Senior Anesthesia: Age Doesn’t Stop The Need For CareMay 21, 2013 While customized monitoring and drugs should be provided for every patient, those falling into the geriatric category—in the last 25 percent of their life expectancy—require extra precaution as underlying health conditions may be more prevalent. Veterinary specialists say senior patients in need of a procedure that requires anesthesia should not be passed off as too old to handle sedation or anesthesia based on age alone. Yet the misconception accounts for one of the top three concerns with using anesthesia. "Owners are reluctant to care for the engine because they assume the body will go bad and they fail to care for the body because they think the engine will go,” Harvey continues. "If nothing is being cared for, it will surely fall apart.”"When veterinarians and pet owners think age is an obstacle to necessary maintenance, it reminds me of mistakes made with older cars,” says Ralph Harvey, DVM, M.S., Dipl. ACVA, associate professor of anesthesiology at the University of Tennessee College of Veterinary Medicine in Knoxville and an AAHA anesthesia task force member. According to the recently released American Animal Hospital Association (AAHA) Anesthesia Guidelines for Dogs and Cats, pre-anesthetic patient assessment and preparation is key …
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Dermatology Can Be Fun: The Art Of Treating Otitis ExternaApril 18, 2013I enjoyed the last dermatology meeting I attended so much, that I thought I should sign up for another one. This conference, presented by Brian Palmeiro, a board-certified dermatologist at Lehigh Valley Veterinary Dermatology in Allentown, Pa., was dedicated to the art of treating otitis externa and media. Turns out that the ear has its own self-cleaning mechanism. A recently discovered concept is "epithelial migration" within the ear. Cells in the center of the tympanic membrane migrate outwards to the walls of the ear canal, and from there, toward the entrance of the ear canal. This allows cerumen, cornified keratinocytes, debris and organisms to be transported upwards and out of the canal (comparable to the mucocilary escalator). This also serves as a repair mechanism, both for the tympanic membrane and the ear canal. How on earth did a bored scientist figure that out? By placing tiny ink dots on the tympanic membrane and then by following their onward migration weekly. The journey occurs at a rate similar to that of the growth of fingernails. Why should we care? This is actually …
How Fluoxetine Treats A Number Of Behavioral Issues In AnimalsApril 4, 2013Originally published in the April 2013 issue of Veterinary Practice News By now, almost everyone has heard about Prozac, though the veterinary brand name Reconcile is less well recognized. Personally, I prefer prescribing Reconcile to manage certain behavior problems because it is licensed for use in dogs, is especially designed for use in dogs in a palatable formulation, and lists the correct canine dosing and side effects on the enclosed data sheets. One problem is that Reconcile is somewhat expensive and finds itself in competition with off extra-label generic fluoxetine. For the purposes of this article, I will mostly refer to Prozac/Reconcile by the generic name fluoxetine. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). That is to say, it delays re-absorption of serotonin into presynaptic nerve endings following its release by blocking the reuptake mechanism. This causes serotonin to persist for longer and thus enhances its effects. Fluoxetine Actions Two other actions of fluoxetine, as opposed to other SSRIs, are that it is a potent 5-HT2C antagonist and a sigma-1 receptor agonist. Overactivity of 5-HT2C contributes to anxiety and depression so antagonism of these receptors may be advantageous. The sigma receptor agonist action may also be beneficial in …
9 Steps of a Professional Pet Dental CleaningApril 4, 2013Dentistry is an exacting science that requires attention to detail. Not all pet dental cleanings are created equally. This article discusses the important components of the professional dental cleaning. Why Anesthesia? This will be a topic of an upcoming stand-alone article, but for now, suffice it to say that no self-respecting dog or cat will allow you to do a thorough subgingival scaling, a complete oral and pharyngeal exam, and dental radiographs when awake! Click here to read tips on how to make anethesia safer. Risk vs. Benefit Much of what I do as a veterinary dentist involves assessing the risk vs. benefit for an elective dental procedure in a patient that may have an inherently higher anesthetic risk than a healthy patient. Veterinary dentists tend to surround themselves with people and machines that help minimize that risk. Click here to watch a three-year-old miniature schnauzer undergo a dental cleaning and extraction. But risk is present even in healthy patients. Appropriate preoperative diagnostics help to assess risk. Step 1: Safety First The cuffed endotracheal tube is checked prior to starting the dental procedure. Care should be taken to …
