staging.vettimes.com

Author: Kele Harris

  • Top dressings tips

    I attended a meeting held by the RCVS with representatives from the Veterinary Defence Society who warned that dressings can be problematic in terms of complaints and litigation.

    Cat with bandaged leg
    Image ©iStock.com/pyotr021

    I’ll be totally honest here: I don’t like doing dressings.

    I was talking to Laura the other day (one of our team of fantastic RVNs) and, because she’s excellent at dressing wounds (her skills easily surpass mine), I thought I’d ask for her “top tips” on the subject.

    Expert advice

    Laura’s words of wisdom were:

    • The right materials are key – she prefers cotton wool for Robert Jones type dressings.
    • Think of the pressure points in advance – how is the limb going to move (or not move) under the dressing with even pressure. Good to pad between the toes, and so on.
    • Ideally, leave the toes out so regular checks can be made to make sure no problems are occurring.

    Of course, a compliant caregiver at home really helps too.

  • Immunotherapy in cats

    Immunotherapy in cats

    Although “off-licence”, immunotherapy is well worth considering in our pruritic feline friends.

    Feline head pruritus secondary to food allergy
    Feline head pruritus, a result of food allergy. Image by Caroldermoid. Licensed under CC BY-SA 3.0 via Wikimedia Commons.

    Of course we need to rule out all other causes of pruritus first:

    • Ectoparasites: As well as all the usual suspects, don’t forget Demodex can occasionally cause ventral alopecia and pruritus (that’s the funny flat form, not the cigar shaped one).
    • Food allergies: Let’s face it, food allergy is tricky to pursue in cats – and if they have a partly outdoor lifestyle, hypoallergenic diets are of not of any use.

    Case study

    I recently saw a case that had typical excoriation lesions around the head and neck.

    The owner was able to keep the cat indoors on Purina HA Hypoallergenic for six weeks, and was happy to dose monthly with Stronghold. This, together with a good response to steroids, was highly suggestive of atopy.

    Serum IgE testing produced a range of high levels to pollens, house dust mite and moulds.

    Our friend has recently started on immunotherapy injections and is now starting to show signs of a good response. With the feline response to immunotherapy reported to be higher than that in dogs, this may be something well worth considering in cats.

  • Needle aspirate subcutaneous masses

    Cytology of a mast cell tumor from a Labrador retriever at a magnification of 1,000x. By Joel Mills (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or CC-BY-SA-2.5-2.0-1.0 (http://creativecommons.org/licenses/by-sa/2.5-2.0-1.0)], via Wikimedia Commons.
    Cytology of a mast cell tumor from a Labrador retriever at a magnification of 1,000x. Image by Joel Mills [GFDL, CC-BY-SA-3.0 or CC-BY-SA-2.5-2.0-1.0], via Wikimedia Commons.
    Fine needle aspiration (FNA) is a valuable tool in subcutaneous skin masses.

    We have all had those lumps that, on palpation, you are sure are lipomas (being soft, freely mobile and slow growing). Indeed, the vast majority are just such benign problems – however, it is worth aspirating them to be sure.

    Felt like lipoma

    We recently had a case in a nine-year-old Labrador with a soft subcutaneous mass the owner had been aware of for a month. It felt just like a lipoma.

    On checking the lump again two weeks later, this had got noticeably bigger. FNAs of the mass revealed the presence of a mast cell tumour.

    Following excision with good 3cm margins, the Lab went on to make a full recovery.

  • Don’t forget cytology and Malassezia dermatitis

    Don’t forget cytology and Malassezia dermatitis

    Tape cytology from dog with Malassezia dermatitis (Dif-Quik stain).
    Tape cytology from dog with Malassezia dermatitis (Dif-Quik stain) – note the “peanut-shaped guys”. Image: Wikimedia Commons

    Ever had one of those cases, which seem to typically occur around this time of year, that you think must be the start of an allergic dermatitis?

    These present with pruritus, erythema and sometimes a yellowish/grey, greasy feel to the skin and hair coat.

    The dog is already on a regular POM-V broad-spectrum antiparasiticide.

    Initial thoughts

    Pyoderma immediately springs to mind – it’s 6.55pm on a Friday, you skip the cytology and start on an appropriate antibiotic; maybe even a short course of prednisolone.

    A week later and the dog has not really improved, so it’s a great time for some cytology. There is a good chance we have got a Malassezia dermatitis, and hey presto – the peanut-shaped guys are visible on microscopy. A couple of Malaseb shampoos later and we are rocking.

