Monday, August 13, 2012

Not your everyday patient

Sadie lioness

Triangle Veterinary Referral Hospital had a wonderful opportunity to support an important organization last Friday.  One of our surgeons, Dr Mike Grafinger, and several of our support staff made a "house call" to the Conservators' Center in Mebane, NC.

The Conservators' Center is home to the largest collection of lions in the Southeast. Their 21 lions and 11 tigers attract visitors who are fascinated by these predaceous felines. Although most visitors are drawn to the Center for the thrill of seeing big cats up close, many leave talking about other species in their eclectic collection, which includes wolves, New Guinea singing dogs, lemurs, binturongs, servals, bobcats, jungle cats, and a lynx.

The lifeblood of the Center is a community of people committed to caring for almost 100 animals. With a very small staff, they depend on volunteers and interns to supply much of the labor; and on visitors, donors, and Lifetime Adopters to help fund their continuing growth. 
  

Sadie was originally part of a large number of big cats living at a breeding facility in Ohio. The facility had been repeatedly cited for a poor safety record, unsanitary conditions, neglecting to provide veterinary care, and other violations. After issuing close to 900 citations, the county's health department soon ordered the 14 lions and tigers to be removed - or euthanized, and the Center stepped in to help by providing a permanent home.   

Sadie had an infected mass on her chin that needed to be removed.  Dr Grafinger and his staff volunteered their time to help out;  what a unique opportunity for TVRH staff to be involved in this field surgery!


Sadie, anesthetized and closely monitored by technicians Beth, Bobby, and Dina


Sleeping well
After the tumor has been removed

Waking up after surgery
 If you'd like more information about the Conservators' Center, information about their animals, how to visit or volunteer, and how to support their important work, learn more at www.conservatorscenter.org  where you can read about the animals, sign up for a free e-newsletter, link to their Facebook pages (be sure to check out Arthur White Tiger's FB page, which is great fun to read), and find a way to get involved.

Dr Grafinger will be writing a blog submission about his experience with Sadie and  her surgery, so be sure to check back!

Thursday, August 9, 2012

Older pets and arthritis



My pet has osteoarthritis?

All the medical advances in veterinary care and improvements in nutrition have resulted in our pets living longer lives.  We get to enjoy their company and unconditional love longer, but unfortunately with a longer life our beloved pets get to experience some of the consequences of older age.  One of the most common orthopedic problems seen in geriatric animals is arthritis. Arthritis (from Greek arthro-, joint + -itis, inflammation) is inflammation on a joint or multiple joints. So now you can tell your friends that you speak Greek!!! A joint is where two bones meet allowing motion (shoulder, elbow, carpus, among others). There are many different types of arthritides, which can be classified as inflammatory or non-inflammatory.  The most commonly seen in older pets is osteoarthritis (OA) or degenerative joint disease classified as a non-inflammatory arthritis. OA is commonly the result of loss of articular cartilage and damage to subchondral bone.  If you just learned that your pet has arthritis, please know that your pet is not alone. OA is the most common type of arthritis in people in the United States and is also the leading cause of disability.  Clinical signs associated with osteoarthritis include joint swelling, pain, stiffness when walking and lameness. With time, decreased joint motion due to pain and discomfort leads to a reduction on muscle mass (muscle atrophy) because of disuse. Use it or lose it! As your pet ages the water content of the cartilage decreases with reduction of proteoglycan content, with the loss of the structural framework the cartilage becomes more susceptible to damage. 

Fig. 1  End stage osteoarthritis in a canine elbow. 

Fig. 2  Normal elbow





 Fig. 3 Hip dysplasia and osteoarthritis present on both hips. 


 Fig. 4  Normal pelvis

How do I know that my pet has OA?


Watch your pet for any evidence of acute or chronic lameness (limping) such as difficulty standing, climbing stairs, reluctance to jump and stiffness when walking. Approximately 20% of dogs over 1 year old are estimated to be affected with OA. Cats also can have clinical signs as a result of arthritis, but they are masters at hiding pain so the condition is underdiagnosed in cats. 

How does my veterinarian diagnose OA?

Diagnosis is based on history, physical exam findings and radiographs of the affected joint(s). On physical examination the affected joint may be swollen, unstable, painful and may have decreased range of motion. Radiographic evaluation of the affected joint(s) is the most common screening tool used by veterinarians. Collecting joint fluid of the suspected joint and analyzing it under the microscope can also give you invaluable information that can help you localize the problem joint as well as rule out other problems that may be affecting the joint. Other advanced imaging that can be used to evaluate the joint are CT scan and MRI, but are not used as often due to added expense. Minimally invasive procedures such as arthroscopy can be used to explore the joint and rule out underlying disease leading to OA. 

How can I help my pet with OA?

Once your veterinarian definitively diagnoses OA on your pet, medical management should be implemented to improve your pet’s quality of life.

