vet science

Liver and Pancreatic Disease: Test Your Knowledge!

2017-01-24T09:23:00.003-08:00

Question

What has happened to this dog's gall bladder?

Answer

This is a gall bladder mucocoele which has been caused by the accumulation of semi-solid to solid mucinous bile-laden concretions in the bladder accompanied by cystic mucinous hyperplasia of the gallbladder wall.

The exact reason for their formation is unknown and many factors are likely implicated in their formation including gall bladder stasis, choleocystitis and localised inflammation. They are seen in some breeds with increased frequency such as Shetland sheepdogs and Cocker spaniels. Endocrine disease, including Hyperadrenocorticism, hypothyroidism and other lipid abnormalities, have been associated with mucocoele formation.

Surgery, as performed in this dog, is usually required and, if successful, is associated with a good long-term outcome.

Test Your Knowledge Cardiac Conundrum

2017-01-15T08:57:00.001-08:00

Question 8

A 6-year-old neutered male Labrador presents to you with a 2-week history of exercise intolerance and a collapsing episode 2 hours before presentation. The collapse happened when the dog tried to chase a cat. The dog seemed unconscious to the owner, there was no tonic or tonic-clonic activity and the collapse episode lasted less than 30 seconds with a fast and complete recovery afterward.

On physical examination the heart rate was 40 bpm with a regular and strong femoral pulse, no cardiac murmur was detected and the clinical examination was otherwise unremarkable. You performed an ECG to characterize the bradycardia.

What’s your ECG diagnosis? And, what is the most appropriate treatment for this patient?

Answer

The ECG shows a complete atrioventricular dissociation (P waves are not associated with the QRS complexes) with a slow ventricular escape rhythm. This is a third degree atrioventricular block (complete AV block). The recommended treatment for complete AV block is a pacemaker implantation.

Third degree AV block is the most common indication for pacemaker implantation. In veterinary cardiology the most frequently implanted pacemaker system is a rate-responsive, single chamber and single lead (VVIR) pacemaker.

What an explosive new "Japanese Cat Communication" study means for cat owners looking to bond with their cats

2016-12-07T05:15:00.000-08:00

In case you're not a follower of all things cat research, I'm happy to present a breakthrough study on the matter…

This new study has shown us something fascinating about how animals think and comprehends us.

The results basically indicated that felines have an astounding ability to understand our words. They can understand human language!

Japanese researchers in Tokyo uncovered this special trait, which separates domestic house cats from all other large, wild felines (tigers, lions and so forth). It turns out the smallest and cutest ones of them all are the most verbally sophisticated. It appears house cats have actually evolved to understand us as part of their domestication.

● They understand us by our pitch. They can tell if we're angry or if we want to hug them.

● They can understand us by our words. They know their name, our name, and a host of other titles we assign to things around the house or activities.

● And most fascinating of all, they've evolved to mirror us. In the wild, cats prefer to be pin drop quiet. They are hunters that catch prey by closing distance through silence and camouflage followed by a brief sprint. This is why when cats communicate to each other, the primary device is their body, not their vocals.

And yet with you and me, cats constantly break this rule. Why, though?

Again, it goes back to domestication. Watching humans communicate to each other through voice, cats have learned to mirror us.

The fascinating thing about this brain-level chance is that cats have developed a sort of language of their own. In between the meows, purrs, and hisses is a genuine language built on tone and word length.

Yes, it can be deciphered. In fact, it already has. This is what the Cat Language Bible by Jonas Jurgella is in a nutshell. It is years of research into the field of human to feline communication, condensed and compressed into a simple guide that anyone can pick up and use on-the-fly with their own cat.

● Use it to interpret cat sounds as they're happening. Now you can finally understand if your cat is sick or just energetic.

● Read his thoughts by reading his body. It's tough to know when your cat wants to be left alone versus when he's genuinely sad and feeling secluded. Now you can tell using some verbal and nonverbal giveaways common to all felines.

● Speak to him in a way that he can understand. Cats may not have the advanced language capability that humans do -- yet they make sounds that can also be understood and interpreted by us.

● Would you like to actually say something to your cat that he could really understand on his own terms? The Cat Language Bible™ will tell you how to do it.

See the FREE video here for more information

In my opinion as a cat owner, this is a must-have in any animal household. Pick it up, and see how much closer a connection you can build with your own feline through the power of direct human to cat conversation.

Cat Language Bible Review

2016-12-05T11:34:00.001-08:00

Review: The Cat Language Bible

Could this guide really be the key to understanding your cat through true-to-word language?

Forgive me for being a bad parent, but sometimes I just can't understand what Scruffles is SAYING between all the meows and purrs.

I guess you could call him a big yapper with the shrewd, "let nothing truly be told" face of a master poker player.

Frankly, he doesn't even need the poker face when he just says the same 2 sounds. Meow. Purrrrrr. How could anyone possibly make sense of that?

Well, you'd be surprised.

As Scruffle’s caretaker and owner, our language miscommunications can cause friction at times. While I'm trying to figure out whether he's hungry or tired, angry or just energetic, he's off in his own world not making anything easier for me.

