Veterinary Forum | October 2009 by davidpsu

NEWS GOLDEN OPHTHALMIC RULES • CONTROLLING THE ITCH IN A PRURITIC DOG

FORUM ®

REAL PRACTICE. REAL MEDICINE. REAL NEWS.

OCTOBER 2009 • VOL. 26, NO. 10

veterinary

Whodunit? Probably not Bartonella Family Violence and Animal Abuse When You Hear Hoofbeats... Congratulations, It’s a Splenectomy! Visit us at www.ForumVet.com

With the introduction of the first vaccine for canine influenza,

only the love is contagious. Now you can provide your patients with more comprehensive protection against respiratory infection. Love is not the only thing in the air. Canine influenza virus (CIV) has been confirmed in dogs across 30 states and the District of Columbia, and its prevalence is rising.1 And because most dogs are naive to the virus, virtually every naive dog exposed will become infected.2 CIV is highly contagious and sometimes deadly. Clinical signs associated with CIV can be confused with kennel cough making accurate diagnosis difficult. Now you can broaden the respiratory protection you currently offer to patients with the addition of the first vaccine for canine flu, Canine Influenza Vaccine, H3N8. Canine Influenza Vaccine, H3N8 —a killed virus vaccine from Intervet/Schering-Plough Animal Health—significantly decreases clinical signs of disease and reduces viral shedding, and its safety has been confirmed in a study involving more than 700 dogs.3

Notice: This product license is conditional. As with all USDA conditionally licensed products, data submitted to the USDA supports a reasonable expectation of efficacy. Safety was established in trials involving more than 700 dogs.

So while CIV, like love, can be easily spread and hard to identify, it no longer has to be so overwhelming. To learn more, contact your Intervet/Schering-Plough Animal Health representative, visit www.doginfluenza.com, or call our technical services team at 800-224-5318.

References: 1. Syndromic surveillance data of Cynda Crawford, DVM, PhD, University of Florida, and Edward Dubovi, PhD, Cornell University. 2. Key facts about canine influenza. CDC Website. Available at: http://www.cdc. gov/flu/canine. Accessed May 1, 2009. 3. Data on file, Intervet/Schering-Plough Animal Health. Copyright © 2009 Intervet International B.V. All rights reserved. SPAH-VC-284:9412

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Editorial Board ANESTHESIOLOGY Donald C. Sawyer, DVM, PhD, DACVA Janyce Seahorn, DVM, MS, DACVA, DACVIM, DACVECC AVIAN Peter Sakas, DVM, MS BEHAVIOR Debra Horwitz, DVM, DACVB Wayne Hunthausen, DVM Gary Landsberg, BSc, DVM, DACVB

NEUROLOGY Ronald O. Schueler, DVM, DACVIM ONCOLOGY Louis-Philippe de Lorimier, DVM, DACVIM Joseph A. Impellizeri, DVM, DACVIM Gregory K. Ogilvie, DVM, DACVIM, DECVIM-CA OPHTHALMOLOGY Terri Gibson, DVM, MS, DACVO PARASITOLOGY Lora Ballweber, DVM, MS

CARDIOLOGY Andrew Beardow, DVM, DACVIM Robert Hamlin, DVM, PhD, DACVIM

PATHOLOGY Lawrence D. McGill, DVM, PhD, DACVP

DENTISTRY Jan Bellows, DVM, DAVDC, DABVP Edward Eisner, DVM, DAVDC Steven E. Holmstrom, DVM, DAVDC Heidi B. Lobprise, DVM, DAVDC Robert Wiggs, DVM, DAVDC

PHARMACOLOGY Lester Mandelker, DVM, DABVP PRACTICE MANAGEMENT Lowell Ackerman, DVM, DACVD, MBA, MPA Stephen Fisher, DVM Ronald E. Whitford, DVM

DERMATOLOGY Dawn Logas, DVM, DACVD Rosanna Marsella, DVM, DACVD Karen Moriello, DVM, DACVD

RADIOLOGY Victor Rendano, VMD, MS, DACVR Candi Stafford, RVT

EMERGENCY & CRITICAL CARE MEDICINE Nishi Dhupa, BVM, DACVECC ENDOCRINOLOGY Arnold Plotnick, MS, DVM, DACVIM, DABVP EPIDEMIOLOGY John Kaneene, DVM, PhD, MPH EQUINE MEDICINE Joseph J. Bertone, DVM ETHICS Bernard Rollin, PhD

REPRODUCTIVE PHYSIOLOGY Susan E. Piscopo, DVM, PhD SURGERY Sean Aiken, DVM, DACVS A. D. Elkins, DVM, MS, DACVS Joseph Harari, DVM, MS, DACVS Robert G. Roy, DVM, MS, DACVS Don R. Waldron, DVM, DACVS THERIOGENOLOGY Gary J. Nie, DVM, MS, PhD, DACT, DABVP, DACVIM

FELINE MEDICINE Gary D. Norsworthy, DVM, DABVP INTERNAL MEDICINE Anthony P. Carr, Dr. med. vet., DACVIM Richard B. Ford, DVM, MS, DACVIM, DACVPM (Hon) Michael R. Lappin, DVM, PhD, DACVIM Kevin Hahn, DVM, PhD, DACVIM

TOXICOLOGY Sharon Gwaltney-Brant, DVM, DABVT VETERINARY LAW Edward J. Guiducci, Esq. Elizabeth M. Hodgkins, DVM, JD

780 Township Line Road • Yardley, PA 19067 PRESIDENT Derrick Kraemer VETERINARY FORUM (ISSN 1047-6326) is published monthly by Veterinary Learning Systems, a division of MediMedia USA, 780 Township Line Road, Yardley, PA 19067. Single copy: $9.00. Payments by check must be in US funds drawn on a US branch of a US bank only; credit cards are also accepted. Periodicals postage paid at Morrisville, PA, and additional mailing offices. POSTMASTER: Send address changes to VLS, 780 Township Line Road, Yardley, PA 19067. All rights reserved. Reproduction in whole or in part without permission is prohibited. Copyright ©2009 Veterinary Learning Systems.

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October 2009 | Veterinary Forum

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OCTOBER 2009

COVER STORY

contents

Whodunit?

Probably not Bartonella Paul Basilio

If a differential diagnosis were a murder mystery novel, Bartonella would be the butler.

FORUM News

Tracking down the itch..........................................................6 Controlling the itch of a pruritic dog can seem like a never-ending endeavor, but key concepts can help diagnose dermatologic disease.

Golden ophthalmic rules ...................................................14 Paul Basilio

Eye examinations can be a rewarding addition to general practice, but veterinarians need the right equipment to properly evaluate the eye.

Clinical Report

Family violence and animal abuse: the veterinarian’s role........................................................16 Dr. Sophia Yin

You see injured animals on a regular basis, but are you able to recognize when these injuries are a result of abuse?

Peer Reviewed CASE REPORT

All Mixed Up.......................................................................20 Drs. Seth Chapman, Angela Wilcox, and Mary Nabity

A 6-year-old Labrador retriever presented with a progressive history of vomiting.

also in this issue Editorial Board ......................1 Web Contents........................4 Book Review........................36 Doctor to Doctor .................38 Statement of Ownership ....40 Product Forum.....................42 Market Showcase ................43 Classified Advertising..........44 Advertisers Index.................45

DENTAL DILEMMA

When You Hear Hoofbeats... ...................................................26 Dr. Jan Bellows

A local veterinarian noticed a 2- to 3-mm irregular, slightly raised focal area of inflammation above the right canine gingival margin.

Most Unusual Case

Goodwill hunters ................................................................45 Dr. Tim Sahli

Congratulations, it’s a splenectomy! ..................................48 Dr. Caroline Lafferty

To receive breaking news in your inbox, visit ForumVet.com. 2

Veterinary Forum | October 2009

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WEB-EXCLUSIVE FEATURES ■ Veterinary industry marks World Rabies Day ■ IFAW helps Taiwanese animals after Typhoon

Morakot ■ Sociologist categorizes dog–owner relationships ■ Grasshoppers can transmit virus to livestock ■ AVMA Survey: Starting salaries increased for vets ■ American University of Antigua to open new veterinary school ■ Albers to step down at AAHA ■ Results reported for 10-year ﬂea monitoring program WEB ARCHIVES Conduct a search in our archives for more web-exclusive features, client handouts, articles, forms and videos.

CONTACT US E-mail your questions, suggestions, breaking news, corrections, or letters to the editor to: editor@ForumVet.com.

Veterinary Forum | October 2009

E-NEWSLETTERS RS Veterinary Forum Online, a monthly e-newsletter, provides webexclusive articles and news as well is as a preview of this month’s journal. Sign com. up at ForumVet.com.

NEWS One Health Commission formed ■ Researcher: Dogs as smart as toddlers ■ ‘No animals harmed’ abused ■ Food safety website includes pet food recall information ■

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Data on file at Merial TS-USA-28701. McCall JW, Alva R, Irwin JP et al. Comparative efficacy of a combination of fipronil/(S)-methoprene, a combination of imidacloprid/permethrin, and imidacloprid against fleas and ticks when administered topically to dogs. J Appl Res Vet Med 2004;2(1):74-77. 3 Franc M, Beugnet, Vermots. Efficacy of fipronil - (S)-methoprene on fleas, flea egg collection, and flea egg development following transplantation of gravid fleas onto treated cats. Vet Ther 2007;285-292. 2

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news

Tracking down the itch LAS VEGAS — Controlling the itch of a pruritic dog can seem like a never-ending endeavor. Understanding the concepts of summation of effect, threshold and perception of pruritus can help with diagnosing dermatologic disease and getting clients to agree to dermatologic workups and followup appointments, said Wayne Rosenkrantz, DVM, DACVD, during a session sponsored by Lilly Animal Health, here at the Western Veterinary Conference. “Sometimes I’ll ask clients if the pet is itchy and they’ll say ‘no,’ but then I’ll ask if it licks, rolls, rubs or drags its bottom and they’ll say ‘yes,’” explained Rosenkrantz, co-owner and partner of Animal Dermatology Clinic in Tustin, Calif. “Sometimes you have to ask the same question using synonyms because clients do not always respond to the words ‘itch’ or ‘scratch.’” The neuroanatomy of pruritus involves an exogenous stimulus that is handled by antigen-processing cells, such as the Langerhans cells, transmitted to the dorsal root ganglion and the spinal cord by unmyelinated C fibers and then on to the brain. Various other endogenous mediators

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also can accentuate and potentiate pruritus. In humans, a perception of pruritus, in which a thought or image of small insects or other things known to cause itching, can compel a person to scratch his or her skin. “You have probably seen this in some clients. You talk about parasites or show an image of a scabies mite under a microscope, and clients may start to scratch,” Rosenkrantz said. “But are dogs capable of these types of sensations? Does an atopic dog think, ‘I have to go outside and be exposed to allergens. Am I itching just thinking about it?’” He posited that some itchy patients may have a more psychogenic cause for scratching, which can potentiate pruritus. Threshold phenomena and summation of effect are old concepts, but Rosenkrantz said he finds them valuable for helping clients understand the variables associated with pruritus and why diagnostic tests are necessary. “For every allergic patient, there is a hypothetical threshold,” he explained. “Above the threshold we see pruritus, and below it we may not. This threshold can be modulated by several factors.” The threshold could be raised after glucocorticoid administration, but it also could be raised if an atopic dog experiences outside stimulation from its owner or something that turns its focus away from its skin disease and, therefore, it shows fewer signs. “We also can see the threshold drop for a variety of reasons, such as additional allergens in the environment or if the pet has been left alone without human contact or interaction,” Rosenkrantz said. “Clients often complain that their pet is scratching, chewing or rubbing more in the evening. Is that because the dog no longer receives attention and stimulation from outside distractions, or are owners are more aware of their dog and noticed that it is itching?” According to Rosenkrantz, the five most common conditions that contribute to pruritus are atopic dermatitis, adverse food reaction or food allergy, parasitic infestation, secondary bacterial overgrowth and secondary yeast overgrowth. “All of these are additive,” he said. “We should conduct cytology to look for bacterial or yeast overgrowth. When we treat the secondary infections, the dog may drop below that theoretical threshold. If we can test for allergies and conduct successful immunotherapy, we can reduce the atopic component. It’s a simplistic concept, but it is valuable and applicable to the pruritic animal.” vF For more information: Rosenkrantz W. Using Comfortis in canine allergic skin disease. Presented at: The Western Veterinary Conference. Las Vegas; Feb. 15-19, 2009.

W W W. A L L E Y C AT. O R G

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Veterinary Forum | October 2009

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Whodunit?

Probably not Bartonella By Paul Basilio ● Associate Editor

If a differential diagnosis were a murder mystery novel, Bartonella would be the butler. Everyone may assume it is responsible for the problem, but the real culprit is most likely something more complicated. In recent years, Bartonella has become a popular answer to many diagnostic questions in cats, despite research that shows that the bacteria is part of a cat’s normal ﬂora and does not play a major role in most disease processes. In 2006, a group of Bartonella experts published an American Association of Feline Practitioners (AAFP) panel report that acknowledged the prevalence of the bacterium but, based on peer-reviewed research, could not name it as a cause of much disease in cats.

