80% Of ‘Painful’ Dogs Have Spinal CompressionJanuary 22, 2010In the late 1990s, a classic study1 drew important conclusions about dogs who have “only” paraspinal pain. Out of 429 dogs diagnosed with thoracolumbar intervertebral disc disease (IVDD), 25 had signs of back pain only. “Back pain only” means they had no proprioceptive deficits and therefore had normal motor function. A myelogram was performed. It revealed that in 80 percent of these dogs, spinal cord compression was detected, which of course was not suspected based on clinical signs alone. The authors’ conclusion is very straight forward: “Dogs with thoracolumbar IVDD that have clinical signs of back pain alone, without neurologic deficits, may have substantial compression of the spinal cord.” The take-home message is simple: If only for liability reasons, you probably should suggest advanced imaging to your client, whether a myelogram, CT or MRI. And you should document this recommendation in the medical record, which of course is also a legal document. The article referenced may seem old, but we verify its conclusion regularly. Rather than steroids, these patients will benefit from surgery. Sure, we know patients who have improved on steroids (and hopefully strict confinement). But we also know patients who were sent home on steroids, were allowed …
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Who Should Euthanize Leia?January 18, 2010"Leia's owners are ready for euthanasia. Who do you want to do it?" It really was a sad situation. Leia, a 12-year-old Jack Russell, had been losing weight over several weeks. She was vomiting and anorexic. Laparotomy confirmed exactly what the referring vet's ultrasound had indicated: a small intestinal mass and enlarged mesenteric lymph nodes. Jejunal resection and anastomosis, as well as biopsies of a lymph node and the liver were uneventful. The following day, Leia remained lethargic and anorexic. She continued to vomit and became hypoglycemic. Hypoglycemia strongly suggested cancer, with lymphoma high on the differential list. Despite intensive care, she didn't improve. The next day, the "stat" biopsy confirmed the suspicion of lymphoma in all three locations: jejunum, lymph node and liver. The owner visited and eventually elected euthanasia. Without any doubt, they were doing the humane thing. Because I was in the middle of a splenectomy, I couldn't perform euthanasia myself, and there was no reason to prolong the owners' agony – and Leia's. "Leia's owners are ready for euthanasia. Who do you want to do it?" asked my nurse. I answered: "Whichever technician is the least emotionally attached." Dr. KL, who was observing surgery for the …
Changing The World, One Patient At A TimeJanuary 4, 201012/21/2009 - Would you have euthanized this patient? 12/07/2009 - Spay a pet, save a life 11/16/2009 - How (In)competent Are You? A local colleague, Dr. L, generated quite a stir in our referral community. Her dog Ursula, a 9 -year-old golden retriever, was recently diagnosed with hemoabdomen, widespread liver cancer and pulmonary metastasis, probably all due to hemangiosarcoma. Strangely, Ursula never missed a meal, and her liver values were normal. There wasn't much to do, besides making her comfortable. I suggested to my referring vet that she look into Pawspice. Remember, dear reader, Pawspice is the concept developed by oncologist and Veterinary Practice News columnist Alice Villalobos, DVM. Pawspice is hospice care for terminally sick patients, whether they have cancer, liver or kidney or heart failure, or the owner can't afford treatment. Dr. L was mentally prepared to euthanize her right away, but Ursula perked up. After some research, she decided to give IV fluids, steroids, vitamin C, coenzyme Q10, a chinese herb called skullcap (aka Scutellaria baicalensis or baical), claimed to have some anti-cancer properties, and even an equivalent of reiki. Unfortunately, Ursula's health declined. She likely had another bleeding episode, and after 10 days, she was euthanized. The story could …
Allergies And Resistant Staph Infections Dominate Dermatological ConcernsDecember 23, 2009Veterinary dermatologists say general practitioners following the “three strikes and you’re out,” policy tend to hold onto the client they referred when future veterinary care is needed. While the down economy may make an owner less willing to comply with treatment, holding onto a case without results for too long can make them leave the practice for good. Just as in general practice, specialists are reporting a slight decline in business correlating with their local economic conditions and the clients’ perceived importance of the problem, but they are also saying clients discuss their disappointment when their pet’s condition persisted for months even with their general practitioner’s treatments. “The general vet should refer cases that have been seen by multiple veterinarians without resolution,” says Terry Nagle, BVSc, MACVS, Diplo. ACVD, Northern California Vet Specialists, Sacramento, Calif. “The chance of making this client happy is very low considering the previous generalists likely treated the animal following the most likely diagnosis. The referring vet can be the hero that referred to a specialist that has the background to treat the animal’s tricky case.” Specialists say allergic dermatitis is still the most common reason they see clients, but the animal’s secondary bacterial …
Would You Have Euthanized This Patient?December 21, 2009I just lost a patient. And I am devastated. Cuddles was a 13-year- old Maltese with right periocular swelling and enophtalmos. MRI revealed a nasal mass causing lysis of the right orbit. The mass extended in the periocular tissues. The owner was clearly informed that the mass was probably malignant. Surgery entailed enucleation and debulking of the mass through the eroded orbital bone. After surgery, the owner was told that the procedure went well but was reminded that the mass was likely malignant. The biopsies would confirm the suspicion. During Cuddles' discharge, the owner couldn't stop repeating how great the surgical site looked. During "call backs," she sounded thrilled, and raved about how cosmetic the incision looked. About a week later, when I called the owner to discuss the confirmed diagnosis--nasal carcinoma--she seemed in shock. This isn't unusual. Before the biopsy, we could only share an impression, based on advanced imaging, gross appearance intraop and experience. But now, we had an actual diagnosis. Radiation therapy was mentioned as an option for follow up treatment. The owner opened up and explained that she "just went through that" with her mother. She had had surgery, chemo and radiation. But unlike the owner's mother, …