The Cat Language Bible™ immediately stood out to me as a way to finally break the code with Scruffles and have an honest, one-on-one, human-to-cat dialogue.

That was if the marketing lived up to the program’s description.

This course brands itself as a way to understand what your cat is trying to communicate to you – through body language as well as actual cat sounds.

Being a feline with more secrets than he has lived, the prospect of knowing what my cat was thinking, feeling, and sometimes plotting against me was immensely interesting.

What can I say, I'm a bit of an eavesdropper, and I wanted to know what Scruffles actually thought about me as he made efforts to hide, stalk, or occasionally pounce me in my sleep!

Body Language

What I really like about this guide is that it's not pure text. They show multiple shots of cats exhibiting different signs based on their behavior. For a book about language including the bodily variety, I think this is essential, and they delivered more than just a basic text description by actually showing cats in various emotional and communicative states.

When you think about it, all animals have certain reflexes that they adapt based on their environment. When scared, they recoil, just like humans do. When excited or fearful, they have different body mechanics to suit each situation.

The reason that you and I struggle with this is because there are slight variations that are hard for non-felines to detect. Just like when a human being furrows his eyebrow to show confusion or disdain, you really need to understand the subtleties that are on display when you look at a cat's body as well.

The Cat Language Bible™ shows that critical nuance of behavior. It goes to that extra depth to really help you understand and decipher the body language of cats.

Verbal communication

Yes, meow, screech, and a purrr are obviously different in meaning. I think of them as the "primary cat words."

But unlike human beings, cats focus more on tone to convey different ideas and emotions than humans do. And here again The Cat Language Bible™ breaks it down, highlighting differences between screeching tones and soft tones, as well as low, high, and medium pitches.

It's worth noting that every cat is different and you need to establish a base for what is loud versus soft with your own feline. Even with Scruffles being as low-key as he is, I didn't find this to be an issue at all.

Overall rating

Are you a cat owner? Do you want to understand your cat better? Then get The Cat Language Bible™. It teaches exactly what it says: the language of a cat.

I don't know of any other guide that goes into such depth with the picture examples, breakdowns of pitch and tone variations, and lessons on cat behaviors and emotional states.

This guide also changed my understanding of Scruffle's true intelligence. It turns out that house cats have evolved to speak to us in the way that no other felines really have. Their language skills, although not quite matching our own, are highly sophisticated and nuanced.

The Cat Language Bible™ is an essential guide then, for understanding how cats think, show emotion, and even manipulate us at times based on their language, both in body and voice.

It's time to talk cat.

Watch author Jonas Jurgella’s FREE video presentation here

Vets Needed in Sharjah, UAE, Salary: 12000

2016-11-27T00:13:00.000-08:00

Posted On:19th November 2016
Employment Type:Full Time
Monthly Salary:8,000 - 11,999
Minimum Work Experience:5-10 Years
Minimum Education Level:Masters Degree
Listed By:Employer
Company Size:1-10
Career Level:Manager

My client is currently looking to recruit a full time vet to work at their award winning Small Animal practice . The practice is forward thinking, modern and constantly looking to improve standards and levels of service. The practice offers an interesting caseload, fantastic facilities, a very committed and enthusiastic team, The ideal candidate will be confident in all areas of surgery and consults and ideally have at least 5 years experience. An interest in feline medicine would be advantageous but not essential.

http://tnydu.biz/H53O

Name This Lung Pattern

2016-05-08T13:41:00.001-07:00

Dear Vets

How would you describe this lung pattern?
List your differential diagnoses.

Answer

This patient has an alveolar lung pattern.

When the normally air-filled alveoli become flooded with fluid or cells, the background opacity of the lung changes from a gas lucency to a soft-tissue opacity.

This soft tissue opacity, caused by the accumulated fluid / cells within the alveoli merges with, and therefore obscures, the normal soft tissue markings of the pulmonary vessels and the walls of the airways.

However, the airways themselves are highlighted against the abnormal soft tissue background, and can be identified as branching linear lucencies (arrowed below). These branching lucencies are known as ‘air bronchograms’ and are the hallmark of an alveolar infiltrate. This patient has an alveolar lung pattern.

Answer continued

Possible differential diagnoses for an alveolar lung pattern include:

Pneumonia
Oedema (cardiogenic or non-cardiogenic)
Haemorrhage
Neoplasia

In this patient the location of the changes (within the cranio-ventral lung fields and superimposed on the cardiac silhouette) would be most consistent with aspiration pneumonia.

Feline Ultrasound Case Study

2016-04-10T14:27:00.001-07:00

Question

A 5 year old domestic short hair cat presents with a 24 hour history of lethargy, anorexia and severe tachypnoea.

Following a physical examination and after initial stabilisation in an oxygen chamber, basic thoracic ultrasound and echocardiography views are obtained.

What are the main ultrasonographic findings on the image below?
What is your differential diagnosis at this stage?

Answer

The first scan shows loss of the normal lung appearance (soft tissue-air interface) which is substituted by a diffuse hypoechogenicity (fluid) and floating pleural tissue. The diagnosis is severe pleural effusion.

