Ultrasound Comes Of AgeAugust 21, 2013 Talking about ultrasound, J.K. Waldsmith, DVM, gets in the zone. Referring to what is often called "zone technology," Dr. Waldsmith, president of Vetel Diagnostics in San Luis Obispo, Calif., will tell you that the biggest thing right now in the world of ultrasound is sound speed corrected ultrasound systems. "These are solid state systems that run on DCP (driver compatibility program) chips and microprocessors, not boards with firmware," Waldsmith said. "They are able to calculate the speed of sound on a pixel-by-pixel basis and apply a display algorithm based on the speed of sound in the tissue at each specific location throughout the image." The result is a clear and distinct image that is uniform in detail, which Waldsmith said is impressive on both shallow and deep structures. Additionally, he noted, the technology eliminates the need for the time consuming process of applying focal zones to an image, and also making time gain compensation adjustments. What does all this mean to veterinarians interested in ultrasound technology? Thanks to its increasing affordability, non-invasive nature and rapid delivery of soft tissue anatomical information, the technology is easily accessible and usable by the typical veterinarian. And thanks …
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Superbugs: Can Plants Save Us?August 9, 2013 If the best defense is a good offense, we’re in trouble—at least when it comes to modern microbes. Growing resistance has sidelined our top-tier players such as methicillin and vancomycin increasingly often. Drug companies have redirected resources away from the anti-infective fight toward more profitable contests of heart disease, cancer and inflammation.1 What now, with infectious organisms outmaneuvering even our drugs of last resort? "Nightmare bacteria," including totally drug-resistant tuberculosis, carbapenem-resistant enterobacteriaceae (CRE) and vancomycin-resistant Staphylococcus aureus (VRSA), prompt proclamations like, "The worst has finally happened”2 and that this "worldwide human health risk” has us facing "an apocalypse."3 "Nightmare bacteria" did not develop overnight. Instead, many attest that the bulk of antibiotic resistance arises from unhealthful and, at times, inhumane cattle-, pig- and chicken-raising practices. The American Veterinary Medical Association sidesteps this accusation by asserting, "There is little to no evidence that restricting or eliminating the use of antimicrobials in food-producing animals would improve human health or reduce the risk of antimicrobial resistance to humans."4 If antibiotics weren’t to blame, why have so many countries across the globe, other than the United States, banned the use of growth-promoting antibiotics in animal feed? Why are …
How To Tell If The Itch Is Atopic DermatitisAugust 7, 2013 Management of the pruritic dog is one of the most common problems general practitioners see. The mistake in general practice that I see time and time again is that most cases of pruritus are handled as if they were the same disease. Pruritus is not a disease. Consider three different presentations: * A 10-year-old dachshund with no previous history of skin disease presents with pruritus and skin lesions on the trunk; * A 5-year-old standard poodle with pruritus to the head and neck and increased scale and alopecia; and * A 3-year-old Labrador retriever with seasonal pruritus to the paws and muzzle. Would you treat them all with antibiotics and steroids? They might temporarily improve with that approach. But they will all relapse and the conditions will recur until the underlying problem is addressed and managed—or until the clients find their way to the practice down the street and you lose not only the patient but the client as well. Managing patients with chronic pruritus requires time, interest and a methodical approach. A common cause of pruritus in the dog is atopic dermatitis, or AD. Arguably the most …
CO2 Laser Surgery: Selecting The Best Delivery SystemJuly 31, 2013 Carbon dioxide (CO2) laser use is widely accepted in veterinary surgery because of its advantages: reduced hemorrhage, swelling and pain, increased precision and minimal tissue trauma, and because of the development of many laser-improved and laser-specific procedures. The popularity of veterinary CO2 laser surgery has attracted many vendors. Each vendor contends that its laser is the best and its marketing creates confusion for veterinarians considering laser devices for their practices. The most important decision when selecting a laser is which delivery system to purchase. What is available? Which best meets patients’ needs? Which will be used most often? Which will give the greatest return on investment? CO2 Laser Delivery Systems Articulated Arm (AA) laser technology was developed in the 1970s. AA lasers deliver the laser beam to the tissue through a sophisticated four elbow, seven mirror articulated arm. The laser beam is focused 2-3 cm from the hand piece by a lens in the hand piece’s base. Since the operator must hold the hand piece away from the tissue for the beam to focus, these devices require a visible aiming beam. Hollow wave guide (HWG) lasers were developed in the 1990s and deliver the laser …
Huperzine: A Useful Addition To A Pharmacological ArmamentariumJuly 26, 2013 Five years ago, my resident and I presented a poster at a Boston-based biotech meeting called BIO 2008. It was fairly quiet around the poster exhibit that day, with only a few people stopping to ask questions. At the poster next to us was an elderly scientist who, like us, was not receiving much attention. I said to my resident, "Why don’t you pop over to see what his poster is about? I’ll hold the fort until you get back.” So off she went and I saw her discussing the poster with him in some detail. She returned a few minutes later with some printed materials and explained what his poster was about. "It’s about treatment of seizures in mice using Huperzine,” she reported. "His name is Dr. Schachter and he’s from Beth Israel Hospital.” "Not Steve Schachter?” "Yes, that him,” she replied, pointing to his name on the printed sheets. "Oh my gosh, I know him from years back,” I said and went over to speak with him. He recognized me immediately so we chatted and caught up. "So what’s this Huperzine stuff?” I asked. "Oh, it’s an herbal extract …
