This month is one of the busiest of my year but as with every month, I make time to spend a day catching up on the latest journals from the veterinary nursing profession.
As of 6 April 2016, all dog owners in England, Wales and Scotland have to ensure their dogs have been microchipped and registered with a government-compliant microchip database.
This article describes the nursing care involved in caring for a spinal patient from the time of admission, pre, peri and post operatively. It highlights the importance of nursing care and treating each patient as an individual. Nursing interventions discussed include monitoring under anaesthesia, post-operative monitoring, bladder management and rehabilitation. An understanding of the importance of postoperative monitoring and rehabilitation is required to promote the patient's recovery in addition to being confident in different bladder management techniques.
NutritionStruvite crystals (MgNH4PO4.6H20) are commonly seen in cats suffering from FIC. Dietary recommendations for these cats include avoiding excessive dietary protein and excessive levels of the minerals that are used within the crystals (i.e. magnesium and phosphorous), and increasing water consumption. Urinary pH needs to be within the recommended range, as the crystals form in an alkaline environment. A range of 5.9–6.1 is ideal for dissolution, whereas 6.2–6.4 is recommended for prevention (Ackerman, 2012). The average urinary pH of a domestic cat consuming a natural diet (small rodents) is 6.3 (Ackerman, 2012). Acidifiers are used to prevent struvite uroliths. Cats receiving long-term dietary acidifiers can suffer from a transient negative potassium balance, with phosphoric acid and ammonium chloride acidifiers. Long-term potassium depletion will stimulate ammonia synthesis at the same site as chronic metabolic acidosis. Acidifying therapeutic veterinary diets need to have potassium levels in excess of the National Research Council's (NRC) minimum allowance of 0.6% (DMB) (Gunn-Moore, 2000). The use of urinary acidifiers alongside an acidifying food is not recommended, as it can lead to metabolic acidosis. The alterations in pH may increase the solubility of some of the solutes within the urine and, in some cases, decrease the solubility of other solutes. This complex and competing interplay between nutritional requirements of the management of oxalate and struvite urolithiasis requires a careful selection in the long-term dietary control of FIC.Figure 1.Nicola Ackerman discussing the requirements for good urinalysis.Excessive levels of protein need to be avoided in cases where struvite crystals and alkaline urine is present. High-protein level can influence pH; a prime example of this is the difference in urine pH between cats and dogs. Cats have higher protein consumption than dogs, and therefore an increased urinary pH. Increasing the protein level in the diet also increases urinary calcium excretion, uric acid and oxalate excretion. Excess dietary protein should be avoided by feeding cats a food that contains 30–45% dry matter (DM) protein (Gunn-Moore, 2000).Diets that promote urinary tract health in cats do tend to have a higher fat content. This is owing to the increased energy density which overall reduces mineral intake. When metabolised, fat produces the highest metabolic water contribution, which also benefits the animal. As a result of the increased fat content, some veterinary therapeutic diets are not available in a dry form. Obesity is a major risk factor for FIC, and a diet with higher fat content may not be indicated in this circumstance.Figure 2.Measuring pH with a pH meter.Cats that suffer from FIC and are overweight need to be placed on an obesity diet. Many of which have higher fibre content. The quantity of calcium being absorbed from the digestive system can be reduced by certain sources of dietary fibre. This can be beneficial with cats suffering from recurrent calcium oxalate urolithiasis.Struvite precipitates form when the urine becomes supersaturated with magnesium, anionic phosphate and ammonium. Therapeutic diets avoid excess dietary magnesium, but low urinary magnesium concentrations have the potential to increase the risk of the formation of calcium-containing uroliths. This highlights the importance of regular urinalysis when on a therapeutic urinary diet. Intake of magnesium and calcium also influences urinary phosphate concentrations.The addition of sodium into the diet is occasionally used in order to aid in increased water intake. Increasing the salt content of the diet can aid in diuresis and lowers the urine-specific gravity (Kirk, 2000).
A new policy was placed on healthcare workers in 2008 that they should all be ‘bare below the elbows’ when dealing with patients. This rule was introduced to try and tackle the problem of hospital acquired infections despite concerns from leaders in the field that it was made hastily as a response to all the media surrounding hospital infections at the time.This rule is now becoming commonplace in veterinary hospitals and practices despite there still being a lack of evidence. This article looks at whether there is any evidence supporting the ‘bare below the elbows’ policy and whether it is a good idea for veterinary establishments to once again follow on from human counterparts.