Differential diagnosis includes a pure transudate (e.g. due to hypoalbuminaemia), a modified transudate (e.g. due to neoplasia, diaphragmatic hernia or congestive heart failure), a pyothorax (due to bacterial infection), a non-septic exudate (e.g. FIP), a chylothorax (e.g. due to cardiac disease, neoplasia or idiopathic) and a haemothorax (due to trauma, neoplasia or coagulopathy).

The second scan is a right parasternal short axis view at the level of the aorta and the left atrium. There is evidence of severe left atrial enlargement with an Aorta/Left atrium ratio markedly above 1.6.

There is evidence of left sided heart disease leading to congestive heart failure (pleural effusion). The most likely disease for a patient of this age is a primary cardiomyopathy such as hypertrophic cardiomyopathy or restrictive cardiomyopathy. Congenital cardiac disease or secondary cardiomyopathies (e.g. hyperthyroidism) are much less likely.

A full echocardiographic examination (after thoracocentesis) should be carried out as the next step. This should be followed by medical therapy for congestive heart failure.

What's wrong with this lung lobe? If you planned to remove it, which surgical approach would you use?

2016-01-26T08:14:00.000-08:00

Question

What is wrong with this lung lobe, and what surgical approach would you use to perform a lung lobectomy?

Answer

This dog has a right middle lung lobe torsion, note the torsion on the pulmonary hilus.

To be able to easily access the pulmonary hilus the best approach is an intercostal thoracotomy at the 4th or 5thintercostal space. This being the right middle lung lobe we chose a 5th intercostal space to gain access into the thorax to perform a lung lobectomy using a stapling device.

Enterotomy Essentials (Case)

2015-11-15T09:23:00.002-08:00

Question

You have diagnosed a small intestinal foreign body and are planning on performing an enterotomy to relieve the obstruction.

How do you plan to close the enterotomy site?

What technique will you use if you decide to resect a section of damaged small intestine?

Where is the most common site of leakage following enterectomy?

Answer

The suture holding layer must include the intestinal submucosa and most surgeons will select a monofilament absorbable suture material on a swaged on needle. Simple interrupted or continuous appositional techniques are ideal but an inverting pattern is used by some surgeons. Closure of enterectomy sites can be achieved with either simple continuous or interrupted appositional patterns.The most common site of leakage is at the mesenteric border due to the increased challenge to accurate suture placement in this location.

Abdominal Mass In Cat (Case)

2015-11-13T01:58:00.003-08:00

Question

Ziggy has an abdominal mass. His owner does not wish to pursue treatment which would require frequent veterinary visits. Which of the following statements is true?

A- There is no point taking matters any further; it must be neoplastic and there are no intra-abdominal tumours that could be managed without frequent veterinary visits.

B- The most common diagnosis for an intra-abdominal mass in a cat is lymphoma.

C- Alimentary lymphoma in cats must be treated with a doxorubicin-containing chemotherapy protocol.

D- There is a high chance that alimentary lymphoma will perforate when chemotherapy is given.

E- Administration of intravenous chemotherapy requires sedation or anaesthesia in cats.

Answer

B is the correct answer.

There are many possible explanations for this cat’s intra-abdominal mass. Some of those are non-neoplastic; some of them can be cured by surgery.

It is true that lymphoma is the most likely diagnosis. Alimentary lymphoma in cats is relatively poorly responsive to conventional chemotherapy. Work is ongoing which will hopefully define better treatment strategies for alimentary lymphoma cases.

A small proportion of feline alimentary lymphoma cases are of a particular type which does not respond to conventional COP or CHOP chemotherapy, instead responding for years to a much less intensive treatment comprising chlorambucil and prednisolone.

Mast Cell Tumour Management (Case)

2015-11-12T06:40:00.001-08:00

Question:

Beech is a golden retriever with a large ulcerated mass circumferentially affecting the skin of the anal region. Which of the following statements is not true?

A- diagnosis can be made by pathological assessment of cell (FNA) or tissue (incisional biopsy) specimens.

B- In cases of mast cell neoplasia, it is inappropriate to commence therapy without knowledge of tumour grade.

C- Canine cutaneous mast cell tumours classically spread to the regional lymph nodes first.

D- Rapidly progressive ulcerated mast cell tumours are more likely to be high-grade than small non-ulcerated minimally progressive mast cell tumours.

E- Approximately 67% of canine cutaneous mast cell tumours in the pivotal trials for both masitinib and toceranib were shown to exhibit mutations in the c-kit gene.

Answer:

B is the wrong (correct) answer.

Decisions about therapy for canine cutaneous mast cells are made based upon many factors. Tumour grade is simply a proxy measure of the probable aggressiveness of a tumour; it is not the only such measure. Proof of metastasis, for example, is a more important finding than histological grade and would effectively render information about grade redundant.

Take Your Scanning Skills (Case)

2015-09-28T00:23:00.004-07:00

Question

What is this structure?

Can you see any abnormalities?

