Clinical Trial Results in New Treatment

By: Terry L. Grieshaber, DVM, DACVD

Golden Retriever with Atopic dermatitis

On June 21 – 22, 2013, I attended a first-to-know meeting sponsored by Zoetis for its launch of Apoquel (oclacitinib). Oclacitinib is a Janus Kinase inhibitor which inhibits the function of many pruritogenic and pro-inflammatory cytokines. This drug was developed for the treatment of Atopic dermatitis in the dog. While I do not feel that oclacitinib should be used as a first line treatment for Atopic dermatitis, it is another option for treating this sometimes devastating disease. Oclacitinib will likely be available after January 1, 2014.

Circle City Veterinary Specialty & Emergency Hospital has been involved in conducting clinical trials to determine the effectiveness of oclacitinib for the past several years. My team and I are proud that we were able to contribute in even a small way to bringing this drug to market. Developing new treatment modalities is not a small undertaking and requires a true team. I thank those veterinarians who referred cases for these clinical trials and those clients (and patients) who chose to participate. Watch our e-mail newsletters and website for further updates.

Note: An additional and completely separate clinical trail for Atopic dermatitis is currently being conducted in our Dermatology Department where patients may still be enrolled. If you would like more information on this 2013 study, click here or contact our Dermatology Department.

 

TTA vs TPLO - Similar until there are complications

By: Kate Fitzwater, DVM, MS, DACVS

Cranial cruciate ligament rupture is the most common orthopedic injury in dogs. There are multiple surgical procedures that can be done to treat this disease, but two of the most popular “osteotomy” (cut in the bone) procedures are the TPLO (tibial plateau leveling osteotomy) and TTA (tibial tuberosity advancement).

Both procedures can provide excellent outcomes and both have their potential complications. Infection can occur with any surgical procedure, but with orthopedic surgeries that involve implants, the risk is higher. That is why prior to an elective orthopedic procedure, the skin is evaluated for infection and antibiotics are used during the procedure and postoperatively to lessen this risk. If a dog licks or chews at the incision, this is highly likely to result in an infection in the immediate postoperative period.  Late infections are also a potential possibility as well, because urinary tract, skin, oral, or ear infections can spread to the site of an implant or area of inflammation (osteoarthritis). If the site of an orthopedic surgery becomes infected, the implants have to be removed to clear that infection completely. This is because the stainless steel implants do not have a blood supply and the bacteria stay on the implant in a “biofilm”. The implants can be removed as long as the bone has healed.

 

When we are dealing with removal of TPLO or TTA implants, the level of difficulty and invasiveness is dramatically different between the two procedures. Below are radiographs of each procedure showing the metal implants. The TTA implants involve a cage (square) that acts as a spacer, and during healing bone grows into this cage. There is also a fork plate and screws that hold the osteotomy in place. When removing TTA implants, the fork plate and screws easily can be removed, but the cage must be “cut” out of the bone, leaving a large defect that has a high risk of fracture. This surgery to remove the cage that is encased in bone is invasive and difficult. The TPLO, on the other hand, doesn’t have a cage and only has a plate and screws, which can easily be removed because the bone doesn’t grow into them.

  TTA radiographs showing cage,
fork plate/screws             

 TTA radiographs showing cage,
fork plate/screws             



TPLO radiographs showing
plate/screws 

TPLO radiographs showing
plate/screws

 

 

 

 

 

 

 

 

 

 

 

 

 

So, when discussing the surgical options for a cranial cruciate ligament rupture, all the potential complications need to be discussed and the risks weighed. Infection risk is low at 7.4% (Gallagher AD et al. Implant removal rate from infection after TPLO in dogs. Vet Surg. 2012), but if it is your dog that needs the implants removed, the process is less complicated to have had a TPLO over the TTA!

“I can’t believe I ate the whole thing…”

By Rebecca Ball, DVM, MS, DACVS-SA

Kitrina is an 11 year old female spayed Shih Tzu mix that presented for gagging and restlessness after eating one of her favorite chew bone treats the night before. Kitrina, like many pets, really enjoys her chew treats.

