What You Need to Know Acupuncture and SepsisJuly 29, 2014Unless sepsis is on your radar, you might well miss it. Sepsis is defined as “a syndrome of microbial infection complicated by systematic inflammation which may subsequently lead to organ dysfunction, shock, and death.”1 The cat with a severe bite wound, the dog with peritonitis and the puppy with parvo may all develop sepsis, but their clinical presentations may vary dramatically. In addition to interspecies differences, diagnosis can prove difficult because of the many ways in which sepsis mimics critical conditions. The diagnosis also eludes clinicians who fail to see the big picture of constellating clinical, physiologic and laboratory changes signaling sepsis. This accounts for many missed opportunities for early intervention and life-saving care.2 That said, even after sepsis is diagnosed, treatment can be daunting and ineffectual. In humans, sepsis leads to over 750,000 hospital admissions and 200,000 deaths each year. The comparative incidence of sepsis in dogs and cats is unknown.3,4 How it Happens How sepsis happens is not fully understood but likely involves an over-exuberant release of inflammatory cytokines in response to a provocation, whether infection, ischemia, injury, trauma or cancer.5 The patient may develop SIRS, i.e., systemic inflammatory response syndrome and progress to MODS, or multiple organ dysfunction syndrome, …
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C-Sections: Anesthesia And SurgeryJuly 25, 2014 This article first appeared in the August 2013 issue of Veterinary Practice News. We continue describing our steps for a happy C-section. [See Part 1 here]. In this article, we focus on anesthesia and surgery. Our goals: safety and speed. 5) Anesthesia Melissa Goodman, DVM, board-qualified in the American College of Theriogenologists at Veterinary Reproductive Services in West Chester, Pa., skips premedication, and prefers masking patients down. She uses the smallest possible dose of propofol only if needed, e.g. in brachycephalic and fractious patients. When giving drugs to the dam, you are indirectly giving them to the babies. Many drugs are rapidly carried through the placental barrier and consequently affect the offspring. This may make resuscitation efforts more difficult. For example, acepromazine, ketamine and atropine can flow through the placenta, so they should be avoided. Glycopyrrolate, if needed, is a better choice than atropine. Choosing an anesthesia protocol that is safe for a caesarean patient is tricky at best. Because hypoxia is a concern for the patient and the neonates, pre-oxygenation for five to 10 minutes is an important precaution. Patients are then intubated and placed on isoflurane or sevoflurane and oxygen. …
Pet C-Section ChecklistJuly 25, 2014 This article first appeared in the July 2013 issue of Veterinary Practice News. Read the first part here. Secrets To A Happy C-Section Be prepared and work quickly. Preparation and speed count. Correct hypotension and any acid-base and electrolyte imbalances. Create two or three teams: surgery/anesthesia and “baby resuscitators.” Withhold analgesia until after babies have been delivered. C-section Risk Factors A large study found seven factors that negatively affect survival of canine neonates. They are: emergency (as opposed to elective) surgery brachycephalic breed more than four puppies a few puppies had a natural delivery some puppies were malformed xylazine was used some puppies had difficulty breathing spontaneously or didn’t cry at birth Factors that improved the outcome included using propofol and not using halothane. C-section Checklist An experienced team will gather as many supplies as possible before a C-section. Here is a non-exhaustive checklist. Anesthesia Team Paperwork (records, forms) Complete list of pre-calculated drug dosages Various syringes and needles Various endotracheal tubes Laryngoscope Surgery Team Surgical blades Scrubbing supplies Extra gauze squares and lap sponges Sterile towels Suction (machine, hose and tip) Warm irrigation fluids Towels on the floor to help cleaning up Suture material …
4 Steps To A Safer Pet C-SectionJuly 25, 2014 This article first appeared in the July 2013 issue of Veterinary Practice News A C-section can be a stressful and chaotic nightmare, or it can be a wonderful and uplifting experience. In this article, part one of three, we will share 10 steps to become better equipped for your next C-section. Our goal is to save the offspring—and of course keep the dam safe. 1) Preparation & Teamwork A successful C-section requires teamwork at its best. This should include pet owners, who should be educated during any pregnancy —especially those at risk — so they know what to expect and when veterinary assistance might be needed. What is normal? What is abnormal? When might a C-section be necessary? When should they call if they think a C-section is required, so you can be ready? Many late night or early morning emergency C-sections could be avoided if more time were spent educating clients. Understanding the client’s wishes is a critical part of the discussion. Does he want the pet spayed? Can she afford another C-section? Can he properly care for another 12 puppies while working two jobs? Does the world really need more hydrocephalic Chihuahuas …
Merck Releases 12-Week Flea, Tick MedicineMay 20, 2014Merck Animal Health today upped the ante in the world of flea and tick preventives with a flavored chew proven to be effective for 12 weeks at a time. "Bravecto is a breakthrough innovation that offers pet owners and veterinarians something that no other product does—the longest-lasting oral flea and tick prevention currently available," said KJ Varma, senior vice president of research and development at Summit, N.J.-based Merck. The product is indicated to kill fleas for 12 weeks, the black-legged tick, American dog tick and brown dog tick for 12 weeks, and the Lone Star tick for eight weeks. The 12-week claims do not apply to dogs less than 6 months old. The active ingredient, fluralaner, is a new ectoparasiticide belonging to the isoxazoline group, Merck noted. The chew may be given to help control flea allergy dermatitis, the manufacturer added. Bravecto's five dosages are based on a dog's weight: 4.4 to 9.9 pounds, 9.9 to 22 pounds, 22 to 44 pounds, 44 to 88 pounds and 88 to 123 pounds. Clinical trials revealed the most common adverse reactions to be vomiting, decreased appetite, diarrhea, lethargy, polydipsia and flatulence.