Answer

This structure is the urinary bladder; the two echogenic structures in the dependent portion of the bladder are uroliths. They are confirmed as uroliths as they cast a distal acoustic shadow, seen as the dark area deep to the surface of the uroliths, this is caused by the mineral content of the urolith; the ultrasound beam is not transmitted through mineral structures such as bone and uroliths and are absorbed or reflected, resulting in the bright interface at the surface of the structure and the deep region of shadowing extending into the deeper part of the image.

The wall of this urinary bladder is also irregularly thickened, reflecting cystitis associated with the uroliths. Uroliths will always be in the dependent portion of the urinary bladder and therefore when scanning the bladder it is important to ensure that the entire bladder is imaged as uroliths can be surprisingly easy to miss if the urinary bladder is distended.

Bladder wall masses, such as neoplasia or granulomatous masses will be composed of soft tissue and therefore will transmit the ultrasound beam, so that the structure of the masses can be seen and there is no distal acoustic shadowing.

How did you do? If you’d like some very practical help with your ultrasound scanning, read on for details of the Abdominal Ultrasound Mini Series online course. Tutor Anna Newitt has helped hundreds of veterinary surgeons like you to develop their skills and confidence in scanning their small animal patients. Join them now!

Dorsal Carpal Region Wound

2015-09-13T03:30:00.000-07:00

Question

This large open wound is over the dorsal carpal region. What are the problems associated with the wound and what possible options for closure are there?

Answer

This is a large wound over a site of high motion with limited surrounding skin in the area. Closure by second-intention healing could be lengthy and lead to suboptimal function and cosmesis. There is no local closure or axial pattern flap available, so the best option would be to plan and place a full-thickness skin graft.

Practical Wound Management ( Test Your knowledge)

2015-09-11T07:21:00.001-07:00

Question

This middle-aged Labrador presents with this enlarging cutaneous mass on her lateral-caudal thigh. What are the key steps in planning definitive treatment of this tumour?

Answer

Initial fine needle aspirates or preferably incisional biopsy should supply the information on the type of tumour present.

This should determine the amount of further staging required and the margin of normal tissue to be excised around the tumour. Surgical management in this area can be difficult due to the increased skin tension and minimal subcutaneous tissue, so a clear surgical plan for excision and then precise execution of the reconstruction is essential.

How Do I Know My Patient is A live?

2015-09-10T03:00:00.004-07:00

Question

You are using a pulse oximeter on a cat undergoing ovariohysterectomy under general anaesthesia. Partway through the surgery the pulse oximeter begins alarming and reporting an oxygen saturation of 87%. What steps should you now take?

Answer

Look at the cat – do the mucous membranes look blue (this is unlikely as our ability to detect cyanosis is quite poor)?

Move the probe – repositioning is very important as a first step as the capillary bed becomes squeezed and the monitor then may give a false reading. Once the probe is reattached, see if the reading has changed (usually it then will increase).

Check the monitor for a good signal, determined by either examining the waveform generated by the pulse oximeter, or by observing a signal indicator light (usually green).

If the reading is still low then a search for a cause must begin. Preferably confirm the reading using blood gas analysis if available. However, an arterial sample from a cat will be difficult to obtain.

How You Dealing With Open Wounds

2015-09-07T23:00:00.003-07:00

Question

What are the key parameters to assess for this large open wound over the right pelvic region?

Answer

Open wounds should be assessed under a number of parameters including:

whether the wound is still in the inflammatory phase or not

the presence or absence of granulation tissue; the degree and type of wound exudate present

whether the wound edges are attached to the underlying tissue

whether any epithelialisation has occurred

You can then make decisions regarding the most appropriate approach by the surgeon to the wound.

Test Your knowledge (Eye Case)

2015-08-23T06:09:00.000-07:00

A 3yo female working Springer spaniel is presented to your practice one day after a field trial, with acute onset right ocular pain and discharge.

Q1: Describe the abnormalities seen, and give the most likely diagnosis.

Q2: What is the most likely aetio-pathogenesis for this condition in this case?

Q3: List the treatment options.

(Answers below image)

A1: Profuse mucopurulent ocular discharge, chemosis and corneal oedema, associated with a large corneal abnormality which is most likely an area of corneal stromal collagenolysis (‘melting’ corneal ulceration).

A2: Traumatic injury to the eye, followed by infection with a bacteria associated with corneal melting (Pseudomonas aeruginosa or beta-haemolytic streptococcus)

A3: Topical treatment with anti-collagenase (topical serum, EDTA, acetylcysteine), appropriate topical and systemic antibiotics (swab and Diffquik staining/ bacterial culture recommended), systemic analgesia, conjunctival grafting if progressive

Pug Eye Problem (Case)

2015-08-20T06:21:00.001-07:00

Question

A 4yo neutered male pug is presented for chronic corneal scarring and recurrent corneal ulceration. History taking and general physical examination identified signs of upper airway disease but no other significant abnormalities.

Q1: Describe the ophthalmic abnormalities.

Q2: List possible treatment options.

