Heatstroke in small animal medicine: a clinical practice review

Objective: To review the pathophysiology, diagnosis, current treatment, and prognosis of heatstroke. Etiology: Heatstroke can be a life‐threatening condition occurring because of an imbalance of heat dissipation and production. Certain factors may predispose some animals to heatstroke. The pathophysiology and sequelae of heatstroke share similarities with that of sepsis; thus, multiple organ dysfunction often ensues. The pathophysiological derangements that occur with heatstroke result from a complex series of events associated with direct cytotoxicity of heat and initiation of the acute‐phase response by endotoxin, inflammatory cytokines, and chemokines. Activation of endothelial cells, coagulation factors, and fibrinolysis (with ensuing microvascular thrombosis) leads to hypoxia and organ dysfunction. Heat shock proteins produced secondary to sudden heating act as protein chaperones or molecular guardians to provide protection against future heatstroke and may be implicated as a possible genetic component of heatstroke. Diagnosis: A history of recent exercise or being confined in a hot and/or humid environment, combined with clinical signs such as body temperature above 40°C (104°F), panting, tachycardia, hyperemia, dry mucous membranes, and depression to prostration is consistent with a diagnosis of heatstroke. A complete blood count performed during the initial examination of dogs with suspected heatstroke often includes nucleated red blood cells. Therapy: The mainstays for treating heatstroke include rapid evaporative cooling, volume replacement to provide cardiovascular support, and management of secondary complications. Prognosis: The prognosis is multifactorial. There is a significant negative correlation between comatose mental status, decreased temperature, and hypoglycemia with mortality.     

Diethylstilboestrol—clinical pharmacology and alternatives in small animal practice

Diethylstilboestrol is currently only available in Australia for oral use in dogs and cats. As an orally and systemically active non-steroidal oestrogen, DES has been widely used in small animal veterinary medicine for a variety of indications. A review of the literature reveals that many of the recommendations for use are founded on anecdotal or unreported clinical observations. While many of the uses may be valid, accurate determinations of optimum dosing regimens have not been defined. This is especially unfortunate in view of the potential toxicity of DES to small animals. Nevertheless, particularly in cases of low-dose intermittent administration, oral DES appears indicated at least until data on alternative safe and effective interventions become available.     

The possibilities and limitations of animal dentistry in the small animal practice

This paper points out, which dental diseases can be treated successfully in the general veterinary practice and which patients should be assigned to a veterinary dental referral practice. Furthermore, the occurrence and shape of defects in the enamel and cementum are discussed, which can be caused by incorrect use of ultrasonic scalers or sharp edges of the instrument tips.     

The present and future of opioid analgesics in small animal practice

Opioids are the cornerstone for the treatment of acute pain in small animal patients. This is primarily because of their remarkable safety profile, high efficacy, and benefit of reversibility. There have been some significant advances in our knowledge on opioid pharmacology and clinical usage in companion animal medicine. This review discusses the progression of opioid use in small animal practice providing current misconceptions and controversies in light of routes of administration. Potential targets for research and drug development and novel therapies are discussed in addition to the concepts of glial cell modulators, individual variability, and opioid tolerance and hyperalgesia. The future brings an interesting perspective with the application of pharmacogenetics and individualized pain management in canine and feline practice.     

The lack of analgesic use (oligoanalgesia) in small animal practice

Oligoanalgesia is defined as failure to provide analgesia in patients with acute pain. Treatment of pain in emergencies, critical care and perioperatively may influence patient outcomes: the harmful practice of withholding analgesics occurs in teaching hospitals and private practices and results in severe physiological consequences. This article discusses the prevalence, primary causes, species and regional differences and ways to avoid oligoanalgesia in small animal practice. Oligoanalgesia may be addressed by improving education on pain management in the veterinary curriculum, providing continuing education to veterinarians and implementing pain scales.     

Attitudes, procedures, and delivery of behavior services by veterinarians in small animal practice

OBJECTIVE: To survey veterinarians in small animal practice concerning their attitudes about delivery of behavior services, frequency of common behavior problems, manner in which services were provided, confidence in their clinical ability to treat these behavior problems, frequency of use of pharmacologic intervention, and number of dogs and cats euthanatized specifically because of behavior problems. DESIGN: Cross-sectional mail survey. SAMPLE POPULATION: Random sample of veterinarians in small animal practice in the United States. PROCEDURE: A self-administered mail survey was sent to a random sample of 2,000 veterinarians. Results were tabulated and statistically analyzed. RESULTS: It was estimated that approximately 224,000 dogs and cats were euthanatized annually in small animal veterinary practices in the United States because of behavior problems. Although veterinarians seemed unwilling to euthanatize animals for behavior problems solely on the basis of a client's request, many veterinarians did not routinely inquire about animal behavior and often were not confident in their clinical skills to treat behavior problems. Female veterinarians tended to be more proactive in addressing behavior problems and to have more positive attitudes than male veterinarians about the importance of animal behavior. CONCLUSIONS AND CLINICAL RELEVANCE: Efforts are needed to increase the number of veterinarians who systematically incorporate inquiries about animal behavior into routine clinical practice and to build the confidence of veterinarians for diagnosing and treating animal behavior problems.     

