Hold in Fight Against CancerJanuary 19, 2015Originally published in the January 2015 issue of Veterinary Practice News The year 2015 is an exciting time to be a veterinary oncologist as we shift away from decades-old chemotherapy regimens and toward a host of emerging therapies for veterinary cancer. More pets are developing cancer, a leading cause of death in companion animals, because they are living longer. Newer therapies are the outcome of research based on need and predominantly from advances in the human oncology arena. Animals with naturally occurring cancer are a driving force to industry, allowing pharmaceutical companies to continue their progress against the dreaded disease for the benefit of both people and companion animals. Improving treatment outcomes stems from staging the patient (i.e., identifying the cancer within the body and any other diseases present) as cancer management is always planned in the best interest of the patient. For the primary care veterinarian, a shift to twice-a-year exams focusing on a complete physical examination has facilitated early identification. In addition, combining laboratory testing and advanced imaging with thoracic radiographs and abdominal ultrasound has afforded early screening in managing many cancers and setting realistic expectations. Indeed, many practitioners have reallocated their thinking—basic diagnostic tests are just as …
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How Great a Surgeon Are You?December 11, 2014Originally published in the December 2014 issue of Veterinary Practice News "A great surgeon is someone who makes a difficult surgery look easy," a colleague once told me. How do you know if you are a good surgeon? How do you know if you are a great one? What does it even mean to be good or great? Does it mean saving all your patients? Does it mean not shaking like a leaf while suturing? Does it mean being worshipped by your technicians? Does it mean knowing it all? Does it mean getting flowers from every pet owner? Trying to define which qualities we strive for, I submitted a challenging question to a number of board-certified surgeons, in the U.S. and abroad: What qualities does a great surgeon have? I heard so many excellent answers that I can share only the top 10—those mentioned the most frequently. 1. Be Ethical Ironically, the most important trait of a surgeon, based on the number of similar responses, is knowing when not to perform surgery. "A chance to cut may not be a chance to cure,” said Joe Harari. “Case selection is king; technique is the prince,” confirmed Steve Withrow. “Integrity goes beyond …
Straight Talk About NSAID ControversiesDecember 4, 2014Originally published in the June 2014 issue of Veterinary Practice News Many controversies surround the proper use of non-steroidal anti-inflammatory drugs (NSAIDs). To shed light on this nebulousness, we talked to Kurt Grimm of Conifer, Colo., who is double boarded in veterinary anesthesiology and veterinary clinical pharmacology. When do you prefer giving an NSAID, pre- or postop? Most NSAIDs approved for perioperative pain management have been evaluated for administration prior to anesthesia and surgery (usually elective procedures such as spays) and have not shown significant adverse effects. I typically administer an NSAID toward the end of surgery. The types of surgeries I usually deal with tend to be longer or complicated, and my patients are often at higher risk. By waiting, I can see if there are any complications, such as hypotension or bleeding, which may be contraindications to NSAID administration. What are the concerns when giving NSAIDs preop? Because most anesthetic drugs alter cardiac output and blood pressure, I’d worry about potentiating any renal toxicity. In normal, healthy kidneys, the risk is relatively low. However, in sick or older patients with limited reserve kidney function, giving an NSAID may pose a significant risk. The dilemma is that we just …
Cannabis for intractable epilepsyDecember 3, 2014Chances are, if you treat patients with seizures, you have encountered a certain percentage whose seizures you just can’t control, even with multiple medications.
How pesticide cocktails can taint 'natural' herbsNovember 25, 2014"Natural” plant medicines can both help and harm, but the more we learn about how medicinal plants are cultivated, harvested, stored and sold, especially in China, the more we realize the need for heightened scrutiny and regulatory enforcement.