AAHA Updates Dental Guidelines For Dogs, CatsMay 21, 2013For The Education Center In 2004, an AAHA task force of boarded veterinary dentists, technicians and general practitioners authored the evidence-based AAHA Dental Care Guidelines for Dogs and Cats. Recently, AAHA assembled some of the original contributors and new, fresh eyes to create an updated report. The 2013 AAHA Dental Care Guidelines are available online at www.aahanet.org/Library/DentalCare.aspx. Figure 2. Stage 3 periodontal disease (5 mm pocket depth) diagnosed under general anesthesia Here are some of the important details in the guidelines that help veterinarians deliver consistent quality of dental care to their patients. The updated guidelines have been peer reviewed by the Journal of the American American Hospital Association and endorsed by the American Veterinary Dental College. Dental health care needs to be part of the preventive healthcare examination discussion. It should begin at the patient’s first appointment and continue throughout all subsequent exams. Semi-annual dental evaluation examinations are recommended. Figure 3. Surgical extraction of retained deciduous tooth Assessment by life stage introduced the concept of periodontal diseases—with its many appearances, compared to the catchall term "periodontal disease” (Figure 1). The professional
Lasers Promote Faster, Stronger Wound ClosureMay 21, 2013 Wounds and dermatology issues represent perhaps the widest variety of ailments in veterinary practice, both in origin and complication. From an acute burn to a chronic lick granuloma, from an ischemic ulcer to a dehiscent surgical site, no two wounds will be alike. Compound this variation with different histologies and enzyme over/under-expressions; then throw bacterial or fungal infections on top of all that; now plan for a dog gnawing at it constantly or a horse sleeping in a dirty stable. Snake Bite This is a snake bite case handled by someone who was skeptical about therapeutic lasers. The dog was bitten in the hind limb and after three days, the entire belly was necrotic. Veterinarians did a full surgical debridement on Day 5 and one day later, the necrotic tissue returned to the entire area. At this point on Day 6 they applied the laser, but in the interest of science and skepticism, they left a control section, lasering two-thirds of the belly and leaving one-third untouched, above right. Two days and two treatments later, the effects on each section are clear. At …
How To Use Constant Rate InfusionsMay 21, 2013What are the benefits of a CRI? The problem with intermittent boluses of pain medications (e.g. buprenorphine every eight hours) is that it creates peaks and valleys above and below the preferred medication plasma level. In comparison, constant rate infusions, or CRIs, provide more consistent medication plasma levels. In addition, CRIs allow you to maintain surgical patients at a lower anesthetic gas rate. This gas-sparing effect should help maintain blood pressure. How do you set up a CRI? I really prefer the expression "manually controlled infusion” (MCI) to CRI. The delivery of such infusion rates is rarely "constant.” We generally vary the delivery rate manually, based on the patient’s needs, the intended drug effect and observed drug influences. It is very important to understand that long-term infusions, even with short duration drugs like fentanyl, lead to depot effects. This can increase plasma levels of the drug if you do not make gradual reductions in the delivery rate. In addition, although one can deliver MCIs via gravity drip sets (i.e. counting drops), actual drug delivery is likely to be inconsistent and therefore riskier. Does the type of IV fluid matter? Any replacement …
Options For Treating Pet Pain Continue To ExpandMay 21, 2013 Not long ago, compassionate and well-meaning veterinarians believed some things about animal pain that we now recognize as completely wrong. For instance, it was "common knowledge” that animals do not feel pain the way humans do. We believed that some post-operative pain was a good thing to assist with keeping an animal quiet after a surgery. Because it is often difficult to assess pain in animals, we often unintentionally overlooked animal pain because we simply did not know how to recognize it. Now we know better. All Pain is Not Created Equal We used to believe that there were many different kinds of pain—acute, chronic, post-operative, cancer/malignant—and we had a limited number of treatment options. We also used to believe that monotherapy (treatment with a single agent) was the strategy of choice. Clifford Woolf, M.D., set us straight with his identification of pain as a continuum from "adaptive” pain—pain that helps us—to "maladaptive” pain—pain that hinders us. An example of adaptive pain is transient physiologic pain. Examples of maladaptive pain include phantom pain following an amputation and the altered sensation that results from unmanaged or undermanaged acute or chronic pain. Because the …
An Emerging Standard Of Care For TL IVDDMay 21, 2013The standards for standard of care are changing. As veterinary medicine falls in step with its human counterpart, the bar for prudent practice will begin to rest on "what ought to be done” in place of "what is being done” by peers.1,2 Clinical guidelines that consider evidence over opinion are increasingly defining standard of care and could one day replace expert testimony.3 Holding that "a doctor does not breach the legal standard of care, and is therefore not negligent, if the practice is supported by a responsible body of similar professionals,”4 would need to change. Consider this in regard to the treatment of dogs with thoracolumbar intervertebral disk disease (TL IVDD). As science evolves and evidence accrues, certain approaches now considered the norm by some may fall by the wayside. The old mindset that nothing can cure a dog but surgery and strict cage confinement (with minimal to no analgesia) remains widely held in some circles, even academia. This ignorance-is-bliss attitude persists despite growing support for integrative medicine.5-8 Footnotes 1 Favre DS. Veterinarian malpractice. Michigan State University College of Law. Animal Legal and Historical Center, 2002. Accessed at https://www.animallaw.info/article/detailed-discussion-veterinarian-malpractice on 03-02-13. 2 Samanta A and Samanta J. …