The report stated that while prevalence rates can vary, studies have shown that the Bartonella organisms are present in about 20% of cats. In one study, antibodies against Bartonella have been shown to be present in as many as 93% of feral cats, but the seroprevalence rate of a population of cats will generally be twice the bacteremia rate. Cats typically contract Bartonella from infected fleas and flea feces, but Bartonella DNA has been found in ticks, biting flies and other blood-feeding

Veterinary Forum | October 2009

parasites. The bacteria are not transmitted through gestation, by milk or from infected cats during breeding. Still, the threat that Bartonella presents to cats is much lower than some anecdotal evidence would suggest. The AAFP panel states that more research will be necessary to conclude that Bartonella is a cause of disease because most cats with Bartonella organisms show no signs of illness. The panel’s findings jibe with what

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Arnold Plotnick, DVM, DACVIM, DABVP, a feline specialist in New York City, sees in his patients. “I think that people jump to Bartonella infection as the answer to a lot of questions without it being an accurate answer,” he says. “Two things can exist in a cat simultaneously, but it doesn’t mean that one is the cause of the other. A cat can have gingivitis and test positive for Bartonella, but that doesn’t mean the Bartonella is causing the gingivitis.” In fact, anecdotal evidence abounds linking Bartonella to stomatitis, but experts agree that correlation is not causation, and appropriately controlled peer-reviewed evidence has shown no statistically significant difference between the Bartonella antibody titers or the positive PCR assays of cats with stomatitis and cats without. The consensus opinion of the AAFP panel states that more solid research will need to be conducted to show the spectrum of Bartonella-associated illness in cats. Plotnick says it can be frustrating when a client comes into an appointment armed with faulty information gathered from the Internet. Online, Bartonella has been accused of causing everything from stomatitis, diabetes and pancreatitis

“I think that people jump to

Bartonella infection as the answer to a lot of questions without it being an accurate answer... A cat can have gingivitis and test positive for Bartonella, but that doesn’t mean the Bartonella is causing the gingivitis.” —Arnold Plotnick, DVM, DACVIM, DABVP

to inflammatory bowel disease, upper respiratory disease and granulomas. “Bartonella is not much of a pathogen in cats,” Plotnick says. “Their bodies are adapted to it. Eight of the next ten cats that come through my door could test positive for Bartonella, but it doesn’t seem to cause significant clinical illness. Many cats test positive for Bartonella and don’t seem to have a problem with it at all.”

J’accuse When it is time to make a definitive diagnosis and convict Bartonella, it is easier said than done. Bartonella “fingerprints” may be all over a certain disease process, but research shows that evidence is mostly circumstantial. The AAFP panel’s consensus for diagnosis of feline bartonellosis includes four points:

Veterinary Forum | October 2009

• Presence of a syndrome reported to be associated with Bartonella spp infection • Exclusion of other causes of the clinical syndrome • Detection of a positive Bartonella spp test (culture, PCR assay or serology) • Response to administration of a drug with presumed antiBartonella activity The problem is that the tests to find Bartonella, such as serum antibody tests and PCR assays, only detect that an organism is or has been present in the cat at some point. It does not prove that the cat is clinically ill from Bartonella infection. Another confounding aspect is that drugs with antiBartonella activity also have activity against other, more serious, pathogens that have been shown to cause disease. The Bartonella panel agrees that serologic tests cannot prove that Bartonella is the cause of a certain disease in cats, and that many chronic conditions that are suspected to be caused by the bacteria may be the result of many factors working together to create disease in the cat. Plotnick, who says he does not often find cause to test for Bartonella in his feline-only practice, will keep the bacteria on the differential diagnosis list in some unusual cases, however. “I had a feline patient with recurrent uveitis,” Plotnick said. “I ruled out some of the common causes, such as feline leukemia, FIV, feline infectious peritonitis and toxoplasmosis, and conducted an antibody test, which came back positive for Bartonella. I treated the cat with azithromycin and the uveitis resolved.” Plotnick said that he couldn’t be 100% certain that the cause of the cat’s uveitis was Bartonella, but the cat satisfied enough of the diagnostic criteria to suggest that the bacteria played a role in the disease. “There are more definitive ways to attribute Bartonella as a cause for uveitis,” Plotnick explains. “If you were to test for antiBartonella antibodies in the cat’s aqueous humor and found the level to be higher than the level found in the bloodstream, it would surely make you think that the uveitis was due to Bartonella. I don’t think many practitioners are comfortable sticking a needle through a cat’s cornea, however. I certainly am not.”

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from an infected cat, but symptoms often resolve on their own or after treatment. Owners who are immunocompromised, however, can be at risk of serious disease if infected with Bartonella, but experts agree that a positive test for Bartonella does not mean an immunocompromised owner must give up his or her cat. If a household with an immunocompromised person wishes to adopt a cat, an older cat from a fleafree environment would be less likely to pose a concern. The Centers for Disease Control and Prevention (CDC) notes that proper handling and the administration of flea control products can limit the risk of contracting Bartonella from cats. The AAFP panel explains that nail trimming, avoidance of rough play with cats and kittens and prompt and thorough cleansing of any wounds can help prevent the transmission of Bartonella. It is important to note that there is no evidence that declawing cats can eliminate the risk of contracting Bartonella. vF

be prepared to help.

For more information: Brunt J, Guptill L, Kordick DL, et al. Association of Feline Practitioners 2006 Panel report on diagnosis, treatment, and prevention of Bartonella spp. infections. J Feline Med Surg. 2006;8:213-226.

Bartonella Tips to Give Owners Owners may come into a clinic armed with misinformation and sensationalistic claims about the zoonotic potential of Bartonella. According to the CDC, the following sensible precautions can help owners reduce the risk of infection: • Avoid “rough play” with cats, especially kittens. This includes any activity that may lead to cat scratches and bites. • Wash cat bites and scratches immediately and thoroughly with running water and soap. • Do not allow cats to lick open wounds. • Control fleas.

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Veterinary Forum | October 2009

We believe you re too good to be micromanaged. We believe in providing more resources, not taking them away. We believe a econd opinion, or third, or fourth, can make yours even stronger. We believe in getting out of the way and letting doctors be octors. We believe you own your career. We believe you went to vet school for a very furry reason. We believe people need eterinarians as much as Pets do. We believe you’re better at your job when you’ve had some time away from it. We believe in iving you the tools you need to do your job. We believe no matter how good you are, you can always get better. We believe t xcellent doctors make excellent colleagues. We believe mentors can learn as much as mentees. We believe in saving the lives f Pets and improving the lives of vets. We believe that you should be focused on your patient, not your paperwork. We belie hat flexible hours make for refreshed doctors. We believe cats aren’t the only animals that purr. We believe we’re helping fam es along with their Pets. We We believe believe experience experience is is powerful powerful medicine. medicine. We believe in providing more resources, not takng them away. We That you’re a healer – not an administrator. yours even stronger. We believe in getting out of the way and etting doctors be doctors. We believe you own And that the right resources make good doctors great. for a very furry reason We believe people need veterinarians as much as Pets do. We believe you’re better at your job when you’ve had some time aw om it. We believe in giving you the tools you need to do your job. We believe no matter how good you are, you can always g etter. We believe that excellent doctors make excellent We We believe believe you you should should look look forward forward to to work. work. mentees. We beli That your your practice practice isis part part of of who who you you are. are. be focused on your patient, not your paperwork. W n saving the lives of Pets and That elieve that flexible hours make for refreshed doctors. We But that your loved ones at home need you too. We believe we’re elping families along with their Pets. We believe you’re too good to be micromanaged. We believe in providing more resourc ot taking them away. We believe a second opinion, or third, or fourth, can make yours even stronger. We believe in getting o f the way and letting doctors be doctors. We believe you own your career. We believe you went to vet school for a very furry eason. We believe people need veterinarians as much as Pets do. We believe you’re better at your job when you’ve had some me away from it. We believe in giving you the tools you need to do your job. We believe no matter how good you are, you c lways get better. We believe that excellent doctors make excellent colleagues. We believe mentors can learn as much as ment We believe in saving the lives of Pets and improving the lives of vets. We believe that you should be focused on your patient, ot your paperwork. We believe that flexible hours make for refreshed doctors. We believe cats aren’t the only animals that pu We believe we’re helping families along with their Pets. We believe you’re too good to be micromanaged. We believe in provid ng more resources, not taking them away. We believe a second opinion, or third, or fourth, can make yours even stronger. We elieve in getting out of the way and letting doctors be doctors. We believe you own your career. We believe you went to vet chool for a very furry reason. We believe people need veterinarians as much as Pets do. We believe you’re better at your job when you’ve had some time away from it. We believe in giving you the tools you need to do your job. We believe no matter h ood you are, you can always get better. We believe that excellent doctors make excellent colleagues. We believe mentors can earn as much as mentees. We believe in saving the lives of Pets and improving the lives of vets. We believe that you should b ocused on your patient, not your paperwork. We believe that flexible hours make for refreshed doctors. We believe cats aren’ Banfield, believeyou’re in our too veterinarians. he only animals that purr. We believe we’re helping families along with theirAtPets. Wewe believe good to be microWe’ll give you the tools you need to do theor fourth, can managed. We believe in providing more resources, not taking them away. We believe a second opinion, or third, best jobbe possible: fromWe resources modern make yours even stronger. We believe in getting out of the way and letting doctors doctors. believeand you own your caree to a healthyas work/life balance, we We believ We believe you went to vet school for a very furry reason. We believe peopletechnology need veterinarians much as Pets do. keep doctors thetools forefront veterinary ou’re better at your job when you’ve had some time away from it. We believe in our giving youatthe youofneed to do your job We believe no matter how good you are, you can always get better. We believe that make care. Weexcellent believe indoctors supporting yourexcellent practice, colleague We believe mentors can learn as much as mentees. We believe in saving the lives of Pets and improving the lives but that you own your career. We believe of thatvets. We elieve that you should be focused on your patient, not your paperwork. Wetogether believewe that forand refreshed do canflexible practice hours quality make medicine ors. We believe cats aren’t the only animals that purr. We believe we’re helping families along with their Pets. believe you make a difference in the lives of Pets andWe their oo good to be micromanaged. We believe in providing more resources, not taking away. We believe a second people. them Because at Banfield, you aren’t just opinion, o hird, or fourth, can make yours even stronger. We believe in getting out of the way and letting doctors be doctors. touching patients – you’re touching the futureWe believe ou own your career. We believe you went to vet school for a very furry reason. We believe people need veterinarians as much of medicine. s Pets do. We believe you’re better at your job when you’ve had some time away from it. We believe in giving you the tools y eed to do your job. We believe no matter how good you are, you can always get better. We believe that excellent doctors mak We’re Banfield. We believe in vets. xcellent colleagues. We believe mentors can learn as much as mentees. We believe in saving the lives of Pets and improving t ves of vets. We believe that you should be focused on your patient, not your paperwork. We believe that flexible hours make or refreshed doctors. We believe cats aren’t the only animals that purr. We believe we’re helping families along with their Pets We believe you’re too good to be micromanaged. We believe in providing more resources, not taking them away. We believe a econd opinion Visit us at banfield.net/veterinarians We believe in getting out of the way and letting doctors be doctor We believe for a very furry reason. We believe people need veterinarians as much as Pets do. We believe you’re better at your j when you’ve had some time away from it. We believe in giving you the tools you need to do your job. We believe no matter h d l b b l h ll

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news

Golden ophthalmic rules By Paul Basilio Associate Editor LAS VEGAS — Eye examinations can be a rewarding and useful addition to general practice, but veterinarians need the right equipment to properly evaluate the eye. Fortunately, an increasing number of veterinarians are purchasing ophthalmic supplies compared with 10 years ago, but there is still room to improve, said Kerry L. Ketring, DVM, DACVO, of the All Animal Eye Clinic in Cincinnati, Ohio, who spoke here at the Western Veterinary Conference about the golden rules generalists need to follow for basic, worthwhile eye examinations.

External examination tools “Rule #1: You have to have the right equipment,” Ketring said, adding that a bright light source and magnifying loupes are essential for an external examination of the eye. “You’d be amazed at what you see when you shine light on the subject.” The older you get, he joked, the more magnification you need for your loupes. “I keep one pair in the exam room and one in my tackle box [for tying] flies.” According to Ketring, purchasing loupes with the highest magnification is not necessary. At 5× magnification, Ketring said, working distance becomes critical, adding that using loupes with 5× magnification means “you have to be on top of your subject, and your depth of field is affected. I think 2.5× or 3× is fine.” Tonometry Ketring warned against looking at a patient’s eye and saying, “‘That looks hard.’ That’s a pet peeve of mine. Concrete walls look hard — eyes cannot. You have to measure the pressure.”

