January 2018   |   Volume 16   |   Issue 1

Top 5 Dental Extraction Complications

in this issue

in this issue

Feline Chronic Gingivostomatitis

Territorial Aggression in a Dog

Top 5 Tips for Animal Transportation

Nutrition Assessment in a Dog with Osteoarthritis & Obesity

Ketamine

Top 5 Complications of Tooth Extractions

Kendall Taney, DVM, DAVDC, FAVD, Center for Veterinary Dentistry & Oral Surgery, Gaithersburg, Maryland

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Top 5 Complications of Tooth Extractions

Because of the prevalence of periodontal disease in companion animals, tooth extraction is commonly performed in veterinary medicine.1 Complications from tooth extractions can arise and may significantly increase anesthesia time and morbidity in patients2; an awareness of the causes of such complications can help prevent them.

Following are the author’s 5 most common tooth extraction complications.

1

Root Breakage

Mucoperiosteal flaps should be developed for most extractions to allow for appropriate exposure for alveolar bone removal, which allows for better visualization and subsequent tooth root elevation.2-4 As a general rule, buccal alveolar bone should be removed before elevation is attempted to expose, at minimum, approximately half of the root.5 A small bur can be used to create a mesial and distal space to allow for placement of a dental elevator. Tooth root elevation is a slow process that fatigues the periodontal ligament; if abrupt force is applied before the periodontal ligament is fatigued or severed, the root often fractures (Figure 1). Adequately exposing soft and hard tissues at the beginning of the procedure can save time and allow for successful root removal; however, even if careful and appropriate techniques are used, roots may still break during extraction (eg, due to tooth resorption or ankylosis of the root to the alveolus). If a root breaks, additional removal of alveolar bone is often necessary to retrieve the remaining root fragment.

Fracture of the mesiobuccal and distal roots (arrows) during extraction of the left maxillary 4th premolar tooth in a dog
Fracture of the mesiobuccal and distal roots (arrows) during extraction of the left maxillary 4th premolar tooth in a dog

FIGURE 1 Fracture of the mesiobuccal and distal roots (arrows) during extraction of the left maxillary 4th premolar tooth in a dog

FIGURE 1 Fracture of the mesiobuccal and distal roots (arrows) during extraction of the left maxillary 4th premolar tooth in a dog

2

Root Tip in Nasal Cavity & Mandibular Canal

A potential sequela of root breakage is root tip protrusion into the nasal cavity (Figure 2) or mandibular canal (Figure 3),6 which, as with root breakage, can be caused by inadequate exposure or bone removal. In cases of root breakage, it is important to determine the location of the root tip and assess bone quality via dental radiography. If there is significant bone loss, a root fragment may be pushed through the apical extent of the alveolus and into an area that makes retrieval challenging. If this complication occurs and the root tip cannot be easily located, closing the extraction site and referring to a dental specialist is recommended. 

Root removal from the nasal cavity can be especially difficult because of the large size of the nasal cavity and the potential for tooth root migration. Large mucoperiosteal flaps, bone windows, and suction can aid in the removal process. Avoiding the mandibular neurovascular structures when removing roots from the mandibular canal can be challenging but is crucial, as hemorrhage can occur if structures are punctured.

3

Hemorrhage

The oral cavity has a rich blood supply from many vascular structures. Bone removal and development of mucoperiosteal flaps for extractions may expose major blood vessels (eg, branches of the maxillary artery [infraorbital in the maxilla and inferior alveolar in the mandible]). Damage to these vascular structures can result in significant hemorrhage (Figure 4A).

Hemorrhage of the mandibular artery during extraction of an impacted mandibular first molar tooth (A). Postcauterization of the mandibular artery (B); the mandibular canal is visible and was close to the roots of the impacted first molar tooth.
Hemorrhage of the mandibular artery during extraction of an impacted mandibular first molar tooth (A). Postcauterization of the mandibular artery (B); the mandibular canal is visible and was close to the roots of the impacted first molar tooth.

FIGURE 4 Hemorrhage of the mandibular artery during extraction of an impacted mandibular first molar tooth (A). Postcauterization of the mandibular artery (B); the mandibular canal is visible and was close to the roots of the impacted first molar tooth.

Hemorrhage of the mandibular artery during extraction of an impacted mandibular first molar tooth (A). Postcauterization of the mandibular artery (B); the mandibular canal is visible and was close to the roots of the impacted first molar tooth.
Hemorrhage of the mandibular artery during extraction of an impacted mandibular first molar tooth (A). Postcauterization of the mandibular artery (B); the mandibular canal is visible and was close to the roots of the impacted first molar tooth.

FIGURE 4 Hemorrhage of the mandibular artery during extraction of an impacted mandibular first molar tooth (A). Postcauterization of the mandibular artery (B); the mandibular canal is visible and was close to the roots of the impacted first molar tooth.

FIGURE 4 Hemorrhage of the mandibular artery during extraction of an impacted mandibular first molar tooth (A). Postcauterization of the mandibular artery (B); the mandibular canal is visible and was close to the roots of the impacted first molar tooth.

Inflamed tissues are a hallmark of active periodontal disease and are prone to heavier bleeding as compared with normal tissues.1 If a major vessel is damaged, procedures to control hemorrhage (ie, direct pressure, ligation, cauterizing, topical hemostatic agents) should be instituted (Figure 4B). In general, there are no major long-term complications of complete ligation of major vessels such as the maxillary and mandibular arteries. The high vascularity of the oral cavity ensures collateral circulation will be available to maintain vitality of the soft and hard tissues7; the only exception to this is damage to vessels that provide major blood supply to mucoperiosteal flaps. For example, damage to the greater palatine artery can lead to failure of a hard palate flap used to close a large defect.8,9

4

Dehiscence & Fistula Formation

When operating in the oral cavity, general surgical principles should be applied to avoid dehiscence and/or formation of an oronasal fistula (Figure 5A). A common cause of oronasal fistula formation is extraction of a diseased maxillary canine tooth without a mucoperiosteal flap. Even if the canine tooth was diseased and easily extracted, flap closure of the extraction site is still indicated. Gentle tissue handling, tension-free closure, and a healthy environment for healing are essential to prevent flap failure at the surgical site. Adequate blood supply in the mouth is generally not an issue, but debridement of diseased bone and soft tissue are important to encourage rapid healing.

Oronasal fistula formation in a dog after extraction of the left maxillary canine tooth (A); closure of the defect was achieved with a single mucoperiosteal flap after debridement of the mature epithelium at the fistula edges. Chronic/recurrent oronasal fistula in a small-breed dog (B); closure of this defect required more advanced flap repair techniques.
Oronasal fistula formation in a dog after extraction of the left maxillary canine tooth (A); closure of the defect was achieved with a single mucoperiosteal flap after debridement of the mature epithelium at the fistula edges. Chronic/recurrent oronasal fistula in a small-breed dog (B); closure of this defect required more advanced flap repair techniques.

FIGURE 5 Oronasal fistula formation in a dog after extraction of the left maxillary canine tooth (A); closure of the defect was achieved with a single mucoperiosteal flap after debridement of the mature epithelium at the fistula edges. Chronic/recurrent oronasal fistula in a small-breed dog (B); closure of this defect required more advanced flap repair techniques.