    Then the fun really starts as we try to determine the underlying cause…

  • Don’t talk to clients about free T4 evaluations

    Don’t talk to clients about free T4 evaluations

    Free, not gratis!
    Free, not gratis – image ©iStock.com/Aquir

    We recently had an elderly cat that presented with typical signs of hyperthyroidism.

    However, as is sometimes the case, total T4 proved stubbornly normal on two estimations a couple of weeks apart.

    So we suggested it would be a good idea to send a blood to the lab for free T4 estimation – and you may be able to guess what’s coming next…

    But, you said…

    Yes, you’re right – the client then complained profusely that they had to pay for the test, because (and I quote): “You said it was free!”

    We now call this an “unbound” thyroid blood test – it just makes life simpler.

  • Check bile acid values in lethargic puppies

    sleeping labrador retriever puppy
    He might look cute asleep, but lethargy and exercise intolerance aren’t a particularly good sign in a puppy. Image ©iStockphoto.com/feedough.

    Have you ever had a puppy that just presents with lethargy, exercise intolerance and sleeps all the time?

    This is normal for my teenage daughters, but not so for a young Lhasa apso that presented to my surgery. Physical exam was unremarkable, but the dog was so sleepy we administered IV fluids to perk it up.

    Routine biochemistry revealed a low blood urea nitrogen (BUN), and a urine sample demonstrated the presence of urate crystals.

    This triggered a request for a bile acid stimulation test, which showed markedly abnormal elevation postprandial levels.

    Our diagnosis of hepatic portosystemic shunt was confirmed at Davies Veterinary Specialists and luckily this was shown to be extra hepatic. So, after some very smart surgery, the dog went on to live an energetic life.

  • Take note of high Hgb and Hct levels on pre-anaesthetic bloods

    A young French Bulldog is sedated prior to surgery.
    A pre-anaesthetic blood test can reveal hidden or undetected health problems that are not obvious from a physical examination alone. Image ©iStock.com/DenGuy

    Have you ever noticed that, sometimes after starving, the haematocrit (Hct) and haemoglobin (Hgb) levels appear a little high on pre-anaesthetic bloods prior to a surgical procedure that morning?

    If so, make sure you look at the figures.

    If, like us, your laboratory machine produces a band with a red marker in the middle indicating some elevation, make sure you also look at the absolute figures.

    I recently saw a nine-year-old boxer that, after a surgical procedure, developed redder and redder skin and mucous membranes. She had high Hct and Hgb on pre-anaesthetic bloods and subsequently turned out to have polycythaemia vera with, eventually, a Hct of 84.9.

    Four episodes of venipuncture (taking 200ml to 300ml of initially very viscous blood on each occasion), plus treatment with hydroxycarbamide, and she was feeling much better.

  • Try out a mentoring scheme in your practice

    MentorIt’s always a real pleasure welcoming new graduates to our practice team, and we have been very privileged to employ two excellent vets in the last couple of years.

    As well as regular coaching sessions, we’ve also introduced an informal mentoring arrangement with an experienced (non-management) veterinary member of our team. This is very informal and what goes on – other than knowing they meet fairly regularly – I have no idea.

    However, the feedback I’ve received is positive from both parties and, with the now-increasingly documented challenges faced by new vets in developing professional skills in their early years, this will hopefully go some way to helping.

  • Routine ear cleaning in chronically waxy ears

    Ear drops
    Consider routine ear cleaning in chronically waxy ears.

    When I attended the North American Veterinary Conference back in January, I was surprised to hear one of the dermatologists say he did not recommend cleaning ears [in chronic cases].

    That being said, I’ve heard other specialists espouse the virtues of routine cleaning from upon high.

    I’m a great believer in the rule of “if it ain’t broke, don’t fix it”, but I do see atopic dogs that develop significant build up of wax – and routine cleaning with my favorite ear cleaner twice weekly just keeps the use of prescription drugs to a minimum and increases the interval between flare ups.

    So, my tip for this week would be to consider this in certain cases.

  • Enjoy veterinary and non-veterinary life equally

    ou_cmyk_masterlogo_19mmAs well as my veterinary role, I also work part time for the Open University Business School, tutoring the first year of its master’s degree in business administration (MBA).

    I recently attended a staff event and thoroughly enjoyed chatting to the academic staff there. However, I couldn’t help but reflect on the fact I was introduced as “Graham the vet” rather than as a tutor – evidence of the high esteem of our profession perhaps?

    On another note, I recently came across three acquaintances who have left the profession, which I personally think is sad, but it has to be said they all seem very happy with their choice.

    My point here is that, as much as I love being in veterinary practice, I also really love tutoring and I think it has contributed to my wellbeing. So my personal top tip here would be to enjoy doing something non-veterinary too. Perspective is great!