Veterinary Forum | October 2009

Ketring said the Tono-Pen Vet is preferred by veterinary ophthalmologists because of its precision and ease of operation. It calculates the average of four valid taps on the cornea and displays the mean intraocular pressure and standard deviation. When using tonometry to screen patients’ eyes, he recommended that veterinarians refer to a list of breeds predisposed to certain eye diseases. “It’s good medicine,” Ketring explained. “It allows you to develop the skill of measuring pressure while helping local breeders become aware of eye problems in their puppies.” But false-elevated pressure readings are possible, Ketring added, especially when examining the eyes of unruly dogs that require restraint. False-low pressure readings, however, are not possible.

Ophthalmoscopy Ophthalmoscopes are used to evaluate the clear media in the eye, Ketring said. “It’s easy,” he explained. “You can use it to evaluate the entire clear media, the fundus and the anterior segment. All you do is set the ophthalmoscope on 0 diopters, stand an arm’s length away from the animal, shine the light in its eye and the light reflects off the posterior segment.” The problem some veterinarians run into, Ketring explained, is not dilating the patient’s pupil before examination. “I don’t care what the manufacturers say — when you’re looking at the fundus, you will see twice as much if you dilate the pupil,” he said. Traumatic ulcers According to Ketring, humaninduced traumatic ulcers are over-

diagnosed in veterinary medicine. The only case he has seen in 31 years involved a woman who had long fingernails and poked the eye of her rottweiler when it jumped up as the woman was petting it. “Have you ever tried to poke a dog in the eye?” he asked. “You can’t do it. You’re not fast enough. “I’m not saying [traumatic ulcers] don’t exist, but you can miss the primary diagnosis if you let the client convince you that the problem is a result of trauma,” Ketring said. “The majority of ulcers are associated with keratoconjunctivitis sicca, exposure keratitis, lid disease and degenerative diseases of the cornea, such as indolent ulcers in dogs.”

Breed incidence The American College of Veterinary Ophthalmologists and the Canine Eye Registration Foundation have compiled a breed list of many eye diseases that can be beneficial for veterinarians to keep on hand. Golden retrievers, for example, are predisposed to ectopic cilia. “If a young golden retriever comes in with periodic tearing or recurring ulcers, it’s either mild entropion or ectopic cilia,” Ketring said. “You know the age, you know the breed and you have the diagnosis. You just need to find the hair in its eye. “I am convinced that if a certain breed walks through your door and you look at the list to find out what diseases that breed has, you can immediately come up with a short list of differentials,” Ketring added. “Ralph Waldo Emerson said, ‘People only see what they are prepared to see.’ He should have been an ophthalmologist.” vF

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clinical REPORT By Sophia Yin, DVM, MS (Animal Science) Column Editor Special to VETERINARY FORUM

Family violence and animal abuse: the veterinarian’s role As veterinarians, we see fractures and other injuries on a regular basis, but are we able to recognize when these injuries are the result of abuse? According to Randall Lockwood, PhD, senior vice president of the ASPCA Anti-Cruelty Field Services, veterinarians are one of the most important links in a successful prosecution for animal cruelty. “They are among the most trusted professionals,” he says. While veterinarians might think an animal abuser would never bring an abused pet in for veterinary attention, they frequently do. Jeanine Moga, director of Social Work Services at the Veterinary Medical Center, University of Minnesota, says that families with histories of violence are just as likely to seek veterinary care as families without that kind of history. “In general, women are the primary caregivers for animals in many households and often will be the client presenting the animal for treatment, regardless of the presenting problem or cause,” she says. Lockwood, who also runs veterinary forensics workshops at veterinary conferences, notes that many veterinarians come to him after a presentation and tell him that they’re embarrassed because they’ve seen cases of abuse and let them go. As with many of the less obvious medical conditions, veterinarians may miss signs of abuse because they aren’t sure what to look for, but Lockwood says that there are several clear indicators of cruelty that can help veterinarians identify a problem.

Subtle but clear signs One of the first indicators that an injury may be nonaccidental is if the narrative given by the client to explain the situation doesn’t add up or is inconsistent with the presentation or injury. “For instance,” says Lockwood, “the client may claim the pet fell off the bed, but it has a spiral fracture of the femur. Or, he or she may say the cat fell out of a high-rise window but there are no injuries to the jaw and instead the cat has bilateral broken ribs.”

Veterinary Forum | October 2009

In other situations, the story may change depending on who tells it or to whom it is told. “For example,” Moga says, “someone may come in to have a muzzle fitted for his or her dog. He or she tells the technician that it bit his or her 3-year-old child, but when the veterinarian comes in, he or she gives a different story.” Another warning sign is an attempt to minimize the problem by the person who brings the animal to the clinic. For instance, the family member who accompanies the pet may say the pet has been limping for a while, as if it has only sustained a minor injury. In reality, the veterinarian may find that the patient has a compound fracture that requires immediate attention. “If there’s been a delay in treatment, it’s often because the owners are scared, don’t want to spend the money or they have been denied the ability to treat. The abuser may refuse to allow family members to get the animal treated,” Lockwood explains. If a veterinarian sees the animal under such suspicious circumstances, he or she should look for another common warning sign that can be found in the medical records — evidence of clinic hopping by the client or multiple suspicious injuries in the family’s pets. “Look at records of all the pets brought to the practice. If this is a client’s 3rd cat in 5 years with a broken leg, it should increase your suspicions,” Lockwood says. To see if clients are clinic hopping, Moga asks them who else they have seen. “They may say, ‘I’ve seen a bunch of people but no one can help,’” she explains. Or, clients may inexplicably refuse to release or share previous veterinary records.

More than just a good history Lockwood, co-author of Forensic Investigation of Animal Cruelty: A Guide for Veterinary and Law Enforcement Professionals, also recommends that you perform full body radiographs if you suspect abuse. Look for evidence or patterns of healed or healing fractures, as well as the presence of BB pellets or bullets lodged in the pet’s body so you can document past history. It is not uncommon

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clinical REPORT Abuse Red Flags Each of the following should raise the level of suspicion when dealing with a suspected case of abuse: • A story that doesn’t match the injury, or one that changes as it is told • An effort to minimize serious injuries • Evidence of clinic hopping or repeat injuries in the client’s medical record

for abusive owners to shoot animals exhibiting behavior that they perceive to be annoying, such as barking, in an attempt to get them to stop.

What should veterinarians do? The first call a veterinarian makes should be to the local humane society. According to the ASPCA, some states mandate that veterinarians report suspected cases of animal cruelty and abuse. In other states, veterinarians are granted civil immunity when they report cases that are based on clinical evidence. In all cases, the AVMA and AAHA support vets that report suspected abuse cases to the proper authorities. However, it is still important to research the specific laws in your state. Veterinarians who report a client may have concerns about losing that client or even have fears for their own personal safety. In response to these concerns, Lockwood points out that people who hurt animals are not nice people. “They are not people you want as clients anyway,” he says. Regardless, veterinarians should not confront the suspected abuser, Lockwood says. “That is a job for law enforcement.” The veterinarian may hospitalize the pet and conduct a few tests. If abuse is still suspected, the proper authorities should be contacted at that point. Each situation depends on the circumstances and the degree of concern. “We’re not asking the veterinarian to be the accuser, judge and jury,” says Lockwood. “The veterinarian’s job is to record what the client has said and make note of suspicions.” Also, veterinarians should not allow themselves to be lulled into not reporting a suspected abuse case because the perpetrator shows signs of remorse. “That’s not the veterinarian’s decision,” Lockwood says. “There’s a cycle of domestic violence — it starts with violence, then an apology, then the honeymoon phase, and then it starts up again.”

care, it is imperative to be aware of other family issues that may be occurring. Moga recalls a case of hers in which a pit bull was brought in for a behavior evaluation. “The dog was behaving in an interesting way — differently when the male owner was in the room than when he was out. Without the male owner, the dog would come out from under the chair, wag his tail and engage other people. But when the male entered, the dog was very timid.” Her staff noticed similar behavior in the female owner. “When her partner left, she’d talk more freely and more emotionally about the dog and how much she loved it. Then, when the male owner walked in, he’d take over the conversation and would glare at her if he didn’t like something she said.” When the male owner left to take a phone call, Moga asked the woman point blank, “Are you safe?” She burst into tears and said, “No. I have not been. I haven’t been for a long time. He takes it out on me and on the dog.” Sometimes this type of question, or a similar one such as, “Is there anything else I can help you with?” are enough for the abused person to understand what the veterinarian is really asking. Moga gave her client a list of hotline numbers for help. For situations such as this, she encourages veterinarians to maintain a short list of resources to provide help to clients in distress. “You can look through the yellow pages for family services or social services that have crisis lines manned 24 hours a day,” says Moga. Make a list, print it and keep it handy. Frequently, obtaining help for abused spouses also involves finding a way to keep the pet safe as well. The spouse may need to be advised to find a relative or someone in a safe home to temporarily watch their pet. It’s also important to keep in mind that documenting an animal’s injuries can help provide the evidence necessary to obtain a restraining order to protect the abused spouse. In other cases, Lockwood points out, “The victim might not feel comfortable pressing charges for herself but may do so for the pet because she feels the pet didn’t deserve to be harmed.” Regardless of the complexities of the family matter, veterinarians can do their part to help both the pet and the family by recognizing the signs of abuse and contacting appropriate authorities or providing the owner with vF appropriate resources for obtaining help. For more information:

Look to the other end of the leash Both Moga and Lockwood stress that pets are often not the only victims of abuse and violence in the household. Because humans are an essential part of the pet’s

Veterinary Forum | October 2009

www.aspca.org. “Report Animal Cruelty” FAQ. www.avma.org

Dr. Yin works at San Francisco Veterinary Specialists in California. Her website is www.AskDrYin.com.

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CASE REPORT

All Mixed Up

By Seth Chapman, DVM, MS, DACVP, Angela Wilcox, BVSc, MS, DACVP, and Mary Nabity, DVM, DACVP six-year-old, 26-kg, female intact Labrador retriever presented to the Texas Veterinary Medical Center with a progressive 4-day history of anorexia, lethargy, and vomiting after eating or drinking.

Physical Exam Findings On physical exam, pertinent findings included tachycardia (150 bpm), a grade I-II/VI right systolic heart murmur, and gagging episodes that occurred during abdominal palpation. The dog was severely dehydrated (estimated 1012%) with dry mucous membranes, prolonged skin tenting, and bilaterally sunken eyes. Initial diagnostics included a CBC, biochemistry panel (Table 1), and upper abdominal radiographs (Figure 1). Because of the marked dehydration, a urine sample for urinalysis could not be obtained. Diagnostics and Treatment The CBC revealed a mild polycythemia and a moderate hyperproteinemia. The biochemistry panel revealed a marked hypochloremia, moderate hypokalemia, and mild hyponatremia. The enzymatic CO2 (similar to bicarbonate) and anion gap were both markedly elevated. In addition, a moderate azotemia, hypermagnesemia, hyperphosphatemia, and panhyperproteinemia were found. A mild hypercholesterolemia was noted as well. A spherical, radiopaque object was present within the upper gastrointestinal (GI) tract on abdominal radiographs. The dog was immediately treated with intravenous fluid therapy including a 1-L bolus of lactated Ringer solution (LRS) followed by 0.9% NaCl with 20 mEq of potassium chloride (KCl) per liter. The presence of an apparent gastric foreign body on radiographs prompted endoscopic

CHEWABLES CAUTION: Federal (U.S.A.) law restricts this drug to use by or on the order of a licensed veterinarian. INDICATIONS: For use in dogs to prevent canine heartworm disease by eliminating the tissue stage of heartworm larvae (Dirofilaria immitis) for a month (30 days) after infection and for the treatment and control of ascarids (Toxocara canis, Toxascaris leonina) and hookworms (Ancylostoma caninum, Uncinaria stenocephala, Ancylostoma braziliense). DOSAGE: HEARTGARD® Plus (ivermectin/pyrantel) Chewables should be administered orally at monthly intervals at the recommended minimum dose level of 6 mcg of ivermectin per kilogram (2.72 mcg/lb) and 5 mg of pyrantel (as pamoate salt) per kg (2.27 mg/lb) of body weight. The recommended dosing schedule for prevention of canine heartworm disease and for the treatment and control of ascarids and hookworms is as follows:

Color Coding 0n Dog Chewables Ivermectin Pyrantel Foil-Backing Weight Per Month Content Content and Carton Up to 25 26 - 50 51 - 100

