The reality behind fake and counterfeit medicinesJune 12, 2015The matter of “fake” medicines has been gaining much media attention of late.1 This publicity followed the release of a special issue of the American Journal of Tropical Medicine and Hygiene dated April 20, 2015, which included 17 articles describing the damage that falsified and substandard medicines are doing around the world.
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Why The Human Side Lags Behind in One HealthJune 10, 2015Pioneers of the One Health movement to blend human, veterinary and environmental health are gaining respect, epidemic by epidemic, but capturing the attention of the human health care establishment remains a challenge. “You have to take the long view,” acknowledged Laura H. Kahn, MD, MPH, of the One Health Initiative team. “It took people over a century to realize the significance of basic sanitation, and lots of countries don’t even have that.” In 1847, human physician Dr. Ignaz Semelweis came up with the idea that if doctors in Viennese maternity wards would wash their hands between patient exams, fewer women would die of childbed fever. The medical community considered his theory outlandish and he died a pariah. But subsequent research by Louis Pasteur and Joseph Lister proved Semelweis was onto something, and today surgical hygiene is universally accepted. In 2006, Dr. Kahn, a physician and research scholar at Princeton University, penned an article for the U.S. Centers for Disease Control and Prevention titled “Confronting Zoonoses: Linking Human and Veterinary Medicine.” “It caught the attention of a number of veterinarians who were very enthusiastic,” she recalled. “One of them was Dr. Bruce Kaplan, who formerly worked in epidemic intelligence for the …
Why You Should Consider Nonsurgical Care for CCL DiseaseJune 8, 2015Originally published by June 2015 issue of Veterinary Practice News As someone who offers her thoughts on veterinary topics in print and online quite often, Narda G. Robinson, DO, DVM, MS, FAAMA, hears a great deal from pet owners and fellow practitioners about cranial cruciate ligament disease, a common aliment that can greatly impact a pet’s mobility and lifestyle. Just don’t try and tell her surgery is the “gold standard” for treating CCL disease. Nor should surgery always be presented as the best treatment, said Dr. Robinson, director at the CSU Center for Comparative and Integrative Pain Medicine at Colorado State University Veterinary Teaching Hospital. “My first question is: ‘What constitutes a ‘gold standard?’” Robinson said. “Is this based on opinion or scientific evidence? I’d prefer to see whatever is a ‘gold standard’ supported by evidence of benefit, safety and the least invasive approach possible rather than often-held opinions.” She noted that there are many instances of pelvic limb lameness that don’t require surgery, yet there isn’t enough evidence to say how a comprehensive rehabilitation program compares to various surgical outcomes for cruciate injury. “Based on what I’ve seen and heard from folks around the country, and even from other countries, …
How to Save Time Before SurgeryJune 3, 2015Originally published in the June 2015 issue of Veterinary Practice News Being efficient in the OR is much easier when you prepare well ahead of the procedure. To quote the great Benjamin Franklin, “by failing to prepare, you are preparing to fail.” So how can we prepare for a successful surgery? We asked several board-certified surgeons to share their favorite tips to nurture an efficient and effective surgical team. Client Communication Clear communication with your client during the consultation is of the utmost importance to avoid misunderstandings. This is the time to discuss the medical and financial aspects of the procedure. What is the (presumptive) diagnosis? Are there non-surgical therapeutic options? What are the options during surgery? What are the pros and cons of each one? What is the prognosis? Which ancillary tests are required? What are possible complications? Being realistic, upfront and thorough with the client will help make decisions quicker during surgery. Consider, for example, a patient who has advanced or potentially inoperable cancer. Will you recover the patient, obtain a biopsy, debulk the tumor, remove it, or possibly prepare for intra-operative euthanasia while the patient is under anesthesia? Will the client want to be present? Time is …