Why Administering Alfaxalone Requires A Bit of EducationNovember 17, 2014Originally published in the November 2014 issue of Veterinary Practice News Twelve years after an application was sent to the Food and Drug Administration, a new anesthetic drug, alfaxalone, just became available on the U.S. veterinary market. To better understand what it is, how it works and which precautions to use, we asked Bob Stein, DVM, Dipl. AAPM, CVA, CCRT, CVPP, CMTPT, to share some information about the drug. He has eight years of alfaxalone experience in small animal practice. Dr. Stein is the founder and webmaster of the excellent Veterinary Anesthesia and Analgesia Support Group (www.vasg.org) as well as the owner of the Animal Pain Management Center in Buffalo, N.Y., and Amherst Small Animal Hospital in Snyder, N.Y. What’s All the Excitement About? Alfaxalone’s arrival on the U.S. market is exciting because of its versatility and relative safety. It can be used on cases ranging from young and healthy patients to more challenging ones like C-sections, cardiac patients and debilitated pets. It has been many years since a new anesthetic agent was approved. Isoflurane was introduced 35 years ago. Propofol and sevoflurane were released about a quarter century ago. Common induction options include …
What ‘One Health’ Is MissingNovember 7, 2014Originally published in the November 2014 issue of Veterinary Practice News While the One Health movement may be making headway toward its goals of improving health care, it may also be overlooking a significant sector of medical practitioners and eco-health considerations. In order to truly embrace the whole, the initiative needs to remedy this. The One Health website, onehealthinitiative.com, lists vision and mission statements that sound progressive, expansive and all encompassing.1 The vision defines seven ways to improve the lives of all species, human and animal, by integrating human medicine, veterinary medicine and environmental science. It outlines that to achieve this goal, those involved will seek to influence medical education, political leaders, disease surveillance, the study of zoonotic transmission, and the delivery of modern medical approaches worldwide. The recent Ebola outbreak in Africa—which just reached the U.S. as we went to press—drives home the timeliness and significance of such an approach.2 Indeed, situations such as this call for interdisciplinary, international and highly coordinated efforts in a holistic approach to emerging diseases.3 And yet, at the same time, this effort fails to mention the most widely practiced form of health care in developing nations, i.e., native healing practices …
The promises and perils of St. John’s wortNovember 3, 2014You, a 34-year-old veterinarian with a husband and three children, are preparing for your day packed with surgeries and procedures. Your technician is performing the intake for Charlie, a 10-year-old neutered male golden retriever who will be receiving a dental cleaning and one or more dental extractions. The form she is completing asks about any new developments or medications since Charlie’s last exam six weeks ago. The client, Claudia, denies changing anything; she does reinforce that Charlie has severe separation anxiety at times like this. The technician remarks that he seems calm now and assures the client that she’ll take good care of Charlie. They say their goodbyes and nothing seems unusual. What’s wrong with this picture? What the technician failed to ask and what Claudia neglected to mention was that Charlie had been taking St. John’s wort (SJW) for many weeks and, in fact, had a double dose before they left the house. Claudia had seen abundant ads and blogs on the Internet advocating SJW for dogs with anxiety, phobias and depression. Having planned this dental procedure weeks earlier, she decided to give the herb a try and see how he did well in advance of his scheduled date. …
How to Diagnose and Treat Uroabdomen CasesNovember 3, 2014Tucker, a 3-year-old border collie, was rushed to your hospital after getting hit by a car at 9 a.m. He is lucky, as he escaped without any fracture or major laceration. He only seems to have a few skin scrapes. You stabilize Tucker throughout the day, and he looks much better by that evening. He is kept overnight for IV fluids and pain medications. By the next morning, you are disappointed to see that Tucker’s condition has worsened overnight. Blood work and abdominal X-rays make you strongly suspect a bladder rupture. Ultrasound confirms it without a doubt. Fortunately, Dr. Jennifer Stafford, a double-boarded colleague in critical care and internal medicine at VCA Veterinary Referral Associates in Gaithersburg, Md., comes to the rescue with a full write-up on uroabdomen (JR Stafford, et al. “A clinical review of pathophysiology, diagnosis, and treatment of uroabdomen in the dog and cat.” J Vet Emerg Crit Care 2013, Vol 23, N 2, p. 216-229). As in Tucker’s case, most uroabdomen cases are caused by blunt trauma to the abdomen, such as getting hit by a car. The chances of this happening depend on the degree of bladder distention at the time of the trauma. Uroabdomen …
4 Myths About AcupunctureOctober 27, 2014What looks like acupuncture, feels like acupuncture and employs the same instruments as acupuncture but is practiced by physical therapists (PTs)? Dry needling is defined by the American Physical Therapy Association as “a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular and connective tissues for the management of neuromusculoskeletal pain and movement impairments. Dry needling (DN) is a technique used to treat dysfunctions in skeletal muscle, fascia and connective tissue, and diminish persistent peripheral nociceptive input, and reduce or restore impairments of body structure and function leading to improved activity and participation.”1 The PT description of DN resembles that of scientific medical acupuncture: “The performance of modern dry needling by physical therapists is based on Western neuroanatomy and modern scientific study of the musculoskeletal and nervous system.”2 A big difference between PTs and medical acupuncturists is that physician and veterinarian medical acupuncturists treat not only pain and myofascial dysfunction but also address digestive, immunologic, cardiopulmonary and a host of other disorders. As with acupuncture, DN requires clean needling technique and awareness of underlying anatomy to avoid complications such as major vessel or organ puncture. …
