The 10 Commandments Of Referral BlissJanuary 4, 2010 Most referred surgery cases lead to a healthy patient, a happy client and a pleased referring veterinarian. Little is learned from a well-oiled referral process, but we can all learn from the rare mishap, occasional slip-up and infrequent diplomatic fiasco. I asked several general practitioners and surgeons from across the U.S. to share stories of surgical cases that should have been routine but turned into a difficult situation. From these discussions come our ever-so-slightly tongue-in-cheek 10 commandments of referral bliss. 1. Thou shalt not use aspirin in vain Photo courtesy of Dr. Phil Zeltzman. This cat, with bilateral sacroiliac luxations, was referred as a paralyzed patient. Aspirin may be an acceptable drug in specific cases, but because of its effect on platelets, it rarely is a surgeon’s best friend. In a perfect world, a seven-day wash-out period should be respected before surgery. This is annoying but doable with an elective procedure such as a ruptured cruciate ligament. But it becomes tricky when the client lives two hours away and needs to drive back one week later. And it is plain risky in …
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Freedom From FolkloreJanuary 4, 2010 The aggressive marketing of Chinese veterinary herbs in the U.S. clouds the longstanding tradition of Western veterinary herbal medicine. As authors in an integrative medicine journal acknowledged, “The rise in popularity of complementary and alternative medicine over the past few decades has placed greater demands on medical practitioners to explain and justify their own systems of knowledge and practice.”1 Their research further illuminated the disparity in objectivity and reliability between Western medical and Eastern diagnostic approaches. Why should we turn over our patients’ health and well-being to a primitive and poorly understood system of Chinese medicine when we can reclaim our heritage of herbal prescribing and still provide quality health care? By first establishing a clear-cut diagnosis, we can determine whether plant-based compounds will offer safe and appropriate treatment. We may even introduce Asian herbs if they meet muster, or decide that no herbs can replace the benefits of medication for a given illness. The following list provides a sampling of evidence pertaining to both Western and Asian herbs administered to dogs. Boswellia Veterinarians will find bos-wellia in canine products designed to treat arthritis and inflammatory bowel disease. Its anti-inflammatory effects are well characterized. …
New Guidelines Published To Promote Appropriate Wellness Care For CatsJanuary 4, 2010 The American Association of Feline Practitioners and the American Animal Hospital Association have released the AAFP/AAHA Feline Life Stage Guidelines, developed to promote appropriate wellness care for cats. These guidelines recommend cats be seen by a veterinarian at least once a year, regardless of the cat's age. The need for such guidelines was identified by the CATalyst Council, a national initiative to champion the cat, in light of "alarming" statistics reported in the 2007 American Veterinary Medical Association U.S. Pet Ownership and Demographics Sourcebook. For instance, the sourcebook revealed that the number of cats kept as pets outnumber dogs, yet receive significantly less veterinary care. Further studies have indicated that an inability to recognize signs of illness of injury is a key factor as to why cat owners are unaware of their cat’s medical needs, according to AAFP and AAHA. In addition, the associations note that the concern of a stressful veterinary visit for both cat and owner is a contributing deterrent to veterinary visits for cats. The aim of the guidelines is to help veterinarians act in partnership with cat owners which will in turn enhance the client-veterinary bond, according to AAFP and AAHA. Specifically, …
Down With Live-Plucked DownJanuary 4, 2010 Many of us like to sleep under down-stuffed comforters and on soft down-filled pillows. When it’s cold, there is something special about the lightweight warmth and breathability of down-filled jackets and coats. Down fills bedding, clothing, gloves, furniture and other heat-preserving items for people. Most high-quality down for commercial use comes from the soft layer of smaller feathers that cover the skin of geese and ducks. The sourcing and production of down goes back hundreds of years. While at the American Veterinary Medical Association conference in Seattle last July, I stopped by the Animal Welfare Institute booth and picked up its fall quarterly magazine, which included an article titled “Down on the Goose and Duck Farm.” It reported on a 2009 Swedish TV documentary that estimated today’s down is provided to manufacturers either as a byproduct from ducks and geese slaughtered for meat or by live plucking. Defining the Term What is live plucking? I had to clarify this question for myself. It seemed offensive to me from the start to learn that down feathers might be plucked or harvested from live geese and ducks. Live plucking is the rapid pulling off of feathers from …
Transaction To Form Butler Schein Animal Health CompletedJanuary 4, 2010 Butler Schein Animal Health has officially formed. Henry Schein Inc. and Butler Animal Health Supply first announced the planned merger on Nov. 30. The transaction closed on Dec. 31. The new company, based in Dublin, Ohio, is 50.1 percent owned by Henry Schein and 49.9 percent owned by the owners of Butler Animal Health Supply, including Oak Hill Capital Partners and The Ashkin Family Group. Combined revenue for the last 12 months was about $850 million on a U.S. General Accepted Accounting Principles basis. About 900 Butler Schein Animal Health team members, including about 300 field sales representatives and about 200 telesales and customer support representatives, will serve animal health customers in all 50 states. Oak Hill Capital Partners is a private equity firm with offices in Stamford, Conn.; Menlo Park, Calif.; and New York. The Ashkin Family Group distributes veterinary and dental products. The Jericho, N.Y.-based company is also involved in a variety of other businesses. <HOME> Butler Schein Animal Health has officially formed. Henry Schein Inc. and Butler Animal Health Supply first announced the planned merger on Nov. 30. Butler Schein Animal Health has officially formed. Henry …
