Clinical Tidbits (January 2019) - American Veterinarian
Advice and insight from veterinary experts throughout the country.
RY A FOOD TRIALA critical step for Craig Webb, DVM, PhD, DACVIM, head of the Small Animal Section at Colorado State University College of Veterinary Medicine, in diagnosing feline gastrointestinal disease, particularly in an adult or young adult cat that is otherwise stable, is a food trial.
“Ass a profession, we’ve come to appreciate food allergy as being pretty prominent in cats, and the only way we still have really to diagnose it is a sold 2–week food trial with a hypoallergenic or a hydrolyzed diet,” he says. “If you miss that diagnostic step–and I consider a food trial a diagnostic test–you may very well end up treating that cat for inflammatory bowel disease for the rest of its life, when in fact it simply needs the appropriate diet.”
TELEPHONE TRIAGE DOS AND DON’TS
Danielle Provost, CVT, VTS (ECC), nursing supervisor at Veterinary Specialty Hospital of the Carolinas in the Raleigh-Durham, North Carolina, area, says that talking to clients in an emergency situation can be quite challenging and what you say should be based on your level of experience. Usually, Ms. Provost says, the focus will be on redirecting the owner to what’s happening right now. “When clients call and they’re in a panic, sometimes they have a tendency to want to talk about the previous 7 years of the pet’s life,” she says. “So we need to redirect them so we can understand the clinical signs they’re calling about today.”
Ms. Provost says you should listen for words or terms that are concerning. For example, if an owner says the pet is weak or dizzy or has collapsed, advise the owner that any one of those individual signs is concerning enough that they should bring their pet in. She cautions people against making a diagnosis or recommending any treatment over the phone, including inducing vomiting in the pet. “That could be quite dangerous and really should be observed by a medical professional.”
THE BIGGEST MISCONCEPTION ABOUT GENETIC TESTING
According to Leslie Lyons, PhD, Gilbreath-McLorn Endowed Professor of Comparative Medicine at the University of Missouri College of Veterinary Medicine, genetic testing isn’t always about finding a cure. “One of the biggest misconceptions that we have with genetic testing is, ‘Oh, that’s obviously going to lead to a cure.’”
It doesn’t lead to a cure, Dr. Lyons says. Instead, it leads to better treatment. “Do we want it to lead to cures? Yes, down the road. We’re making big advances with gene therapies and stem cell therapies where we may be able to cure some diseases and some presentations eventually,” she says. “But mostly, these genetic mutations allow us to determine why a given individual has a certain presentation and really tailor our treatment plans to that animal.”
ADVISING CLIENTS ABOUT PET POISONINGS
Preventing a majority of pet poisonings isn’t difficult, says Justine Lee, DVM, DACVECC, DABT, founder of the podcast and webinar service VETgirl, but it requires that pet owners become aware of simple mistakes they may be making. “Statistics show that 50% of the poisons dogs and cats get into are human medications,” Dr. Lee says, “drugs like prescription antidepressants, prescription amphetamines, cardiac medications, and nonsteroidal anti-inflammatory drugs [NSAIDs].”
She offers owners 3 tips to help minimize the risk of pet poisoning. First, advise clients who use weekly pill holders not to put them on a counter. “If your dog is going to counter surf, that can be really, really deadly,” she says. Her second piece of advice is to hang up your backpack, purse, or briefcase because they are full of poisonous things, such as small containers of NSAIDs or other potentially dangerous medications, a cell phone with a battery in it, coins, and gum sweetened with xylitol. Finally, she says, make sure guests don’t put all their pills into a small plastic bag and leave it in the suitcase. “It’s really easy for dogs and cats to chew into that,” she adds.
BE A BEHAVIOR RESOURCE
Even if you don’t know the specific answer to a behavioral modification question or concern, as a veterinarian you should be able to offer referral resources to your clients, says Amy L. Pike, DVM, DACVB, chief of the Behavior Medicine Division at the Veterinary Referral Center of Northern Virginia.
“I think veterinarians need to be the primary source for all things pet, and that includes training,” she says. “Unfortunately, there is not a lot of behavior education in veterinary school, and so we don’t know a whole lot.” Nevertheless, your client should be able to come to you and ask about pet training. “If you don’t know how to address certain issues,” Dr. Pike advises, “know where to refer.” Veterinarians should know the positive reinforcement trainers in their area, attend a class, or even partner with trainers to hold classes in the practice after hours. “It’s a good practice builder as well,” she says.
GERIATRIC PAIN MANAGEMENT CHALLENGES
Janice Huntingford, DVM, DACVSMR, CVA, CVPP, CCRT, CAVCA, owner and medical director of Essex Animal Hospital, Canine Rehabilitation and Fitness, in Ontario, Canada, believes that the most common challenge veterinarians face with regard to geriatric pain management is that clients frequently do not recognize when their animals are in pain. They figure that being a geriatric is simply getting old and that many of the pain signs they show are from old age, not from pain.
Cats show very strange pain signs, as far as people are concerned. Dr. Huntingford says. If you have a cat that does not like to be petted, some people think that’s just the cat’s personality. “Sometimes it isn’t,” she says. “Sometimes it’s pain.” Or, as the pets get older, they stop doing things that they normally had been doing. “I had a client who was thrilled to tell me that her cat finally learned not to jump up on the counter at the age of 10,” Dr. Huntingford recalls. “I told her, ‘That’s not so great. That means that the cat is painful.’”
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