Answer

A1: The patient is showing signs of bilateral breed-related exophthalmos, pigmentary keratitis, exposure keratitis, macropalpebral fissure, probable lagophthalmos (inability to completely close the eyelids), nasal fold trichiasis and medial lower eyelid entropion

A2: Bilateral medial canthoplasty is indicated to correct the medial entropion, improve tear film distribution and shorten the eyelids. A nasal fold resection may be indicated for the nasal fold trichiasis.

Eye Test

2015-08-09T06:45:00.001-07:00

Question

A 3yo neutered female domestic shorthair cat is presented for evaluation of a left ocular abnormality (see Figure). The cat is a confirmed FHV-1 carrier but is otherwise healthy. The owner reports that the eye condition was first noticed around 3 weeks previously and that it has gradually progressed since that time. No signs of ocular discomfort have been noted and the other eye is unaffected.

What is the most likely diagnosis in this case?

How could the diagnosis be confirmed?

Answer

The clinical appearance is characteristic of eosinophilic keratitis.

Diagnosis can be confirmed by corneal cytology, which should show a mixed inflammatory response including eosinophils.

Ketosis (Acetonaemia) in Cattle

2015-07-23T11:12:00.001-07:00

Ketosis in Cattle

The Condition

Ketosis, or acetonaemia, is a metabolic disorder. Hypoglycaemia is the major factor involved in the onset and development of clinical signs of ketosis. There is a gradual loss of body condition over several days or even weeks. There is also a moderate decline in milk yield over two to four days before the onset of obvious clinical signs. The disease is most commonly seen in high-yielding dairy cows in early lactation. Secondary ketosis as a result of another disease can be seen at any stage of lactation. Beef cows can also suffer from ketosis during pregnancy.

Introduction

Ketosis is a common disease of adult cattle. It typically occurs in dairy cows in early lactation and is most consistently characterized by partial anorexia and depression. Rarely, it occurs in cattle in late gestation, at which time it resembles pregnancy toxemia of ewes. In addition to inappetence, signs of nervous dysfunction, including pica, abnormal licking, incoordination and abnormal gait, bellowing, and aggression are occasionally seen. The condition is worldwide in distribution, but is most common where dairy cows are bred and managed for high production.

Ketosis in dairy cows

The clinical signs include a refusal to eat grain and concentrate feeds and a more sudden drop in milk output. There is a sweet smell of acetone in the breath and milk. Some cows may exhibit nervous signs, which include excessive salivation, abnormal chewing movements, licking of walls, gates or metal bars, malcoordination with apparent blindness and a degree of aggression. The nervous signs often only last for a few hours. The affected cows have fatty infiltration and degeneration of the liver. To satisfy the requirements of milk production, the cow can draw on two sources of nutrients, food intake and body reserves. During early lactation, the energy intake is insufficient to meet the energy output in milk and the animal is in a negative energy balance.

In conventional farming, this is considered to be a normal metabolic situation in high-yielding dairy cows. These cows will have slightly raised blood ketone levels and may even excrete ketones in urine and milk. Cows in early lactation are therefore in a vulnerable situation, and any stress that causes a reduction in feed intake may lead to the onset of clinical ketosis. A reduction in the production of propionic acid, the main precursor of glucose in ruminants, will result in hypoglycaemia. Hypoglycaemia leads to a mobilization of free fatty acids and glycerol from the fat stores. However, the liver cannot deal with the acetyl-CoA, which results from the oxidization of these fatty acids, because of a lack of energy. The excess acetyl-CoA is converted into the ketone bodies, acetoacetate and b -hydroxybutyrate and, to a small extent, acetone. Tissues other than the liver can use ketone bodies, but if their production exceeds the rate at which they are used by muscle and other tissues, they accumulate, and ketosis is the result. Ketone bodies are excreted in milk and urine.

The reduction of propionic acid production is usually the result of underfeeding or a reduced feed intake caused by inappetance. The inappetance may be caused by a deterioration of forage quality, sudden changes in diet or excessive fatness at calving. Other risk factors are parity, ketosis in the previous lactation, 305-day milk yield in the previous lactation and the average milk protein percentage in the previous lactation. Butyrate is a precursor of acetyl-CoA and is therefore ketogenic. In the UK, the butyric acid content of silage is of considerable importance in the aetiology of the disease, because wet conditions predispose to butyric fermentation of the silage. Silage intake containing high levels of butyric acid is also less palatable to cattle.

Secondary ketosis

Secondary ketosis is common and is the result of diseases causing a reduction in appetite in early lactation, such as displaced abomasum, mastitis, metritis, etc. In areas of cobalt deficiency, ketosis is commonly diagnosed in grazing cattle. Cobalt is required for rumen microbial synthesis of vitamin B12 and is also essential for adequate utilization of propionic acid.

Etiology and Pathogenesis

The pathogenesis of bovine ketosis is incompletely understood, but it requires the combination of intense adipose mobilization and a high glucose demand. Both of these conditions are present in early lactation, at which time negative energy balance leads to adipose mobilization and milk synthesis creates a high glucose demand. Adipose mobilization is accompanied by high blood serum concentrations of nonesterified fatty acids (NEFA). During periods of intense gluconeogenesis, a large portion of serum NEFA is directed to ketone body synthesis in the liver. Thus, the clinicopathologic characterization of ketosis includes high serum concentrations of NEFA and ketone bodies and low concentrations of glucose.

