Why Heartworm Preventive Sales Should Not Go Over The CounterApril 26, 2010 The current monthly oral and topical heartworm preventives, as well as ProHeart6, the injectable six-month formulation for dogs, are all members of the same pharmaceutical class: the macrocyclic lactones. These are compounds or chemical derivatives of compounds produced by various soil-dwelling species of actinomycete bacteria within the genus Streptomyces. Ever since the introduction to small animal veterinary medicine of the first member of the class, ivermectin (as Heartgard), these compounds have become the mainstay of heartworm prevention in the United States and around the world. These are amazing compounds with efficacy at remarkably low doses against internal and external parasites. With the exception of the well-known blood-brain barrier problem in certain collie breeds, this drug class poses almost no significant safety concerns. These compounds have moved heartworm prevention from the world of the daily into the monthly (or semi-annual with ProHeart6) and, either on their own or in formulations with other products, also provide concurrent protection against internal parasite infections. All in all, from the point of view of the dog and cat, health care now is similar to that of people after World War II when penicillin and related antibiotics jumped onto the scene and …
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Herd Health & Welfare: A ResponseApril 19, 2010Editor: We would like to respond to Dr. Laura Zehnder Jones’ comments on the article “Food Animal Vets Dispute Abuse Charges” [February 2010]. One overarching concern seems to be about the farm size, business orientation and business relationships of many of today’s operations. We do not believe it is disingenuous to note that the majority of farms are family owned. Trends in business in recent decades have been toward larger entities regardless of whether the subject is retail businesses such as the shopping supercenters, the pharmaceutical industry, railroads or manufacturing. Animal agriculture has experienced these same trends. These trends reflect that increased scale often increases efficiency. In the face of an increasing population and reduced land mass resources, becoming more efficient has become a requirement for farm survival. It is common to observe changes in business structure and business processes as farms increase in size. Frequently, more formal, legal business relationships come into existence, which make possible shared ownership and management responsibilities among close relatives and across several generations. These larger farms are capital intensive and require extensive use of risk-management tools such as crop insurance, hedging and contracts to secure inputs and sale of production. …
Is Palliative Surgery Ethical?April 1, 201004/12/2010 - Reflections of a Modern Dinosaur 03/29/2010 - I Don't Want to Put Him Through This 03/15/2010 - Who cares about the diagnosis? You've heard of palliative chemotherapy. Sure, there are cases where we hope for a cure or a remission (think lymphoma). But in many cases, chemo is offered to increase survival despite a grim prognosis. And you've heard of palliative radiotherapy. For example, four fractions could be given to a dog with osteosarcoma when amputation is not possible for the patient or not acceptable to the owner. Is there a treatment called palliative surgery? Is it doable? Is it ethical? Triple yes. There are many situations where palliative surgery can be offered. Here are a few recent cases. Sadie, a 10-year-old golden retriever presented with a hemoabdomen. Ultrasound or radiograph suggested a ruptured splenic mass, likely cancerous. If we offer to perform a splenectomy, then we are offering a form of palliative surgery. With hemangiosarcoma, the patient could die within three to six months. The owner elected splenectomy. Beaches, a 13-year-old mix breed dog, was diagnosed with recurrent malignant melanoma at the commissure of the lips. Besides the constant bleeding from self-trauma, she was otherwise doing very well. Because this …
Reflections Of A Modern DinosaurApril 1, 2010I was very disappointed by the disappearance of the print edition of the Journal of the American Animal Hospital Association. Remember? That was in December 2003! Since then, several other journals have disappeared from mail boxes. The good news? Fewer unread journals gathering dust in our offices. And fewer killed trees. The bad news? Probably less circulation, obviously less sharing within clinics, possibly less readership. I suspect that many people read a journal whenever they have a break, between consultations, before bedtime or maybe even on the (ahem) throne. The same feeling of disappointment was recently expressed by Colin F. Burrows, an internist at the University of Florida vet school and Editor in Chief of the excellent Clinician's Brief journal (January 2010 editorial). Our colleague wondered if that feeling makes him a dinosaur. Many of his readers say they are proud to be dinosaurs, too: .A vet in NewYork: "I find reading off a computer screen difficult and tiring. … Half of my journal reading is done spur of the moment." A vet in Pennsylvania: "Most of my reading is done late at night or during short, slow spells at the office." A vet in New Jersey: "It is so …
Behavior Expertise Can Generate RevenueMarch 1, 2010 It’s not uncommon for clients to ask a veterinarian about their dogs’ behavior. While most veterinarians refer their clients to trainers, a new AAVSB-approved continuing education program developed by a canine behavior specialist and author of “Good Dog!” means veterinarians, technicians and assistants can address the behavior themselves, possibly increasing overhead at the same time. “The ASPCA reports that 42 percent of dogs acquired in the U.S. annually are surrendered in the first year of life because of behavior,” says the behaviorist, Donna Chandler. “If veterinarians take behavior training into their clinics, not only will the dog remain in the family, but the veterinarian will keep the client. “No one has to lose if there is someone on the staff who can help.” Jeanette Raikos, DVM, of VCA West 86th Street Animal Hospital in Indianapolis, Ind., notes that relinquishment is a big problem. “So we are pre-emptive,” she says. “If we have a first-time dog owner, we’ll help them start out right so they don’t have a problem down the line. We have Donna come in and conduct classes here, and then she follows up with the patients at home. “Having someone on staff …