1 1 1

68 mcg 136 mcg 272 mcg

57 mg 114 mg 227 mg

Blue Green Brown

HEARTGARD Plus is recommended for dogs 6 weeks of age and older. For dogs over 100 lb use the appropriate combination of these chewables. ADMINISTRATION: Remove only one chewable at a time from the foil-backed blister card. Return the card with the remaining chewables to its box to protect the product from light. Because most dogs find HEARTGARD Plus palatable, the product can be offered to the dog by hand. Alternatively, it may be added intact to a small amount of dog food.The chewable should be administered in a manner that encourages the dog to chew, rather than to swallow without chewing. Chewables may be broken into pieces and fed to dogs that normally swallow treats whole. Care should be taken that the dog consumes the complete dose, and treated animals should be observed for a few minutes after administration to ensure that part of the dose is not lost or rejected. If it is suspected that any of the dose has been lost, redosing is recommended. HEARTGARD Plus should be given at monthly intervals during the period of the year when mosquitoes (vectors), potentially carrying infective heartworm larvae, are active. The initial dose must be given within a month (30 days) after the dog’s first exposure to mosquitoes. The final dose must be given within a month (30 days) after the dog’s last exposure to mosquitoes. When replacing another heartworm preventive product in a heartworm disease prevention program, the first dose of HEARTGARD Plus must be given within a month (30 days) of the last dose of the former medication. If the interval between doses exceeds a month (30 days), the efficacy of ivermectin can be reduced. Therefore, for optimal performance, the chewable must be given once a month on or about the same day of the month. If treatment is delayed, whether by a few days or many, immediate treatment with HEARTGARD Plus and resumption of the recommended dosing regimen will minimize the opportunity for the development of adult heartworms. Monthly treatment with HEARTGARD Plus also provides effective treatment and control of ascarids (T. canis, T. leonina) and hookworms (A. caninum, U. stenocephala, A. braziliense). Clients should be advised of measures to be taken to prevent reinfection with intestinal parasites. EFFICACY: HEARTGARD Plus Chewables, given orally using the recommended dose and regimen, are effective against the tissue larval stage of D.immitis for a month (30 days) after infection and, as a result, prevent the development of the adult stage. HEARTGARD Plus Chewables are also effective against canine ascarids (T. canis, T. leonina) and hookworms (A. caninum, U. stenocephala, A. braziliense). ACCEPTABILITY: In acceptability and field trials, HEARTGARD Plus Chewables were shown to be an acceptable oral dosage form that was consumed at first offering by the majority of dogs. PRECAUTIONS: All dogs should be tested for existing heartworm infection before starting treatment with HEARTGARD Plus which is not effective against adult D. immitis. Infected dogs must be treated to remove adult heartworms and microfilariae before initiating a program with HEARTGARD Plus. While some microfilariae may be killed by the ivermectin in HEARTGARD Plus at the recommended dose level, HEARTGARD Plus is not effective for microfilariae clearance. A mild hypersensitivity-type reaction, presumably due to dead or dying microfilariae and particularly involving a transient diarrhea, has been observed in clinical trials with ivermectin alone after treatment of some dogs that have circulating microfilariae. Keep this and all drugs out of the reach of children. In case of ingestion by humans, clients should be advised to contact a physician immediately. Physicians may contact a Poison Control Center for advice concerning cases of ingestion by humans. Store at controlled room temperature of 68°F - 77°F (20°C - 25°C). Excursions between 59°F - 86°F (15°C - 30°C) are permitted. Protect product from light. ADVERSE REACTIONS: In clinical field trials with HEARTGARD Plus, vomiting or diarrhea within 24 hours of dosing was rarely observed (1.1% of administered doses). The following adverse reactions have been reported following the use of HEARTGARD: Depression/lethargy, vomiting, anorexia, diarrhea, mydriasis, ataxia, staggering, convulsions and hypersalivation. SAFETY: HEARTGARD Plus has been shown to be bioequivalent to HEARTGARD, with respect to the bioavailability of ivermectin. The dose regimens of HEARTGARD Plus and HEARTGARD are the same with regard to ivermectin (6 mcg/kg). Studies with ivermectin indicate that certain dogs of the Collie breed are more sensitive to the effects of ivermectin administered at elevated dose levels (more than 16 times the target use level) than dogs of other breeds. At elevated doses, sensitive dogs showed adverse reactions which included mydriasis, depression, ataxia, tremors, drooling, paresis, recumbency, excitability, stupor, coma and death. HEARTGARD demonstrated no signs of toxicity at 10 times the recommended dose (60 mcg/kg) in sensitive Collies. Results of these trials and bioequivalency studies, support the safety of HEARTGARD products in dogs, including Collies, when used as recommended. HEARTGARD Plus has shown a wide margin of safety at the recommended dose level in dogs, including pregnant or breeding bitches, stud dogs and puppies aged 6 or more weeks. In clinical trials, many commonly used flea collars, dips, shampoos, anthelmintics, antibiotics, vaccines and steroid preparations have been administered with HEARTGARD Plus in a heartworm disease prevention program. In one trial, where some pups had parvovirus, there was a marginal reduction in efficacy against intestinal nematodes, possibly due to a change in intestinal transit time. HOW SUPPLIED: HEARTGARD Plus is available in three dosage strengths (see DOSAGE section) for dogs of different weights. Each strength comes in convenient cartons of 6 and 12 chewables. For customer service, please contact Merial at 1-888-637-4251. 2007 12-month Market Dynamics data; Share report: monthly canine heartworm preventive, vet-dispensed treatments; data on file at Merial. Data on file at Merial. 3 Of dogs showing a preference in three studies conducted by independent investigators, dogs preferred HEARTGARD® (ivermectin) Chewables over INTERCEPTOR® (milbemycin oxime) FlavorTabs® by a margin of 37 to 1; data on file at Merial. 4 HEARTGARD Tablets Freedom of Information Summaries 1987. 1

Figure 1. A spherical radiopaque foreign body was discovered in the upper right abdominal quadrant.

Veterinary Forum | October 2009

®HEARTGARD and the Dog & Hand logo are registered trademarks of Merial. ®INTERCEPTOR is a registered trademark of the Novartis Corporation. ®FLAVOR TABS is a registered trademark of Novartis AG. ©2009 Merial Limited, Duluth, GA. All rights reserved. HGD08PBWORMSAD.

INTESTINAL WORMS

HEARTGARD® Plus (ivermectin/pyrantel) – Truly Signiﬁcant Broad-Spectrum Protection By preventing heartworm disease AND treating and controlling 5 of the most common canine intestinal worms – 2 species of rounds and 3 of hooks – HEARTGARD Plus protects against the worms most likely to infect your clients’ dogs. No wonder it’s the Veterinarians’ #1 Choice!1 HEARTGARD is well tolerated. All dogs should be tested for heartworm infection before starting a preventive program. Following the use of HEARTGARD, digestive and neurological side effects have rarely been reported. For more information, please visit www.HEARTGARD.com.

Dispense HEARTGARD Plus, in the easy-to-give Real-Beef Chewable dogs love.3 See Page 20 for Product Information Summary

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peer reviewed

Problem Prob l lem DEFINED DEFIN NED

Solu Solution Sol ution tion DE ELIVERE ED DELIVERED

evaluation, which was delayed for approximately 12 hours while the animal received treatment for the marked dehydration and electrolyte derangements. Endoscopy led to the discovery of a golf ball lodged at the junction of the pyloric antrum and proximal duodenum (Figure 2), and an enterotomy was required for successful removal. Additional treatments included intravenous broad spectrum antibiotics, gastroprotectants, and antiemetics. Fluid therapy with LRS was continued with increased KCl supplementation (40 mEq/L) until the deficits from dehydration and ongoing fluid loss were corrected. Within approximately 48 hours, the initial metabolic and electrolyte abnormalities had resolved, with the exception of a slightly increased enzymatic CO2 at 30 mmol/L. The dog was discharged 5 days after admission.

Discussion Foreign body ingestion is common in small animal practice and may result in a complete or partial obstruction in the proximal or distal GI tract. Regardless of the site of the obstruction, the development of fluid, acidâ&#x20AC;&#x201C;base, and electrolyte abnormalities are common, especially hypochloremia and metabolic alkalosis.1 The severity and chronicity of the obstruction will affect the degree of dehydration and biochemical abnormalities present. Gastric fluid contains high levels of chloride and hydrogen, and lower concentrations of potassium and sodium.2 In this case, loss of gastric fluid from repeated vomiting led to substantial electrolyte deficits and a net loss of acid, which resulted in the development of metabolic alkalosis. The profound dehydration and resulting decrease in glomerular filtration rate led to pre-renal azotemia with subsequent elevations in magnesium, phosphorous, plasma proteins, and PCV. While a urine specific gravity was not obtained, the rapid correction of the azotemia with fluid therapy suggested that a renal component to the azotemia was less likely. A mixed acidâ&#x20AC;&#x201C;base disorder was diagnosed in this case based on the markedly elevated enzymatic CO2, compatible with metabolic alkalosis, and a concomitant markedly elevated anion gap, consistent with metabolic acidosis. Elevations in the anion gap are associated with an increase in unmeasured anions such as organic or inorganic acids. Common causes of an elevated anion gap include lactic acidosis, uremic acidosis, ethylene glycol toxicity, and diabetic ketoacidosis.2 The profound dehydration and azotemia in this animal were consistent with development of both lactic and uremic acidosis, although metabolic alkalosis was the primary underlying disorder. Midmark Corporation 60 Vista Drive, P.O. Box 286 Versailles, OH 45380-0286 1-800-MIDMARK Fax: 1-877-725-6495 midmark.com

Veterinary Forum | October 2009

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Figure 2. Endoscopic evaluation revealed a golf ball lodged in the distal pylorus.

Another key finding was the disproportionate severe hypochloremia with mild hyponatremia. This pattern suggests loss of chloride in excess of sodium and water, which may be associated with severe vomiting or sequestration of gastric fluid. The total body levels of both sodium and chloride were likely even lower considering the marked dehydration, which may artificially elevate serum values from hemoconcentration. Mixed acid–base disorders characterized by hypochloremic, hypokalemic metabolic alkalosis with a high anion gap also may be accompanied by a low urine pH. This phenomenon, known as paradoxical aciduria, occurs when inappropriately acidic urine is found in the presence of metabolic alkalosis. In these cases, a disorder such as pyloric outflow obstruction can result in metabolic alkalosis that worsens in severity as the kidney is forced to secrete hydrogen and reabsorb bicarbonate to conserve sodium and water.3 This process is initiated with activation of the renin-angiotensin-aldosterone system (RAAS). This triggers an increase in sodium reabsorption (along with chloride and water) in the proximal and distal tubules to maintain effective circulating volume and electroneutrality.4 Under the effect of aldosterone, there also is increased exchange of potassium for sodium in the distal tubule, resulting in a loss of potassium into the urine. If hypokalemia develops, hydrogen ions may be used as a substitute for potassium. In addition to the loss of hydrogen into the urine (aciduria), this excretion of hydrogen also can generate bicarbonate.2 If there is increased renal bicarbonate reabsorption, in combination with excess loss of hydrogen (e.g., gastric fluid loss, urinary loss), meta-

October 2009 | Veterinary Forum

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CASE REPORT

Table 1. Biochemical Parameters* Parameters

Female Dog Reference Unit

Glucose 128 Cholesterol 256 Blood Urea Nitrogen 118 Creatinine 3.6 Magnesium 4.2 Calcium 10.9 Phosphorus 10.8 Total Protein 9.6 Albumin 4.6 Globulin 5.0 Alanine Aminotransferase 63 Alkaline Phosphatase 59 Gamma Glutamyltransferase 16 Total Bilirubin 0.6 Sodium 136 Potassium 2.6 Chloride 58 Enzymatic Carbon Dioxide 49 Anion Gap (Calculated) 32

60 - 135 120 - 247 5 - 29 .3 - 2 1.7 - 2.1 9.3 - 11.8 2.9 - 6.2 5.7 - 7.8 2.4 - 3.6 1.7 - 3.8 10 - 130 24 - 147 0 - 25 0 - .8 139 - 147 3.3 - 4.6 107 - 116 21 - 28 10 - 18

mg/dL mg/dL mg/dL mg/dL mg/dL mg/dL mg/dL g/dL g/dL g/dL U/L U/L U/L mg/dL mmol/L mmol/L mmol/L mmol/L mmol/L

*VITROS 250, Ortho-Clinical Diagnostics Inc., Rochester, NY, USA

Selected CBC Parameters* Parameters

Female Dog Reference Unit

Red Blood Cell Count Hemoglobin Hematocrit (calc.) Plasma Protein (Refractometer)

9.39 21.7 58.2 9.6

5.50 - 8.50 12.0 - 18.0 37.0 - 55.0 6-8

M/Âľl g/dL % g/dL

*CELL-DYN 3700, Abbott Laboratories, Abbott Park, IL, USA

bolic alkalosis will occur. Another complicating factor is the development of hypochloremia, which also can increase tubular reabsorption of bicarbonate. This overall process can become a vicious cycle as metabolic alkalosis can further exacerbate hypokalemia. This is associated with a compensatory mechanism that drives blood potassium into the cells in exchange for hydrogen.4 Fluid therapy is essential in these types of cases, and proper management requires correction of dehydration deficits and replenishing any ongoing fluid loss. Depending on the status of the patient, aggressive fluid therapy for shock may also be necessary. In addition to fluids, appropriate chloride and potassium supplementation is vital.5 While the treatment of hypokalemia in