 

Kitrina’s family veterinarian took an x-ray and suspected that she may have overzealously eaten the entire bone, whole! She received barium (a contrast agent that shows up  as white on x-rays) to see if it could help determine if she had indeed eaten the bone whole. Unfortunately the x-ray showed that she not only had eaten the bone whole, but that it was stuck in her esophagus.

Here is an x-ray that shows the barium (white) in Kitrina’s esophagus outlining the chew bone (black) stuck in her esophagus.

 

 

In this picture, the chew bone has been outlined with blue arrows.

 

Kitrina was referred to Circle City Veterinary Specialty and Emergency Hospital and evaluated to see if her chew bone could be removed with an endoscope. An endoscope is a camera that can be inserted into the esophagus and instruments passed through to grab and remove objects. Unfortunately, Kitrina’s chew bone was so tightly stuck in her esophagus that it could not be removed. Kitrina had to undergo emergency surgery to remove the stuck chew bone.

An incision was made through the side of Kitrina’s chest and another incision was made into her esophagus. The chew bone was successfully removed piece by piece and the incision into Kitrina’s esophagus was repaired.

The esophagus is a very delicate area to perform surgery on and because of the movement associated with swallowing and other anatomical factors, complications with esophageal surgery can be high. Because of these factors and the fact that the chew bone was in Kitrina’s esophagus overnight causing inflammation and irritation, it was decided that it would be best to allow her esophagus to rest for at least a few days after surgery to let it heal. In the meantime however, Kitrina would still need to eat! A gastrostomy tube (a tube inserted surgically through the skin into the stomach) was placed and allowed us to continue to feed Kitrina while also letting her esophagus rest and heal.

 

Kitrina did well after surgery and after one week she was allowed to begin to eat soft solid foods by mouth. Again, Kitrina did well and after two weeks her gastrostomy tube was removed and she was allowed to continue to eat soft foods by mouth and will begin to eat dry foods in the near future.

Kitrina’s family is delighted to have their wonderful dog back, healthy, and happy!

 

Spring is the Time for Leptospirosis

By Amy Rader, DVM, Residency Trained, American College of Veterinary Emergency and Critical Care

 

Spring is the season when we see an increase in certain infectious diseases. There are several reasons for this phenomenon. First our pets our outside playing and we are taking them on weekend excursions so they have more exposure to potential infections. Second, with warmer weather, bacteria, viruses and parasites live longer in the environment. And, the third reason is that vectors (parasites like ticks and fleas, and wildlife like raccoons, opossums, foxes and skunks) are more active in our environments.

Leptospirosis is a bacterial infection that can cause severe illness in our pets (dogs, horses, cows) and it can cause severe illness in people. Cats are more resistant to the infection so they rarely show any signs of illness. Dogs on the other hand, can become severely ill and some dogs die from this infection. Depending on the type (strain) of the bacteria it can cause kidney failure, liver failure, bleeding, and spontaneous abortions.

The leptospirosis bacteria are transmitted through the urine of infected animals.  Wildlife (opossums, raccoons, coyotes, foxes) can all be infected and spread the bacteria. When the soil is wet or there is standing water, the bacteria can live in the environment for several days. This allows the bacteria to still be present and infective when your pet walks through a wet area or when they drink from a puddle of standing water.  Once your pet ingests the bacteria it can replicate in the kidneys and liver causing inflammation in these organs leading to organ damage and failure.

The clinical signs that you will see are: lethargy, loss of appetite, vomiting, diarrhea, weakness, and possibly yellowing of the skin or mucous membranes.  It is very important that this disease be diagnosed and treated aggressively very early on. Delays in treatment can lead to permanent damage to the kidneys, liver and / or the death of the pet.

Treatment includes intravenous fluids to replace fluid losses from the vomiting and diarrhea, nutritional support since pets are not eating, and antibiotics that are effective against this bacteria. Most pets are in the hospital for 1-2 weeks while they are being treated.  Special precautions have to be taken while the pet is in the hospital to prevent transmission of the infection to people.