Oronasal fistula formation in a dog after extraction of the left maxillary canine tooth (A); closure of the defect was achieved with a single mucoperiosteal flap after debridement of the mature epithelium at the fistula edges. Chronic/recurrent oronasal fistula in a small-breed dog (B); closure of this defect required more advanced flap repair techniques.
Oronasal fistula formation in a dog after extraction of the left maxillary canine tooth (A); closure of the defect was achieved with a single mucoperiosteal flap after debridement of the mature epithelium at the fistula edges. Chronic/recurrent oronasal fistula in a small-breed dog (B); closure of this defect required more advanced flap repair techniques.

FIGURE 5 Oronasal fistula formation in a dog after extraction of the left maxillary canine tooth (A); closure of the defect was achieved with a single mucoperiosteal flap after debridement of the mature epithelium at the fistula edges. Chronic/recurrent oronasal fistula in a small-breed dog (B); closure of this defect required more advanced flap repair techniques.

FIGURE 5 Oronasal fistula formation in a dog after extraction of the left maxillary canine tooth (A); closure of the defect was achieved with a single mucoperiosteal flap after debridement of the mature epithelium at the fistula edges. Chronic/recurrent oronasal fistula in a small-breed dog (B); closure of this defect required more advanced flap repair techniques.

Most surgical wounds in the oral cavity heal rapidly (ie, in 10-14 days). Appropriate suture materials and patterns should be selected; absorbable suture materials are recommended to avoid the need for suture removal posthealing. The sutures will need to remain intact for the healing period of 14 days, which is typically not an issue for most available absorbable suture materials. If the extraction site has not healed after 14 days or an oronasal fistula has formed, the patient should be reevaluated under anesthesia to assess the need for biopsy and/or culture and susceptibility testing to rule out neoplasia or osteomyelitis as a cause of dehiscence.

A single, well-developed mucoperiosteal flap may be all that is required to close an oronasal fistula after debridement of the fistula edges. For more challenging cases or recurrent fistulas, a double-flap or other advanced technique by a dental specialist may be needed (Figure 5B).10-13

5

Iatrogenic Jaw Fracture

Dental radiography can provide information (eg, bone quality, root structure, pathology) that can help avoid iatrogenic jaw fracture (Figure 6A). Many patients with severe periodontal disease will have significant bone loss (Figure 6B) but teeth that are still well anchored in the alveolar bone. Tooth resorption and ankylosis provide further obstacles to successful extraction. The mandibular canine and mandibular first molar are the most common locations for iatrogenic jaw fracture.3,4

FIGURE 6 Iatrogenic fracture of the left rostral mandible after extraction of the left mandibular canine tooth (A; arrows). Same patient with iatrogenic jaw fracture after extraction (B); significant bone loss from periodontal disease was present, which contributed to this complication. Dilacerated root of the left mandibular first molar in a small-breed dog (C). The first molar in these breeds is often very large as compared with the width of the mandible. The hook on the mesial root can make extraction more challenging.

Small-breed dogs have a high first molar:mandibular height ratio, which increases the risk for fracture in cases of periodontal disease.14 In such cases, the roots can also be dilacerated (ie, there is an abnormal bend, hook, or overall shape to the root[s]); the tooth may have significant bone loss and appear to be an easy extraction, but the hook on the end of the root tip often makes removal much more difficult (Figure 6C).

For most patients, prognosis after iatrogenic jaw fracture is good. Complete recovery can be expected with appropriate reduction and stabilization.15

Conclusion

Owners should be made aware of the specific types of complications that may be encountered with tooth extraction. Patients with significant periodontal disease may be at increased risk, and owners should be informed before the procedure that complications, some of which could warrant referral to a boarded veterinary dental specialist, may arise. The scenarios presented here provide the more common complications that may be encountered and can provide clinicians talking points to discuss with owners to establish appropriate informed consent. With open and honest communication between the owner and veterinarian, these difficult situations can be handled with the patient’s best interest in mind.

References and Author Information

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

Material from Digital Edition may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.


Feline Chronic Gingivostomatitis

Heidi B. Lobprise, DVM, DAVDC, Main Street Veterinary Hospital & Dental Clinic, Flower Mound, Texas

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Feline Chronic Gingivostomatitis

Stomatitis can refer to any inflammation in the oral cavity, but, clinically, it typically refers to the exaggerated immune response of some cats to minimal accumulations of plaque and calculus. In contrast, when such irritants accumulate on the teeth of relatively normal cats, periodontal disease with loss of tissue (eg, gingiva, bone) may occur.

It is important to identify cases with just alveolar and labial/buccal mucositis and no caudal mucositis. If these patients respond to adequate Phase I treatment (ie, complete cleaning and polishing, radiographs, and select extractions), stomatitis is unlikely.

Patients with caudal mucositis in the area bordered medially by the palatoglossal folds and fauces (formerly termed faucitis, which is less accurate) generally will not respond to Phase I treatment; Phase II intervention (ie, caudal mouth extractions, complete removal of all remaining premolars and molars, and debridement of inflamed tissues [eg, friable gingival margins and alveolar ridges]) is often recommended. Incisors can also be removed, but, unless there is significant inflammation or bone loss, the canine teeth are kept because of the additional surgical time and expense required for full-mouth extractions and/or owner preference to preserve the canines.

References and Author Information

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

Material from Digital Edition may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.


Ketamine

Ketamine

Khursheed Mama, DVM, DACVAA, Colorado State University

Peer Reviewed

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Ketamine

Ketamine is a commercially available cyclohexanone with a long-standing role in global veterinary anesthesia.

Overview

  • The commercially available formulation, ketamine hydrochloride, is acidic and can cause pain on intramuscular injection (author experience). However, the drug itself—which is a racemic mixture of 2 optical isomers—is a weak base, with a pKa of 7.5. 
  • No receptor-specific reversal agent exists for ketamine.

Pharmacokinetics & Clinical Use

  • Ketamine is typically administered intravenously, but intramuscular administration may be used in some instances (eg, feline feral neuter programs, primate or wildlife management). 
  • Drug uptake following intramuscular administration is approximately 93%.1 
  • Although oral administration may occasionally be recommended (eg, to treat fractious animals), extensive first-pass metabolism can result in low bioavailability (≈16%) in systemic circulation, making this route somewhat impractical.1 
  • Ketamine continues to be extensively used in the anesthetic management of horses, nonhuman primates, and other nondomesticated species, but its popularity as an anesthetic induction agent in dogs and cats continues to decline in the United States. 
    • This decline is likely due to the availability of other drugs as well as ketamine-induced behavioral adverse effects (eg, excitement on emergence from anesthesia, myoclonus, increased motor activity). 
      • To help counter these behavioral effects and muscle hypertonicity, ketamine is most commonly used with other drugs (eg, benzodiazepines, α2-adrenergic agonists).
  • Its use with propofol has been evaluated in dogs; results have shown improved heart rate and blood pressure but increased respiratory depression as compared with use of propofol alone.2
    • Induction and intubation conditions were also consistently good with this drug combination.
    • This combination has also been used with favorable results to provide total intravenous anesthesia for cats undergoing ovariectomy.3