In contrast to many other species, cattle with hyperketonemia do not have concurrent acidemia. The serum ketone bodies are acetone, acetoacetate, and β-hydroxybutyrate (BHB). There is speculation that the pathogenesis of ketosis cases occurring in the immediate postpartum period is slightly different than that of cases occurring closer to the time of peak milk production.

Cases of ketosis in very early lactation are usually associated with fatty liver. Both fatty liver and ketosis are probably part of a spectrum of conditions associated with intense fat mobilization in cattle. Ketosis cases occurring closer to peak milk production, which usually occurs at 4-6 wk postpartum, may be more closely associated with underfed cattle experiencing a metabolic shortage of gluconeogenic precursors than with excessive fat mobilization. The exact pathogenesis of the clinical signs is not known. They do not appear to be associated directly with serum concentrations of either glucose or ketone bodies. There is speculation that they may be due to metabolites of the ketone bodies.

Epidemiology:

All dairy cows in early lactation (first 6 wk) are at risk of ketosis. The incidence in lactation is estimated at 5-16%, but incidence in individual herds varies substantially. Ketosis occurs in all parities (although it appears to be less commin in primiparous animals) and does not appear to have a genetic predisposition, other than being associated with dairy breeds. Cows with excessive adipose stores (body condition score ≥3.75 out of 5.0) at calving are at increased risk of ketosis, compared with those with lower body condition scores. Lactating cows with hyperketonemia (subclinical ketosis—serum BHB concentrations >12 mg/dL) are at increased risk of developing clinical ketosis, compared with cows with lower serum BHB concentrations.

Clinical Findings:

In cows maintained in confinement stalls, reduced feed intake is usually the first sign of ketosis. If rations are offered in components, cows with ketosis often refuse grain before forage. In group-fed herds, reduced milk production, lethargy, and an “empty” appearing abdomen are usually the signs of ketosis noticed first. On physical examination, cows are afebrile and may be slightly dehydrated. Rumen motility is variable, being hyperactive in some cases and hypoactive in others. In many cases there are no other physical abnormalities.

CNS disturbances are noted in a minority of cases. These include abnormal licking and chewing, with cows sometimes chewing incessantly on pipes and other objects in their surroundings. Incoordination and gait abnormalities occasionally are seen, as are aggression and bellowing. These signs occur in a clear minority of cases, but because the disease is so common, finding animals with these signs is not unusual.

Diagnosis:

The clinical diagnosis of ketosis is based on presence of risk factors (early lactation), clinical signs, and ketone bodies in urine or milk. When a diagnosis of ketosis is made, a thorough physical examination should be performed because frequently ketosis occurs concurrently with other peripartum diseases. Especially common concurrent diseases include displaced abomasum, retained fetal membranes, and metritis. Rabies and other CNS diseases are important differential diagnoses.

Trace to mildly positive results for the presence of ketone bodies in urine do not signify clinical ketosis. Without clinical signs, such as partial anorexia, these results indicate subclinical ketosis. Milk tests for acetone and acetoacetate are more specific than urine tests. Positive milk tests for acetoacetate and/or acetone usually indicate clinical ketosis. A dipstick designed to detect BHB in milk, available in Japan and Europe, is more sensitive than milk tests for acetone and acetoacetate and may be useful for monitoring incidence of subclinical ketosis.

Treatment

Treatment is aimed at reestablishing normoglycemia and reducing serum ketone body concentrations. Bolus IV administration of 500 mL of 50% dextrose solution is a common therapy. This solution is very hyperosmotic and, if administered perivascularly, results in severe tissue swelling and irritation, so care should be taken to assure that it is given IV.

Bolus glucose therapy generally results in rapid recovery, especially in cases occurring near peak lactation. However, the effect frequently is transient and relapses are common. Administration of glucocorticoids including dexamethasone or isoflupredone acetate at 5-20 mg/dose, IM, generally results in a more sustained response. Glucose and glucocorticoid therapy may be repeated daily as necessary.

Propylene glycol (250-400 g/dose, PO, [~8-14 oz]) acts as a glucose precursor and may be effective as ketosis therapy, especially in mild cases or in combination with other therapies. This dose may be administered twice per day. Overdosing propylene glycol leads to CNS depression.

Ketosis cases occurring within the first 1-2 wk after calving frequently are more refractory to therapy than those cases occurring nearer to peak lactation. In these cases, a long-acting insulin preparation given IM at 150-200 IU/day may be beneficial. Insulin suppresses both adipose mobilization and ketogenesis, but should be given in combination with glucose or a glucocorticoid to prevent hypoglycemia. Use of insulin in this manner is an extra-label, unapproved use. Other therapies that may be of benefit in refractory ketosis cases are continuous IV glucose infusion and tube feeding.

Prevention and Control:

Prevention of ketosis is via nutritional management. Body condition should be managed in late lactation, when cows frequently become too fat.

The dry period is generally too late to reduce body condition score. Reducing body condition in the dry period may even be counterproductive, resulting in excessive adipose mobilization prepartum.

