Ice therapy: cool,current and complicated

This is the fourth Capsule review article provided by the WSAVA Global Pain Council and which discusses the use of ice or cold therapy as a non-pharmacologic modality for pain control in small animal practice. The physiological effects of cold therapy on tissues, receptors and ion channels are discussed; as well as indications, recommendations for, and limitations of use.     

Ocular pharmacology

Many new drugs come on the market each year, and some very useful ones become unavailable. Medical treatment of some of the more common ophthalmic conditions observed in small animal practice are discussed in this article. Selection of the appropriate antibiotic or antiviral is critical for effective treatment, and indications for these drugs are provided. Anti-inflammatory medications and their indications and contraindications are also discussed. Medical therapy of glaucoma is also addressed.     

Acupuncture for general veterinary practice.

Since the International Society of Veterinary Acupuncture (IVAS) was founded in 1974, acupuncture (AP) has received greater acceptance by veterinary professionals throughout the world. This article introduces some important animal diseases that respond well to AP therapy. These include resuscitation of small animals, treatment of anoestrous gilts and sows, bovine reproductive disease, canine vertebral problems and equine backpain, etc. Conventional medicine considers these to be difficult cases to treat. Veterinarians have become more aware of the benefits of AP especially for those diseases, thanks to the efforts of experienced practitioners and scientists, and the many published reports on veterinary AP that have introduced some good indications for AP therapy in veterinary practice. Possible mechanisms behind the effectiveness of AP are discussed. This article aims to introduce veterinarians to good indications for AP to initiate their interest in the practice of AP. Although this is a rapidly expanding field, a long march must begin with one step. We wish this article to be the shoes for such a march. For more information on veterinary AP, contact IVAS , P.O. Box 1478, Longmont, CO.. 80502, USA (http://www.ivas.org), or your national veterinary acupuncture society (http://www.komvet.at/ ivadkom/vapsocs.htm).     

Clinical indications and applications of radiotherapy and hyperthermia in veterinary oncology

The response of dogs and cats with neoplasia to radiation therapy has improved significantly during the past 10 years. This has largely been due to more aggressive radiation therapy treatment schedules, more accurate planning, and refinement of clinical indications. Sufficient numbers of dogs and cats irradiated with curative intent have not been accumulated to yet define the full impact of more aggressive therapy. However, many tumors will likely remain resistant to irradiation because of concomitant normal tissue injury that must be minimized. Systematic investigation of combination therapy (surgery, radiation, chemotherapy, and hyperthermia) should succeed in reducing local tissue side effects and increased local tumor control. A comprehensive approach to tumor management begins with decisions thoughtful of optimal treatment for suspected malignant tumors even at the time of initial examination and client counseling. An incisional biopsy provides essential information to determine the therapeutic course and should be considered prior to initial excision. More aggressive treatment, of even small tumors, early in the clinical course will lead to prolonged tumor control. Radiation therapy should be considered fundamental in the comprehensive treatment plan of many solid tumors.     

Exploration of developmental approaches to companion animal antimicrobials: providing for the unmet therapeutic needs of dogs and cats

AAVPT Workshop White Paper Committee. Exploration of developmental approaches to companion animal antimicrobials: providing for the unmet therapeutic needs of dogs and cats. J. vet. Pharmacol. Therap. 33 , 196–201. The American Academy of Veterinary Pharmacology and Therapeutics (AAVPT) and the United States Pharmacopeia (USP) co‐sponsored a workshop to explore approaches for developing companion animal antimicrobials. This workshop was developed in response to the shortage of antimicrobials labeled for dogs and cats, as there is a shortage of approved antimicrobials for the range of infectious diseases commonly treated in small animal practice. The objective of the workshop was to identify alternative approaches to data development to support new indications consistent with the unmet therapeutic needs of dogs and cats. The indications for currently approved antimicrobials do not reflect the broader range of infectious diseases that are commonly diagnosed and treated by the veterinarian. Therefore, the labels for these approved antimicrobials provide limited information to the veterinarian for appropriate therapeutic decision‐making beyond the few indications listed. Industry, veterinary practice, and regulatory challenges to the development of new antimicrobial indications were discussed. The workshop resulted in short‐ and long‐term recommendations. Short‐term recommendations focus on the use of additional data considerations for product labeling. Long‐term recommendations center on legislative or regulatory legal initiatives. The workshop recommendations will need collaboration from industry, academia, and regulatory authorities and a legal shift in the drug approval and availability processes.     

When, why, and how to perform cardiac radiofrequency catheter ablation

Radiofrequency catheter ablative techniques provide a unique opportunity to cure dogs of certain supraventricular tachyarrhythmias, rather than simply controlling the rhythm with drug therapy. Accessory pathways, which can participate as one limb of a rapid, narrow complex tachyarrhythmia circuit, have a particularly high cure rate with radiofrequency catheter ablation. Focal atrial tachycardias also provide a substrate that can be amenable to ablation. Tachycardia-induced myocardial dysfunction resulting from frequent tachyarrhythmic episodes will resolve after a successful ablation. This report outlines the indications, equipment, and techniques used in dogs for performing catheter ablation with temperature-controlled radiofrequency energy delivery.     

