Wendy Blount, DVM - PowerPoint PPT Presentation

Loading...

PPT – Wendy Blount, DVM PowerPoint presentation | free to view - id: f966-OTkxN



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Wendy Blount, DVM

Description:

Other bacteria can be secondary invaders. Upper ... Increase in the nucleus-to-cytoplasm ratio (nucleus too big) ... Innova EVO (California Naturals - Natura) ... – PowerPoint PPT presentation

Number of Views:209
Avg rating:3.0/5.0
Slides: 62
Provided by: wendyb2
Category:
Tags: dvm | big | blount | naturals | wendy

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Wendy Blount, DVM


1
Wendy Blount, DVM
Things We Dont Do that we Should Things We
Do that we Shouldnt
2
Wendy Blount, DVM
  • DVM TAMU 1992
  • Private Practice Houston 2 years
  • Westbury Animal Hospital
  • Small Animal Internal Medicine Residency
  • TAMU 1994-1997
  • Private Practice 1997-present
  • Nacogdoches and Lufkin, TX
  • See appointments at 3 practices
  • CE for groups and in-house

3
Wendy Blount, DVM
  • drblount_at_vonallmen.net
  • www.wendyblount.com

4
Upper Respiratory Infections - Cats
  • How do many of us treat feline URI?
  • Penicillins (Amoxidrops, Clavamox)
  • Eye ointment (triple antibiotic)
  • Supportive
  • antihistamines
  • Fluids if needed

5
Upper Respiratory Infections - Cats
  • What causes feline URI?
  • Feline calicivirus
  • Feline herpesvirus (FHV-1)
  • Feline Infectious Peritonitis (FIP) coronavirus
  • Chlamydia psittaci var. felis
  • Mycoplasma spp.
  • (Maybe Bordetella bronchiseptica)
  • Other bacteria can be secondary invaders

6
Upper Respiratory Infections - Cats
  • How primary organisms treated?
  • Feline calicivirus
  • supportive
  • Feline herpesvirus
  • Lysine
  • Vaccination if naive
  • Anti-herpetics (acyclovir) dont work well
  • FIP
  • (pentoxyphylline, prednisone)
  • Chlamydia psittaci, Mycoplasma spp.
  • Tetracyclines, quinolones

7
Upper Respiratory Infections - Cats
  • So how can we tell the cause?
  • Conjunctivitis
  • NOT Mycoplasma or Bordetella
  • Oral ulcers
  • FHV-1, FCV
  • Keratitis
  • FHV-1
  • Coughing
  • FHV-1, Mycoplasma, Bordetella
  • More commonly lower respiratory disease
  • Lameness
  • FCV, (Chlamydia)

8
Upper Respiratory Infections - Cats
  • So how should we treat?
  • Supportive
  • Fluids, decongestants, mucolytics
  • Antivirals?
  • You can try them if FHV-1 is suspected
  • Recurring disease, oral ulceration,
    conjunctivitis, keratitis
  • Lysine?
  • If FHV-1 is suspected
  • Antibiotics and eye ointment?
  • PO - Tetracyclines or quinolones
  • OU tetracyclines, chloramphenicol

9
Identifying Skin Masses
  • Can we tell whether a skin mass should be
    removed, just by looking at it?
  • Sebaceous gland adenoma - 98 benign
  • Differential diagnoses for hairless skin masses
  • Histiocytoma - benign
  • Plasmacytoma malignant or benign
  • Mast cell tumor - malignant
  • Melanosarcoma - malignant
  • Fibroma - benign
  • Follicular tumor - benign
  • SGA - benign
  • Perianal gland tumor benign or malignant

10
Identifying Skin Masses
  • So what should we do to decide whether a skin
    mass should be removed?
  • Cytology
  • Inflammatory, or non-inflammatory?
  • What is the cell type?
  • Characteristics of malignancy or not?
  • If malignant, is it a tumor that metastasizes?
  • If so, do met check prior to removing skin mass
  • Draining lymph nodes
  • Chest x-rays, abdominal US