A survey of anaesthesia in small animal practice: AVA/BSAVA report

Over 150 veterinary surgeons from 53 small animal practices collaborated in a prospective survey of anaesthetic accidents and emergencies by recording all anaesthetics administered and detailing the problems they encountered. From these records it is estimated that 1 in 679 of the healthy dogs and cats died primarily as a result of anaesthesia; many of these deaths apparently occurred at a time when the animal was not under close observation. Anaesthetics involving the use of xylazine seemed to result in an exceptionally high mortality rate. Complications following endotracheal intubation appeared to be associated with several deaths in cats. The death rate in cats and dogs with pathological but not immediately life-threatening conditions was estimated to be 1 in 31. There was no evidence to suggest that some breeds (with the possible exception of the Pekingese) were more likely than others to die under anaesthesia.     

Advances in wound healing in small animal practice: current status and lines of development

Abstract In the past 5 years advances in the management of wounds in dogs and cats have included the development of materials and techniques used to enhance the healing of both open and closed wounds. New topical and locally injected medications as well as new bandaging materials have been evaluated. The use of omental flaps to enhance wound healing has been found to be promising. Ultrasonography has been found useful in assessing wound tissues to guide treatment. Because tension is a major factor in dealing with wound closure, skin expanders, skin stretchers, presutures and adjustable horizontal mattress sutures have been described as means of overcoming tension. Recently completed research projects at the Scott-Ritchey Research Center studied the woundhealing effects of fibrin sealants, topical bovine collagen, omega-3 fatty acid-enriched diets and magnetic field therapy. Projects underway are evaluating the healing effects of a new biological tissue adhesive, a macrophage stimulant and a thromboxane synthestase inhibitor. Parameters for evaluating wound healing have included histopathology, tensiometry, planimetry, laser Doppler image scanning, biochemistry and immunohistochemistry. Resumen En los últimos 5 años, algunos de los avances en la curación de heridas en perros y gatos ha incluido el desarrollo de materiales y técnicas utilizados para mejorar la curación tanto de heridas cerradas como abiertas. Se han evaluado nuevas medicaciones tópicas y sistémicas asi como nuevos marteriales de vendaje. El us0 de injertos omentales para estimular la curación de heridas ha mostrado resultados prometedores. La ecografia es un método éutil en la valoración de los tejidos lesionados para guiar el tratamiento. Debido a que la tensión es un factor importante en el caso de cerramiento de heridas, se describen como métodos de evitar la tensión productos como expansores cutáneos, estiradores cutáneos, presuturas y suturas cutáneas horizontales acolchonadas ajustables. Algunos proyectos de investigación recientemente finalizados en el Centro de Investigación Scott-Ritchey estudiaron los efectos sobre la curación de heridas de selladores de fibrina, colágeno tópico bovino, dietas enriquecidas con ácido graso omega-3 y terapia de campo magnético. Otros proyectos en realización están evaluando los efectos curativos de un nuevo adhesivo tisular biológico, un estimulante de macrófagos y un inhibidor de la tromboxano-sintetasa. Los parámetros para evaluar la curación de herida han incluido la histopatología, la tensiometría, la planimetría, el scanner por imágen doppler laser, bioquímica e inmunohistoquímica. [Swaim, S.F. Advances in wound healing in small animal practice: current status and lines of development (Avances en la curcion de heridas en pequeños animales: estado actual y lineas de desarrollo). Veterinary Dermatology 1997; 8 : 249–257] Zusammenfassung In den letzten 5 Jahren wurden Fortschritte in der Wundversorgung bei Hund und Katze unter anderem durch die Entwicklung von Materialien und Techniken erzielt, die zur besseren Heilung von offenen und geschlossenen Wunden verwendet werden. Neue lokale und systemische Medikamente sowie neue Verbandsmaterialien wurden untersucht. Die Verwendung von Omentumlappen zur Verbesserung der Wundheilung scheint vielversprechend zu sein. Ultraschalluntersuchungen waren von Nutzen, um Wundgewebe zu beurteilen und die Behandlung zu lenken. Spannung ist ein wesentlicher Faktor im Wundverschluss, Hautexpander, Hautdehner, vorbereitende Nähte und regulierbare, horizontale Matratzennähte wurden zur Überwindung der Wundspannung beschrieben. Kürzlich fertiggestellte Forschungsprojekte am Scott-Ritchie Research Center erforschten die Effekte von Fibrindichtungsmitteln, lokalem bovinen Kollagen, Futtermitteln mit Omega-3 Fettsäurenzusatz und Magnetfeldtherapie. Gegenwärtige Forschungsprojekte bewerten die Heilungseffekte eines neuen, biologischen Gewebehaftmittels, eines Makrophagenstimulans und eines Thromboxansynthetasehemmers. Parameter zur Bewertung der Wundheilung waren Histopathologie, Tensiometrie, Planimetrie, Laser Doppler, physiologische Chemie und Immunhistochemie. [Swaim, S.F. Advances in wound healing in small animal practice: current status and lines of development (Fortschritte bei der Wundheilung in der Kleintierpraxis: Derzeitiger Stand und Entwicklung). Veterinary Dermatology 1997; 8: 249–257] Résumé Durant les 5 dernières années, le progrés dans le traitement des plaies chez les chiens et les chats ont inclus le développement de matériaux et de techniques utilisés pour augmenter la cicatrisation des plaies ouvertes et fermées. De nouvelles médications topiques et systémiques ainsi que de nouveaux matériaux de bandages ont étéévalués. L'utilisation de lambeaux d'éplipon s'est révélée prometteuse dans l'amélioration de la cicatrisation des plaies. L'ultrasonographie s'est montrée utile dans le traitement de guidance de l'évaluation des plaies tissulaires. La tension étant un facteur major lors de la fermeture de plaies, expansseurs cutanés, étireurs cutanés et surjets de matelassier ajustables ont tous été décrits comme moyens permettant de vaincre la tension. Récemment des projets de recherche achevés au Scott-Ritchey Research Center ont étudiés les effets des joints de fibrine, du collagène bovin topique, des régimes enrichis en acides gras omega-3 et de la thérapies de champs magnétiques sur la cicatrisation des plaies. Les projets mis en route sont l'évaluation des effets sur la cicatrisation d'un nouvel adhésif tissulaire biologique, d'un stimulant de macrophages et d'un nouvel inhibiteur de la thromboxane synthase. Les paramètres intervenant dans l'évaluation de la cicatrisation des plaies ont inclus l'histopathologie, la tensiométrie, la planimétrie, le laser Doppler, l'imagerie, la biochimie et l'immunohistochimie. [Swaim, S.F. Advances in wound healing in small animal practice: current status and lines of development (Progres de la cicatrisation en pratique des petits animaux: etat actuel et lignes de developpement). Veterinary Dermatology 1997; 8 : 249–257]     