How To Perform A Thorough Oral ExaminationMay 15, 2014 Courtesy Dr. John Lewis Figure 1: Laceration on ventral suface of a dog's tongue Published in the April 2014 issue of Veterinary Practice News. It was the day after Valentine's Day, and the East Coast was in the throes of yet another snowstorm. An 8-year-old male great Dane presented to our hospital through the emergency service for sudden onset of bleeding from either the mouth or nose at home. The dog had a prior history of immune mediated thrombocytopenia, so it was a surprise when a complete blood count showed a normal platelet count. The patient was not very cooperative for a conscious oral examination, and no source of bleeding was visible because bleeding had subsided prior to the patient's arrival. The pet owners declined an anesthetized oral exam, but two hours later a second and more severe episode of bleeding brought the owners and the pet back to the hospital. The dog's face and front legs were drenched in blood, and packed cell volume and total protein were found to be 24/6.0. During the active bleed, it became obvious that the bleeding was arising from the oral cavity. The patient …
The Anesthetized Intraoral ExaminationMay 15, 2014 Working ends of an ODU 11/12 explorer, left, and an UNC periodontal probe, right. Courtesy of John Lewis, VMD, BVMS, Dipl. ACVS In last month's column, we discussed the components of the conscious intraoral and extraoral examination. The conscious examination, however, reveals only so much. A comprehensive oral examination requires anesthesia to obtain a complete assessment of oral health and disease. In particular, the periodontium (the attachment structures of the teeth) cannot be evaluated without using a probe at multiple sites around each tooth. Each patient deserves an individual treatment plan based on appropriate diagnostics. The same hold true for teeth: The adult dog's mouth contains 42 patients and the adult feline mouth contains 30 patients that require individual attention. Use your dental probe, explorer and dental radiographs to determine if each and every tooth will be able to provide pain-free function or if it is non-salvageable. Start the anesthetized exam by assessing those structures that were not adequately assessed in the conscious examination: tonsils, pharynx, soft palate, caudal tongue, caudal buccal mucosa. Identify each of these structures as normal or abnormal and document this information on the dental record. Determine the …
Chinese Herbs: Selling StrychnineMarch 25, 2014 Weary of worrying about what's in Chinese products?1 What about when Chinese products are made in America?2 Do we drop our concerns then? Perhaps we are heading to a future where Chinese and American manufacturing standards become one and the same. In mid-2013, a Chinese company purchased Smithfield Foods Inc., one of the largest pork producers in the United States3. If approved, this deal will mark the "largest takeover of a U.S. company by a Chinese firm." Eat up, America. Enjoy your pork. Never mind that "In recent weeks, China's news media have reported sales of pork adulterated with the drug clenbuterol, which can cause heart palpitations." The list goes on, and includes "pork sold as beef after it was soaked in borax; rice contaminated with cadmium; arsenic-laced soy sauce; popcorn and mushrooms treated with fluorescent bleach; bean sprouts tainted with a animal antibiotic"4 and so on. Chinese herbal products pose problems as well, saddled with a long history of adulteration and contamination. An investigation by Harvard researchers showed that 100 percent of the raw Chinese herbal medicines analyzed contained at least one heavy metal, with a third showing the presence of every metal they tested …
The Highs and Lows of Medical Marijuana for DogsMarch 13, 2014 The cannabis trade, also known as “cannabis-ness,” has evolved from a budding homegrown operation into a blossoming industry, projected to top $10 billion in the next five years,1 signaling the emergence of “Big Marijuana.”2 But, medical marijuana for dogs? Whether or not veterinarians are ready, it’s already here. Certainly, rigorous scientific research should precede its sale for the canine consumer, but the public isn’t waiting. Customers are purchasing products laced with cannabis for dogs or sharing some of their own stash with their cats. Veterinarians may rebuke the notion, dismissing it as “untried, unproven and unregulated.”3 A few brave, outspoken professionals have taken a more proactive approach. One created a cannabis tincture called “Canine Companion,” designed to relieve pain, inflammation and other cancer-related or end-of-life health issues.4 Testimonials favoring veterinary cannabis, even on the AVMA website, speak highly of the improvements they see such as rapidly replenishing quality of life and restoring mobility to animals otherwise unwilling or unable to ambulate. In addition, it has restored appetite and reduced reliance on mainstream pharmaceuticals that the animal could not tolerate.5 Taking a Closer Look Given the seemingly immense potential of “pot for pets,” why …
Strategically Timed Heartworm Prevention is RiskyMarch 13, 2014 In some northern states, heartworm prevention for pets is a relatively new necessity in “mosquito season,” much less during winter months, which probably prompted a letter published in January’s Journal of the American Veterinary Association. “Heartworm development unit data suggest a 3.5- to 4-month heartworm transmission season in Wisconsin and indicate that although mosquitoes may be seen during the winter, they almost certainly will not contain infective larvae,” states the letter to the editor by James C. Frank, DVM, of Milwaukee in the Jan. 1 issue. “What, then, is the evidence to support current recommendations for year-round administration of heartworm preventatives in the north half of the country?” The thoroughly-researched and well-written letter by Dr. Frank cited referenced research studies in Georgia, Louisiana and northern Florida that demonstrated a zero percent heartworm transfer rate between Dec. 15 and April 15. “This winter, absence of heartworm transmission was also found during a second and a third winter, despite having microfilaremic dogs housed in kennels adjacent to uninfected dogs,” Frank wrote. The study found an 86 percent heartworm transfer rate from April 15 to Aug. 15, and a 73 percent transfer rate from Aug. 15 through Dec. 15, …