11
Identifying Skin Masses
  • Differential diagnosis for a fully haired dermal
    mass
  • Epidermal inclusion cyst - benign
  • Mast cell tumor malignant (grade III
    metastasizes)
  • Fibrosarcoma malignant (locally invasive)
  • Hemangiopericytoma malignant (locally invasive)
  • Hemangiosarcoma malignant (metastasizes)
  • Lipoma benign
  • Malignant histiocytosis malignant (metastasizes)

12
Cytology
  • Inflammatory or Non-inflammatory?
  • Are inflammatory cells present?
  • Neutrophils
  • Macrophages
  • Lymphoid/plasma cells
  • Eosinophils

13
Cytology
  • Cell Type?
  • Epithelial cells
  • Round to oval in shape
  • Distinct cytoplasmic borders
  • Lines of cell-to-cell adherance (clumps of cells)
  • Round cells
  • Round in shape
  • Distinct cytoplasmic borders
  • Cells are single
  • Mesenchymal cells
  • oval to cigar shaped nuclei
  • Diffuse-fading cytoplasmic borders
  • Cells are single

14
Cytology
  • Characteristics of Malignancy?
  • Variation in the size and shape of nuclei
  • Multinucleation and indentation of nuclei as a
    result of abnormal mitosis (especially odd
    numbers)
  • Increase in the number and size of nucleoli
  • Abnormal (asymmetrical) or frequent mitosis
  • Increase in the nucleus-to-cytoplasm ratio
    (nucleus too big)
  • Increased basophilia of the cytoplasm (cytoplasm
    too purple)

15
Cytology
  • Examples
  • Subcutaneous mass mammary area 10 yr female
    poodle
  • Moderately inflammatory, epithelial tumor with
    characteristics of malignancy
  • Suspect mammary carcinoma
  • Aspirate local lymph nodes, take chest x-rays
  • Then excise
  • Raised, hairless pink skin mass 1 cm diameter
  • Non-inflammatory epithelial tumor with no
    characteristics of malignancy
  • Suspect basal cell or other adnexal tumor

16
Cytology
  • Examples
  • Raised, hairless pink skin mass 1 cm diameter on
    lip
  • Non-inflammatory, round cell tumor with
    characteristics of malignancy
  • Aspirate local lymph nodes
  • Then excise
  • Raised, hairless pink skin mass 1 cm diameter
  • Inflammatory (eosinophils) round cell tumor with
    no characteristics of malignancy
  • Suspect agranular mast cell tumor
  • Aspirate local lymph nodes, then excise

17
Cytology
  • Examples
  • Raised, hairless pink skin mass 1 cm diameter
  • Mildly inflammatory, mesenchymal cell tumor with
    characteristics of malignancy
  • Suspect sarcoma
  • Aspirate local lymph nodes, do chest x-rays
  • Then excise
  • Hairless pink skin mass 1 cm diameter, 1 week
    after vaccination
  • Pyogranulomatous inflammation, with no organisms
  • Suspect vaccination granuloma
  • Observe, excise if gets bigger or not resolved in
    3-4 weeks

18
Cytology
  • Examples
  • Hairless pink skin mass 1 cm diameter, 1 week
    after vaccination
  • Non-inflammatory mesenchymal tumor with strong
    characteristics of malignancy
  • Suspect vaccine associated sarcoma
  • Excise immediately, with wide borders

19
Spot Checking Diabetics
  • Quiz Spot glucose checks at insulin time
  • What Would you do?
  • 250, 260
  • 350, 335
  • 245, 265
  • 200,200

20
Spot Checking Diabetics
  • Which values in a glucose curve are used to
    determine dose?
  • Nadir (lowest glucose values - insulin peak)
  • Lowest glucose value should be around 100
  • Which values on a glucose curve are used to
    determine interval and insulin type?
  • Peak glucose values (insulin nadir)
  • If glucose nadir is ideal, and glucose peaks are
    too high, then you need to give insulin more
    often, or you need a longer acting insulin
  • Ideally, a majority of the time, glucose should
    be between 100 and 200
  • Never go lower than 80-90