Veterinary Forum | October 2009

this case was considered conservative, it is important to remember that intravenous potassium supplementation should not exceed 0.5 mEq/kg per hour. In this patient, the primary problem of a gastric foreign body causing an outflow obstruction was relatively straightforward. However, the secondary metabolic derangements presented a complex biochemical picture including numerous electrolyte abnormalities and a mixed acidâ&#x20AC;&#x201C;base disorder. While recovery in similar cases depends on resolution of the obstruction, proper fluid and electrolyte therapy is also necessary to correct any metabolic disturbances. Failure to correct these disturbances can result in progressive decompensation and damage to the kidneys due to prolonged decreased renal perfusion. These animals also may be poor anesthesia candidates at presentation, requiring treatment prior to endoscopy or surgery. For example, anesthetic risk may increase with severe hypokalemia, which has been associated with cardiac arrhythmias and respiratory depression from muscle weakness or paralysis.5 Supportive care may be needed several days beyond the initial corrective procedures. While this case illustrates a gastric foreign body, any cause of GI obstruction (e.g., tumor, granuloma) resulting in prolonged, severe vomiting may present with comparable abnormalities. Recognition of specific biochemical patterns by the clinician may aid in both identifying the underlying cause and correcting any secvF ondary complications. References 1. Boag AK, Coe RJ, Martinez TA, et al. Acid-Base and Electrolyte Abnormalities in Dogs with Gastrointestinal Foreign Bodies. J Vet Intern Med. 2005; 19(6):816-821. 2. Meyer DJ, Harvey JW. Veterinary Laboratory Medicine. 2nd ed. Philadelphia: W. B. Saunders Co; 1998. 3. Latimer KS, Mahaffey EA, Prasse KW. Veterinary Laboratory Medicine: Clinical Pathology. 4th ed. Ames: Iowa State Press; 2003. 4. Cunningham JG. Textbook of Veterinary Physiology. 2nd ed. Philadelphia: W. B. Saunders Co; 1997. 5. DiBartola SP. Fluid Therapy in Small Animal Practice. 2nd ed. Philadelphia: W. B. Saunders Co; 2000.

Have an Interesting Case to Share? Case reports should focus on how you successfully tackled a specific case, followed by a discussion section. For submission guidelines, go to ForumVet.com.

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DENTAL DILEMMA

By Jan Bellows, DVM, DAVDC, DABVP Column Editor

When You Hear Hoofbeats… n the evaluation part of an oral assessment, treatment, and preventative care visit (Oral ATP) on a 6-year-old, 4.5-kg neutered Yorkshire terrier, a local veterinarian noticed a 2- to 3-mm irregular slightly raised focal area of inflammation above the patient’s right canine gingival margin. After discussion with the dog’s owners, an incisional biopsy was performed. The histological report from a major national reference laboratory noted, “epithelial hyperplasia and elevation over a broad sheet of hypertrophic, mildly variable neoplastic spindle cells.” The final diagnosis was fibrosarcoma with a guarded prognosis, and the recommendation was for wide excision. The dog’s veterinarian referred the patient to All Pets Dental, in Weston, Fla., for intraoral radiographs

Figure 1. Clinical appearance of the healing biopsy site on presentation.

Veterinary Forum | October 2009

and definitive care. The referring veterinarian prepared the clients for a treatment plan that included a partial maxillectomy and removal of the right maxillary canine, incisors, and at least the first premolar. On presentation, the dog appeared clinically normal other than a 4 mm x 6 mm slightly raised inflamed lesion in the attached gingiva, which extended to the gingival margin (Figure 1). Both mandibular lymph nodes were normal on palpation. Client discussion included the general behavior and common signalment of dogs affected with oral fibrosarcoma. Fibrosarcoma, the third most common oral tumor in dogs after melanoma and squamous cell carcinoma, usually affects the palate or the mandible in middle-aged to older large breed dogs. The initial diagnostic plan before anesthesia for radiographs included review of complete blood count (CBC) and serum profile tests supplied by the referring veterinarian, evaluation of three-view thoracic radiographs for metastasis, and coagulation testing. The chest films were read electronically by a radiologist and appeared clear of disease. Coagulation tests, including bleeding time, were within normal limits. The dog was premedicated with hydromorphone at 0.1 mg/kg IM combined with acepromazine at 0.02 mg/kg IM; induced with propofol at 3 mg/kg IV, intubated, and maintained on 2% isoflurane. Temperature was controlled with the Hot Dog patient warming system (Hot Dog USA). Clinical oral examination was essentially normal other than the above noted post biopsy lesion in the right maxillary canine attached gingiva, an opaque appearing right maxillary first premolar crown (Figure 2), and what appeared as a right maxillary persistent deciduous second premolar. Full mouth intraoral radiographs and dorsal ventral rostral nasal films were exposed and evaluated. The alveolar bone around the right canine tooth and the nasal films appeared normal. Incidental findings included a fractured right maxillary deciduous second premolar,

Figure 2. Maxillary incisors and canines.

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DENTAL DILEMMA

Figure 3. Intraoral radiograph of the right canine and premolars.

Figure 4. Intraoral radiograph of the maxillary incisors and canines.

Figure 5. Three moderately atypical mesenchymal cells most consistent with fibroblastic origin that exhibit mild anisocytosis and anisokaryosis with an increased nuclear:cytoplasmic ratio. The cells are spindle-shaped with indistinct borders and a moderate amount of pale basophilic cytoplasm that occasionally contains fine colorless vacuoles; the nuclei are large, oval, and paracentrally-placed with a coarse chromatin pattern and occasional prominent nucleoli.

absence of a permanent right maxillary second premolar, as well as enlarged left and right first and left second maxillary incisor root canals compared to the adjacent incisors. Moderate periapical lucency was evident in the left second maxillary incisor (Figures 3 and 4). The first dental dilemma in this case was created by the lack of radiographic evidence of infiltrative disease, and the question was, “What to do next?” Trust the biopsy report even though it did not fit the breed, appearance, or location, and proceed with the recommended wide excision therapy for oral neoplasia? Could other tests be performed to validate the diagnosis before invasive surgery? While the dog was still anesthetized, a touch impression and fine needle aspiration of the lesion was performed for immediate cytological evaluation (Figures 5-7). There

Veterinary Forum | October 2009

Figure 6. Two mesenchymal cells consistent with macrophagic or fibroblastic origin which exhibit mild anisocytosis and anisokaryosis with an intermediate nuclear:cytoplasmic ratio. They have a moderate amount of wispy, mildly vacuolated cytoplasm and indistinct cell borders; the nuclei are large, oval to slightly indented, and eccentrically-placed with a coarsely clumped chromatin pattern and subtle nucleoli.

were a few enlarged mesenchymal cells apparent, but without significant malignant criteria. A fine needle aspiration of the ipsilateral lymph node also was performed. The slides were stained and evaluated but revealed no significant abnormalities. Based on these findings and discussion with the referring veterinarian and the dog’s owners, more information would be needed before en-bloc surgery would be performed. Our plan was to have the original slides read by Barbara Powers, DVM, MS, PhD, DACVP, a professor and

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DENTAL DILEMMA Types of Oral Tumors

Figure 7. One mesenchymal cell consistent with macrophagic or fibroblastic origin (top) and a reactive macrophage (bottom). The mesenchymal cell has an intermediate nuclear:cytoplasmic ratio with a moderate amount of wispy cytoplasm and indistinct borders; the nucleus is oval and eccentrically-placed with a coarse chromatin pattern and inapparent nucleoli.

Figure 8. Surgical site after excision biopsy.

board-certified veterinary pathologist practicing at Colorado State University. Dr. Powers was familiar with oral tumors. In addition, an excisional biopsy would be harvested and sent to the same pathologist for evaluation. The cytological samples also were sent for pathologist review. Care for the fractured deciduous second premolar and endodontically affected maxillary incisors would await a definitive diagnosis. A number 15 scalpel blade was used to excise the lesion, preserving at least 3 mm of attached gingiva. To control postoperative bleeding, a CO2 laser was used at a 2-watt setting (Figure 8). The patient made an uneventful recovery from anesthesia. The owner was in-

Veterinary Forum | October 2009

Malignant melanoma is one of the two most common oral malignancies in dogs. Malignant melanoma most frequently occurs in males, especially cocker spaniels, German shepherds, Chow Chows, and dogs with heavily pigmented mucous membranes. Oral melanomas behave aggressively. Affected patients often present with oral bleeding, ptyalism, and halitosis. The lip or mucocutaneous junction is another site for melanoma in the dogâ&#x20AC;&#x2122;s oral cavity.

Squamous cell carcinoma is the second most common malignant tumor in dogs, originating from the gingival epithelium. It appears red and ulcerated, and may have cauliflower projections. Older, large breed dogs are predisposed.

Fibrosarcoma has predilection for the maxilla of large, male, middle-aged dogs especially retrievers. The gingiva around the maxillary fourth premolar is commonly affected.

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Figure 9. Healed surgical site one month post operation.

structed to medicate with clindamycin at 15 mg/lb q12h for five days and firocoxib at 5 mg/kg q24h for 3 days. Dr. Powers reread the original slide as mild lymphoplasmacytic stomatitis with fibroplasia without evidence of neoplasia. She read the excisional biopsy as an inflammatory lesion without evidence of neoplasia. Both the cytological samples (the gingival lesion and ipsilateral lymph node) were read out as inflammatory. On reexamination 1 month after the excisional surgery, the area appeared clinically normal with a slight amount of inflammation at the gingival margin (Figure 9). The client was instructed to control plaque in the area twice daily with the application of Dentacetic wipes (DermaPet). Extraction of the endodontically affected incisors and the fractured deciduous second premolar are planned in the near future. The last dilemma in this case was whether to present the original pathologist with the results. I decided to share the reports with the pathologist for two reasons. First, because I would like to be informed if I made a mistake and hopefully learn from the experience; and second, I expect the pathologist would have the slides internally reviewed and perhaps the reviewers would disagree with Dr. Power’s analysis. If that happened, I had several other pathologists to send the slides to for further analysis. The original pathologist had the slide internally reviewed and concluded that the spindle-cell population observed was a reactive change and the recommendation for follow up and rebiopsy in the future pending clinical outcome should have been advised.

October 2009 | Veterinary Forum

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peer reviewed Discussion A histopathology report is generally regarded as the definitive document used to base therapy and prognosis upon. As shown in this case, the pathology report must be regarded as part of the overall clinical findings. If the pathologist’s findings do not agree with the practitioner’s impression, a second opinion should be sought. Discordant pathology results have been reported in the human and veterinary literature. In one human study, hepatopathologists and general community pathologists disagreed in the reading of liver biopsy specimens concerning the degree of fibroplasias dictating therapy by approximately 50%. When you hear hoofbeats, think horses, not zebras. As clinicians, it is important to separate zebras from horses. In this case, the diagnosis of fibrosarcoma would have been classified as a zebra, representing a rare to nonexistent representation of this oral malignancy. However, inflammation was the horse in this case. Fortunately, it is rare in veterinary practice to receive discordant pathology reports. It is important that the clinician develops a list of pathologists who have special interests in neoplasia or specific organ systems to rely upon. Quality control programs in the major reference laboratories should also be reviewed to prevent such occurrences. This case was read initially by a nonboarded pathologist. Perhaps the work of nonboarded pathologists should be reviewed by board-certified veterinary pathologists before release. The radiographic evidence of endodontically affected maxillary incisors described above probably occurred secondary to local trauma sustained around 1 year of age, which caused irreversible pulpitis, pulpal death, and the cessation of dentin production. Extraction is the treatment of choice for these teeth. vF Acknowledgements

The author thanks Rebekah Gunn, DVM, DACVP, for assistance in cytological interpretation.

For more information: Bellows, JE. Small Animal Dental Equipment, Material and Techniques, Blackwell Publishing; 2004. Freeman, KP, Bauer N, Jensen AL, Thoresen S. Introduction to ISO 15189: a blueprint for quality systems in veterinary laboratories, Vet Clin Pathol. June 2006;35(2):157-71. Osborne CA. Misdiagnosis by intuition-seven diagnostic axioms to enhance patient care. DVM Newsmagazine. 2002;33(4):48-50. Robert M, Sofair AN, Thomas A, et al. A Comparison of Hepatopathologists’ and Community Pathologists’ Review of Liver Biopsy Specimens From Patients with Hepatitis C. Clin Gastro Hepatol. 7(3):335-338. Smith CS, Paauw DS. When you hear hoof beats: four principles for separating zebras from horses. J Am Board Fam Pract. 2000;13(6):424-429. Thway K, Fisher C. Histopathological diagnostic discrepancies in soft tissue tumours referred to a specialist centre. Sarcoma. 2009:741975.