A critical area in ketosis prevention is maintaining and promoting feed intake. Cows tend to reduce feed consumption in the last 3 wk of gestation. Nutritional management should be aimed at minimizing this reduction. Controversy exists over the optimal dietary characteristics during this period.

It is likely that optimal energy and fiber concentrations in rations for cows in the last 3 wk of gestation vary from farm to farm. Feed intake should be monitored and rations adjusted to maximize dry matter and energy consumption in late gestation. After calving, diets should promote rapid and sustained increases in feed and energy consumption. Rations should be relatively high in nonfiber carbohydrate concentration, but contain enough fiber to maintain rumen health and feed intake. Neutral-detergent fiber concentrations should usually be in the range of 28-30% with nonfiber carbohydrate concentrations in the range of 38-41%.

Dietary particle size will influence the optimal proportions of carbohydrate fractions. Some feed additives, including niacin, calcium propionate, sodium propionate, propylene glycol, and rumen-protected choline, may be beneficial in preventing and managing ketosis. To be effective, these supplements should be fed in the last 2-3 wk of gestation, as well as during the period of ketosis susceptibility.

A cat Drunk Some Water From The Lily Vase (Case)

2015-07-15T02:01:00.001-07:00

Test Your Knowledge

Question

You receive a telephone call from a client asking for some advice. Her 1-year old male neutered domestic shorthair cat has just drunk some water from the lily vase.
The client knows that lilies can be harmful to cats, is not sure why she kept them in the house (!) and wants to know if she needs to be concerned. What do you recommend?

Answer

Yes, be concerned, be very concerned!
Lilies can cause renal toxicity in domestic cats and at this time this is thought to be a non-dose dependent idiosyncratic type of toxicity.
There are reports of cats developing acute kidney injury after drinking vase water in which lilies have been immersed and you should advise that the client brings the cat to the practice. Gastrointestinal decontamination may be considered if within a suitable time frame and the cat should be hospitalised on intravenous fluids for 48-72 hours. A baseline blood renal panel and urinalysis is recommended and screening should be repeated prior to discontinuing fluids and discharging the kitty.

Chocolate Poisoning in Dog (Case)

2015-07-12T07:34:00.004-07:00

Chocolate Poisoning in Dog

Question

A 2-year old female neutered Crossbreed dog is presented 90 minutes after ingesting 2 pieces of luxury dark chocolate.
At presentation the dog is bright and alert and physical examination is unremarkable. How would you proceed to manage this case?

Answer:
Although she has only eaten 2 pieces of chocolate, the theobromine concentration of luxury dark chocolates can be very high so consult appropriate resources to work out what the risk is here.
Further evaluation suggests that the amount of theobromine consumed by this patient is very close to the toxic dose for dogs and you should proceed with gastrointestinal decontamination.
There are no contraindications for inducing emesis in this patient at this time so this should be done, ideally using apomorphine, and followed up with multidose activated charcoal. The patient should be fine to go home once she has recovered adequately from having emesis induced. Administering metoclopramide once sufficient emesis has occurred can be a nice patient-friendly thing to do!

Pain management in Pets

2015-06-21T04:21:00.000-07:00

Question
Should tramadol be used as a first line treatment for pain caused by osteoarthritis in cats and dogs?

Answer

Despite being unlicensed, and recently being reclassified as a Schedule 3 drug, Tramadol is a popular oral analgesic for the management of chronic pain in dogs and cats. Tramadol is a centrally acting synthetic analogue of codeine that has two different principle analgesic modes of action. Tramadol and O-desmethyl metabolites exert an agonist effect at opioid receptors as well as inhibiting norepinephrine and serotonin re uptake in the central nervous system (CNS) thereby modulating descending analgesia pathways. Reasons for choosing Tramadol for the management of osteoarthritis pain include a perceived lack of side effects, particularly in relation to NSAIDs, cost (it is cheap), and perceived efficacy.
However it is worth noting that the evidence base for Tramadol in both cats and dogs for the management of chronic pain is very weak to non existent, and owner reported efficacy of a treatment, due to the placebo effect, is not the most robust means to assess efficacy of an analgesic treatment.
The analgesia provided by Tramadol is dependent on the action of the parent drug (which provides mainly non opioid mediated analgesia) and the production of metabolites (which probably provide opioid mediated analgesia). However in dogs, metabolism of tramadol is very variable, with a range of different metabolites being produced. Furthermore, many dogs produce very little of the metabolite that mediates opioid analgesia, limiting the analgesic efficacy of the drug in these dogs.
Cats probably produce more of the metabolite that mediates opioid analgesia, which is advantageous, but on the other hand, the opioid like metabolite is probably also associated with more side effects (sedation, drowsiness, dysphoria, nausea).
Given the current evidence base for Tramadol, NSAIDs should be considered the first line treatment for osteoarthritis related pain in both cats and dogs. There are NSAIDs licensed for this indication in both species and a large evidence base to support efficacy. Tramadol should be considered a second line therapy, either in dogs and cats that are intolerant of NSAIDs or to support NSAID therapy in animals where NSAIDs alone provide inadequate pain relief.

