Building a practice with a computer

It should be emphasized that the primary function of the computer is information-handling and communication. It remembers who and when and why, organizes the information, and then communicates by reminders, letters, labels, word processing, and statements. The computer becomes a faithful employee, not altogether immune from physical illness but generally ready to work at the flip of a switch. Best of all, the computer never asks for overtime or a percentage of the profits.     

Building a practice. Budget forecasts and performance monitoring

In order to run a small business effectively you must be in financial control and this means that you have to be aware how the business is performing. If you wait until your accountant has got out the annual accounts valuable time has been wasted in making necessary decisions and corrections to poor trends in your business so monthly/quarterly records are required. Decisions as to whether you can afford to take another assistant, set up a branch surgery, the level of your fee increases, whether to buy or lease your cars; are all dependent on having available up to date financial knowledge of your business. If you have a microcomputer in the practice you can use spreadsheets which will allow the accurate prediction of cash flow or profitability. You can also ask the question 'what happens if...?' and get the answer in seconds. But even without a computer, financial control can be easily maintained if you are prepared to spend a couple of hours each month with your practice figures.     

Thoracotomy in adult dairy cattle: 14 cases (1979-1991).

Fourteen cows were subjected to thoracotomy as an aid in the treatment of either septic pericarditis (n = 7) or unilateral pleuritis (fibrous or purulent; n = 7). Thoracic lesions were primary in 4 cows, secondary to traumatic reticuloperitonitis in 9 cows, and secondary to extension of a liver abscess in 1 cow. Thoracotomy was performed on 9 cows under local anesthesia. Surgery was performed on 5 cows under general anesthesia; 2 died during anesthesia, and 2 others were euthanatized. Of the 10 cows allowed to recover from surgery, 4 had pericarditis and 6 had pleuritis. Four cows with pleuritis had thoracic abscesses. All but 1 cow with pericarditis died or were euthanatized, and 5 of the 6 cows with pleuritis were discharged from the hospital. A year after surgery, 1 cow was culled because of infertility, and the other 5 cows were returned to production.     

Lymphocytic/plasmacytic gastroenteritis in cats: 14 cases (1985-1990).

Over a 5-year period, lymphocytic/plasmacytic gastroenteritis was diagnosed in 14 cats. Purebred cats were affected significantly (P less than 0.025) more often than nonpurebred cats. Mean age at onset of clinical signs was 6.8 years (range, 1 to 13 years); 11 cats were male. Vomiting and weight loss, each reported in 10 of 14 cats, were the most common clinical signs. Diarrhea was reported in 7 of 14 cats. Alopecia was found in 4 of 14 cats. High hepatic enzyme activities and low plasma protein concentrations were frequent biochemical findings. Hyperemia, hemorrhage, and a roughened or "cobblestone" mucosa were visualized by endoscopy in only 2 of 8 cats with duodenal disease and in 2 of 5 cats with gastric disease. Lymphocytic/plasmacytic inflammation was detected in biopsy specimens from the stomach or duodenum or both in all cats; the duodenum was affected most commonly. Degree of inflammation frequently varied among gastric, duodenal, and colonic specimens from the same cat. Glucocorticoid treatment and dietary management adequately controlled clinical signs in 7 cats, but treatment was ineffective in 6 cats, 5 of which were euthanatized because of severity of clinical signs.     

Diskospondylitis associated with Brucella canis infection in dogs: 14 cases (1980-1991).

A retrospective study of 135 dogs with diskospondylitis revealed 14 dogs with concurrent Brucella canis infection. Sexually intact male dogs and dogs in the southeastern United States appeared to be at higher risk. Results of bacteriologic culturing of blood were less likely to be positive for dogs with diskospondylitis caused by B canis infection than for dogs with diskospondylitis caused by other organisms. Follow-up evaluation of 13 of the 14 dogs revealed complete remission of clinical signs in nine, but serologic test results continued to be positive for B canis infection long after resolution of clinical abnormalities. Radiographic follow-up evaluation in 6 dogs revealed active lesions despite complete remission of clinical abnormalities.     

Paratuberculosis in a mandrill (Papio sphinx).

A 2.5-year-old captive female mandrill (Papio sphinx) died following a protracted course of intermittent abdominal bloat, diarrhea, and severe weight loss. Necropsy revealed emaciation and marked gastrointestinal distention with gas and ingesta. Histologic evaluation revealed severe diffuse granulomatous enterocolitis and mesenteric lymphadenitis with massive numbers of 1-2-microm acid-fast bacilli within macrophages. Additionally, there was moderate to severe multifocal myocardial and vascular amyloidosis, moderate multifocal pyogranulomatous interstitial pneumonia with no acid-fast bacteria, and moderate multifocal glossal candidiasis. Samples of feces, ileum, and colon were positive for Mycobacterium avium subsp. paratuberculosis by radiometric culture and a polymerase chain reaction-amplified DNA probe specific for the insertion sequence IS900 of this organism.     

Cryptococcosis in a llama (Lama glama).