Cardiovascular Effects

  • Primary cardiovascular effects of ketamine administration include an increase in sympathetic tone and potential depression of baroreceptor feedback in healthy humans and animals.
    • This most commonly causes an increase in heart rate and blood pressure, despite mild vasodilation.4,5
  • Myocardial work and oxygen consumption are also increased with ketamine administration.
    • Although well tolerated in normal patients, ketamine is not recommended in animals with restrictive or hypertrophic cardiac diseases and other conditions for which an increase in sympathetic tone is undesirable (eg, hyperthyroidism, pheochromocytoma).6-8 
  • Although myocardial contractility may increase, decrease, or remain unchanged in animals, depression of myocardial function has been seen in isolated heart preparations.7,9 
    • Blood pressure has also been shown to decrease following ketamine administration in hypovolemic animals.10,11 

Respiratory Effects

  • Mild, transient decreases in ventilation and oxygenation have been reported following ketamine administration.12,13  
    • However, an increase in respiratory rate may also be observed if excitement is an effect of anesthetic induction.12,13 
    • An apneustic breathing pattern is common following ketamine administration. 
  • Ketamine serves as a bronchodilator and may be of value in animals with chronic obstructive pulmonary disease or asthma.14 
    • Pharyngeal and laryngeal reflexes often remain, but intubation conditions are good once the mouth is open. 
    • An antisialagogue may be beneficial to counteract increased salivation seen with ketamine administration.

Analgesia

  • Although ketamine is less commonly used as a sole anesthetic induction agent in dogs and cats, its use in the prevention of wind up or spinal facilitation of pain is increasing. 
    • Veterinary studies are limited but, along with clinical impressions, suggest that NMDA (N-methyl-D-aspartate) antagonist actions are beneficial in painful animals. A study has shown that, when a ketamine infusion was administered as part of a balanced analgesia plan in the intraoperative period to dogs undergoing forelimb amputation, the need for additional postoperative analgesics was reduced.15

ADDITIONAL Adverse Effects

  • Seizure-like effects have been reported, although ketamine has been used to treat seizures.14 
    • These effects are noted less in the positive (or S) isomer, which may be available in some countries.16,17 
  • Although racemic ketamine is generally efficiently cleared by the liver and excreted with its metabolites by the kidneys, factors affecting metabolism or excretion can prolong clearance. 
    • Emergence reactions (eg, presumed hallucinogenic or excitatory behaviors exhibited upon emergence from anesthesia) may therefore result.
      • Because both ketamine and the active first metabolite norketamine are excreted by the kidneys, these negative behavioral effects may be further exacerbated in cats with renal disease.18,19

References and Author Information

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

Material from Digital Edition may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.


Seizure Classification in Cats

Heidi L. Barnes Heller, DVM, DACVIM (Neurology), Barnes Veterinary Specialty Services, Madison, Wisconsin

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Seizure Classification in Cats

In the Literature

Stanciu GD, Packer RMA, Pakozdy A, Solcan G, Volk HA. Clinical reasoning in feline epilepsy: which combination of clinical information is useful? Vet J. 2017;225:9-12.


FROM THE PAGE …

Several schemes have been used for seizure classification in cats and dogs.1,2 In 2015, the International Veterinary Epilepsy Task Force recommended seizure classification in dogs as reactive seizures (ie, metabolic or toxic causes); secondary epilepsy (ie, identified intracranial pathology likely responsible for seizure); and idiopathic epilepsy.3 With a few modifications, this system can be applied to cats. The decision to pursue additional diagnostic testing in a cat with seizures is complicated. Owner finances, comorbid patient disease, and likely underlying causes must be considered. 

This study statistically evaluated specific clinical characteristics commonly used to predict seizure cause in dogs for applicability to cats. The goal was to provide information to aid in decisions about advanced imaging. Following univariate analysis, logistic regression multivariable analyses of record data from 110 cats identified 5 risk factors for the development of either idiopathic or secondary epilepsy. Reactive seizures were not included in the comparison. 

Purebred cats older than 7 years with an abnormal neurologic examination were more likely to be diagnosed with secondary epilepsy than with idiopathic epilepsy. Of importance, because juvenile-onset seizures were not included as a subset, the predictive factors in this study should not be applied to cats younger than 12 months. Cats with seizure onset before 12 months of age are diagnosed more commonly with secondary epilepsy.4 

Ictal factors (eg, salivation, vocalization) were considered predictive of either secondary or idiopathic epilepsy; however, caution should be exercised when including these factors in practice. Owner descriptions of events can be erroneous and should be interpreted cautiously.5 Recognition of a change in cognition, limb movement, vocalization, and salivation may be clouded by emotion or poorly recognized because only a portion of the event was visualized.


… To Your Patients

Key pearls to put into practice:

1

Cats that are 1 to 7 years of age at seizure onset are more likely to be diagnosed with idiopathic epilepsy as compared with secondary epilepsy.  

2

A normal neurologic examination was reported in 79% of cats with idiopathic epilepsy as compared with 48.9% of cats with secondary epilepsy.

 

3

Type of seizure (ie, focal vs generalized) was not predictive of seizure classification.  

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

Material from Digital Edition may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.


Novel Canine Oxygen Therapy Techniques

Rebecca A. Johnson, DVM, PhD, DACVAA, University of Wisconsin School of Veterinary Medicine

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Novel Canine Oxygen Therapy Techniques

FIGURE Bilateral nasal catheter in a Bernese mountain dog. Catheters are directed medially through the ventral meatus and secured to the skin for oxygen administration. For high-flow nasal cannulas, double-prong cannulas should be approximately 50% the diameter of the nares to allow high-flow administration with minimal airway pressure increases.

In the Literature

Daly JL, Guenther CL, Haggerty JM, Keir I. Evaluation of oxygen administration with a high-flow nasal cannula to clinically normal dogs. Am J Vet Res. 2017; 78(5):625-630.


From the Page …

Acute respiratory distress is frequently treated with conventional oxygen-delivery systems (eg, face masks, hoods, oxygen cages, unilateral or bilateral nasal cannulas or catheters; Figure) using nonheated, 100%-inspired oxygen. However, patient intolerance, patient complications (eg, barotrauma, pneumonia, pneumothorax), and low or variable alveolar oxygen levels can cause difficulties, and if more invasive oxygen-delivery techniques (eg, continuous positive airway pressure, mechanical ventilation) are required, cost, equipment, need for sedation, and personnel required must be considered. Thus, a clinically useful, noninvasive method to improve alveolar, and subsequently arterial, oxygen levels is desirable.

This study evaluated the use of a commercially available high-flow nasal cannula (HFNC; double-prong, ≈50% of nares diameter) to deliver heated, humidified oxygen at high flow rates. HFNCs use improved dead-space washout to increase consistency and concentration of alveolar oxygen, subsequently increasing arterial oxygenation with minimal alterations in transpulmonary pressures and gastric distension. Three techniques (ie, conventional oxygen therapy at 100 mL/kg/min, HFNC at 20 L/min, HFNC at 30 L/min) were administered randomly to 6 sedated dogs. All oxygen delivery methods improved arterial partial pressure of oxygen (PaO2) from baseline (median PaO2, 85.9 mm Hg); however, PaO2 values with HFNC at 20 L/min and 30 L/min were significantly higher (median PaO2, 519.9 mm Hg and 538.1 mm Hg, respectively) than with conventional nasal oxygen flows (median PaO2, 202.9 mm Hg). Transpulmonary pressures did not differ from baseline and among treatments, and although radiographic evidence of gastric distension was observed in one dog, it was not apparent clinically.