Emerging Threat Of Canine InfluenzaDecember 7, 2009The growing range of influenza viruses has many people concerned about their risk of infection and the risk level of their pets. Private practitioners bear the brunt of inquiries and are being asked to make determinations of viral spread that stump virologists and epidemiologists. What is known about the canine influenza virus is that the country’s shelter populations and boarding facilities are at the highest risk. Experts say the virus could spread in a shelter environment as readily as other respiratory infections, including canine infectious tracheobronchitis, or kennel cough. But show dogs, race dogs, boarded dogs and even those that frequent dog parks are at heightened risk of exposure as well. “This is an emerging disease which is the impetus for all of the funding dollars going toward research,” says Wayne A. Jensen, DVM, Ph.D., MBA, chief scientific officer for Morris Animal Foundation. “There are all sorts of questions about this virus, and not a lot of knowledge. Our earlier concerns about the virus were that it would be deadly. Although it has largely been controlled, we need to quickly gather information as we don’t know the virus’ speed of mutation or full capabilities yet.” The U.S. strain of H3N8 …
Spay A Pet, Save A LifeDecember 1, 2009Ever have a hard time convincing pet owners to spay their cat or dog? You might want to share some compelling numbers with them. It actually might help you save your patient's life. The risk of a dog having mammary tumors is 0.05 percent if she is spayed before the first heat. Then it shoots up to an 8 percent risk after the first heat, and 26 percent after the second heat. If the dog is spayed after 2 years of age, then there is no more protection. . Over 25 percent of non-spayed female dogs will develop mammary tumors! . Being obese or having received some hormones (estrogens, progesterone) can increase that risk. . In dogs, approximately 50 percent of mammary tumors are benign and 50 percent are malignant. . In cats, 90 percent of mammary tumors are malignant, so spaying is even more important. . Size does matter. In dogs, if a malignant tumor is smaller than 2 inches in diameter, we hope for a survival of one to two years. If the tumor measures more than 2 inches in diameter, survival could be 6 months. . In cats, the cutoff is …
Pet Insurance: Benefit Schedules As Managed CareNovember 23, 2009 Jack L. Stephens, DVM, the father of pet health insurance in the U.S., wrote an article about the 80/20 percent reimbursement model of pet insurance on June 25, 2009. On August 20, 2009, Tom Kendall, DVM, replied, warning of pitfalls in that model making the case for a benefit schedule. In this piece, Dr. Stephens responds and poses a challenge. Tom, Pet insurance can and must be easy and straightforward to understand. Pet owners need to know how much they will be reimbursed for their pet’s care, otherwise how can pet owners plan financially? With the benefit schedule you describe, clients receive 50-55 percent reimbursement of veterinary care according to the VPI report to the Vet Partners Association. I believe this is a form of managed care, when fees are set with no regard to practice cost, quality of care, differences in economic areas and, of course, the severity or complications of treatments. For example, as you know, not all pets with pancreatitis respond the same, so how can there be only one benefit amount? When reimbursements are much …
Veterinarians Do Double Duty At Trade ShowsNovember 19, 2009 WANTED: Veterinarian engaged in small-animal practice. Must love dogs, cats, parrots that talk back and energetic monkeys, and enjoy working and networking in a social setting. If this sounds beyond the scope of a typical small-animal hospital environment, it is. These days, veterinarians are enjoying getting out of the exam room and being on call at the many pet trade shows that are big business across America. “Over the years we’ve had a variety of emergency and bizarre incidents,” says Colette Fairchild, trade show manager for H.H Backer Associates Inc., a company that hosts two shows a year in Chicago and Baltimore. “But the year a dog bit a huge chunk out of another dog and the consequences turned into a verbal and legal debacle, we decided that it would be a good idea to have a veterinarian on call throughout each event who could immediately determine the level of the emergency and suggest further treatment. We also have 24-hour veterinary hospitals in the area on alert to assist should the need arise. “It turned out to be a very good decision because the first year we had a veterinarian on call, a dog taking …
Obesity Is Just As Bad As SmokingNovember 1, 2009The fact that obesity reduces lifespan is a well established fact in dogs and several other animal species. Dr. Kealy1 and others have shown, in a classic study, that thin Labs outlive overweight Labs by almost two years (13 years vs. 11 years on average). I've always wondered when physicians would show a similar correlation in people. They finally have. A recent article in the Lancet2 made the point. This is a gigantic study: The researchers reviewed 57 studies, for a total of 900,000 human patients in the US, Europe, Japan, etc. These results should therefore be reliable. Moderate obesity (about one third overweight, or 50 to 60 pounds over the ideal) reduces human lifespan by about three years. Severe obesity (double the ideal weight), reduces lifespan by 10 years, or about as much as smoking. The body mass index (BMI) helps describe overweight and obesity. BMI is the weight (in kilograms) divided by the square of the height (in meters). A BMI greater than 50 kg/m2 defines obesity. Mortality is the lowest for a BMI between 22.5 and 25 kg/m2. For each 5 kg/m2 increase of the BMI, mortality increases by 30 percent. The most common causes …