A review of the physiological effects of alpha2-agonists related to the clinical use of medetomidine in small animal practice

Medetomidine is a relatively new sedative analgesic drug that is approved for use in dogs in Canada. It is the most potent alpha2-adrenoreceptor available for clinical use in veterinary medicine and stimulates receptors centrally to produce dose-dependent sedation and analgesia. Significant dose sparing properties occur when medetomidine is combined with other anesthetic agents correlating with the high affinity of this drug to the alpha2-adrenoreceptor. Hypoventilation occurs with medetomidine sedation in dogs; however, respiratory depression becomes most significant when given in combination with other sedative or injectable agents. The typical negative cardiovascular effects produced with other alpha2-agonists (bradycardia, bradyarrhythmias, a reduction in cardiac output, hypertension +/- hypotension) are also produced with medetomidine, warranting precautions when it is used and necessitating appropriate patient selection (young, middle-aged healthy animals). While hypotension may occur, sedative doses of medetomidine typically raise the blood pressure, due to the effect on peripheral alpha2-adrenoreceptors. Anticholinergic premedication has been recommended with alpha2-agonists to prevent bradyarrhythmias and, potentially, the reduction in cardiac output produced by these agents; however, current research does not demonstrate a clear improvement in cardiovascular function. Negatively, the anticholinergic induced increase in heart rate potentiates the alpha2-agonist mediated hypertension and may increase myocardial oxygen tension, demand, and workload. Overall, reversal with the specific antagonist atipamezole is recommended when significant cardiorespiratory complications occur. Other physiological effects of medetomidine sedation include; vomiting, increased urine volumes, changes to endocrine function and uterine activity, decreased intestinal motility, decreased intraocular pressure and potentially hypothermia, muscle twitching, and cyanosis. Decreased doses of medetomidine, compared with the recommended label dose, should be considered in combination with other sedatives to enhance sedation and analgesia and lower the duration and potential severity of the negative cardiovascular side effects. The literature was searched in Pubmed, Medline, Agricola, CAB direct, and Biological Sciences.     