This study presented a novel method of oxygen supplementation that provides advantages such as improved delivery of humidified and warmed oxygen to alveoli with minimal side effects in normal dogs. Other studies are beginning to investigate the efficacy of such methods in compromised patients such as those with intrinsic pulmonary disease or ventilation disorders.1 Further studies regarding any associated histopathology are needed.


… To Your Patients

Key pearls to put into practice:

1

With conventional supplemental oxygen administration, alveolar oxygen levels are often low or variable despite 100% oxygen delivery.

2

Commercially available HFNC systems (flow, 20-30 L/min) may offer advantages (eg, improved PaO2) over conventional oxygen-delivery techniques using nasal cannulas (100 mL/kg/min).

3

Although significant complications associated with HFNCs appeared minimal in normal dogs in this study, further studies regarding complications associated with such high flows are needed.

References and Author Information

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

Material from Digital Edition may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.


Laparoscopic Spay in Dogs with von Willebrand Disease

Jonathan Miller, DVM, MS, DACVS, Oradell Animal Hospital, Paramus, New Jersey

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Laparoscopic Spay in Dogs with von Willebrand Disease

In the Literature

Keeshen TP, Case JB, Runge JJ, et al. Outcome of laparoscopic ovariohysterectomy or ovariectomy in dogs with von Willebrand disease or factor VII deficiency: 20 cases (2012-2014). J Am Vet Med Assoc. 2017;251(9):1053-1058.


FROM THE PAGE …

Coagulopathies such as von Willebrand disease, which has a reported 1.5% prevalence in dogs,1 and factor VII deficiency can cause clinically significant bleeding during elective canine procedures. Human studies have shown more bleeding complications have occurred during open procedures as compared with minimally invasive procedures.2-5 

In this retrospective study, 16 Doberman pinschers were diagnosed with von Willebrand disease via a low von Willebrand factor antigen concentration (median, 19%; normal, 70%-180%) or via a buccal mucosal bleeding time of more than 5 minutes. Four dogs (including a beagle, a springer spaniel, a Scottish deerhound, and an Alaskan Klee Kai) were diagnosed with factor VII disease by a low serum factor VII activity or prolonged prothrombin time. Two dogs had a history of epistaxis, and one dog had previous facial bruising and swelling.

Of the 16 dogs with von Willebrand disease, 12 received desmopressin preoperatively; 4 received desmopressin and an infusion of cryoprecipitate, which is high in von Willebrand factor. Of the dogs with factor VII deficiency that received preoperative treatment, one received desmopressin and one received a plasma transfusion; the remaining 2 dogs received no specific treatment. Laparoscopic ovariectomy or ovariohysterectomy with or without gastropexy was performed with no unexplained intraoperative or postoperative hemorrhage.  

This study showed no increased risk to dogs with preoperatively diagnosed coagulopathies that underwent laparoscopic elective procedures; no difference between single incisions and multiport incisions was noted. Preoperative identification and prophylactic treatment were likely key to successful procedural outcomes.


… To Your Patients

Key pearls to put into practice:

1

Preoperative testing for heritable coagulopathies is recommended in predisposed breeds.

 

2

Treatment with desmopressin and/or plasma products before elective surgeries in dogs with von Willebrand disease or factor VII deficiency is recommended.

 

3

Based on study findings, minimally invasive ovariohysterectomy or ovariectomy may be considered in female dogs affected with von Willebrand disease or factor VII deficiency.

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

Material from Digital Edition may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.


Effect of Feline Diabetes on Cardiac Function

Rebecca L. Quinn, DVM, DACVIM (SAIM, Cardiology), Cape Cod Veterinary Specialists, Buzzards Bay, Massachusetts

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Effect of Feline Diabetes on Cardiac Function

In the Literature

Pereira NJ, Novo Matos J, Baron Toaldo M, et al. Cats with diabetes mellitus have diastolic dysfunction in the absence of structural heart disease. Vet J. 2017;225:50-55.


FROM THE PAGE …

In human medicine, diabetes mellitus (DM) is a well-documented cause of cardiac dysfunction, specifically diastolic dysfunction. Unlike patients with systolic dysfunction, patients with diastolic dysfunction have preserved pumping abilities.1 Although previous studies have identified high incidences of congestive heart failure in diabetic cats, this study was the first to prospectively evaluate the incidence of diastolic dysfunction in cats with DM.2 The purpose was to determine if cats with newly diagnosed DM acquired diastolic dysfunction similarly to humans and, secondarily, to determine if diastolic dysfunction progresses over time.

Thirty-two diabetic cats and 10 healthy age- and weight-matched controls were included in the study. All 32 cats with DM and 10 controls underwent baseline echocardiograms and Doppler blood pressure measurements. No evidence of systolic dysfunction was noted in any study cats. On initial evaluation, diastolic studies were completed in 21 of the 32 cats with DM and 5 of the 10 controls. Of the 21 cats with DM, 33% were normal and 67% had evidence of diastolic dysfunction. Of the 5 control cats, 80% were normal and 20% had evidence of diastolic dysfunction.

On 6-month follow-up examination, 17 of the 32 cats with DM had either died or were lost to follow-up or the owners declined follow-up. The remaining 15 cats with DM underwent recheck echocardiograms 6 months after initial assessment. Of these, 5 were in DM remission, whereas the remaining 10 required continued treatment with glargine +/- exenatide (a glucagon-like peptide-1-receptor agonist) therapy. Twelve of the cats with DM underwent diastolic studies at 6-month follow-up; 17% had normal diastolic studies, whereas 83% demonstrated diastolic dysfunction. Fewer cats in diabetic remission still had evidence of diastolic dysfunction (60%) as compared with cats not in remission (100%). None of the cats developed congestive heart failure secondary to diastolic dysfunction.


… To Your Patients

Key pearls to put into practice:

1

Diastolic dysfunction is diagnosed by employing specific echocardiographic techniques.

2

Cats with DM demonstrate diastolic dysfunction, which appears to worsen over time in cats that require continued antidiabetic therapy. It is possible that diastolic dysfunction may progress to congestive heart failure in some cats with DM.

3

Cats in diabetic remission continue to show evidence of diastolic dysfunction, but dysfunction appears improved as compared with cats not in remission.  

4

Cats with DM may experience cardiac complications over time and may benefit from routine echocardiography, even in the absence of cardiac murmurs.

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

Material from Digital Edition may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.


Research Note: Tritrichomonas foetus & Giardia duodenalis Coinfection

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Tritrichomonas foetus and Giardia duodenalis are possible causes of diarrhea in cats. T foetus infection results in chronic diarrhea and often affects cats from shelters or catteries. The trophozoite stage of T foetus has previously been described in cats, but the pseudocyst stage is typically found only in bovine animals. Giardia duodenalis infection is more variable in cats. The organisms are known to coinfect cats.