21
Spot Checking Diabetics
  • Doing glucose curves
  • If patient doing well, do fructosamine first. If
    normal, no need to do a glucose curve
  • Begin when insulin given and fed
  • Every 2 hours until 2 values in a row with a
    significant uptrend
  • Every hour when glucose
  • If your curve is not finished at the end of the
    business day, it must be finished in order to
    know how to give insulin properly
  • Have owners finish at home, with their own
    glucometer
  • Transfer to emergency clinic if you have one
    available

22
Spot Checking Diabetics
  • Interpreting glucose curves
  • Duration of curve
  • If your curve is 10 hours or less, you need to
    give insulin BID, not SID
  • Glucose range
  • If all values are 100-200, leave it alone
  • Consider the same if 100-250, if clinical signs
    are controlled

23
Spot Checking Diabetics
  • Interpreting glucose curves
  • 3. Glucose nadir
  • If
  • If 100-150 and glucose peak too high, increase
    insulin dose
  • 4. Glucose peak
  • If nadir OK and peak too high, change to longer
    duration insulin
  • NPH shortest
  • Then Vetsulin (Lente)
  • Then PZI
  • Lantus longest (not for most dogs)

24
Spot Checking Diabetics
  • Interpreting glucose curves
  • 3. Glucose nadir
  • If
  • If 100-150 and glucose peak too high, increase
    insulin dose
  • 4. Glucose peak
  • If nadir OK and peak too high, change to longer
    duration insulin
  • NPH shortest
  • Then Vetsulin (Lente)
  • Then PZI
  • Lantus longest (not for most dogs)

25
Spot Checking Diabetics
  • If you were only allowed two glucose checks in
    every 24 hour period, when would you want to take
    them?
  • At Insulin Time?
  • 5-7 hours after insulin?
  • One of each?

26
Spot Checking Diabetics
  • Correct Your Quiz
  • 250, 260
  • Need to decrease insulin
  • 350, 335
  • Increasing insulin would probably make this dog
    or cat hypoglycemic
  • Need to change insulins instead
  • 245, 265
  • Need to increase insulin
  • 200,200
  • Insulin should not be changed

27
Surgery Without IV Catheterization
  • 12 of 58 (20) of systemically healthy dogs
    undergoing anesthesia for orthopedic surgery
    experienced clinically significant hypotension
    (prior to surgery
  • Use of ephedrine and dopamine in dogs for the
    management of hypotension in routine clinical
    cases under isoflurane anesthesia
  • Vet Anaesth Analg. September 200734(5)301-11. Hu
    i C Chen1, Melissa D Sinclair, Doris H Dyson

28
Surgery Without IV Catheterization
  • MP could result in renal failure in dogs with
  • subclinical upper urinary tract infection
  • subclinical renal disease
  • Rx ACE-inhibitor, diuretics, NSAIDs
  • Dehydration (NPO overnight??)
  • We get away with it on a regular basis
  • Would our A clients appreciate it, if the knew?

29
Surgery Without IV Catheterization
  • The cost of an IV catheter and IV fluids is
    minimal
  • IV catheter can be put in in minutes
  • Doing surgery on systemically ill animals without
    IV fluid support is probably outside protection
    by standard of care

30
Surgery Without IV Catheterization
  • Using pre-operative NSAIDs without IV fluid
    support is probably outside protection by
    standard of care
  • Owners who shop elective surgeries can accept
    lack of IV support/access at their own risk, if
    you wish to allow that

31
Perioperative NSAIDs
  • Deramaxx and Rimadyl Package Inserts
  • Laboratory tests to establish …baseline data
    prior to, and periodically during, administration
    of any NSAID should be considered
  • Owners should be advised of the potential for
    adverse reactions and be informed of the clinical
    signs associated with drug intolerance
  • The use of parenteral fluids during surgery
    should be considered to reduce the potential risk
    of renal complications when using NSAIDs
    perioperatively

32
Perioperative NSAIDs
  • Rimadyl Package Insert
  • Always provide Client Information Sheet with
    prescription
  • For control of postoperative pain, administer
    approximately 2 hours before the procedure