Veterinary Forum | October 2009

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book REVIEW*

First Steps With Puppies and Kittens A Practice-Team Approach to Behavior Author: Linda M. White Publisher: American Animal Hospital Association Press

his book offers the veterinary health care team a pragmatic approach to behavior and training issues in puppies and kittens — in the author’s words, addressing “behavioral needs before they become behavior problems.” It does not cover behavior theories but rather draws on the author’s 30 years of training experience to offer practical advice and methods for achieving cooperation and harmony between owner and pet.

T Year: 2008 Pages: 211 ISBN: 978-1-58326-101-9

This practical book will help veterinarians realize the goal of a full-service practice that addresses every aspect of pet health and well-being.

Because they know that they are the primary source of advice concerning all aspects of pet ownership, most veterinarians provide information about feeding, care and training during the initial puppy or kitten visit. Unfortunately, owners frequently feel overwhelmed, retaining only a portion of the instructions, and many practices are too busy to implement a comprehensive, ongoing training program. This book explains how such a program can be developed. It takes the reader through a stepby-step process and describes how to involve every member of the health care team in the effort. It also comes with a companion CD containing forms and instructional materials that can be customized and printed out to give to owners. The book begins with a discussion of the “business side” of training, addressing financial considerations and the roles of various members of the health care team. The author describes how the veterinary team can become “patient behavior advocates” using methods such as operant and associative conditioning and verbal, target and clicker training. Concepts include reinforcement and punishment, extinction, cure, reward, shaping and counterconditioning. Special emphasis is given to socialization and desensitization. This is followed by a detailed section on puppy development that covers basic commands (e.g., come, down, sit, stay) and how to handle undesirable behaviors such as barking, biting, and “counter surfing.” The next chapter similarly covers kitten development and behavior, including common problems like scratching, biting, and litterbox issues. These chapters, which establish the fundamentals of the training program, are followed by six appendixes with samples of handouts dealing with every issue raised in the book. The material is presented in brief, discrete sections, highlighted by a wealth of useful lists. Each training exercise is broken down into specific, detailed steps tailored to the particular behavior in question. Equipment is described as well, including collars, leashes, harnesses and training aids. This practical book will help veterinarians realize the goal of a full-service practice that addresses every aspect of pet health and well-being. By viewing the pet and ownerfamily as a whole, rather than individuals, it should help veterinarians promote the human–animal bond to enable owners to work with their pets in the animals’ best interests, as well as help establish behaviors that will lead to less stressful office visits and vF more practice loyalty. *Written by Patricia L. Van Horn, a freelance writer in Long Branch, N.J.

Veterinary Forum | October 2009

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DOCTOR

Calming the complainers It may be difficult to acknowledge, but the concerns of unhappy clients need to be addressed immediately. If client expectations are not met, it is important to learn how to address concerns in a professional, straightforward manner. The goal is to resolve conflicts and work toward an outcome that is beneficial to your clinic, your clients and your patients. Clients can become upset for many reasons, such as: • Finances • Treatment complications • Dissatisfaction with the level of service • Time conflicts • Poor communication • Lack of satisfactory information Conflicts do not go away if they are ignored; they must be dealt with head-on. Because of this, it is crucial to immediately address problems to avoid losing existing or potential clients. Dealing immediately with unsatisfied clients helps you gain insights that can improve the practice, avoid recurrence of similar problems and increase the chances of timely payment for services rendered. The first step to conflict resolution is letting clients know that the practice team values their honest opinion. Make it easy for clients to complain by having your staff ask open-ended questions that give clients ample opportunity to be honest and explicit. Classifying angry clients also may be helpful in resolving problems. Sometimes, even-tempered clients may have justifiable reasons to complain or they may simply be having a tough day. These encounters may become confrontational, so your staff needs to develop skills that allow them to deal with uncomfortable situations and soothe dissatisfied clients. Clients who complain need to be: • Listened to and taken seriously • Reassured that attempts will be made to avoid future inconveniences

Veterinary Forum | October 2009

• Treated with respect The first rule of dealing with a dissatisfied client is not to take his or her complaints personally. Although some of the angrier complainers may hurl personal insults, staff members must control their anger. It is usually hard for a complainer to be angry at someone who smiles and refuses to fight back.

Illustration by Art Glazer

Above all, veterinarians have a responsibility to resolve the complainer’s concerns, minimize potential embarrassment to other clients and minimize disruption in the practice. Clients who are upset usually calm down if they feel they are being taken seriously and someone is willing to understand and address their issues. vF Ronald E. Whitford, DVM, owns three practices and is a management speaker, author and consultant. Recommendations in this column are based on his personal experiences as a practitioner, practice owner and practice management consultant and are not necessarily the opinion of the publisher. He can be reached at ronaldwhitford@bellsouth.net.

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STATEMENT OF OWNERSHIP, MANAGEMENT AND CIRCULATION (Required by 39 U.S.C. 3685) 1. Title of Publication: Veterinary Forum, 2. Publication Number: 1047-6326, 3. Date of Filing: October 1, 2009, 4. Frequency of Issue: Monthly, 5. Number of Issues Published Annually: 12, 6. Annual Subscription Price: $37, 7. Complete Mailing Address of Known Ofﬁce of Publication: Veterinary Learning Systems, 780 Township Line Road, Yardley, Bucks County, PA 19067, Contact Person: Christine Polcino, Telephone: 267-685-2419, 8. Complete Mailing Address of Headquarters or General Business Ofﬁce of the Publisher: Veterinary Learning Systems, 780 Township Line Road, Yardley, PA 19067, 9. Full Names and Complete Mailing Addresses of Publisher, Editor, and Managing Editor—Publisher: Derrick Kraemer, Veterinary Learning Systems, 780 Township Line Road, Yardley, PA 19067; Editor: Tracey Giannouris, 780 Township Line Road, Yardley, PA 19067; Managing Editor: Paul Basilio, 780 Township Line Road, Yardley, PA 19067, 10. Owner: Veterinary Learning Systems/ MediMedia USA, 780 Township Line Road, Yardley, PA 19067, 11. Known Bondholders, Mortgagees, and Other Security Holders Owning or Holding 1 Percent or More of Total Amount of Bonds, Mortgages or Other Securities: None, 12. Tax Status – Has Not Changed During Preceding 12 Months, 13. Publication Title – Veterinary Forum, 14. Issue Date for Circulation Data Below: July 2009, 15. Extent and Nature of Circulation—15a. Total Number of Copies (Net Press Run) Average Number Copies Each Issue During Preceding 12 Months: 55,335, Actual Number Copies of Single Issue Published Nearest to Filing Date: 34,707, 15b(1) Paid/Requested Outside-County Mail Subscriptions Stated on Form 3541 - Average Number Copies Each Issue During Preceding 12 Months: 533, Actual Number Copies of Single Issue Published Nearest to Filing Date: 463, 15b(3). Sales Through Dealers and Carriers, Street Vendors, Counter Sales, and other Non-USPS Paid Distribution - Average No. Copies Each Issue During Preceding 12 Months: 0, Actual No. Copies of Single Issue Published Nearest to Filing Date: 0, 15c. Total Paid and/ or Requested Circulation - Average No. Copies Each Issue During Preceding 12 Months: 533, Actual No. Copies of Single Issue Published Nearest to Filing Date: 463, 15d(1). Free Distribution by Mail (Samples, Complimentary, and Other Free): Outside-County as Stated on Form 3541 - Average No. Copies Each Issue During Preceding 12 Months: 51,906, Actual No. Copies of Single Issue Published Nearest to Filing Date: 32,088, 15d(4). Free or Nominal Rate Distribution Outside the Mail - Average No. Copies Each Issue During Preceding 12 Months: 0, Actual No, Copies of Single Issue Published Nearest To Filing Date: 0, 15e. Free Distribution Outside the Mail - Average No. Copies Each Issue During Preceding 12 Months: 51,906, Actual No. Copies of Single Issue Published Nearest to Filing Date: 32,088, 15f. Total Distribution - Average No. Copies Each Issue During Preceding 12 Months: 52,439, Actual No. Copies of Single Issue Published Nearest to Filing Date: 32,551, 15g. Copies not Distributed - Average No. Copies Each Issue During Preceding 12 Months: 2896, Actual No. Copies of Single Issue Published Nearest to Filing Date: 2156, 15h. Total - Average No. Copies Each Issue During Preceding 12 Months: 55,335, Actual No. Copies of Single Issue Published Nearest to Filing Date: 34,707, 15i. Percent Paid - Average No. Copies Each Issue During Preceding 12 Months: 1%, Actual No. Copies of Single Issue Published Nearest to Filing Date: 1%, 16. This Statement of Ownership will be printed in the October 2009 issue of this publication. 17. I certify that the statements made by me above are correct and complete: Derrick Kraemer, Publisher.

Cat owners listen to their cats. Listen to your cat owners. Cats and their owners agree: a topical dewormer beats a pill any day. In fact, nearly 90% of cat owners prefer topical drops to pills or tablets.* So listen to your cat owners. Choose the only feline dewormer that treats and controls roundworms, hookworms and tapeworms with the ease and convenience of a topical application: ProfenderÂŽ Topical Solution. *From a survey of 736 cat owners. Data on file.

Federal (U.S.A.) law restricts this drug to use by or on the order of a licensed veterinarian. Children should not contact application site for twenty-four (24) hours. See Page 40 for Product Information Summary

P08711n

PRODUCTFORUM

CareCredit

Dechra Veterinary Products

Desktop Tool

Canine Cushing’s Treatment

CareCredit, a client payment plan program, has released a new desktop tool that can instantly connect to six exclusive online resources, including a payment calculator, CareCredit reports and a resource center. With the new tool, offices can order supplies, submit applications and process transactions quickly from a single interface. They can also show clients available payment plans and estimated monthly payments. 800-865-9975 • www.carecredit.com

Vetoryl capsules, manufactured by Dechra, contain the drug trilostane, which has been demonstrated to be effective in the treatment of Cushing’s syndrome in dogs. Dechra has just received FDA approval to market 10-mg Vetoryl capsules in addition to the 30-mg and 60-mg sizes. Vetoryl is the only FDA-approved product that is indicated for use in pituitary-dependent and adrenal-dependent hyperadrenocorticism in dogs. The 10-mg capsules will be available from distributors shortly. 866-933-2472 • www.dechra-us.com

IDEXX Reference Laboratories

Electrolyte Analyzer IDEXX’s new Electrolytes 8 Plus cassette for the VetStat electrolytes and blood gas analyzer combines the capabilities of the electrolytes cassette and the fluid therapy/acid–base cassette. The new cassette allows electrolyte values, acid– base disorders, and ventilation status to be assessed from a single venous whole blood sample for the same price as the electrolytes cassette. Results provide in-depth information regarding the Na+, K+, Cl–, tCO2 and HCO3– concentrations; pH; PCO2 and the anion gap. 888-433-9987 • www.idexx.com A.S. Enterprises

Dog Sling A.S. slings are designed to allow owners and veterinary professionals to assist dogs in standing, walking, and performing orthopedic exercises during rehabilitation. The slings are made from durable terry cloth and are machine washable. The handles are made from long-lasting, thick poly nylon that provides a strong, comfortable grip. A.S. slings are offered in a variety of colors and can include custom embroidery of hospital name, logo and phone number. The slings come in shorter and longer lengths for large- and small-breed dogs. 714-938-4725

Wahl Clipper Corporation

Touch-Up Trimmer Wahl has added a new product to its line of animal grooming instruments. The dual-head rechargeable Touch-Up Trimmer is a single trimmer with two blades. The first blade is the standard-width blade for regular trimming; the second is a narrow detail blade for closer definition. Changing between the blades is simple with the Quick Detach Blade System. The trimmer is cordless and, with a fully charged battery, will run continuously for 40 minutes. 800-776-9245 • www.wahl.com Vetericyn, Inc.

Wound Care Vetericyn VF is a special veterinary formulation of the FDAapproved Vetericyn wound and infection treatment. The first nontoxic, broad-spectrum topical antimicrobial on the market, Vetericyn is scientifically designed to treat a wide variety of wounds, skin ulcers and abrasions. It also inhibits the release of histamines, which cause chronic wound inflammation, and lessens wound odor by killing bacteria, helping to keep flies and other pests away from outdoor animals during treatment. Vetericyn also decreases healing time. 866-318-3116 • www.vetericyn.com Virbac Animal Health

Shampoo Advanced Monitors Corporation

Wireless Otoscope The Tele-View TV-200V wireless magnifying otoscope allows veterinarians to easily magnify and display ear pathology on any television or computer. Its many features include a highresolution sensor, improved illumination, 2× zoom capability, working channel specula and easy computer image download. The wireless capability allows images to be displayed on monitors or televisions to be shared with clients. 877-838-8367 • www.tele-view.com

Allergroom shampoo has been reformulated to include glycotechnology, a patent-pending advancement that reduces adherence of bacteria and yeast to the skin surface. The moisturizing, hypoallergenic shampoo is designed for frequent use to treat dry skin in cats, dogs and horses. It is also emollient and antiseborrheic and contains spherulites microspheres, an exclusive encapsulation system that allows the slow release of ingredients long after product application. 800-338-3659 • www.virbacvet.com

The product descriptions presented here are provided from the manufacturers and are not an indication of endorsement by VETERINARY FORUM.