How to Become a Veterinarian

2015-06-11T10:45:00.000-07:00

Becoming a veterinarian or how to become a veterinarian
Occupational Specialty: veterinarianClassification of professional specialization: research / investigation

The nature of work:A veterinarians plays a big and important role in pet health care, livestock, zoo animals, the animals that participate in sporting events and laboratory animals. Also plays a big role in the protection of human from animal diseases & vice versa. Some specializes in the application of basic knowledge and theories using new science and knowledge and it processes to treating pets in the backyard, such as cats, dogs, birds, rabbits and other domestic animals. Some work on the treatment of several different animals such as pigs, goats, sheep.
The veterinary also diagnose of health problems for the animals and give them medical vaccines against diseases, and treating infectious diseases of the animals in the field, treatment of fractures and heal the wounds, surgical procedure, giving animal owners advises on how to feed them, train them, breeding. Some of them responsible for large-sized animals such as treatment horses, cattle and securing proper food from farms and veterinary field. A veterinarian use medical equipment such as a microscope, a surgical equipment &diagnostic equipment such as X-ultrasound.

Working conditions:
Working a long hours, and they may work under demand through phone calls throughout their work at night and the holiday period and for a veterinarian who works independently solo may even work weekends and be responsible for all emergency telephone calls, always their workplace crowded and annoying . And a veterinarians who work on farms spend most of their time between the fields in the outdoors, are forced to perform surgeries for animals under unhygienic conditions, their dealings with animals that may become panicked and pain when detect them, which may expose them to biting, kicking, scratching.
Veterinarians working in the field of research and development are the cleanest places of work and non-annoying and are dealing with human beings instead of animals.

Academic qualification:
A doctorate in veterinary medicine duration is 4 years, in addition to training courses in how to deal with situations when animals panic and he has the patience and the length of mind and ability to deal with the animals because dealing with them difficult.

Veterinarian and dentist collaborate to help cat through unique dental procedure

2014-11-15T00:39:00.002-08:00

A Siamese-mix cat named Darryl is recuperating well after receiving a metal prosthesis to correct a palate injury in his mouth, thanks to a unique collaborative dental procedure performed Oct. 29 at the University of Florida Small Animal Hospital.
The procedure involved affixing a metal prosthesis to the roof of Darryl's mouth to close a gaping hole between his oral and his nasal cavities. Fong Wong, D.D.S., an associate professor of prosthodontics and maxillofacial prosthetics in UF's College of Dentistry, conducted the procedure and was assisted by Amy Stone, D.V.M., Ph.D., a clinical assistant professor in UF's College of Veterinary Medicine.
This is a procedure Wong routinely performs in human patients with cleft palates or defects after cancer surgery.
"This was a different approach than has ever been done before," said Stone, who also serves as chief of the veterinary college's primary care and dentistry service. "We have not had an exact procedure for palate issues that is entirely successful for every species, and Darryl's problem was one likely caused, or at least exacerbated, by injury. There were also other complications, so his situation required something a bit different."
Added Wong, "Usually medical procedures are first tried in animals, and then, when successful, used in human patients. In this case, it was the animal that benefited from a procedure that is routine in humans but has not been part of routine veterinary medicine."
Darryl was originally rescued from Alachua County Animal Services, where he had been slated for euthanasia, by the Alachua County Humane Society. Even though the massive hole in his hard palate was obvious, Darryl quickly became a staff favorite, said Julie Levy, D.V.M., Ph.D., a professor of shelter medicine at UF who fostered Darryl and later adopted him.
"Every bite of food he took was painful, and he had constant nasal infections," Levy said. "Despite struggling to eat and being extremely messy with his food, he was always affectionate and craved attention from staff and volunteers."
But his condition made adoption impossible, so Darryl became a long-term resident of the Humane Society. Levy meanwhile began investigating solutions to his palate problem and transferred the cat to the Maddie's Shelter Medicine Program at UF.
Various specialists at UF examined Darryl. Katherine Polak, D.V.M., a former UF shelter medicine resident, performed an examination in February. Then Nick Bacon, Vet.M.B., an associate professor of small animal oncology, conducted a biopsy of an oral lesion to rule out cancer. A feeding tube was inserted a few months later, allowing Darryl to gain weight and for his mouth to heal without the trauma of eating and drinking.
By April, Levy had taken Darryl into her home as her foster pet in order to provide the intensive care she knew was needed to bring him back to health. Various specialists weighed in, or attempted to heal Darryl's palate defect. Soon after Levy contacted UF's College of Dentistry seeking assistance, Wong got involved.
After performing a separate examination, she proposed a prosthodontic solution. In August, she made a cast of Darryl's mouth and crafted a custom acrylic appliance to cover the defect. The appliance was sutured into place on a trial basis to see if the approach would work in a cat.
The approach was successful, and on Oct. 29, Darryl's permanent metal prosthesis was installed. His feeding tube was removed two days after the procedure and he was able to eat normally for the first time in more than a year.
"He is doing great," Levy said. "Many thanks to the entire team who pitched in to help this lovely cat."