33
Perioperative NSAIDs
  • Deramaxx Package Insert
  • Appropriate monitoring procedures should be
    employed during all surgical procedures

34
Deworm Vomiting Dogs Cats
  • Why should we deworm vomiting dogs and cats?
  • Worms can make dogs and cats vomit
  • Physaloptera spp.
  • Obscure?
  • Found on endoscopy in dogs and cats referred for
    chronic vomiting
  • Easily treated with pyrental pamoate

35
Nutrition for Diabetic Cats
  • For many years, we fed diabetic cats high fiber,
    low fat diets, just like dogs people
  • 2000 - Randomized, controlled crossover study
  • Improved glycemic control when fed 12 insoluble
    fiber
  • Both diets high in carbs (35)
  • J Am Vet Med Assoc. 2000 Apr 1216(7)1082-8.
    Effect of dietary insoluble fiber on control of
    glycemia in cats with naturally acquired diabetes
    mellitus. Nelson RW, Scott-Moncrieff JC, Feldman
    EC, DeVries-Concannon SE, Kass PH, Davenport DJ,
    Kiernan CT, Neal LA.

36
Nutrition for Diabetic Cats
  • 2001 ACVIM Abstract
  • Low carb-low fiber diet (canned Hills Feline
    Growth) compared to high carb-high fiber diet
    (canned W/D)
  • 31 fed LC diet were able to d/c insulin, and an
    additional 46 decreased insulin dose
  • None of the HC cats were able to reduce or
    discontinue insulin
  • Comparison of a low carbohydrate versus high
    fiber diet in cats with diabetes mellitus.
    Bennet N, Greco DS. ACVIM 2001. 13 cats.
  • J Feline Med Surg. April 20068(2)73-84. 63 cats.

37
Nutrition for Diabetic Cats
  • Since 2001
  • Goal of treatment is remission rather than merely
    good control
  • Achieved by using low carb-high protein diets
    with long acting insulin (glargine - Lantus)
  • 1998 ACVIM article - median survival 2 years
  • Some papers have reported remission rate as high
    as 68
  • Chances of remission increases four-fold by
    feeding low carb-high protein diet

38
Nutrition for Diabetic Cats
  • Use of a High-Protein Diet in the Management of
    Feline Diabetes Mellitus. Vet Ther 23238-246
    Summer'01 Clinical Study 14 Refs. G Frank W
    Anderson H Pazak E Hodgkins J Ballam D
    Laflamme.
  • The Effect Of High Protein, High Fat Or High
    Carbohydrate Diets On Postprandial Glucose And
    Insulin Concentrations In Normal Cats. ACVIM
    2002. H A Farrow, J S Rand, G D Sunvold.
  • Use of glargine and lente insulins in cats with
    diabetes mellitus. J Vet Intern Med. 2006
    Mar-Apr20(2)234-8. KE Weaver, EA Rozanski, OM
    Mahony, DL Chan, LM Freeman.

39
Nutrition for Diabetic Cats
  • Ideal diet for diabetic cats
  • 40 protein and
  • A little different from DM basis (fat is 2x as
    calorie dense as protein carbohydrate)
  • Only one dry diet on the market that fits the
    bill
  • Innova EVO (California Naturals - Natura)
  • Purina DM and Hills R Diet M/D dry - 15 carbs,
    protein OK
  • Many commercial canned diets fit the bill
  • Handout

40
Nutrition for Diabetic Cats
  • Myth 1 Diabetic cats should be meal fed if
    they are to be well regulated
  • Fresh food BID allowed to eat ad lib
  • Multiple small meals eaten throughout the day and
    night
  • 24 hour glucose curve done (q2h)
  • no correlation between blood glucose and the
    amount of food consumed over the previous 2-h
  • overnight fast did not significantly alter
    morning blood glucose
  • J Feline Med Surg. 1999 Dec1(4)241-51. Food
    intake and blood glucose in normal and diabetic
    cats fed ad libitum. Martin GJ, Rand JS.

