Why platelet-rich plasma is a pretty remarkable productFebruary 10, 2016Have you heard about platelet-rich plasma (PRP)? No, it’s not a drug, and it’s not a nutraceutical. It seems like one of the newest treatments to hit the pain medicine and rehabilitation field, but in actuality, PRP injection dates to the 1950s for treatment of dermatologic and oral maxillofacial problems in humans.
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The Veterinary Surgeon's Dilemma: To Biopsy or Not Biopsy?February 9, 2016Let’s discuss two common dilemmas that are commonly encountered in everyday veterinary surgery. What is your philosophy when it comes to biopsies? Dilemma No. 1 Let’s pretend you need to perform a cystotomy on a patient. While tying the patient to the surgery table, your technician notices a firm, not-so-mobile 1-inch-diameter mass on the hock. While you are in surgery, a receptionist calls the owner to see if he wants you to excise the mass. He approves the extra surgery fee but declines the fee for histopathology despite your impression that the mass is malignant. What would you do? Clearly, some colleagues will remove the mass with no second thought. Others firmly believe that “if it’s worth taking out, it’s worth sending out.” What is the right thing to do? Being lenient? Being dogmatic? We asked a few specialists to share their thoughts. Veterinary pathologist Jim Walberg, DVM, Dipl. ACVP, of VetPath Services in Stone Ridge, N.Y., reminds us that in human medicine, where lawsuits are so prevalent, all excised tissues are sent to pathology. “Similarly, we should insist that any mass excised be evaluated histologically,” Dr. Walberg said. “In reality, cost is often …
What to do When Gums Overgrow Their BoundariesFebruary 8, 2016A 5-year-old male Rhodesian ridgeback presented to me for evaluation of proliferative gingival enlargement over the maxillary canine teeth. Historically, the owner noted a flap of partially detached gingiva over tooth 104, which had since become completely detached, resulting in the unique combination of gingival recession over most of the lateral portion of the tooth and gingival enlargement over the mesial, distal and palatal surfaces of the tooth (Figure 1). John Lewis, VMD, FAVD, Dipl. AVDC Figure 1: The right maxillary quadrant showing generalized gingival hyperplasia and gingival recession over the labial (vestibular) surface of the right maxillary canine tooth (tooth 104). Tooth 204 had a similar appearance, though more irregular, with a large circumscribed area of enlargement toward the distal portion of the crown (Figure 2). Nearly every tooth in the mouth was affected at least mildly by gingival enlargement, though the canines and incisors were affected most severely (Figure 3). The appearance of the gingiva over teeth 104 and 204 likely was due to the following events: Gingival enlargement results in pseudopockets. Pseudopockets allow for hair, plaque and debris to be trapped …
What You Need to Know About Pet PainFebruary 5, 2016Originally published in the February 2016 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today! Duncan X. Lascelles puts the importance of identifying pain in pets right up there with the best pharmaceutical pain killers on the market. The North Carolina State University professor and clinical pain-management expert sees promise in new health and activity monitors—“Fitbits for cats and dogs,” in his words—but he hasn’t abolished traditional measurement tools like the Feline Musculoskeletal Pain Index (FMPI). Dr. Lascelles, BVSc, Ph.D., CertVA, believes the most useful developments in pain management will come with improved activity monitoring. “That area has a lot of potential,” said Lascelles, Dipl. ACVS, Dipl. ECVS. “It just needs to mature. I see a lot of potential in post-surgical monitoring, and also just monitoring pets in the home environment as they age and get more diseases.” Practitioners can’t go wrong, he said, with pain-grading scales like FMPI, which Lascelles helped develop at NCSU’s College of Veterinary Medicine. FMPI, now in its 10th version, is a questionnaire designed to help owners assess the severity of chronic pain in their …
Where's the research on animal chiropractic?January 21, 2016When you tried to find scientifically based information on the mechanisms of action with the search terms “chiropractic” and “spinal manipulative therapy (SMT),” you find yourself surprisingly empty-handed.