Veterinary Forum | October 2009

market SHOWCASE

PRODUCTS AND SERVICES FOR VETERINARIANS

For more information about these products and services, email productinfo@ForumVet.com. For advertising information, call 800-237-9851 or email vetforum@rja-ads.com.

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Northgate Veterinary Supply, the makers of Ultra Cage and Econocage, now offers choice of glass door or rod gates. Available in standard and custom sizes.

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VETERINARIANS WANTED

VETERINARIANS WANTED CONTINUING EDUCATION

VETERINARIANS WANTED

NORTH CAROLINA – Well-established, 24-hour, AAHA-accredited small animal hospital in central North Carolina needs an emergency/critical care veterinarian and an associate veterinarian. Located only hours from the mountains and coastlines, our busy, progressive, and expanding five-doctor practice is fully equipped and staffed by 25 highly motivated veterinarians, technicians, and lay staff. Established more than 27 years, our hospital has an excellent client base and strong emphasis on quality care. Work in a great practice environment with an excellent opportunity for career development. Competitive salary and benefits include 401(k), profit sharing, CE, and insurance. Experience preferred. Send resume to Dr. Karl B. Milliren, 303 National Highway, Thomasville, NC 27360; email tvh303@cs.com; fax 336-475-0140.

TEXAS Associate Veterinarian Full-time position for enthusiastic individual with excellent work ethic. Busy small animal clinic located in thriving West Texas has full diagnostic and surgical capabilities, including ultrasound, endoscopy, and neurosurgery. All interested applicants welcome. Call 432-332-5782

For classified advertising information, email vetforum@rja-ads.com.

Mid-South Regional Conference November 13, 14, 15, 2009 Harrah’s Casino and Convention Center (formerly the Grand Casino and Convention Center) Tunica, Mississippi. Conference will feature topics on Ophthalmology, Dermatology, Oncology, Orthopedics, Infectious Diseases and Immunology, Spay/Neuter Techniques, Practice Management and VLE principals. Technician Track, November 14, 2009 Physical Therapy/Rehab, Emergency/Critical Care, Spay/Neuter & Shelter Med Topics, Parasitology. For more information and registration form, contact: Lee Hughes, Executive Director Memphis/Shelby County Veterinary Medical Association 901-754-1615 Lmhughes@bellsouth.net

RELIEF VETERINARY SERVICES Log in at VetRelief.com Relief veterinarians: search for work dates, view job details, then bid. Hospitals: post your job openings; no charge until you hire. Contact: www.vetrelief.com info@vetrelief.com • 949-234-1960

Place Your Ad Where It Will Get Noticed And Acted Upon. Contact Susan Deakins at vetforum@rja-ads.com or call 800-237-9851, ext. 258 44

Veterinary Forum | October 2009

HAVE YOU HEARD THE NEWS? Veterinary Forum's Market Showcase and Classified advertising sections deliver your product, service or opportunity to thousands of potential buyers and responders each issue. Every ad is also featured on vetclassifieds.com for even greater marketing exposure.

Contact Susan Deakins to create a marketing plan or to schedule your classified ad–we are here to assist! Call: 800-237-9851, ext. 258 or e-mail: vetforum@rja-ads.com

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Goodwill hunters

AAHA AAHA Accreditation ...........................................................29 Abaxis VetScan Laboratory System ..................................................7

By Tim Sahli, DVM Aberdeen, S.D.

Abbott Animal Health AlphaTRAK .................................................................Cover 3 Fluid Therapy .......................................................................17

ne Sunday afternoon this past December, my cell phone rang unexpectedly. One of my clients had found a dog on the way home from a hunting trip. He said the dog had a “bad” front leg but was friendly and would not leave his side. In fact, the pup jumped into the truck on its own. The hunters were in a remote area but managed to contact the local humane society and ask some locals if the dog had a known owner. I agreed that the hunters had covered all reasonable options, and I told them I would see the dog the next morning. One of the hunters had been a client of mine for some time, and I knew that he possessed an unusually big place in his heart for dogs. The dog was a small female black Labrador retrievermix, about 1 to 3 years of age, 29 lb and bright, alert and happy on examination. Her right front leg, however, was dangling near the elbow joint. Radiographs confirmed that the joint was badly fractured. I informed the client of the available options: front leg amputation, referral to the local university hospital to correct the joint or euthanasia. After I explained that I couldn’t be sure of the extent of nerve and Doc Tim relaxes with his blood vessel damage because I dog, BJ. didn’t know how long the dog had been injured, he agreed to amputation. My first thought was that the hunters who found her would choose to euthanize the dog after I quoted the price for surgery, but they decided to split the cost between all five of them. “She is too gentle and deserves a chance,” one of them said. “We want to give her a good chance at life and we’ll find her a good home.” I could not stop thinking about how lucky this dog was to stumble across my client and his friends that day. After the surgery, my client took care of her and gave her medication for 3 weeks, then found her a good home. Gracie is now a happy and healthy three-legged patient in my rural practice. vF

October 2009 | Veterinary Forum

Alley Cat Allies Feral Cat Protocols ................................................................6 Andis AGR+ Vet Pak Clipper Kit ...................................................27 Animal Health Options ProNeurozone .....................................................................31 Banﬁeld, The Pet Hospital Career Opportunities ..........................................................13 Bayer HealthCare, Animal Health New Product Packaging......................................................35 Profender .............................................................................41 ResQ .....................................................................................11 Companion Animal Hyperbarics Veterinary Hyperbaric Solutions ........................................10 Dentalaire Bio-Ray SDX Digital Dental X-Ray System .........................34 IAMS ProActive Health ...................................................................9 Intervet/Schering-Plough Animal Health Canine Inﬂuenza Vaccine ..........................................Cover 2 Pet Diabetes Month ...................................................Cover 4 Kelco Supply Quiesco Pet Remembrance Products .................................12 Merial Frontline Plus .........................................................................5 Heartgard Plus .....................................................................21 Previcox ................................................................................47 Midmark Treatment Room Savings....................................................22 Nutramax Laboratories, Inc Dasuquin ................................................................................3 Pet King Brands Zymox Otic ...........................................................................23 Summit VetPharm Vectra for Cats and Kittens ................................................25 Vectra 3D .............................................................................15 VCA Animal Hospitals Practice Your Way ...............................................................39 Hospital Purchase Programs ...............................................19 Veterinary Learning Systems Vetlearn.com .......................................................................37 Vetstreet Practice Communication and Management Tool ........32,33

market showcase The following advertisers appear in the Market Showcase on page 43. Dewey’s Wheelchairs for Dogs Engler Engineering Corporation Anesthesia Machine Engler Engineering Corporation Son-Mate Dental Combo Northgate Veterinary Supply Glass Doors and Rod Gates

Trimline Manufacturing Co. Recovery Collar Veterinary Solutions Cat and Dog Muzzles and Catheter Guards WhereTechsConnect.com Job Source and Marketplace

The VETERINARY FORUM Advertisers Index is provided as a service to our readers. The publisher does not assume responsibility for any errors or omissions. Listed companies advertise products and services in this issue.

CHEWABLE TABLETS BRIEF SUMMARY: Before using PREVICOX, please consult the product insert, a summary of which follows: CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian. CONTRAINDICATIONS: Dogs with known hypersensitivity to firocoxib should not receive PREVICOX. WARNINGS: Not for use in humans. Keep this and all medications out of the reach of children. Consult a physician in case of accidental ingestion by humans. For oral use in dogs only. Use of this product at doses above the recommended 2.27 mg/lb (5.0 mg/kg) in puppies less than seven months of age has been associated with serious adverse reactions, including death (see Animal Safety). Due to tablet sizes and scoring, dogs weighing less than 12.5 lb (5.7 kg) cannot be accurately dosed. All dogs should undergo a thorough history and physical examination before the initiation of NSAID therapy. Appropriate laboratory testing to establish hematological and serum baseline data is recommended prior to and periodically during administration of any NSAID. Owners should be advised to observe for signs of potential drug toxicity (see Adverse Reactions and Animal Safety) and be given a Client Information Sheet about PREVICOX Chewable Tablets. For technical assistance or to report suspected adverse events, call 1-877-217-3543. PRECAUTIONS: This product cannot be accurately dosed in dogs less than 12.5 pounds in body weight. Consider appropriate washout times when switching from one NSAID to another or when switching from corticosteroid use to NSAID use. As a class, cyclooxygenase inhibitory NSAIDs may be associated with renal, gastrointestinal and hepatic toxicity. Sensitivity to drug-associated adverse events varies with the individual patient. Dogs that have experienced adverse reactions from one NSAID may experience adverse reactions from another NSAID. Patients at greatest risk for adverse events are those that are dehydrated, on concomitant diuretic therapy, or those with existing renal, cardiovascular, and/or hepatic dysfunction. Concurrent administration of potentially nephrotoxic drugs should be carefully approached and monitored. NSAIDs may inhibit the prostaglandins that maintain normal homeostatic function. Such anti-prostaglandin effects may result in clinically significant disease in patients with underlying or pre-existing disease that has not been previously diagnosed. Since NSAIDs possess the potential to produce gastrointestinal ulcerations and/or gastrointestinal perforations, concomitant use with other anti-inflammatory drugs, such as NSAIDs or corticosteroids, should be avoided. The concomitant use of protein bound drugs with PREVICOX Chewable Tablets has not been studied in dogs. Commonly used protein-bound drugs include cardiac, anticonvulsant, and behavioral medications. The influence of concomitant drugs that may inhibit the metabolism of PREVICOX Chewable Tablets has not been evaluated. Drug compatibility should be monitored in patients requiring adjunctive therapy. If additional pain medication is needed after the daily dose of PREVICOX, a non-NSAID class of analgesic may be necessary. Appropriate monitoring procedures should be employed during all surgical procedures. Anesthetic drugs may affect renal perfusion, approach concomitant use of anesthetics and NSAIDs cautiously. The use of parenteral fluids during surgery should be considered to decrease potential renal complications when using NSAIDs perioperatively. The safe use of PREVICOX Chewable Tablets in pregnant, lactating or breeding dogs has not been evaluated. ADVERSE REACTIONS: Osteoarthritis: In controlled field studies, 128 dogs (ages 11 months to 15 years) were evaluated for safety when given PREVICOX Chewable Tablets at a dose of 2.27mg/lb (5.0 mg/kg) orally once daily for 30 days. The following adverse reactions were observed. Dogs may have experienced more than one of the observed adverse reactions during the study. Adverse Reactions Seen in U. S. Field Studies Adverse Reactions

PREVICOX (n=128)

Active Control (n=121)

5 1 3 1 2 1 1

8 10 3 3 1 1 0

Vomiting Diarrhea Decreased Appetite or Anorexia Lethargy Pain Somnolence Hyperactivity

PREVICOX (firocoxib) Chewable Tablets were safely used during field studies concomitantly with other therapies, including vaccines, anthelmintics, and antibiotics. Soft-tissue Surgery: In controlled field studies evaluating soft-tissue postoperative pain and inflammation, 258 dogs (ages 10.5 weeks to 16 years) were evaluated for safety when given PREVICOX Chewable Tablets at a dose of 2.27 mg/lb (5.0 mg/kg) orally approximately 2 hours prior to surgery and once daily thereafter for up to two days. The following adverse reactions were observed. Dogs may have experienced more than one of the observed reactions during the study. Adverse Reactions Seen in the Soft-tissue Surgery Postoperative Pain Field Study Adverse Reactions

Firocoxib Group (n=127)

Control Group* (n=131)

5 1 1 1 1 1

6 1 1 0 0 0

Vomiting Diarrhea Bruising at Surgery Site Respiratory Arrest SQ Crepitus in Rear Leg and Flank Swollen Paw *Sham-dosed (pilled)

Orthopedic Surgery: In a controlled ﬁeld study evaluating orthopedic postoperative pain and inﬂammation, 226 dogs of various breeds, ranging in age from 1 to 11.9 years in the PREVICOX-treated groups and 0.7 to 17 years in the control group were evaluated for safety. Of the 226 dogs, 118 were given PREVICOX Chewable Tablets at a dose of 2.27 mg/lb (5.0 mg/kg) orally approximately 2 hours prior to surgery and once daily thereafter for a total of three days. The following adverse reactions were observed. Dogs may have experienced more than one of the observed reactions during the study. Adverse Reactions Seen in the Orthopedic Surgery Postoperative Pain Field Study Adverse Reactions

Firocoxib Group (n=118)

Control Group* (n=108)

1 2** 2 1 0 9 2

0 1 3 2 1 5 0

Vomiting Diarrhea Bruising at Surgery Site Inappetence/ Decreased Appetite Pyrexia Incision Swelling, Redness Oozing Incision A case may be represented in more than one category. *Sham-dosed (pilled). **One dog had hemorrhagic gastroenteritis.