Skeletal scintigraphy in the horse: current indications and validity as a diagnostic test

Gamma scintigraphy is a well established imaging modality, which in equine practice is predominantly used in the investigation of lameness and suspected musculoskeletal problems. Whilst there is a growing literature on the indications for scintigraphy in the horse, there has been little emphasis so far on identifying the validity of scintigraphy as a diagnostic test. In particular, to what extent can the results of a scintigraphic examination be trusted? In this opinionated review the current indications for skeletal scintigraphy in the horse are considered and its validity as a diagnostic test reviewed. It is concluded that in the majority of published studies, inherent biases in study design make it difficult to assess accurately the validity of skeletal scintigraphy in the horse. Further well designed, prospective studies are required to assess the validity of skeletal scintigraphy as a diagnostic tool, particularly in horses with subtle alterations in radiopharmaceutical uptake.     

Colloids: current recommendations.

Colloids are increasingly becoming considered indispensable in the management of critically ill patients. Typical indications for colloid administration include patients with tissue edema, hypovolemia, and low oncotic pressure. Current guidelines for the use of colloids in veterinary patients balance the purported benefits of colloid fluid administration with the potential risks, such as volume overload and coagulation disturbances. This article focuses primarily on hydroxyethyl starches, because they are the most commonly used colloid in veterinary practice, and because recent advances in colloid therapy have been achieved with this colloid. Newer colloids have been modified to limit effects on the coagulation system, and they may be used to modulate the inflammatory response, which could prove to be particularly useful in the management of critically ill patients. A better understanding of how different fluids influence the host response may enable us to explore new applications of fluid replacement therapy beyond simply replenishing volume deficits.     

A critical review of current methods for induction of parturition in the mare.

The efficacy and safety of oxytocin, dexamethasone and prostaglandin, used alone or in combination as inducing agents, are discussed. It is contended that insufficient evidence exists to support the routine application of any of these methods in practice. Oxytocin has been the most widely used and it is claimed by some to be free from side effects. However, the synthetic prostaglandin analogue, fluprostenol, seems to pose the least risk to the foetus and dexamethasone appears to be either ineffective, or too dangerous to use at all. The main indications for induced foaling are managerial convenience or for research and teaching purposes. There are few clinical indications, although ventral rupture and cases of prolonged gestation have been mentioned by various workers. It is considered that foetal maturity is the pre-requisite before a decision to induce should be made in practice, and 3 criteria are essential: 1) a gestational length of greater than 320 days, 2) substantial mammary development, 3) the presence of colostrum in the mammae.     

The collection and treatment of feed samples, particularly when suspecting mycotoxins

The sampling-procedure for feedstuffs in the official supervision of these products is performed according to the standards decreed by the feedstuff order in which the sampling tools, the wrapping and the pattern of acting are specified. In suspicion cases for mycotoxins in feedstuffs it is suitable to complete the sampling protocol with additional informations about feed and feeding practice as well as possibly observed health disturbances in animals. In this connection attention is directed to microbial caused changes of feedstuffs, which sometimes are clearly observable. Such indications allow to accommodate sampling to a present situation and can help substantially in clearing up cases of mycotoxicoses. In scope of mycotoxin research, sampling technique and procedure will be subjected to the special scientific questions.     

Collection and preparation of blood products

Blood-component therapy has become an integral part of veterinary practice. Although access to veterinary blood banks has increased, practitioners may prefer to create their own blood-donor program to provide for their blood-product needs or to respond to an emergent need. Before embarking on such an endeavor, it is important to understand the techniques and requirements for such a program. This article will discuss issues in donor selection and management, supplies and techniques of blood-component acquisition, and supplies and techniques of blood-component preparation.     

Management of complications of cancer chemotherapy

Although the use of anticancer agents can be associated with severe side effects, on a practical basis complications of therapy are minimal to nonexistent. The clinician usually learns to feel more comfortable with these drugs as he or she treats more patients, to the point where treating a cancer patient with chemotherapy will become routine practice.     

Peritoneal dialysis in emergency and critical care medicine

Peritoneal dialysis is a technique that has been used to treat acute renal failure in humans since 1923. Peritoneal dialysis is used in people to manage acute and chronic renal failure, as well as to remove dialyzable toxins (ethylene glycol, barbiturates, and ethanol), reduce severe metabolic disturbances, and for the treatment of peritonitis, pancreatitis, uroabdomen, hypothermia, and fluid overload. In veterinary medicine, acute renal failure is the prevailing indication for dialysis. This report will discuss the pathophysiology of peritoneal dialysis, indications, and contraindications. Catheter selection and placement will be reviewed. Types of dialysate solution will be discussed and the protocol established for instituting peritoneal dialysis. The report will conclude with a discussion of potential complications and methods to minimize them.     