41
Nutrition for Diabetic Cats
  • Myth 2 You shouldnt give insulin to pets who
    arent eating
  • If glucose 300 for any period of time, insulin
    needs to be given to prevent diabetic
    ketoacidosis
  • Dogs and cats with DKA will remain acidotic until
    they get insulin
  • If you are chicken, give small amounts only as
    needed
  • A small amount of insulin can do a great deal of
    good in a DKA patient

42
Nutrition for Diabetic Cats
  • Flop
  • Day 0
  • not feeling well, abscess on toe, Tx clindamycin
    PO BID
  • Day 3
  • still not feeling well, not eating
  • UA shows ketones and glucose, blood glucose 298
  • Treated with IV fluids and IV antibiotics
  • No insulin given because not eating
  • Day 6
  • Very weak, vomiting blood
  • BUN 41, glucose 290, venous pH 7.035, K Phos 1.6
  • Diabetic ketoacidosis with pancreatitis

43
Annual Vaccination
  • Appropriate for bacterins
  • Leptospirosis
  • Bordetella
  • Lyme Disease (in endemic areas)
  • Reasonable for Feline Leukemia
  • No published studies investigating duration of
    immunity beyond 1 year

44
Annual Vaccination
  • In 1978, University of WI-Madison recommended
    ideal MLV protocol
  • Puppy/kitten series, boost a 1 year of age
  • Then every 3 years
  • No one is recommending that we dont vaccinate
  • puppy/kitten vaccines, and boosters at 1 year are
    crucial
  • We shouldnt overvaccinate adult pets

45
Annual Vaccination
  • Duration of Immunity (DOI)
  • Rabies
  • Vaccine manufacturers have known for decades that
    rabies vaccines protect very well for at least 3
    years
  • They are under no obligation to share any data
    they may have that shows longer DOI
  • Only 5 states have ever required use of rabies
    vaccine more often than on the label
  • The rest of the world has used rabies vaccines
    according to the label for more than 50 years
    with exceedingly rare vaccine failure

46
Annual Vaccination
  • Duration of Immunity (DOI)
  • Rabies
  • No person has ever contracted rabies from any
    domestic animal that has ever received a rabies
    vaccine
  • 1-year and 3-year vaccines are in almost all
    cases the same vaccine
  • 1999 RD Schulz DOI Study
  • single rabies vaccine given to puppy
  • no booster at 1 year of age
  • 95 protection by challenge at 3 years
  • 95 protection by titers at 7 years

47
Annual Vaccination
  • Duration of Immunity (DOI)
  • Distemper
  • Vaccinated or not, it is exceedingly rare for
    adult dogs to get this disease
  • Dont confuse old dog distemper with active
    disease
  • 1999 RD Schulz DOI Study
  • single distemper vaccine given to puppy
  • no boosters
  • 95 protection by challenge at 5-7 years
  • 95 protection by titers at 9-15 years

48
Annual Vaccination
  • Duration of Immunity (DOI)
  • Parvovirus
  • Vaccinated or not, it is exceedingly rare for
    adult dogs to get this disease
  • 1999 RD Schulz DOI Study
  • single parvo vaccine given to puppy
  • no boosters
  • 95 protection by challenge at 7 years
  • Giving parvo boosters every 6 months
  • started in the 70s when panleukopenia vaccines
    were given to dogs
  • Not based on any study - empirical

49
Annual Vaccination
  • Duration of Immunity (DOI)
  • Canine Infectious Hepatitis
  • 1999 RD Schulz DOI Study
  • single CAV-1 vaccine given to puppy
  • no boosters
  • protection by challenge at 7 years
  • Protection by titers at 9 years

50
Annual Vaccination
  • Duration of Immunity (DOI)
  • Feline Parvovirus (panleukopenia)
  • Vaccinated or not, it is exceedingly rare for
    adult cats to get this disease
  • 1999 Scott Geissinger DOI Study
  • SPF cats vaccinated at 8 12 weeks
  • no boosters
  • 95 protection by challenge at 7.5 years
  • Protection also evaluated by titers