POST APPROVAL EXPERIENCE: The following adverse reactions are based on voluntary post-approval reporting and are consistent with those reported for other cyclooxygenase inhibitory NSAID class drugs. The categories are listed in decreasing order of frequency by body system.

GASTROINTESTINAL: Vomiting, anorexia, diarrhea, melena, hematemesis, hematochezia, weight loss, nausea, gastrointestinal ulceration, gastrointestinal perforation, salivation. URINARY: Azotemia, elevated creatinine, polydipsia, polyuria, urinary tract infection, hematuria, urinary incontinence, renal failure. HEMATOLOGICAL: Anemia, thrombocytopenia. HEPATIC: Hepatic enzyme elevations decreased or increased total protein and globulin, decreased albumin, decreased BUN, icterus, ascites, pancreatitis. NEUROLOGICAL / BEHAVIORAL / SPECIAL SENSE: Lethargy, weakness, seizure, ataxia, aggression, tremor, uveitis, mydriasis, nystagmus. CARDIOVASCULAR / RESPIRATORY: Tachypnea. DERMATOLOGICAL / IMMUNOLOGICAL: Fever, facial / muzzle edema, pruritus, urticaria, moist dermatitis. In rare situations, death has been reported as an outcome of the adverse events listed above. INFORMATION FOR DOG OWNERS: PREVICOX, like other drugs of its class, is not free from adverse reactions. Owners should be advised of the potential for adverse reactions and be informed of the clinical signs associated with drug intolerance. Adverse reactions may include vomiting, diarrhea, decreased appetite, dark or tarry stools, increased water consumption, increased urination, pale gums due to anemia, yellowing of gums, skin or white of the eye due to jaundice, lethargy, incoordination, seizure, or behavioral changes. Serious adverse reactions associated with this drug class can occur without warning and in rare situations result in death (see Adverse Reactions). Owners should be advised to discontinue PREVICOX therapy and contact their veterinarian immediately if signs of intolerance are observed. The vast majority of patients with drug related adverse reactions have recovered when the signs are recognized, the drug is withdrawn, and veterinary care, if appropriate, is initiated. Owners should be advised of the importance of periodic follow up for all dogs during administration of any NSAID. EFFECTIVENESS: Two hundred and forty-nine dogs of various breeds, ranging in age from 11 months to 20 years, and weighing 13 to 175 lbs, were randomly administered PREVICOX or an active control drug in two field studies. Dogs were assessed for lameness, pain on manipulation, range of motion, joint swelling, and overall improvement in a noninferiority evaluation of PREVICOX compared with the active control. At the study’s end, 87% of the owners rated PREVICOX-treated dogs as improved. Eighty-eight percent of dogs treated with PREVICOX were also judged improved by the veterinarians. Dogs treated with PREVICOX showed a level of improvement in veterinarian-assessed lameness, pain on palpation, range of motion, and owner-assessed improvement that was comparable to the active control. The level of improvement in PREVICOX-treated dogs in limb weight bearing on the force plate gait analysis assessment was comparable to the active control. In a separate field study, two hundred fifty-eight client-owned dogs of various breeds, ranging in age from 10.5 weeks to 16 years and weighing from 7 to 168 lbs, were randomly administered PREVICOX or a control (sham-dosed-pilled) for the control of postoperative pain and inflammation associated with soft-tissue surgical procedures such as abdominal surgery (e.g., ovariohysterectomy, abdominal cryptorchidectomy, splenectomy, cystotomy) or major external surgeries (e.g., mastectomy, skin tumor removal ≤8 cm). The study demonstrated that PREVICOX treated dogs had significantly lower need for rescue medication than the control (sham-dosed-pilled) in controlling postoperative pain and inflammation associated with soft-surgery. A multi-center field study with 226 client-owned dogs of various breeds, and ranging in age from 1 to 11.9 years in the PREVICOX-treated groups and 0.7 to 17 years in the control group was conducted. Dogs were randomly assigned to either the PREVICOX or the control (sham-dosed-pilled) group for the control of postoperative pain and inflammation associated with orthopedic surgery. Surgery to repair a ruptured cruciate ligament included the following stabilization procedures: fabellar suture and/or imbrication, fibular head transposition, tibial plateau leveling osteotomy (TPLO), and ‘over the top’ technique. The study (n = 220 for effectiveness) demonstrated that PREVICOX-treated dogs had significantly lower need for rescue medication than the control (sham-dosed-pilled) in controlling postoperative pain and inflammation associated with orthopedic surgery. ANIMAL SAFETY: In a target animal safety study, firocoxib was administered orally to healthy adult Beagle dogs (eight dogs per group) at 5, 15, and 25 mg/kg (1, 3, and 5 times the recommended total daily dose) for 180 days. At the indicated dose of 5 mg/kg, there were no treatment related adverse events. Decreased appetite, vomiting, and diarrhea were seen in dogs in all dose groups, including unmedicated controls, although vomiting and diarrhea were seen more often in dogs in the 5X dose group. One dog in the 3X dose group was diagnosed with juvenile polyarteritis of unknown etiology after exhibiting recurrent episodes of vomiting and diarrhea, lethargy, pain, anorexia, ataxia, proprioceptive deficits, decreased albumin levels, decreased and then elevated platelet counts, increased bleeding times, and elevated liver enzymes. On histopathologic examination, a mild ileal ulcer was found in one 5X dog. This dog also had a decreased serum albumin which returned to normal by study completion. One control and three 5X dogs had focal areas of inflammation in the pylorus or small intestine. Vacuolization without inflammatory cell infiltrates was noted in the thalamic region of the brain in three control, one 3X, and three 5X dogs. Mean ALP was within the normal range for all groups but was greater in the 3X and 5X dose groups than in the control group. Transient decreases in serum albumin were seen in multiple animals in the 3X and 5X dose groups, and in one control animal. In a separate safety study, firocoxib was administered orally to healthy juvenile (1013 weeks of age) Beagle dogs at 5, 15, and 25 mg/kg (1, 3, and 5 times the recommended total daily dose) for 180 days. At the indicated (1X) dose of 5 mg/kg, on histopathologic examination, three out of six dogs had minimal periportal hepatic fatty change. On histopathologic examination, one control, one 1X, and two 5X dogs had diffuse slight hepatic fatty change. These animals showed no clinical signs and had no liver enzyme elevations. In the 3X dose group, one dog was euthanized because of poor clinical condition (Day 63). This dog also had a mildly decreased serum albumin. At study completion, out of five surviving and clinically normal 3X dogs, three had minimal periportal hepatic fatty change. Of twelve dogs in the 5X dose group, one died (Day 82) and three moribund dogs were euthanized (Days 38, 78, and 79) because of anorexia, poor weight gain, depression, and in one dog, vomiting. One of the euthanized dogs had ingested a rope toy. Two of these 5X dogs had mildly elevated liver enzymes. At necropsy all five of the dogs that died or were euthanized had moderate periportal or severe panzonal hepatic fatty change; two had duodenal ulceration; and two had pancreatic edema. Of two other clinically normal 5X dogs (out of four euthanized as comparators to the clinically affected dogs), one had slight and one had moderate periportal hepatic fatty change. Drug treatment was discontinued for four dogs in the 5X group. These dogs survived the remaining 14 weeks of the study. On average, the dogs in the 3X and 5X dose groups did not gain as much weight as control dogs. Rate of weight gain was measured (instead of weight loss) because these were young growing dogs. Thalamic vacuolation was seen in three of six dogs in the 3X dose group, five of twelve dogs in the 5X dose group, and to a lesser degree in two unmedicated controls. Diarrhea was seen in all dose groups, including unmedicated controls. In a separate dose tolerance safety study involving a total of six dogs (two control dogs and four treated dogs), firocoxib was administered to four healthy adult Beagle dogs at 50 mg/kg (ten times the recommended daily dose) for twenty-two days. All dogs survived to the end of the study. Three of the four treated dogs developed small intestinal erosion or ulceration. Treated dogs that developed small intestinal erosion or ulceration had a higher incidence of vomiting, diarrhea, and decreased food consumption than control dogs. One of these dogs had severe duodenal ulceration, with hepatic fatty change and associated vomiting, diarrhea, anorexia, weight loss, ketonuria, and mild elevations in AST and ALT. All four treated dogs exhibited progressively decreasing serum albumin that, with the exception of one dog that developed hypoalbuminemia, remained within normal range. Mild weight loss also occurred in the treated group. One of the two control dogs and three of the four treated dogs exhibited transient increases in ALP that remained within normal range. Made in Canada Marketed by: Merial LLC, Duluth, GA 30096-4640, U.S.A. 1-877-217-3543 U.S. Patent Nos. 5,981,576; 6,541,646; and 6,677,373 NADA 141-230, Approved by FDA

Designed for Dogs, approved for Surgery

As a class, cyclooxygenase inhibitory NSAIDs may be associated with gastrointestinal, kidney or liver side effects. These are usually mild, but may be serious. Pet owners should discontinue therapy and contact their veterinarian immediately if side effects occur. Evaluation for pre-existing conditions and regular monitoring are recommended for pets on any medication, including PREVICOX. Use with other NSAIDs, corticosteroids or nephrotoxic medication should be avoided. Refer to the prescribing information for complete details or visit www.previcox.com. ÂŽPREVICOX is a registered trademark of Merial. ÂŠ2009 Merial Limited, Duluth, GA. All rights reserved. PVX08NASURGTRADEAD. See Page 46 for Product Information Summary

For more information, please call Merial Customer Service at 1-888-MERIAL-1 (1-888-637-4251), or contact your Merial Sales Representative or Merial Sales Agent Representative.

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UNUSUAL CASE

Congratulations, it’s a splenectomy! By Caroline Lafferty, DVM Mantua, N.J.

Dr. Lafferty remembers this unusual C-section.

s I got to my clinic at the usual time, I already had a feeling it was not going to be a typical day. Instead of seeing patients, my colleagues and I met with an oncologist to review the latest cancer treatments. I was excited, because that meant free CE and food! However, my hopes for a quiet afternoon nibbling on sandwiches quickly diminished when one of our technicians informed me that a pug with dystocia was being brought to the clinic. Surgery would take me away from part of the meeting, but C-sections don’t take that long, and I would be able to return for the remainder of the oncologist’s presentation. The 10-year-old pug, Annabelle, was in poor shape when she arrived. The owner reported that Annabelle had produced one puppy sometime between 7:00pm and 10:00pm the night before, but no one was home to take care of it. The puppy had been decapitated, and the owner was afraid the head was lodged in the birth canal. I quickly examined Annabelle, who was actively laboring. She was pale, dehydrated and weak. On palpation, she had several large bulges in her abdomen that indicated more puppies to come. There were no puppies in the birth canal, just an amniotic sac. I explained to the owner that the first puppy was likely ingested by either Annabelle or one of the other dogs in the house. The owners had financial concerns, so instead of obtaining radiographs, I brought the patient straight to surgery. The C-section was routine — one puppy in each uterine horn — but we were only able to revive one newborn. I performed a routine spay, and as I ligated the left ovarian pedicle I thought something was amiss. I finished removing the uterus, and then went back to check the pedicles for bleeding. As I placed my hand into the area of the left ovarian pedicle, I felt something large and firm. I investigated further, and attached to the spleen was a bulging 7-cm mass. Omentum had adhered itself to the mass, telling me it had bled in the past. I had never performed a splenectomy, but had seen my colleagues perform them. My technician called the dog’s owner, who gave permission for the additional surgery. Of course, the visiting oncologist heard the word “mass” and came running. He said that because of its size, the mass was likely to be benign. Who knew that my C-section would turn into a case study for our oncology meeting? Annabelle recovered well from surgery and her biopsy revealed lymphoid hyperplasia with no evidence of malignancy. Today, Annabelle is doing well. Perhaps her pregnancy at 10 years old was a blessing in disguise. vF

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Data on file.

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Help them understand what to look for. Did you know that less than half of all pet owners are aware that diabetes can affect dogs and cats? Common signs of diabetes — excessive thirst, frequent urination , lethargy—may not be getting the attention they deserve from your clients. That’s where you come in. Be sure to talk to your clients about pet diabetes—its risk factors (eg, obesity), diagnosis, and management — so that their pets can live happy, healthy, and active lives.

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Sponsored by Intervet/Schering-Plough Animal Health. Pet Diabetes Month is the property of Intervet International B.V. or affiliated companies or licensors and is protected by copyrights, trademark and other intellectual property laws. Copyright © 2009 Intervet International B.V. All rights reserved. SPAH-PDM-9577CH9/09 Intervet/Schering-Plough Animal Health 56 Livingston Avenue • Roseland, New Jersey 07068 • USA Phone: 800 521 5767 • www.intervetusa.com