Occupational health and safety in small animal veterinary practice: Part I--nonparasitic zoonotic diseases

Zoonotic diseases are an ever-present concern in small animal veterinary practice and are often overlooked. A variety of nonparasitic zoonotic diseases may be encountered in small animal practice, including cat scratch disease (bartonellosis), cat bite abscesses, rabies, leptospirosis, methicillin-resistant Staphylococcus aureus, Clostridium difficile-associated diarrhea, salmonellosis, avian chlamydiosis, campylobacteriosis, dermatophytosis, and blastomycosis. These may cause human disease ranging from mild and self-limiting to fatal. The risk of development of a zoonotic disease can be lessened by early recognition of infected animals, proper animal handling, basic biosecurity precautions, and, most importantly, personal hygiene.     

The responsible use of chloramphenicol in small animal practice. 1. Pharmacological considerations

Three important criteria which the clinician should consider when selecting an antibiotic are its antibacterial spectrum, pharmacokinetic properties, and potential toxicity. Pharmacokinetics is a study of how the body handles drugs: that is, their absorption, distribution in the tissues (an antibiotic must reach the site of infection in effective concentration), metabolism and excretion. This article reviews these criteria with respect to chloramphenicol in dogs and cats.     

Incidence of antibodies to Borrelia burgdorferi in dogs in small animal practice in North Bavaria]

With help of indirect immunofluorescent assay antibodies were detected to Borrelia burgdorferi, agent of Lyme borreliosis in 46 (35.5%) serum samples of 130 randomly selected dogs of a small animal practice in Northern Bavaria. A positive reaction of the indirect immunofluorescent assay was demonstrated in 15 cases in a serum dilution of 1:64, in 9 cases in a serum dilution of 1:128, in 5 cases in a serum dilution of 1:256, in 2 cases in a serum dilution of 1:512, in 3 cases in a serum dilution of 1:1024, in 2 cases in a serum dilution of 1:2048 and in 10 cases in a serum dilution of 1:4096 and higher. There was significant correlation between the symptoms pain of segments or muscles in dorsal region, between painful arthritis, between paralysis of hind legs or between chronic erythema ("hot spot") and the positive reaction of the immunofluorescent assay in the serum dilution of 1:256 ("borderline titre") and higher.     

Clinical skills and knowledge used by veterinary graduates during their first year in small animal practice

OBJECTIVE: To determine the clinical skills and areas of knowledge used by veterinarians in small animal practice during their first year after graduation and the degree of assistance and supervision they received while developing these skills. DESIGN: A postal survey was sent in December 1999 to 59 veterinarians who completed their training at Murdoch University in December 1998. PROCEDURE: The first part of the survey asked for information on veterinary work patterns since leaving university. The second part consisted of a list of diagnostic and therapeutic skills of varying complexity and the graduates were asked to indicate whether they had used these skills in practice and whether they had been assisted or supervised while doing them. The respondents were also asked if they had had the opportunity to practise these skills as undergraduates at university or during extramural experience. In the third part the areas of knowledge used in practice were assessed by analysis of a series of consecutive cases. RESULTS: Forty replies were received but since three graduates had done no small animal work the analysis of the skills section is based on 37 responses. Thirty graduates supplied information on 994 canine cases and 308 feline cases. The distribution of the mean work time was dogs and cats 69%, horses 13%, farm animals 11%, birds 3% and others 4%. Skills used by over 90% of graduates included general anaesthesia, examination of the tympanic membrane, taking and interpreting an abdominal radiograph, catheterising a male cat, fine needle aspiration of a mass, neutering dogs and cats, tooth scaling and extraction and treating an aural haematoma. The survey also identified the opportunities for undergraduates to practise some of these skills during extramural experence and the extent of assistance given to new graduates during their first year in practice. The areas of knowledge used in over 10% of the cases included vaccination, anaesthesia/sedation, skin/coat problems, general advice on pet health, neutering and musculoskeletal diseases. CONCLUSION: Veterinarians, in their first year after graduation, use a wide range of complex diagnostic and therapeutic skills. Although many of these skills are acquired during the undergraduate training, a significant contribution is made by extramural practical work undertaken during the clinical years of the undergraduate course and in the first year following graduation. Practising veterinarians play an important role in providing opportunities and supervision for clinical training.     