51
Annual Vaccination
  • Duration of Immunity (DOI)
  • Feline Calicivirus (FCV)
  • Considerable genetic variation results in
    resistant strains
  • Multivalent vaccines may be more effective
  • Vaccine does not prevent infection, just
    minimizes clinical signs
  • Does not eliminate the carrier state
  • 1999 Scott Geissinger DOI Study
  • SPF cats vaccinated at 8 12 weeks
  • no boosters
  • Titers begin falling after 3-4 years
  • 63 protection by challenge at 7.5 years

52
Annual Vaccination
  • Duration of Immunity (DOI)
  • Feline Herpesvirus (FHV-1)
  • Vaccine does not prevent infection, just
    minimizes clinical signs
  • Does not eliminate the carrier state, though
    period of shedding is shortened
  • 1999 Scott Geissinger DOI Study
  • SPF cats vaccinated at 8 12 weeks
  • no boosters
  • Titers begin falling after 3-4 years
  • 52 protection by challenge at 7.5 years

53
Annual Vaccination
  • Adverse Reactions to vaccines
  • Attention began in 1990s with the first articles
    associating vaccines with IMHA and VAS
  • 1999 DOI studies published
  • Vaccinating older dogs and cats
  • Adverse reactions to vaccines may be
    significantly more likely than getting the
    disease
  • FPV, CPV, CDV, ICH

54
Annual Vaccination
  • Adverse Reactions to vaccines
  • Life threatening
  • acute anaphylaxis
  • vaccine associated sarcomas
  • 22,000 cases per year
  • Risk is 1 in 10,000
  • post vaccinal encephalitis
  • CDV and CAV
  • especially MLV in pups
  • IMHA

55
Annual Vaccination
  • Adverse Reactions to vaccines
  • Life threatening
  • post-vaccinal infection
  • Increased virulence of vaccine
  • Patient immunosuppression
  • Greyhounds - hot CDV vaccine
  • Snyder Hill CDV on exotic animals
  • fetal malformation/abortion
  • hypertrophic osteodystophy
  • especially Weimeraners

56
Annual Vaccination
  • Adverse Reactions to vaccines
  • Potentially serious
  • local allergic reaction
  • Swelling of face, paws, hives
  • Panniculitis - rabies
  • Puppy strangles
  • Vaccine contamination
  • No preservatives in MLV
  • Mycoplasma has been found in vaccines
  • CAV has been isolated from feline vaccines
  • Canine parvo conspiracy theory

57
Annual Vaccination
  • Adverse Reactions to vaccines
  • Potentially serious
  • multifocal ischemic dermatopathy - rabies
  • hypothyroidism
  • Facial/nasal dermatitis, stomatitis - IN
  • Polyarthritis
  • Vaccines given by wrong route
  • IN vaccines given SC
  • Inflammatory disease
  • Liver failure and occasionally death
  • SC vaccines given IN
  • Severe necrosing facial/nasal dermatitis

58
Annual Vaccination
  • Adverse Reactions to vaccines
  • Usually self-limiting
  • Itching, redness, sneezing
  • Pain, soreness, lethargy fever
  • Local reaction
  • Swelling
  • Ulceration, irritation, Hair loss
  • Thrombocytopenia
  • CDV MLV
  • Behavior changes

59
Annual Vaccination
  • Vaccination protocols
  • Titers validated for all but rabies
  • Vaccine manufacturers guarantee MLV vaccines for
    3 years
  • Including FeLV
  • All vet schools in US for 10 yrs
  • triennial vaccination for MLV vaccines
  • AAFP, AAHA, ACVIM, AVMA and TVMA reports
    extended vaccine intervals
  • AAFP Report AAHA Report

60
Annual Vaccination
  • Vaccination protocols
  • Nov 2005 - TSBVME Policy on Vaccination an
    Informed Consent
  • Followed Feb 2003 open letter and Nov 2004
    Reminder to review vaccine protocols
  • Reminds DVMs to stay informed
  • DVMs must communicate possible adverse vaccine
    reactions and get informed consent
  • Must be documented in the record
  • Specifically recommends against CCV

61
  • It takes less time to do things right than to
    explain why you did it wrong.
  • --Henry Wadsworth Longfellow
About PowerShow.com