Cryptococcosis was diagnosed in a 17-year-old male llama that had been euthanatized following an acute onset of neurologic disease. Tissues affected included the brain, spinal cord, lung, and kidney. The character of the leukocytic response varied from minimal to pyogranulomatous. Cryptococcosis has not been previously reported in a llama, although the infection has been described in 2 other species of New World camelids. The pathogenesis of cryptococcosis is briefly reviewed.     

Glucagonoma in a jaguar (Panthera onca).

An obese adult jaguar (Panthera onca) was euthanized because of progressive lameness. Two 3-cm-diameter pancreatic nodules were identified as islet cell tumors, which were positive with immunohistochemical stains for glucagon, neuron-specific enolase, chromogranin A, and synaptophysin. The jaguar did not present clinical evidence of hyperglucagonemia.     

Treatment of chronic pleural effusion with pleuroperitoneal shunts in dogs: 14 cases (1985-1999).

OBJECTIVE: To describe complications and outcome associated with chronic nonseptic pleural effusion treated with pleuroperitoneal shunts in dogs. DESIGN: Retrospective study. ANIMALS: 14 dogs. PROCEDURE: Medical records at 4 veterinary schools were examined to identify dogs with chronic nonseptic pleural effusion that were treated by use of a pleuroperitoneal shunt between 1985 and 1999. Signalment, history, physical examination and laboratory findings, cause and type of pleural effusion, medical and surgical treatments, complications, and outcome were reviewed. RESULTS: 10 of 14 dogs had idiopathic chylothorax, and 4 had an identified disease. All but 1 dog with idiopathic chylothorax and 1 dog with chylothorax from a heart base tumor had unsuccessful thoracic duct ligation prior to pump placement. No intraoperative complications developed during shunt placement. Short-term complications developed in 7 of 13 dogs, necessitating shunt removal in 2 dogs and euthanasia in 1. Eight of 11 dogs with long-term follow-up developed complications; the overall mean survival time and the interval in which dogs remained free of clinical signs of pleural effusion were 27 months (range, 1 to 108 months) and 20 months (range, 0.5 to 108 months), respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Pleuroperitoneal shunts can effectively palliate clinical signs associated with intractable pleural effusion in dogs. Numerous short- and long-term complications related to the shunt should be expected. Most complications can be successfully managed, but even when shunts are functional some treatments fail because of severe abdominal distension or massive pleural fluid production that overwhelms the functional capacity of the shunt.     

Retroperitoneal teratoma in a skunk (Mephitis mephitis).

A 4-yr-old striped skunk (Mephitis mephitis) developed an 11- x 7- x 7-cm retroperitoneal mass caudal to the left kidney. The mass was surgically excised and, on the basis of histology and immunohistochemistry, diagnosed as a benign teratoma. Six months later, a second histologically similar neoplasm was excised from the same location and was considered to represent local tumor recurrence. The skunk died 16 mo later without recurrence. Complete excision of the tumor appeared curative in this case and supported the benign diagnosis. An extragonadal teratoma should be considered as a differential diagnosis for an abdominal mass in a skunk.     

Paecilomycosis in a nonhuman primate (Macaca mulatta).

Focal granulomas caused by fungi in the genus Paecilomyces occurred at subcutaneous and laryngeal sites in a Rhesus monkey. Slight wheezing was noted 8 months before the monkey died. Death was unexpected and was caused by asphyxiation after occlusion of the larynx by a fungal granuloma.     

Ovariectomy in a brook trout (Salvelinus fontinalis).

A 1.7-kg mature, female brook trout (Salvelinus fontinalis) was diagnosed with egg retention. Eggs could not be manually stripped and so were surgically removed. To prevent future complications, bilateral ovariectomy was performed. Complications were minimal, and the fish resumed eating within 2 days. Sutures were removed 21 days after surgery. Ovariectomy in display aquarium fish is a viable option for the resolution of ovarian disease.     

Adult-onset hypothyroidism in a lynx (Lynx canadensis).

A 19-yr-old female lynx (Lynx canadensis) presented for an acute onset of anorexia and reluctance to move. Physical examination, radiography, hematology, and serum biochemistry revealed evidence of renal failure, presumptive uremic gastritis, chronic intervertebral disk disease at T13-L1, and markedly low serum levels of total thyroxine (1.54 nmol/L) and total triixodothyronine (0.55 nmol/L). Twenty-five hours after its original presentation, the lynx exhibited horizontal nystagmus, which has been suggested as a clinical sign associated with hypothyroidism in domestic dogs. The lynx was euthanatized because of poor prognosis, and medical management concerns related to its chronic renal failure. Necropsy examination substantiated that the lynx had true hypothyroidism with 60-90% of the thyroid gland replaced with adipose tissue. Although feline adult-onset hypothyroidism may have low incidence, it should still be considered as a cause of nonspecific signs of disease in cats, as well as signs suggestive of hypothyroidism. Routine monitoring of baseline exotic felid thyroid levels throughout life would help to identify normal values and diagnose a potential disease that has obscure clinical signs.