Hindsight IS 20-20February 27, 2014Personally, well professionally, I’ve never really liked dealing with eyeballs. One of the first emergency cases I ever saw was a Lhasa or some such dog with an eyeball “popped out” … that was enough to make me question my new career path, needless to say! So I’ve never learned much about eyes, considering that to be an area I could safely steer away from. Then, as always, my own pet’s eyeballs became the concern, and it was literally staring me back in the face. Georgia, my little rescue dog that picked ME as her person (even though I kept telling her that I’m a CAT person), started squinting one eye, then both, six weeks ago. I was on the road, so my partner took her promptly to the vet, who suspected conjunctivitis. I returned from the road the next night, a Friday, and all weekend long I watched as she seemed very uncomfortable. She kept her eyes squinty, but she ate, and in her stoic way, didn’t let on just how MUCH pain she felt. Monday I kept my scheduled recheck, and …
How To: Anesthesia Pt. 1February 22, 2014 brightcove.createExperiences(); Click here to watch Part 2. 4/30/2012 1:05 PM
Cruciates: Less Cutting, More Self-RepairFebruary 10, 2014 What is it about the cruciate that makes so many want to intervene with blades and power tools? After all, the cruciate has feelings, too, and the limb has a vested interest in remaining intact. With the lame dog, shouldn’t we investigate thoroughly to find out the facts before surgery? We can’t uncut a tibia that has been refashioned after that of a human. Ancillaries Where there is a department of surgery, let us also assemble departments of wellness, rehabilitation and scientific integrative medicine. Let us foster healthy debate and critique, so that forward-thinking orthopedic surgeons and like-minded individuals are no longer accused of “making waves” and performing “surgical (or professional) suicide.”1 I agree that, “In this era, it is important to re-evaluate and modify traditional treatment approaches with information gleaned from evidence-based medicine.”2 We now have evidence that the minimally invasive extracapsular repair approach known as the TightRope, far less traumatic than the tibial plateau leveling osteotomy (TPLO) and tibial tuberosity advancement (TTA), demonstrates the highest safety–to–efficacy ratio over the long term, allowing dogs to avoid catastrophic complications and the intensive trauma of revisionist methods.3 The time has come for a …
Sleep Well, Hurt LessFebruary 7, 2014Thankfully, more practices are adopting patient-centric, rather than practice- or staff-centric, orientations, meaning that patients’ comfort, healing and wellness needs are coming to the forefront instead of being seen as a luxury. Specific examples include sure-footing surfaces for spinal cord injured patients and quiet music to support the healing process. It may translate into adding cat towers and other feline friendly appointments, thick pads with clean, washable and soft cloths for the surface that allow for examination and treatment on the floor instead of only on cold, steel tables. Such forward-looking practices institute measures that at the very least meet standard of care, such as controlling pain in a multimodal fashion so that patients can sleep. This typically requires individually tailored integrative and pharmacologic protocols that alleviate pain and address and/or prevent spinal cord windup. Ensuring that an animal receives restorative sleep requires appropriate analgesia, not just tranquilizing them into a stupor to stop them from vocalizing in pain. The latter does little to protect the nervous system in a health-supporting manner. Zzzzzzzzzzzz Many of us experience the value of a good night’s sleep, especially after going to bed achy and tired and awaken refreshed, ready for a new …
Scrub in or rub in?January 30, 2014 Dr. John Smith is getting ready for his first surgery of the day. He puts on his cap and mask, adjusts them methodically, and starts to rigorously prepare his hands for surgery. He grabs a brush soaked with chlorhexidine scrub and goes to work, as if it were a ritual: First his fingers, then the palm of each hand, then the back, then his wrists, then his forearms, for a full five minutes, just like he has been doing for the past 15 years as a surgeon. Sounds perfectly acceptable, doesn't it? What Dr. Smith doesn't know is that his surgical scrub routine is actually detrimental to the health of his hands, increases the likelihood of contamination, and puts him at risk of developing occupational dermatitis. Meanwhile, Dr. Denis Verwilghen of Copenhagen, Denmark, is getting ready for his first surgery of the day. He puts on his cap and mask, adjusts them methodically, and starts to rigorously prepare his hands for surgery. He first gently washes his hands with a mild, non-medicated soap, dries them with a non-sterile paper towel, and then meticulously rubs a hydroalcoholic solution on his hands and arms for a couple of minutes — until they are …
Music as medicine: It doesn’t have to be MozartJanuary 28, 2014 Stop for a moment. What do you hear? Dogs barking, cats meowing, people talking and telephones ringing? How do these sounds make you feel? Happy? Sad? Stressed? Relaxed? Do you hear music? Put yourself in your patients’ position. They are stuck in a cage, for hours, days or weeks at a time, unsure why they’re there or when they’ll go home. They may be hungry and anxious, unfed before surgery and upset by the heavy metal music the kennel staff prefers.1 Could this negatively affect their physiologic state prior to surgery? Yes. Are there alternatives? Yes. You can, today, shift the acoustic stimuli to which you expose your patients from stressful to supportive with safe and inexpensive, though carefully selected, music. Music is medicine. A 2013 Cochrane review determined that “music interventions may provide a viable alternative to sedatives and anti-anxiety drugs for reducing preoperative anxiety.”2 This follows the findings of “three other Cochrane systematic reviews on the use of music interventions for anxiety reduction in medical patients.” Why not modify our clinic soundscapes to keep stress and anxiety to a minimum and reduce over-reliance on sedatives and other psychoactive agents? The Impact …
Three Techniques to Treat Toe FracturesJanuary 22, 2014 Although metacarpal and metatarsal fractures are fairly common injuries in cats and dogs, the best way to treat is somewhat controversial. Incomplete or complete fractures of one or two metacarpal/metatarsal bones can be treated with external coaptation. The splint should immobilize the carpus/tarsus completely to be effective. Generally, external coaptation requires six to 12 weeks to achieve bony union. Splints should be changed at least weekly to decrease the risk of pressure sores in an at-risk area because of the lack of soft tissue coverage. If three or four metacarpal/tarsal bones are fractured and displacement is present, external coaptation may be a poor choice. When multiple bones are fractured, the splint cannot maintain reduction properly, and while union may occur, the recovery will be prolonged and deformity is likely. Surgery is considered a better choice in such cases. Indications for surgery Internal fixation is used for simple or comminuted metacarpal/metatarsal bone fractures or in patients with three or four fractured bones. In multiple bone fractures, the fixation can be used for all fractured bones or for metacarpal/metatarsal bones 3 and 4 only, i.e. weight-bearing toes. Options for fixation include plating or wiring (rarely performed), …
Surgical Insights: How To Make A Soaker Catheter In 6 Easy StepsNovember 15, 2013Also called a wound or diffusion catheter, a soaker catheter is a cheap, easy and effective tool to improve patient comfort after amputation, excision of large skin and subcutaneous masses and mastectomy. You can purchase a commercial soaker catheter, or you can make one for a fraction of the cost in a few minutes, during surgery. To avoid increasing anesthesia time, you can also make one preoperatively … assuming you have ethylene oxide sterilization available. The main drawback is that one catheter may not have the appropriate length for a particular patient. Ideally, several catheters would be made ahead of time. Let's go over the six easy steps to make your own soaker catheter. 1. Cut Most patients can use a 5F red rubber catheter. Measure the length of your incision and add 2-4 inches at the proximal end of the catheter. Cut off the end of the red rubber at the appropriate length. The premade opening is much too big for our purpose. 2. Pinch and heat The next step is to seal the cut end. Burning the tip of the red rubber catheter with a lighter will not work: It will melt or burn it without …