Leptospirosis can be difficult to definitively diagnose. You can help decrease your pets risk of infection by keeping your pet away from standing water. This includes ornamental ponds and fountains that we may have in our yards. Replace any bowls of water that are left outside with fresh water every morning. Wild life are more active in the evenings and early morning, they will use our pets water bowls and our ornamental ponds as a water source.  Discuss vaccination against leptospirosis with your primary veterinarian. This vaccine is not 100% protective but it may help boost a dogs immune system if they are at higher risk of being exposed to the bacteria.

If you pet shows any signs of illness, please seek medical attention for your pet as soon as possible. The earlier any illness is treated the better the outcome for your pet.

Just Old Age or Something More Serious?

By:  Rebecca Ball, DVM, MS, DACVS-SA

 

As spring time and warmer weather return, you may notice your older dog breathing heavier and not being able to play as long as he once had.  Many pet owners attribute this to aging, but heavy breathing and exercise intolerance are not always just due to old age.  

Laryngeal paralysis is a disorder of geriatric large breed dogs where the larynx (the opening to the trachea or breathing tube) is not able to open as it should when the dog inhales.  This is due to a failure of the recurrent laryngeal nerve that innervates the muscles of the larynx.  As a result, the airway remains closed and dogs are not able to get enough air into their lungs when they inhale.  Clinical signs include loud breathing and panting, a change in bark, a dusky bluish color to the mucous membranes when exerted and in severe cases or in a crisis, collapse and potentially death. 

 

 The cause of laryngeal paralysis is not fully known, but may be part of a generalized neuromuscular disorder.  Patients should be evaluated for underlying causes such as a low thyroid level, masses in the neck or chest or other neurologic disease. 

Treatment of this disorder typically involves surgery to pull one side of the Laryngeal paralysis  open and hold it in an open position called a laryngeal “tie-back” procedure.  Possible complications postoperatively include aspiration pneumonia (due to food or water getting into the lungs) or failure of the suture holding the larynx open leading to a recurrence of clinical signs.  Aspiration pneumonia is treated with antibiotics and dogs can recover quickly if diagnosed early. 

If you feel your dog is showing signs of laryngeal paralysis, talk to your family veterinarian about a consultation with one of our surgeons.

 

 

Visiting Varmints, Control, and Unintended Consequences

Over the last decade, our Environmental Protection Agency (EPA) has been delving into the safety and control of commercial rodenticides (mouse and rat poison).  Now they have begun banning many of those products for ‘do-it-yourselfers’ in an attempt to reduce the risk of accidental exposure to children and pets.  But, before we breathe a sigh of relief, let’s review what was and what will be available after the EPA is finished with their good intentions. 
Traditionally, mouse and rat control products available at your local store came in the form of pellets in a small container. You could open the container to expose the pellets and the little critters would come to feed.  The pellets were easily accessible and were often carried back to the nest.  These pellets contain anticoagulants that, when ingested at toxic levels, will cause the animal to bleed internally to death.

The bad news – exposure to pets and children can produce the same results if not treated promptly.

The good news – Treatment to combat the affect of these household rodenticides is decontamination (vomiting, activated charcoal to limit absorption of the toxin) and then a regimen of Vitamin K to combat the anticoagulant. Even in cases where discovery is delayed and internal bleeding has begun, blood transfusions will increase the patients clotting factors.  The pellets often have bright food coloring that can alert a parent or pet owner to a possible ingestion, the anticoagulant is relatively slow acting, and the prognosis for a complete recovery is very good.    

The items now available over-the-counter for consumers contain different chemicals that, depending on which is used and how much is consumed will, cause seizures or  high blood calcium levels that lead to organ failure. 

The good news – These new traps are self-contained and no poison is exposed.  The rodent walks in, can’t get back out, eats the poison, and dies.  They are ‘technically’ child and pet resistant. 

Hooray for the EPA, right?  Not quite…

The bad news – “Pet resistant” does not mean “Pet proof”.  Our canine friends can, and will, chew these products open and ingest the poison.  Once eaten, there is little that can be done.  There is no test and no antidote!  Immediate treatment with standard decontamination, IV fluids and/or steroids may help in low exposure, but if your pet eats a lot, death is almost certain.