Veterinary Medical Acupuncturists Point To ScienceMarch 27, 2013 Every now and then, a spate of stories on veterinary acupuncture sweeps through the popular press. The Washington Post ran two such stories between May 20121 and February 2013.2 Columns typically begin by describing how an animal benefited by acupuncture when drugs and surgery failed. The piece then proceeds to discuss acupuncture's growth within the profession and a list of responsive conditions. ABC-TV's “Nightline” produced a similar story this year, as well.3 Publicity for acupuncture is a good thing. It causes consumers to consider trying a safe and relatively non-invasive intervention that they might otherwise have overlooked. In the past, veterinary acupuncturists who believed in invisible “Qi” or energy would confess that they could not adequately explain acupuncture's effects. Nowadays, fortunately, more integrative practitioners are describing the neural influences of needling, perhaps because they themselves hungered for a legitimate explanation. More Defined In the past, when these “Qi-ists” would espouse unfounded notions about needles unblocking stuck energy, it seemed reasonable and warranted for authors to invite a skeptic or “quackbuster” to call out the pseudoscience. Because more veterinary acupuncturists have accepted contemporary biomedical explanations, the …
Looking For A Therapeutic Laser To Love?March 5, 2013 Searching for a laser therapy unit? Determining which company sells the best laser for your practice can feel like looking for the perfect mate. Sleek exteriors and claims of amazing achievements may attract us at first, but which one will last and keep us happy over the long haul? Several options have uniquely desirable features, making us wish we could take parts of each to create the ultimate package of reliability and safety, a product that looks good and feels solid. Whether a laser or a lover, we want it all. While someday we may be able to build one to our specifications, for the moment at least, we need to examine prebuilt models and select the one that fits our needs. Most practitioners want a device that supports the spine, softens the muscles and soothes the skin. Ongoing research is identifying which wavelengths, power settings and frequencies make the most meaningful changes in deep and superficial conditions. Two studies from 2012 illustrate how lasers significantly benefit common problems, each deploying different dosing parameters, wavelengths and delivery mechanisms. Disk Disease in Dogs Laser therapy for spinal cord injury has become a mainstay treatment within the …
Treatment Options For Canine Cruciate Ligament Disease (CCLD)January 30, 2013 Due to the large volume of feedback received in response to the previously published Veterinary Practice News article on canine cruciate surgery, it is clear that some confusion exists regarding our current clinical management of patients with canine cruciate ligament disease (CCLD). Recognizing that there are, unfortunately, large knowledge gaps regarding the clinical efficacy of many treatments for this disease, we do our best to tailor our treatment recommendations to the specific needs of the patient and pet owner. While in some instances this may mean a non-surgical therapy approach, surgical treatment is provided as a component of the overall patient care for the majority of patients presented to the orthopedic service. Nonetheless, we prefer not to think about CCLD patient care (or clinical research) in terms of a simple “surgical versus non-surgical” dichotomous relationship; instead, we prefer the integrative approach of determining the best combination/choice of surgical, pain management, rehabilitation and complementary medicine techniques. The most important question we should ask ourselves is: “Which treatment combinations can provide the best long-term quality of life?” Obviously, the answer to this question differs based on patient signalment and athleticism, concurrent disease and owner’s expectations. The goal of this …
Ultrasound: A Go-to Diagnostic ToolJanuary 30, 2013 Using ultrasound equipment in everyday practice means offering a minimally invasive service that is growing in appeal to clients. But before making the $10,000 to $200,000 investment, experts say veterinarians need to know their clients are interested in the service and then figure the return on investment. “Even with the economic climate over the past several years, ultrasound sales have continued to see positive trends,” says Mia Varra, marketing director for E. I. Medical Imaging in Loveland, Colo. “Much of the increase is due to the fact that veterinarians see diagnostic equipment as a revenue-generating tool.” But earning revenue requires the right equipment and, an up-front investment in marketing, training and time. “Veterinarians take a leap of faith with a company,” says Randy Laufersky, president of Core Ultrasound Inc. in Grand Rapids, Mich. “Looking at three companies is a standard that allows for a broader perspective on what is being offered. A good salesperson will ask the right questions that will answer which machine will meet a practice’s needs.” Customer service is an often-overlooked component of the buying process. Knowing the product warranty period, repair policy and a company’s customer service hours can mean the …
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 …
‘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.