Why Gloves Can be Your No. 1 Weapon Against SSIsJanuary 20, 2016Originally published in the January 2016 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today! Surgical site infections, or SSIs, are a constant concern for surgeons and surgery lovers. Infection can lead to dissatisfaction, distress and even death (spontaneous or via euthanasia). Given the rise of nosocomial infections from drug-resistant bacteria, keeping infection prevention front and center is of ever-increasing importance. The prevention of SSIs can be visualized as a patient/pathogen/procedure triangle: Patient factors relate to the incision or the wound, tissue depth, systemic defenses and risk factors such as diabetes (at least theoretically) and malnutrition. Pathogen factors include the bacteria, their quantity and virulence. Procedure factors are those we should strive to control: antibiotic prophylaxis, hypothermia avoidance, gentle tissue manipulation and aseptic technique. Using aseptic technique includes appropriate surgical attire. Caps, masks, gowns and surgical gloves are the first line of defense against SSIs. Surgical gloves, however, are not invincible and can perforate. Unfortunately, this happens much more often than we suspect. Defects often are not noticed until the gloves are removed after surgery and blood is observed on a finger. Noticing …
What Veterinary Dentistry Trends and Tools to Look for in 2016January 13, 2016Originally published in the January 2016 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today! I’m writing this as I return from the 29th annual Veterinary Dental Forum in Monterey, Calif. This year, the forum was combined with the 13th World Veterinary Dental Congress, so leaders in the field from around the world converged upon Monterey. Here are some of the hot trends and tools for 2016 that I noted at the conference. Dental Radiography and Dental Teleradiology More and more general practices are getting digital dental radiography, and with good reason. Dental radiography provides the necessary information to allow veterinarians to diagnose and treat oral diseases. Radiography also provides assurance that treatment has been successful. The most important thing to do once you purchase a dental radiography system is to use it. Every patient can benefit from dental radiographs. Learning radiographic positioning and radiographic interpretation takes time. Positioning can be learned with a site visit or by attending continuing education events. Learning positioning will require some practice with a skull or cadaver to master the intricacies of tube head positioning. …
How to Use an Allograft Membrane to Fix Oral TraumaJanuary 6, 2016Originally published in the December 2015 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today! Halo, an 8-week-old female pit bull mix, was presented as a referral to the Dentistry and Oral Surgery Department at North-Star VETS. Halo had been attacked by an adult pit bull, suffering injuries to her head and face. She was stabilized at a specialty hospital and sent to me for evaluation of fractures of her right maxilla and hard palate. A physical exam revealed normal findings except for mucoid discharge from the right nostril, sneezing and puncture wounds over the right muzzle. Halo refused a conscious oral examination. John Lewis, VMD, FAVD, Dipl. AVDC Figure 2: Initial suture placement of an allograft bone membrane before trimming the membrane to a size slightly larger than the size of the defect After preoperative CBC and chemistry screen proved to be unremarkable, Halo was placed under anesthesia for an oral examination. It revealed a defect of the palatine process of the maxilla and a large defect of the palatal soft tissue that should cover the hard palate (Figure 1). A right midmaxilla fracture extended …
10 Tips to Manage Recumbent Veterinary PatientsDecember 28, 2015Originally published in the December 2015 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today! Recumbent patients are not all paralyzed or in a coma. They include patients with limited mobility: those recovering from surgery or anesthesia, suffering from trauma such as hit by car or dealing with metabolic imbalances, polytrauma, brain diseases or severe sickness. Prolonged recumbency affects virtually every body system and organ. Here are 10 tips to manage your recumbent veterinary patients. 1. Pressure Sores Decubital ulcers are probably the first complication that comes to mind when we manage “down” patients. Bed sores are much easier to prevent than to treat. Patients should be kept on thick, dry, clean bedding at all times. The heavier the patient, the thicker the padding should be. The size of the cage should be proportional to the patient. If you don’t have a run, you may need to be creative and arrange an area on the floor. Your treatment sheet should include: Rotating …
What Would You Do if it Were Your Pet?December 17, 2015One of the most common things I hear from veterinary clients is: “What would you do if it were your pet?” I sometimes reply that of course I would do exactly the same thing to my pet. Or to my parents’ pet. Or to my neighbor’s pet. To be honest, I didn’t come up with these various lines. I borrowed them from the surgeons who trained me during my residency. Sometimes, because emotions might interfere with my judgment if it were truly my pet, I reasoned, I’ve always thought that it was not a fair question, which I’ve told many clients. Other times, it feels like a silly question. Hopefully, my pet would not have been walked off leash and therefore would not have been hit by a car. Hopefully, I would not have allowed my pet to grow a tumor bigger than his head. Hopefully, I would not allow my great Dane or German shepherd to go through life without a prophylactic gastropexy. In other words, many avoidable situations would hopefully be avoided. But in other cases, I realize that “What would you do if it …