Licensed, regulated pest control companies still have access to the anticoagulant type rodenticides so if you have a chronic or severe infestation, you might want consider that option.  No matter what you choose, vigilance and following instructions can prevent accidents when combating those visiting varmints.  

And remember - there is still the timeless, tried-and-true, method of ‘pest control’…own a cat!  J    

NOTE:  The ASPCA Poison Control Center received 2,271 reported cases of rodenticide exposure in Indiana last year.  Those are just the reported cases; the count is likely much higher because veterinary hospitals typically treat without calling.  The majority of reported poisonings were from the treatable anticoagulant type poison, but as time goes on and these become limited, we will see those percentages change. 

Callie's Care - Remembering the 'Purple Cow'

Callie

We may have thought the 'olden days' where neighbor helped neighbor in times of need were long gone, replaced instead by governmental programs to solve problems for us, fostering apathy in its wake.  Not true, not yet anyway!  Here is a delightful story of a determined pet owner who bypassed traditional solutions to provide for her dog's care, looking instead to her own creativity, and while doing so, brought an entire community along with her:

"After a play session with friends, Callie came away limping and favoring her left leg. Then, just when she seemed to be getting back to normal, she fell down the stairs and couldn't get up. A trip to Dr. Dana Graham at Carter Veterinary Medical Center revealed the unfortunate truth about her injury; she needed a complex, and expensive, surgery. When I found out that Callie had sustained a rupture of her cruciate ligament, I was heartbroken. She is such an active, bouncy girl, who loves long walks and rough-housing with other dogs.

Callie is a rescue. She had a rough start in life, having been neglected, mistreated, and eventually given up. Though many would say I saved her life when I adopted her, I argue that it is she who rescued me with her pure devotion, unconditional love, acceptance, and appreciation.  So, when faced with news that Callie would need a specialized surgery to correct her injury, there was no question in my mind that she would have it. What I had no idea about was how I was going to afford her care. Single and self-employed, I had no clue where I would find the funds to get her back to the quality of life she loves and deserves.

First, I cried. Then, with a month before Callie’s surgeon, Dr. Kate Fitzwater, was available to do her procedure I had time to figure something out! Realizing I had to get creative, I summoned what I'd learned while studying for my degree in public relations, and knew I had a chance. I was going to run a public relations campaign for Callie to raise the money for her care, and it worked!


Callie After Surgery



In four weeks I went from an evening of hand-wringing and crying to organizing and managing three different fundraisers, all entitled "Callie's Care." My combined efforts gathered a small army of supporters, including a handful of key individuals who became very involved and recruited others for monetary and in-kind donations.

My three fundraisers consisted of a page on GiveForward.com for those who simply wanted to donate dollars, a special 'Groupon-style' sale for bodywork or yoga sessions with me, and a benefit dinner and raffle at a favorite locally owned restaurant, Moe and Johnny's, in Broad Ripple. I made sure that everybody was kept in the loop about progress with regular Facebook updates and an email campaign. Callie has a separate bank account in her name and I included photos of her in my outreach whenever possible.



Callie's Get Well Card



I never knew what my little endeavor would generate; I just focused instead on Callie and set the intention that she was going to get what she needed...somehow. I chose to stay positive and I told her story to anyone who would listen, anyone at all. In the process, I've not only raised the funds we needed, but also made new friends and amazing contacts. Moreover, I have experienced firsthand the power within a community and their heartfelt willingness to lend a hand to a neighbor. I still haven't been able to talk about this much without getting teary-eyed, but I'm working on it.




Brigid, Betsy, & Callie at Circle City

I am proud of my friends, their friends, and the local business owners who reached out to help - they are a special lot - each and every one! I am so honored to have had the chance to go to work for my dear Callie. Finally, I am grateful that I had access to the attentive, compassionate, and expert care Callie received at Carter Veterinary Medical Center and Circle City Veterinary Specialty and Emergency Hospital."




*For those of you who have not heard of the term, 'Purple Cow', it's the one who stands out from a crowd of brown ones.  The 'Purple Cow' represents a belief that we can accomplish anything with new ideas and determination.