This case report described 2 littermate cats with a coinfection of G duodenalis and T foetus in the pseudocyst stage. One littermate was originally presented for diarrhea. After an ascarid infection was confirmed, both littermates were treated orally with milbemycin and praziquantel. As diarrhea persisted in the affected cat, coproantigen testing was performed. Results were positive for Giardia spp, and the kitten was treated with fenbendazole for 5 days. Ongoing diarrhea in the affected kitten was treated with a 10-day course of spiramycin and metronidazole. Although clinical signs briefly resolved, both cats developed diarrhea a few days later.

Fecal smears stained with Lugol solution and Giemsa stain identified Giardia spp cysts and trophozoites as well as unidentified drop-shaped elements, which were discovered to be T foetus pseudocysts. PCR analysis confirmed T foetus infection. The patients were treated with ronidazole for 14 days, and clinical signs resolved.

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

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Research Note: Treats & Owner Psychology

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The objective of this study was to examine owner attitudes and views about treats, with a focus on owner perceptions and motivations for feeding treats. In response to researcher-mediated questionnaires, pet owners (n = 280) almost unanimously viewed the word treat within a nutritional context as opposed to as a toy or reward. Most (96%) owners fed treats, with 69% feeding store-bought treats on a daily basis. Most owners fed multiple types of treats, with dog biscuits and chews predominating.

Many views, both positive and negative, regarding the feeding of treats as beneficial and as a contributor to weight gain were expressed. Nearly three-quarters of owners considered treats to be an additional component to their dog’s diet; however, only a minority made adjustments to their pet’s meal intake. Owners cited such reasons for giving treats as providing essential variety in the diet, rewarding good behavior, or keeping their pet happy.

These views demonstrate the complex and multifactorial roles that pets have in society, with many owners equating their pet with a friend or child. The authors concluded that more research is needed to understand pet owner psychology regarding provision of treats, especially as it relates to the rise in pet obesity.

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

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The Importance of Dietary History

Jennifer Larsen, DVM, PhD, DACVN, University of California, Davis

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The Importance of Dietary History

In the Literature

Giacometti F, Magarotto J, Serraino A, Piva S. Highly suspected cases of salmonellosis in 2 cats fed with a commercial raw meat-based diet: health risks to animals and zoonotic implications. BMC Vet Res. 2017;13:224.


From the Page …

Diets containing raw meat, organs, egg, or bones are preferred by some pet owners; these diets are either homemade or commercially available products that may or may not be nutritionally complete or balanced. Salmonella spp and other potentially pathogenic microorganisms are commonly identified in commercial raw pet foods, and there have been reports of dogs and cats contracting salmonellosis from dietary sources.1-3 

This case report described the presentation and treatment of 2 previously healthy cats from the same household that were diagnosed with salmonellosis. The first cat was presented for anorexia, weight loss, vomiting, and diarrhea. The owner reported feeding homemade and commercial dry pet food. Diagnostics included CBC and serum chemistry profile, as well as fecal flotation and SNAP ELISA for Giardia spp, both of which were negative. Significant findings included neutrophilia, monocytosis, mild elevations in liver enzymes, and hypoalbuminemia. Hepatopathy with probable infectious enteritis was diagnosed; treatment included IV fluids, antibiotics, parasiticides, probiotics, a veterinary therapeutic intestinal diet, and S-adenosylmethionine. 

The second cat in the household was presented 4 days later for similar clinical signs and had similar laboratory findings. Further dietary history revealed the homemade food to be a commercial raw poultry-based diet. The differential list was expanded to include enteropathogens from a contaminated dietary source; stool was submitted for PCR assay, which detected Salmonella spp and Clostridium perfringens enterotoxin gene. Salmonella spp were also detected in the raw diet but not the kibble; small numbers of C perfringens were cultured from both diets. Because C perfringens is likely an opportunistic pathogen but is also found in healthy cats, salmonellosis was the probable cause of clinical signs in both cats described in this report.4,5


… To Your Patients

Key pearls to put into practice:

1

A thorough dietary history should be collected for every patient at each visit. Initially, the owner in this case did not reveal that the diet included raw animal products. Recording diet details, including brand and product names, is essential. 

2

Clinicians and owners should discuss owner goals and philosophies of feeding unconventional diets, as fear or guilt sometimes influences these choices due to misinformation regarding risks and benefits of specific products and feeding practices. 

3

Owners should be educated about the health risks of feeding homemade or commercial diets containing raw animal products, which are more likely to be contaminated with pathogenic microorganisms.

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

Material from Digital Edition may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.


Territorial Aggression in a Dog

Lore I. Haug, DVM, MS, DACVB, CABC, Texas Veterinary Behavior Services, Sugar Land, Texas

Behavior

|Peer Reviewed

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Territorial Aggression in a Dog

Ruger, a 2-year-old intact male Australian cattle dog, was presented after biting a man walking past the owner’s house. The bite tore through the man’s jeans and inflicted 2 shallow punctures and several scrapes along the back of the thigh. In the past, the dog has been sociable and friendly during regular visits to the clinic.

History

Ruger was acquired as a 10-week-old puppy from a local breeder. He attended puppy class at 16 weeks of age, where he barked at some of the other puppies but otherwise did well. At approximately 10 months of age, Ruger began barking and growling at humans walking past the house and at unfamiliar visitors who entered the house. These behaviors escalated over the next year. 

The dog spent a lot of time alone in the backyard during the day. The yard backed up to a golf course and was enclosed by a 5-foot-high wrought iron fence. Ruger consistently ran along the fence barking and growling at humans, other dogs, or golf carts passing by. Six months before presentation, Ruger began barking at dogs and certain humans when he was out walking near the house. He did not bark at dogs or humans at the veterinary clinic or in the homes of friends or relatives. He attended pet daycare one to 4 times per month and regularly visited the dog park without incident. Medical history was unremarkable.

Physical Examination & Behavior

Ruger wagged his tail and solicited attention from the clinic staff during the visit. He readily took treats and responded well to his name and a verbal cue to sit. Physical examination was unremarkable.

DIAGNOSIS:

Territorial aggression resulting from extended time outside and reinforced behavior 

Discussion

Some dog breeds—typically guarding breeds and herding breeds—appear to have a low threshold for developing excessive territorial aggression.1 This may be compounded by inadequate or inappropriate socialization, leading to a comorbid diagnosis of fear aggression. However, behavior—aggressive or otherwise—is always a reaction to some aspect of the dog’s environment, rather than an aspect of the dog itself. Genetics and perinatal experiences do affect the likelihood with which some behaviors develop, but appropriate environmental conditions must exist for the behavior to be expressed.

Testosterone can mediate offensiveness, competitiveness, and aggression in some contexts. However, many intact male dogs do not show behavior problems. In fact, a slowly growing body of research suggests that gonadectomized dogs may be at higher risk for expressing certain behavior (eg, anxiety, aggression) than intact dogs.2-4

Territorial behavior is not a result of dominance or pack hierarchy and is, actually, normal in dogs. Even extremely sociable dogs will generally bark to announce the arrival of someone onto the owner’s property. In domestic dogs, the territory generally encompasses the owner’s house and yard. Dogs may also defend the space in and around a vehicle or cage. Territorial behavior tends to be most intense directly along boundary lines. Unlike fear aggression, which often manifests at an early age, territorial and protective behaviors generally begin at around 8 to 10 months of age5 and escalate over the next 12 to 24 months, particularly if the dog’s environment is not carefully managed.