Clinical skills and knowledge used by veterinary graduates during their first year in small animal practice

Objective To determine the clinical skills and areas of knowledge used by veterinarians in small animal practice during their first year after graduation and the degree of assistance and supervision they received while developing these skills. Design A postal survey was sent in December 1999 to 59 veterinarians who completed their training at Murdoch University in December 1998. Procedure The first part of the survey asked for information on veterinary work patterns since leaving university. The second part consisted of a list of diagnostic and therapeutic skills of varying complexity and the graduates were asked to indicate whether they had used these skills in practice and whether they had been assisted or supervised while doing them. The respondents were also asked if they had had the opportunity to practise these skills as undergraduates at university or during extramural experience. In the third part the areas of knowledge used in practice were assessed by analysis of a series of consecutive cases. Results Forty replies were received but since three graduates had done no small animal work the analysis of the skills section is based on 37 responses. Thirty graduates supplied information on 994 canine cases and 308 feline cases. The distribution of the mean work time was dogs and cats 69%, horses 13%, farm animals 11%, birds 3% and others 4%. Skills used by over 90% of graduates included general anaesthesia, examination of the tympanic membrane, taking and interpreting an abdominal radiograph, catheterising a male cat, fine needle aspiration of a mass, neutering dogs and cats, tooth scaling and extraction and treating an aural haematoma. The survey also identified the opportunities for undergraduates to practise some of these skills during extramural experience and the extent of assistance given to new graduates during their first year in practice. The areas of knowledge used in over 10% of the cases included vaccination, anaesthesia/sedation, skin/coat problems, general advice on pet health, neutering and musculoskeletal diseases. Conclusion Veterinarians, in their first year after graduation, use a wide range of complex diagnostic and therapeutic skills. Although many of these skills are acquired during the undergraduate training, a significant contribution is made by extramural practical work undertaken during the clinical years of the undergraduate course and in the first year following graduation. Practising veterinarians play an important role in providing opportunities and supervision for clinical training.     

The clinical practice of CPCR in small animals: an internet‐based survey

Objective – To characterize the provision of CPCR by small animal veterinarians in clinical practice and to assess how this practice varies among different levels of expertise. Design – Internet‐based survey. Setting – Academia, referral practice, and general practice. Subjects – Six hundred and two small animal veterinarians in clinical practice. Respondents were grouped a priori according to level of expertise: board‐certified (ACVECC, ACVA, ECVAA) specialists; general practitioners in emergency clinics; general practitioners in general practice (GPG). Interventions – Email invitations to the online questionnaire were disseminated via a veterinary internet platform and mailing list server discussion groups. Questions explored respondent characteristics, CPCR preparedness, infrastructural and personnel resources, and techniques of basic and advanced life support. Main Results – In this group of practitioners, the majority (65%) were in general practice. GPG were more likely to perform CPCR <5 times per year and to have 3 or fewer members on their resuscitation team. Most practitioners have a crash cart and drug‐dosing chart available. GPG were less likely to obtain resuscitation codes on their patients, and less likely to use end‐tidal carbon dioxide monitoring or defibrillation. Intubation, oxygen supplementation, vascular access, and external thoracic compressions were widely used, however, GPG were more likely to use lower chest compression rates. Drugs used for CPCR differed among the groups with GPG more likely to use doxapram and glucocorticoids. Conclusions – CPCR is heterogeneously performed in small animal veterinary medicine; differences exist, both among and within different types of veterinarians with varying levels of expertise, in respect to available infrastructure, personnel and CPCR techniques used.     

Pros and cons of using alpha-2 agonists in small animal anesthesia practice

The alpha-2 agonists have been used in veterinary practice for over 30 years following the introduction of xylazine (ROMPUN, Bayer Corp., Shawnee Mission, KS) in 1962. The decision to use alpha-2 agonists in anesthesia practice should be based on factors including patient disposition, presenting complaint, type of procedure, and the veterinarian's familiarity with the drug. Controversy surrounds the issue of using anticholinergic agents concurrent with the alpha-2 agonists. Patient selection and procedure type can aid in determining when use of an anticholinergic with the alpha-2 agonist is advantageous. Antagonism of alpha-2 agonists can be readily accomplished. Commonly, alpha-2 agonists are used in combination with other agents to provide neuroleptanalgesia or sedation prior to general anesthesia.