Interview With A Suture GuruDecember 30, 2009 Suture material is the most common foreign body intentionally left inside patients. It can delay wound healing, cause infection or create an ugly scar. Choosing which suture type to use should therefore be taken seriously. In a perfect world, suture material would be strong, easy to handle, non-reactive, non-toxic and affordable. It also would offer good knot security and be reabsorbed by the body at a predictable rate once the tissue has healed. Courtesy of Dr. Phil Zeltzman Appropriate suture choice and technique are just the beginning. It is important to use an E-collar to prevent self-trauma, as in this 10-year-old Labrador, who had a hemilaminectomy for a disc hernia. But the variety of suture materials and needles can be overwhelming. We asked Thomas McMahan, sort of a suture guru, to help us untangle the web of suture materials in an exclusive interview. Q. What is your background? A. I have been involved in the medical field for the past 40 years. I am a surgical devices consultant for Novartis Animal Health, where I help educate and train veterinarians, vet students, vet technicians and sales …
Natural Vs. Synthetic VitaminsDecember 30, 2009 From holistic websites to nutritional seminars, messages bombarding consumers and the profession argue that “natural” vitamins are better than “synthetics” and often espouse the “more is better” line for orthomolecular or megavitamin therapy. Skeptics counter this by insisting that “with minor exception, molecules made in the ‘factories’ of nature are identical to those made in the factories of chemical companies.”1 They maintain that a good diet should supply all necessary nutrients. The true story builds a much more complex picture. With respect to the argument in favor of food-based vitamins, even natural sources of vitamin A in unnatural quantities produce problems like metabolic osteopathy in cats, a species with particularly high susceptibility to vitamin A toxicity.2 For precursors to vitamin A, the carotenoids, as many as nine factors influence their bioavailability when ingested in food. These variables include: • Their type, diversity and quantity. • The host’s nutrient status, genetic makeup and digestive health. • The integrity of the plant substrate when carotenoids are ingested in food.3,4 The carotenoid lycopene, which lowers prostate cancer risk, illustrates this last point. Cooking improves lycopene bioavailability because heating and homogenizing lycopene-rich tomatoes into paste disrupts …
Factors To ExtinctionDecember 30, 2009 If seeing the great animals of Africa is on your wish list, go as soon as you can! I recently led a Seminars in the Sun group to South Africa with wildlife expert Dr. Peter Brothers. His guidance and lectures gave us insight into the complexity and multilevel challenges that Africa faces to preserve its amazing biodiversity and heritage as the birthplace of man. Malayan sun bears may become extinct sooner than expected, two ecologists say. The most disturbing concept for me to absorb is the heartless process of extinction. It happened to the dinosaurs after a huge meteor hit the planet. It happens as life proceeds. It is happening now despite desperate conservation measures. Many factors come into play, such as weather, habitat loss, environmental toxins, disease, shrinking population dynamics. These factors can be analyzed to predict extinction risks and rates for endangered species. But some species may become extinct much faster than predicted because scientists have not updated the standard extinction prediction model. Alan Hastings at the University of California, Davis, and Brett Melbourne at the University of Colorado in Boulder are ecologists who believe that conservation organizations are using …
Tui Na: Chinese Massage Or Something More?December 30, 2009 Veterinary Tui Na, or Chinese bodywork, has recently joined the Traditional Chinese Medical repertoire along with TCM-style acupuncture and food therapy. Proponents point to the antiquity of Tui Na, citing its origin as circa 1700 BCE.1 Why some practices survived so long, however, is that the closed society of China kept its medicine primitive and folkloric until the Communist Revolution. Today, TCM risks extinction in China because of decreasing enrollment and interest by medical students.2 Calls for the “abolition of traditional Chinese medicine” have erupted in scholarly circles due its lack of scientific basis and outdated precepts.3 Even TCM hospitals are adopting more Western medical style diagnostics and relying less on techniques such as tongue and pulse diagnosis.4 China is now banking on the West’s appetite for all things Asian to keep TCM alive as well.5 Indeed, Americans have transformed both TCM and its veterinary counterpart, TCVM, into big business. It is curious to note that as China works to upgrade its veterinary medical educational standards to meet those outside of China,6 some U.S. holistic groups point to TCVM as a gold standard.7,8 However, the wholesale importation …
Step-by-Step Surgery For Anal Sac CancerDecember 30, 2009 Anal sac cancer causes local problems, mainly because of pain and straining to defecate. Anal sac apocrine gland adenocarcinoma also leads to systemic issues, including hypercalcemia and metastasis. Affected patients are older female dogs in 90 percent of the cases. A few cases have been described in cats. It is important to keep an open mind. Differential diagnosis for perianal disease includes anal sac impaction, abscess (which may rupture), sacculitis, perianal adenomas, perineal hernias, perineal fistulas and other malignancies, such as perianal malignant melanoma. Any of these conditions affect the quality of life of the patient. Photo courtesy of Dr. Phil Zeltzman. A preoperative view of a left anal sac adenocarcinoma in a 9-year-old male Akita mix. An anal sac tumor is suspected on rectal exam. If it is large enough, subcutaneous swelling may be visible. Occasionally, the tumor is bilateral. A diagnosis can sometimes be reached with cytology if enough cells exfoliate. Histopathology gives a definitive diagnosis. Incisional biopsies are rarely used, whereas excisional biopsy is typically the preferred course of action. Standard preoperative workup includes a CBC and blood chemistry, including a calcium level. Approximately …