The primary concern in this case was the time Ruger spent outside unsupervised rehearsing aggressive territorial reactions. Every behavior serves a function for a dog; when the dog barks and chases someone or something along the fence and it leaves, the territorial behavior is reinforced. Barriers tend to escalate these reactions.

Many dogs have intense reactions at the front door. The level of arousal rehearsed there can lead to biting behavior, even in otherwise friendly dogs.

During Ruger’s bite episode, he performed the same behavior that he did every day but was able to reach the trigger by breaking through the fence. There is a higher risk for bite by an escaped dog that spends a lot of time patrolling the perimeter of the property, fence running, and barking at humans and other animals from the home.

Management 

The first treatment intervention included only allowing Ruger outside time while supervised and to avoid situations in which he practiced aggressive responses to humans or dogs. A program of basic obedience was also initiated; the owner was instructed to begin training an alternative response when Ruger saw humans on walks or when he was in the yard.

The Take-Home

When managing any behavior problem, it is crucial to evaluate the patient’s environment and the context in which the problem behavior occurs. Information regarding the animal’s environment is often far more important than information about the animal itself (eg, signalment). A clinician must be aware of environmental factors that trigger the behavior or allow the animal to perform the behavior to make recommendations to prevent the animal from rehearsing—and therefore receiving reinforcement—for the behavior.

References and Author Information

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

Material from Digital Edition may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.


Top 5 Tips for Animal Transportation

Brian A. DiGangi, DVM, MS, DABVP, University of Florida

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Top 5 Tips for Animal Transportation

Companion animals may be transported for various reasons, including owner relocation and travel, animal participation in competitions and exhibitions, and relocation of homeless animals by humane groups to areas where adoption is more likely.1

Animal health and welfare must be considered during all aspects of transportation. Veterinarians should be prepared to provide guidance to both humane groups and owners to ensure that companion animal transportation is safe and comfortable while adhering to state, federal, and international regulations. Below are the author’s top 5 tips for safe, comfortable, and humane animal transportation.

1

Review Travel Regulations

Regulations differ regarding intrastate, interstate, and international transportation of animals and vary according to species and purpose of travel (eg, sale, exhibition, vacation). Importation regulations are determined by the destination state; the office of the state veterinarian determines requirements for transportation of animals to or within that state. State regulations vary substantially and frequently are updated based on current trends and risks for pathogen transmission. Most states require proof of current rabies vaccination and a Certificate of Veterinary Inspection at minimum, although the minimum age for rabies vaccination varies. Dogs imported from a rabies-free country may be exempt from vaccination by the Centers for Disease Control but are subject to state regulations.2,3 

Other requirements can include additional vaccinations, diagnostic testing, and limitations on duration of stay, depending on the purpose of travel. Animals granted limited durations of stay (eg, those traveling only for short-term exhibition) may be exempt from some vaccinations and testing. The United States Department of Agriculture’s Animal and Plant Health Inspection Service maintains a pet travel website that details state-specific regulations that owners, humane groups, and veterinarians should review when planning travel with companion animals.4 

For animals traveling by air, options generally include travel in the cabin as a carry-on or checked as cargo. Individual airlines should be consulted for details and regulations. Restrictions on animal age, breed, species, and size are common, as are stipulations on crate size and construction, type of aircraft, flight route and duration, and ambient temperatures at both point of origin and destination. Additional regulations, including exclusions involving specific countries and quarantine periods, often apply for international travel. The International Air Transport Association annually publishes an extensive set of guidelines for safe and humane air transportation of pets to which most major airlines are expected to adhere.5 

Understanding Best Practices for Large-Scale Animal Relocation

Veterinarians who advise shelters and rescue groups involved in large-scale animal relocation programs have access to a variety of evidence-based and experiential best practices.15-18 Additional guidelines have been created for emergency large-scale evacuation events.19 Each set of recommendations discusses the responsibilities of participating individuals and organizations at both source and destination shelters, recommends safe and humane housing and handling during transportation, and offers insight into the objectives of individual relocation programs as well as their risks and benefits. When planning large-scale relocation programs, population-level considerations must include steps to assess and minimize the risk for infectious disease transmission before, during, and after transportation, particularly when relocating animals to different geographic regions. Steps should be taken to ensure animal comfort and safety, and those involved in relocation should have a high degree of confidence that the overall risk:benefit ratio lies in favor of relocation for both the individuals and the affected animal populations as a whole.

2

Explain the Importance of Preventive Care

Veterinary visits before long-distance transportation and/or relocation should include a review of preventive healthcare guidelines and travel preparedness based on risk.6 A thorough physical examination should be conducted, preventive treatments (eg, internal and external parasite control, core vaccinations) administered, and spay/neuter counseling provided as appropriate. A plan for follow-up assessment should be created for animals for which travel or relocation will be temporary, particularly if the travel destination has significant infectious disease risks. 

The veterinary team should assist the owner or humane group in formulating a plan for emergency care during travel, which should identify after-hours veterinary hospitals in the travel area and ensure timely access to the animal’s medical records. The owner may be provided with a printed copy of pertinent medical records or access to digitized versions. For animals with chronic conditions, an adequate supply of any ongoing prescription drugs for the duration of travel should be provided.

3

Recommend Permanent Identification

Animals that will be traveling must have adequate identification (ie, permanent identification with a microchip). Collars and tags are highly visible and do not require special equipment to read; however, they can be lost, stolen, damaged, or removed. The functionality of existing microchips should be confirmed using a microchip scanner and the accuracy of the registration information verified in the AAHA Universal Pet Microchip Lookup database (Table 1). This database is not a registry, so missing or erroneous information must be corrected using an independent pet recovery service, which may require a fee. Each microchip company has a different fee structure and package of services. Free, instant, lifetime registration of any brand of microchip, along with listing in the AAHA database, is available through the Found Animals Microchip Registry (Table 1). International travel may require additional identification with an International Standards Organization-compliant (15-digit, 134.2-kHz) microchip.

Table 1

Transportation Information Resources

Source Uses
AAHA Canine Vaccination Guidelines: Lifestyle-Based Calculator Checklist for lifestyle characteristics to tailor vaccination recommendations
AAHA Universal Pet Microchip Lookup Microchip information database; microchip and contact information must be provided by individual, independent pet recovery services
American Heartworm Society Transport Guidelines Guidelines for minimizing heartworm transmission in relocated dogs
Animal and Plant Health Inspection Service: Pet Travel Links to requirements for pet export and import to and from individual states or countries
Centers for Disease Control and Prevention: International Travel with Your Pet Owner-friendly resource with travel tips and links to government regulations
Found Animals Microchip Registry Independent pet recovery service; user-friendly, free, instant, lifetime registration for any brand of microchip
PetTravel.com Owner-friendly resource for airline policies, import requirements, pet-friendly accommodations, and travel supplies
International Pet and Animal Transportation Association Resource for international animal transportation policies and requirements

Although not a form of permanent identification, collars and tags are still recommended in addition to microchips, as they can provide supplemental identification and increase the likelihood of lost pet recovery.7 Identification tags should include the pet’s name and the owner’s name, address, and phone number. Ensuring the pet’s microchip number also appears on an identification tag will aid in recovery in the absence of a microchip scanner. 