I Don't Want To Put Him Through ThisMarch 1, 201003/15/2010 - Who cares about the diagnosis? 03/01/2010 - Feed Them and They Will Come 02/12/2010 - Dealing With (Mis)guidance The most common line to decline surgery in my practice is "Yeah, well … I don't want to put him through this." To be fair, it probably means different things to different people. The vast majority of the time, I suspect that it means, "There is no way I'm spending that kind of money on this mutt." Sometimes, it means that the owner is truly concerned about how invasive surgery is. A classic example is amputation. Pet owners invariably unconsciously anthropomorphize and just can't imagine themselves hopping on one leg. Of course, we know better. I have never seen a three-legged patient not walk. Even with DJD in the remaining limbs. I have had my own doubts and hesitations. Colleagues, surgeons and oncologists questioned over the years have all agreed. They have never seen a three-legged patient not walk. Surely, there must be exceptions. The same reasoning applies to mandibulectomies and maxillectomies. They typically sound horrifying to clients (and some referring vets). Yet surgeons are often amazed that their patient will most of the time eat the very next day after surgery. …
Feed Them And They Will ComeMarch 1, 201002/12/2010 - Dealing With (Mis)guidance 02/01/2010 - Anesthesia: It Ain't Over Till It's Over 01/18/2010 - Who should euthanize Leia? Let me share a little secret with you. "Feed them and they will come" is what speakers and sponsors say about you, dear reader. Please don't tell anyone. It's a secret. A referring vet once told me, half-jokingly: "It's really strange. Young surgeons who have more energy and time, but less experience, are the one giving all the talks. Senior surgeons who have less energy and time, but more experience, are the ones who rarely give talks." Likewise, an executive at our local veterinary medical association recently noticed: "It's really strange. Young vets who have less knowledge and experience rarely join us for CE meetings. Senior vets who have more knowledge and experience are the ones who show up routinely." We began trying to understand what it would take for our young local colleagues to join us. This is what we have to offer: • Great speakers from various specialties and practices, sometimes from out of state, eager to share their knowledge. • Generous sponsors who provide great food and information about new products and services. • An open forum to discuss difficult …
Veterinary Cardiologists Pump Out Progressive Treatments For Common DiseasesFebruary 7, 2010 Veterinary cardiology research projects are gaining interest and funding from human medical associations and animal alike. Morris Animal Foundation lists 17 cardiac grants it has awarded for canine and feline cardiac research in the last two years alone. All colleges of veterinary medicine dedicate time and resources to carrying out the research, allowing the specialty of cardiac medicine to reach new heights. Mitral valve disease and dilated cardiomyopathy (DCM) are the most common canine heart diseases, while hypertrophic cardiomyopathy (HCM) and restrictive cardiomyopathy are the most common heart diseases found in cats, says Mark A. Oyama, DVM, Dipl. ACVIM (cardiology). Researchers are investigating these and other cardiac diseases to identify the cause of disease–whether a genetic role exists, how to diagnose earlier and how to most effectively treat the diseases. “For many diseases we suspect or have shown a congenital or heritable predilection such as feline HCM, Boxer DCM, but many other causes of disease is largely unknown,” says Dr. Oyama, an associate professor at the University of Pennsylvania School of Veterinary Medicine. Because genetics plays such a large role in breed-specific cardiac disease, Washington State University created the canine cardiac genetic lab and is …
Anesthesia: It Ain't Over Till It's OverFebruary 1, 201001/18/2010 - Who should euthanize Leia? 01/04/2010 - Changing the world, one patient at a time 12/21/2009 - Would you have euthanized this patient? David Brodbelt, a British board-certified anesthesiologist, undertook a massive thesis known in the anesthesia world as CEPSAF.1 In the rest of the world, it is called the Confidential Enquiry into Perioperative Small Animal Fatalities. After the thesis was published, some more data has been published in various journals2. Our colleague looked at anesthesia records of more than 98,000 dogs and 79,000 cats (OK, and more than 8,000 rabbits), from more than 100 practices. Obviously, this represents unusually huge numbers for a veterinary study. Anesthetic-related death was defined as perioperative death within 48 hours of termination of anesthesia. Countless interesting conclusions can be drawn from the study, and I would like to focus on one specific point. Let's start with a pop quiz: would you say that most perianesthetic deaths occur during induction, surgery or recovery? The correct answer is that over half of the perianesthetic deaths occurred within 3 hours of termination of anesthesia. It is difficult to know exactly why these patients died; only 10 percent had necropsies. Granted, some of these patients may have …
Dealing With (Mis)guidanceFebruary 1, 2010"I can't believe what Dr. A told my client," a colleague told me recently about an obstipated cat. "He told her that cats do miserably after colectomy." The owner went online, read a very different story, and went to Dr. B, who referred her to us for surgery. This is a very delicate situation. Communication with referring vets is a like a religion. Should I call Dr. A to discuss the real prognosis of colectomy? Should I let Dr. A know that he has lost a client and why? But then if Dr. A calls the owner, will the client be mad at me for "ratting?" In such a case, ignoring the situation may be the most diplomatic situation. The biggest loser will, however, be other obstipated cats who meet Dr. A. (Note: It goes without saying that Dr. A is an excellent vet who truly cares about the welfare of his patients.) A similar situation occurred a few years ago. Dr. C told her client that 100 percent of the laryngeal paralysis patients she has seen died after surgery. That time, I did dare to call Dr. C, wondering about this dismal track record. I asked her, "How many …