The use of IV lipid emulsion for lipophilic drug toxicities

IV lipid emulsion (ILE) therapy is emerging as a potential antidote for lipophilic drug toxicities in both human and veterinary medicine. ILE has already gained acceptance in human medicine as a treatment of local anesthetic systemic toxicity, but its mechanism of action, safety margins, and standardized dosing information remains undetermined at this time. Experimental and anecdotal use of ILE in the human and veterinary literature, theorized mechanisms of action, current dosing recommendations, potential adverse effects, and indications for use in human and veterinary emergency medicine are reviewed herein.     

Trends in veterinary cancer imaging

With the recent advances in diagnostic imaging technology, cancer imaging in veterinary medicine has become more specific for disease diagnosis, more accurate for determining tumour margins and more sensitive for detecting metastatic disease. Ultrasound provides highly detailed images of parenchymal masses and infiltrative lesions while providing a means for aspiration or biopsy using real‐time image guidance. Computed tomography and magnetic resonance‐imaging techniques provide exquisite anatomical resolution that improves diagnostic accuracy, provides an accurate means of radiation or surgical treatment planning and a quantitative means for monitoring response to therapy. In addition to traditional anatomic imaging, new techniques are being developed for estimating functional parameters such as tumour perfusion, cell metabolism and gene expression. While conventional planar scintigraphy has been available for some time, newer nuclear imaging modalities such as positron emission tomography promise to further improve the accuracy of initial tumour diagnosis and staging and determination of response to therapy. Although many of these functional techniques are not yet clinically available, it is highly likely that some will be integrated into routine clinical practice in the near future.     

Treating wounds in small animals with maggot debridement therapy: a survey of practitioners

Many small animals succumb to complications of serious wounds. Sometimes infection and sepsis overwhelm the animal; sometimes the costs of intensive care overwhelm the owner. Maggot therapy, a method of wound debridement using live fly larvae, could provide effective, simple, low cost wound care. All eight US veterinarians who had been provided with medicinal maggots were surveyed to determine if this treatment was being used for small animals, and for what indications. At least two dogs, four cats and one rabbit were treated with maggot therapy between 1997 and 2003. The most common indications for using maggot therapy were to effect debridement and control infection, especially if the wound failed to respond to conventional medical and/or surgical therapy. Practitioners reported the treatments as safe and often beneficial. Amputation and euthanasia may have been avoided. It is concluded that maggot therapy may have utility for small animals, and should be evaluated further.     

Instrumentation for external fixation.

External skeletal fixation is a very useful technique for managing many orthopedic problems in veterinary practice. The Kirschner apparatus has been the most widely used fixator for many years in veterinary orthopedics because of its versatility, simplicity, and economy in use. The medium-sized device has the widest indications and is easiest to begin with. The small size can be acquired later for use on cats and small dogs. The new "raised thread" fixation pin designs improve bone-pin integrity and can be used in combination with nonthreaded pins to decrease the incidence of postoperative complications and for economy. Acrylic-pin external fixators are particularly useful for treatment of mandibular fractures and transarticular application since they allow nonlinear placement of fixation pins in highly contoured bones. A commercial system, currently being developed, will have all the equipment and materials necessary for their application in a convenient kit. Circular fixators (Ilizarov design) use thin K wires placed under tension to replace rigid fixation pins. Their unique adjustability characteristics make them useful in the treatment of limb deformity and shortening. Many other human fixators can be used for veterinary application if the basic principles of fixators are followed. Instrumentation required for external fixator application include a pin driver, pin cutter, and wrenches. Although surgical versions of these materials are available, less expensive alternatives are available using gas sterilization instead of autoclaving. The use of selected orthopedic instrumentation such as a periosteal elevator, bone clamps, and curets will facilitate fracture management.     

Enhanced communication by developing a non-anxious presence: a key attribute for the successful veterinarian

In the recent past much has been written about non-technical skills in veterinary medical education. This dialogue has focused extensively on competence in behaviorally based communication skills for successful veterinary practice. Other relationship-based communication skills are also useful in communication, such as self-awareness, flexibility, non-judgment (compassion), and being present. All of these relationally based skills are present in the concept of non-anxious presence. This article will review the history of the term 'non-anxious presence' (NAP), discuss a proposed model of NAP for the veterinary medical environment, and review some methods useful in teaching NAP in veterinary medical education.     

Permanent transvenous cardiac pacing

Transvenous cardiac pacing is a commonly employed treatment for symptomatic bradyarrhythmias in dogs. Medical management of these conditions has not proven to be successful leaving pacing as the only viable alternative. The technique of pacemaker implantation is not difficult, but successful pacemaker therapy requires an understanding of electrophysiology, cardiac fluoroscopic anatomy, pacemaker instrumentation, and programming. Proper patient selection and identification of the underlying rhythm disturbance is essential to a successful clinical outcome. This article discusses the indications, equipment, techniques, complications, and outcome of permanent transvenous cardiac pacing.