4

Identify & Mitigate Travel-Specific Risks

Disease risks vary based on geographic region and should be discussed with the owner or humane group, along with activities that might enhance the animal’s risk for exposure. Exposure risks include contact with other animals, exposure to natural bodies of water, exposure to vector and reservoir host species, seasonal variations, and zoonotic potential of pathogens that may be encountered (Table 2). 

Table 2

Common Geographic Distribution of Infectious Agents of Dogs & Cats in the United States8

United States Geographic Region Infectious Agent (Animal Affected)
Northeast

Anaplasma phagocytophilum* (C, D)

Borrelia burgdorferi* (C, D)

Cytauxzoon felis (C)

Rickettsia rickettsii* (C, D)

Midwest

Anaplasma phagocytophilum* (C, D)

Blastomyces dermatitidis* (C, D)

Cytauxzoon felis (C)

Histoplasma capsulatum* (C, D)

Leishmania spp* (C, D)

Rickettsia rickettsii* (C, D)

Southeast

Anaplasma phagocytophilum* (C,D)

Babesia canis (D)

Blastomyces dermatitidis* (C, D)

Cytauxzoon felis (C)

Ehrlichia spp* (C, D)

Hepatozoon spp (C, D)

Histoplasma capsulatum* (C, D)

Leishmania spp* (C, D)

Pythium insidiosum (C, D)

Rickettsia rickettsii* (C, D)

Trypanosoma cruzi* (C, D)

Northwest

Neorickettsia helminthoeca (D)

Rickettsia rickettsii* (C, D)

West

Anaplasma phagocytophilum* (C, D)

Rickettsia rickettsii* (C, D)

Yersinia pestis* (C, D)

Southwest

Coccidioides immitis* (C, D)

Rickettsia rickettsii* (C, D)

Trypanosoma cruzi* (C, D)

Yersinia pestis* (C, D)

*Indicates agents with the potential for human impact

C = cats, D = dogs

Risk-based vaccinations are recommended for dogs in addition to core vaccines; these include “lifestyle” vaccinations against Bordetella bronchiseptica, parainfluenza virus, leptospirosis, Borrelia burgdorferi, and canine influenza.9 AAHA offers a lifestyle-based vaccine calculator that facilitates creation of an individualized risk-based vaccination protocol (Table 1). Fewer risk-based vaccination options are available for cats, but cats that travel should be evaluated for supplemental vaccinations against feline leukemia virus, Chlamydophila felis, and Bordetella bronchiseptica.10 

Pet owners should also consider seasonal, emerging, and otherwise timely disease risks when preparing for travel. In 2017, the American Heartworm Society reported increased incidence of canine heartworm disease across the United States and released guidelines for minimizing heartworm disease transmission during travel (Table 1).11 Heartworm disease remains a year-round threat across the United States, and precautions should be taken to protect animals traveling through endemic areas and animals that might be exposed to infected dogs. In June 2017, canine H3N2 influenza re-emerged in the United States, primarily throughout the southeast and midwestern states.12 If exposure is likely, vaccination against both H3N2 and H3N8 strains should be considered at least 4 weeks before travel.9

5

Discuss Steps to Protect Behavioral Health & Welfare

An animal’s behavioral health and welfare must be protected throughout its transport. The Five Freedoms (ie, Freedom from Hunger and Thirst; Freedom from Discomfort; Freedom from Pain, Injury or Disease; Freedom to Express Normal Behavior; Freedom from Fear and Distress) provide a useful framework for assessing animal welfare during the transport process and can guide individual animal treatment plans.13 Environmental stressors (eg, temperature extremes, the impact of various modes of transportation), methods for reducing individual animal stress (eg, the use of pheromones, toys and treats, opportunities for exercise and elimination), and acclimation to expected travel conditions (eg, crate training, habituation to car rides) must all be assessed. Use of anxiolytics for individual patients may be considered. Use of sedatives or tranquilizers (eg, acepromazine) is not recommended and may even be prohibited for air travel.14 

Conclusion

Clinicians play an important role in ensuring safe transportation of companion animals. Familiarity with state, federal, and international travel regulations is essential to prevent travel delays and potentially unsafe and inhumane conditions. Companion animals should undergo physical examination prior to transportation, and appropriate treatment should be provided when necessary. Protection against seasonal and/or emerging diseases and prevention of infectious disease transmission should be given special consideration. Microchipping ensures that animals can be identified in the event of loss, and planning ahead for emergencies helps facilitate treatment of unexpected illness or injury. Becoming familiar with the Five Freedoms will help veterinarians counsel clients and humane groups on minimizing an animal’s stress during travel and relocation.


Global Commentary

Adam Parascandola, Director Animal Protection & Crisis Response, Humane Society International

Animals are transported globally for a variety of reasons, including the rehoming of animals through adoption, the sale of animals online, and owners traveling internationally with their pets.

Requirements and procedures for transporting animals can vary widely between countries. Some countries require animal identification (eg, microchipping) and proof of rabies vaccination (eg, vaccination certificate, titer testing, quarantine upon arrival) for animal travel. In addition to identification and vaccination documentation, some countries require government inspection and approval before an animal is allowed to leave the country. For example, South Korea requires animals to be presented for inspection before a certificate may be issued by the Animal and Plant Health Inspection service allowing the animal to leave the country. 

Animal transport in most countries is strictly regulated to prevent the spread of rabies and zoonotic diseases, but often, laws and regulations are slow to change and have not kept up with the prevalence and emergence of diseases in animals. For example, the Asian strain of canine influenza (H3N2) has been transmitted to several western countries through the import of dogs. Though there may not be legal requirements for canine influenza screening and vaccination, a responsible importer should test and vaccinate for canine influenza before importing a dog from a country where this disease is present. In addition, international animal rescue efforts have increased with the emergence of the Internet and social media. While this global awareness and connectivity has helped save the lives of thousands of animals, individuals or groups transporting rescue animals are responsible for preventing the spread of disease. Pet owners adopting internationally may import an animal with unknown, incomplete, or inaccurate medical records; internationally adopted pets should always be thoroughly examined by a veterinarian upon arrival at their final destination. Veterinarians should be aware of the risks of international pet travel and potential disease transmission and may recommend that pet owners consider at-home quarantine until the health of an imported animal can be examined.

Animal travel regulations also vary depending on whether the animal is being transported as a personal pet or for commercial purposes. In the United States, animals being transported for adoption or rehoming may be considered a commercial purpose, while in the European Union, animals traveling separately from their owners may be considered commercial. Entry requirements for working dogs being transported internationally for the purpose of disaster responses may be expedited or waived if the dog is certified under an internationally recognized response agency. Import and export restrictions can vary not only by country, but even by region, and some countries impose breed restrictions that prohibit the importation of certain breeds entirely. For example, importing and exporting dogs in Indonesia is legal when traveling to or from Jakarta, while the island of Bali forbids both the import and export of dogs. People transporting animals internationally may benefit from the services of an international pet relocation service or broker, required by some airlines and some countries (See Resource). These companies ensure people transporting animals are compliant with laws, while also handling customs fees and retrieval requirements for unaccompanied animals. Ultimately, when transporting animals internationally, it is important to know import and export laws of the animal’s country of origin, as well as the country and local jurisdiction of the final destination.