The five mainstays of medical management are:

Weight loss or weight management- Your pet may be obese because of inactivity, sometimes associated to the OA pain. Reduced weight decreases that stress and forces placed on the joints. A variety of commercial weight management diets are available to control the daily caloric intake of your pet while giving them the sense of satiety. Visit your veterinarian for diet recommendations. Weight management will require regular visits to your veterinarian (Doggy Weight Watchers, if you will) to monitor weight and diet.  

Nutritional supplements- Nutraceuticals are not marketed to diagnose, treat, or prevent disease, but are presumed to protect the cartilage and inhibit degradation of cartilage with positive effects in experimental and clinical trials. The most common nutraceuticals used are Glucosamine, Chondroitin, Methylsulfonylmethane (MSM), and Omega-3 Fatty Acids. Chondroprotectants include Adequan (Polysulfated glycosaminoglycan), sodium hyaluronate, and pentosan polysulfate.

Controlled regular exercise- Your pet should be rested during the initial onset of clinical signs. During the recovery period low impact regular exercise improves and maintains joint range of motion and muscle mass. Swimming is a great exercise since it helps joint motion without the added stress to the joints.  

Pain management- A multimodality approach to pain control should be followed when it comes to pain control on these patients. Pain management may include some or all of the following modalities depending on the severity of pain:
Veterinary non-steroidal anti-inflammatories such as Carprofen (Rimadyl®), Deracoxib (Deramaxx®), Etodolac (EtoGesic®), Meloxicam (Metacam®), Tepoxalin (Zubrin®), Firacoxib (Previcox®), are frequently used for pain control of orthopedic conditions. Potential side effects include vomiting, diarrhea, inappetence, anemia, and dark tarry stool. NSAID use can result in stomach ulcers, colitis, and can be toxic to the liver and kidneys. If any side effects are noted it is imperative that the medication is discontinued and to contact your veterinarian for further recommendations.

Tramadol is a centrally acting synthetic analgesic used to treat mild to moderate pain. Tramadol has been used as an alternative to pure opioid medications and also given in combination with a NSAID.  
Acupuncture may result in increase function and muscle strength by ameliorating pain in pets diagnosed with arthritis.

Amantadine is an antiviral medication used in people that may reduce the tolerance to other analgesic medications in animals. Typically it is used in combination with other pain medications because it is unknown if amantadine has any analgesic properties when given alone.


Just like in people, arthritis in animals is a condition that does not have a cure, but can be managed with a combination of exercise restriction, weight management, pain medications and neutraceuticals. Once your pet’s condition is not responsive to medical management other options may include stem cell therapy and total joint replacement. Stem cell therapy in animals holds promise, but further research is needed to confirm efficacy and results of treatment.

 



 Submitted by Dr Leonardo Baez

Wednesday, August 8, 2012

The dreaded "Cone of Shame"


We get it.  We really do.  That baleful look you give us when we say “Your pet will need to keep the e-collar on for 7-10 days.” Or “…..until the wound is healed.” Or “ …until the bandage comes off.”   Some of the many reasons we pass out the despised Elizabethan collar, aka “cone of shame”, “satellite dish”, “lampshade”….whatever term of endearment you chose, we all hate them.  We do not love putting them together. (FYI, watching first timers attempt assembly of an e-collar can provide for at least several minutes of amusement…)  We know what is going through your head when we present you with this lovely piece of plastic secured to your pets head with a white ribbon of gauze.  You are thinking, “How is he/she going to eat?”  “How will he/she fit in the crate?”  Or if you have experienced the displeasure of an e-collared dog in your house before, you might be thinking, “Oh no, the backs of my legs are about to take a beating!”  (Picture a 90 pound canine running up behind you and ramming your calves.)   

Unfortunately these stiff plastic leg bruisers are one of those necessary evil kinds of things.  We promise we aren’t passing them out just to make your life miserable for a couple of weeks.  We really do have your pets’ best interest in mind.  We make them don this head gear to keep us from needing to re-stitch a surgery site, or mend self inflicted wounds or tell you your pet’s eye has gotten worse because they have been rubbing it obsessively. We understand that e-collars are sometimes a huge inconvenience, however animals usually adapt quite well to wearing these “hats”, with the exception of those that just simply refuse, and we know that happens too.  Just try to stick it out and do the best you can to keep your little critter safe from themselves.  It is only temporary, and hey, you can take cute pictures of your furry family member looking pretty pitiful while they wear their collar!


 

Cayleb, my 90 pounder with an allergic reaction and corneal abrasion on his right eye.

 


 

Cayleb sporting his cone!  His eye was back to normal in 7 days.  We did have to bust out our super duper big crate for him to fit in with his e-collar, and of course watch out for the backs of our legs in our tiny living room!




Submitted by Michelle Schoepper  LVT