The Pros and Cons of Scrubbing With Betadine, ChlorhexidineMay 6, 2015“Should I scrub patients with Betadine or chlorhexidine?” This is probably one of the most frequently asked questions, yet practices seem to be divided between the Betadine clinics and the chlorhex hospitals. Based on a non-representative sample, my impression is that there are far more practices that use chlorhexidine to scrub patients. So what should we do? When quizzed, few people even know why they do what they do. “That’s the way we’ve always done it” is usually the answer. Most times, the protocol has been transmitted from technician to technician for years. Likewise, many practitioners scrub patients the way they were taught in vet school. Let’s investigate the pros and cons of each preparation to clean the skin, the mouth, the eye and the prepuce. What is the best way to scrub the skin? Once clipped, the surgical site may be cleaned up with a rough prep in the treatment room. Regardless, a sterile scrub is applied in the OR. The skin cannot be sterilized. “What we are trying to do is to significantly reduce the number of bacteria present. Then the immune system can take care of the remaining flora,” explains Scott Weese, DVM, Dipl. ACVIM. Our colleague …
Cerclage Wire for Rostral Mandibular InstabilityMay 6, 2015Originally published in the April 2015 issue of Veterinary Practice News Last month we discussed iatrogenic mandibular fractures of the rostral mandible, specifically the iatrogenic parasymphyseal fracture. One of the repair techniques for this fracture, and for traumatic symphyseal separation, is use of a cerclage wire placed behind the canine teeth. Though most practitioners are familiar with this seemingly basic procedure, there are subtle nuances of placement that will help your patients thrive following placement of the cerclage. No. 1. Not every patient with instability requires placement of a cerclage wire Some animals, especially brachycephalic small-breed dogs and some cats, may have significant symphyseal laxity as an incidental finding on anesthetized oral examination. If the patient is not showing signs of discomfort or jaw locking, symphyseal laxity is not likely causing any problems. In cases with no recent history of trauma, placement of a cerclage wire will likely not allow for a long-term decrease in laxity without a more invasive procedure such as symphysiodesis (cutting into the fibrous joint of the symphysis and encouraging scar tissue formation), and this is often not necessary. No. 2. Step-by-step: placement Before placing a cerclage wire, the intraoral soft tissues dorsal to the …
How to Avoid the Iatrogenic Jaw FractureApril 13, 2015Originally published in the March 2015 issue of Veterinary Practice News? Not a subscriber? Subscribe today! If you extract enough firmly rooted mandibular canine teeth in your lifetime, basic anatomy suggests that you may find yourself to be the creator of an iatrogenic jaw fracture. The root of the mandibular canine tooth of dogs and cats makes up a large portion of the rostral mandible and it is nearly twice as long as the crown of the tooth. Bone is very thin between the lingual surface of the root and the caudal symphysis. Photos © 2014 John R. Lewis, NorthStar VETS. Radiograph of an iatrogenic jaw fracture that occurred during attempted extraction of the left mandibular canine tooth in a cat. Iatrogenic jaw fractures that occur during canine tooth extraction tend to be parasymphyseal fractures rather than symphyseal separations. Forces required to deliver this tooth root may also, in some cases, be sufficient to result in fracture of the bone. Here are some tips that I’ve learned on how to avoid iatrogenic fracture. Dental Rads Take dental radiographs and adjust your therapeutic approach accordingly. Dental radiographs are important from both diagnostic and therapeutic …
FAQ: What you need to know about hemp and dogsApril 10, 2015Confused about hemp for dogs? You’re not alone. The state of affairs around cannabis for companion animals might be summarized as, “If you’re not confused, you’re not asking enough questions.”
10 Tips for Veterinary Surgery LoversApril 7, 2015Originally published in the March 2015 issue of Veterinary Practice News You don’t have time to make every mistake in your career, especially in surgery: A mistake could cause significant harm to a pet, get you in a sticky situation or cost your patient his life. These suggestions are meant to start a reflection, not to offend anyone. They apply to new grads as well as seasoned surgery lovers. 1) Make it Big “Big surgeons make big incisions.” Unless you are performing minimally invasive surgery, don’t make mini-laparotomies. Sure, you can remove a spleen or a gastric foreign body through a short incision. However, stopping there would be a disservice to your patient; that’s only half of your job. The other half is to perform a thorough laparotomy, from the liver to the bladder. 2) Perfect Your Suture Pet owners will never appreciate how flawless a surgery you performed on Kiki. The only thing they see, and they may see for the next 10 years, is your skin suture. So work hard at crafting the prettiest skin suture possible. Learn how to close dead space. Strive to appose skin spots neatly. Strive to get rid of dog ears. Figure out where you …
Animal acupuncture: Come one, come all?March 11, 2015Most animal lovers, at some point in their lives, have thought about becoming a veterinarian. Only a small fraction of these folks ever realize their dream. Still, though, who wouldn't want to work with animals and the dedicated, compassionate clients we find ourselves so fortunate to serve?