References and Author Information

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

Material from Digital Edition may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.


Nutrition Assessment in a Dog with Osteoarthritis & Obesity

Nutrition Assessment in a Dog with Osteoarthritis & Obesity

Maryanne Murphy, DVM, PhD, DACVN, University of Tennessee

Tamberlyn D. Moyers, LVMT, VTS (Nutrition), University of Tennessee

Gregg K. Takashima, DVM, WSAVA Global Nutrition Committee Series Editor

Kara M. Burns, MS, MEd, LVT, VTS (Nutrition), Olathe, Kansas

Nutrition

|Peer Reviewed

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Nutrition Assessment in a Dog with Osteoarthritis & Obesity

THE CASE

An 8-year-old neutered male pug was presented for a weight-loss plan 2 weeks after bilateral cranial cruciate ligament (CCL) repair; the surgeon had suggested the weight-loss plan to aid in healing and long-term health. The owners reported that, before CCL repair, the dog was reluctant to walk, seemed stiff, and spent the majority of most days in a recumbent position.

On presentation, the dog weighed 71.9 lb (32.6 kg), with a BCS of 9 out of 9 and adequate muscle mass. Body fat percentage was estimated at 65% based on palpation and a body fat index chart.1 He was able to walk only a few steps at a time with substantial sling support, which had not been necessary before surgery. The owners had been instructed to maintain crate rest because of the CCL repair until otherwise directed by the surgeon.

CBC, serum chemistry profile, urinalysis, and T4 results were within normal limits. Bilateral stifle radiographs obtained before surgery showed periarticular osteophytes on both patellae and trochlear ridges, bilateral effusion, and bilaterally compressed fat pads.

Dietary History

The dog was reportedly fed once daily in the evening. A typical meal consisted of either 2 hot dogs, half a grilled boneless skinless chicken breast, or a grilled hamburger and one to 2 chocolate chip cookies. He also had access to an adult dry feline maintenance diet, which was always available for the 5 cats living in the home. No commercial dog food was included in his diet. Based on the USDA National Nutrient Database for Standard Reference, the human foods contributed approximately 374 to 566 calories per day.2 The owners were unable to identify the manufacturer of the feline diet or estimate the dog’s daily consumption of this diet, so additional caloric contribution could not be determined.

DIAGNOSIS:

OSTEOARTHRITIS & OBESITY

Treatment

Based on the dog’s weight on presentation and estimated body fat percentage, the dog’s ideal body weight (IBW) was approximately 31.5 lb (14.3 kg).3,4 Using this IBW, his resting energy requirement (RER) was estimated to be 515 kcal/day, and maintenance energy requirement (MER) was 412 kcal/day using a 0.8 life stage factor (see How to Calculate IBW, RER, & MER).5 A life stage factor of 0.8 to 1.0 is recommended for weight loss; the lower factor was chosen in this case due to the patient’s high BCS. These calculations mirrored similar caloric recommendations reported in other weight-loss regimens.6 If a treat allowance is required, reserving 10% MER for this purpose is generally recommended.

How to Calculate IBW, RER, & MER3

  • IBW = [current body weight in kg × (100% – body fat percentage)] ÷ 80%

[32.6 kg × (1.0 – 0.65)] ÷ 0.8 = 14.3 kg

  • RER = 70 × (ideal body weight in kg)0.75

70 × (14.3 kg)0.75 = 515 kcal/day

  • MER = RER × life stage factor

515 kcal/day × 0.8 = 412 kcal/day

Of this patient’s 412-kcal/day MER, 377 kcal/day was allocated to the selected maintenance diet and 35 kcal/day to treats. One and two-thirds cups (375 kcal) per day of a dry therapeutic weight-loss diet formulated to meet the nutrition requirements established by the Association of American Feed Control Officials (AAFCO) Dog Food Nutrient Profiles for maintenance was prescribed. The owners were given a list of various human foods—and their associated caloric content—that could be used for the dog’s 35-kcal/day treat allowance. He was also started on eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) provided via a liquid fish oil product (see Suggested Reading). Each teaspoon contained 690 mg of EPA, 414 mg of DHA, and 41 kcal, which was not factored into the dog’s weight-loss plan due to concerns about owner compliance (see Owner Education). The owners were instructed to remove access to the feline dry food.

Outcome

The dog’s progress was rechecked once weekly for the first month of the weight-loss plan, then every 4 weeks over the next year. Once he was cleared for activity by the surgeon who performed the CCL repair, the owners were instructed to start 5-minute leash walks twice daily, with an eventual increase to 20 minutes twice daily. Daily feeding amounts were periodically adjusted to maintain a weight-loss rate of 1% to 2% of the dog’s current body weight per week. As he lost weight, the owners reported it was easier for him to rise from a sitting position and that he seemed less stiff when walking as compared with before CCL repair. When the dog achieved his ideal weight and BCS, the owners reported return to an apparent normal gait. He no longer had difficulty rising and was able to take 30-minute daily leash walks with at least one 60-minute walk per week.

Owner Education

The owners were feeding an unbalanced diet consisting of human food of low nutritional value. Part of the initial weight-loss consultation included discussing the challenges the owners may have faced when switching the dog from a human-food–based diet to an extruded kibble-based diet. The owners were instructed to introduce the new diet by adding a small portion of the new diet to the evening meal and removing a portion of the human food items. The owners were also instructed to stop feeding chocolate chip cookies. Over approximately 4 to 7 days, the kibble portion was increased while the human food portion was decreased. If they could not make this transition within that time frame, a balanced homemade diet plan could be considered. 

The owners were concerned about continued begging for food. Specific scenarios and suggested responses were discussed. For example, when the dog would beg for food, the owners could initiate an activity (eg, playing with toys, going for a leash walk); however, due to the CCL repair and the osteoarthritis, all activity also had to be based on this dog’s ability and with the approval of the referring surgeon.

Ideally, the calories provided from supplements, including fish oil, are included in a daily treat allowance. In this case, however, the owners felt the recommended treat allowance was too low, and the veterinary team was concerned about plan adherence if fish oil was the only allowed daily treat. Because total caloric intake—including diet, treats, and supplements—was assessed at each weight recheck, treat allowance could be adjusted based on rate of weight loss. This information was used to further educate the owners about the effect excess calories can have on weight-loss success. If fish oil needed to be incorporated as part of the treat allowance, a reasonable alternative would have been to reserve some of the daily portion of the complete and balanced kibble as a treat.

Conclusion

This case illustrates the importance of nutritional management for weight loss and pain management to improve clinical signs associated with osteoarthritis. It also demonstrates the importance of owner education and compliance.

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AAFCO = Association of American Feed Control Officials, CCL = cranial cruciate ligament, DHA = docosahexaenoic acid, EPA = eicosapentaenoic acid, IBW = ideal body weight, MER = maintenance energy requirement, RER = resting energy requirement

Diet in Disease is a series developed by the WSAVA, the Academy of Veterinary Nutrition Technicians, and Clinician’s Brief.

References and Author Information

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

Material from Digital Edition may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.


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