As techniques progress in veterinary medicine, alternative treatments are available for a wide range of diseases and pathologies and veterinary professionals should be discouraged from automatically adopting a traditional approach to the treatment of their patients because ‘that is the way it has always been done’. Evidence-based practice is favourable, locating and appraising the available literature associated with alternative treatments to enhance practitioner knowledge, but to also ensure they are informing their clients about all options for their pets. The extraction of teeth is a common procedure performed in veterinary practice, and there are numerous indications for this intervention, however there are alternative ways to treat diseased teeth to salvage them, such as endodontic therapies. This article aims to outline the basic anatomy and physiology pertinent to the jaws and oral cavity before exploring the rationale and process of tooth extraction, including contraindications and some disadvantages. Throughout the discussion there will be consideration of alternative treatments.
Babesia canis is a tick-borne disease of canids, capable of causing acute lifethreatening disease. Pet travel has brought an increasing number of UK dogs into European countries where the parasite is endemic. This has not only put these dogs at risk of being exposed to the parasite abroad, but also increased the risk of the parasite becoming endemic in the UK. Although, until recently, the UK was thought to be free of B. canis, Dermacentor reticulatus ticks capable of harbouring the parasite are present in endemic foci across the south of the country. This combination of factors has led to a focus of B. canis infection becoming established in Essex, with subsequent cases of babesiosis. This article discusses B. canis distribution and control, as well as identification of ticks that may transmit the parasite.
Feline injection site sarcoma (FISS), formerly known as vaccine associated sarcoma (VAS), is a rare but life-threatening disease. The incidence estimates have varied from one case of FISS per 1000–10 000 cats vaccinated in North America and between one per 5000–12 500 vaccination visits in UK. It has been primarily associated with vaccine administration, but several other injectable materials/substances have been implicated as aetiologic agents, namely lufenuron, penicilin, metilprednisolone, meloxicam, non-absorbable suture material and microchip. FISS can have a long latency period (3 months to 13 years), but 8 years old is the average age of onset. FISS are tumours that arise subcutaneously, reaching a variable number of layers beneath the skin (muscle, bone). They are firm, not painful, solid and variable in size. Clinical assessment and biopsy are the basis for FISS diagnosis. In order to prevent FISS, vaccination should be carefully planned and be provided in easily resectable regions. Hind legs, tail and flanks, are preferable regions for vaccine administration.
IntroductionPlacement of urinary catheters in female canines is a procedure that, once mastered, can easily be performed by qualified, trained veterinary nurses. This is not a completely benign procedure, and adequate knowledge and care must be taken. There is much fear of female catheterisation.
The cat flea Ctenocephalides felis is a source of revulsion, distress and irritation for pet owners worldwide. In addition, C. felis can also cause flea allergic dermatitis (FAD) in susceptible pets as well as significant bite reactions in people. This in combination, with the cat flea’s capability of transmitting a number of vector-borne diseases, makes control of this parasite vital. Veterinary nurses play a key role in educating clients about fleas and putting practical control programmes in place. A crucial component of this is the flea reproductive break point, which if not considered will lead to failure of flea control programmes.This article considers flea control, and the importance of the reproductive break point in ensuring that flea control strategies are successful.
Stages of DCMDCM has been described as having distinct stages (Table 2). The first stage contains dogs with no abnormal findings on echocardiography (echo) or electrocardiography (ECG); however, they are at risk of developing the disease at a later time. The next stage is the ‘occult’ or preclinical stage. During this stage, echocardiographic changes can be seen, such as left ventricular enlargement and/or VPCs can be identified on ECG. However no clinical signs are seen and the animal will generally appear outwardly healthy and normal to the owner. The final stage is CHF, also known as the ‘overt’ phase of DCM. As mentioned, even with optimal treatment, survival time once in CHF is generally very short (Martin et al, 2010).Table 2.Phases of dilated cardiomyopathy (DCM)Stages of DCMClinical findings1. At-riskNormal cardiac appearance on echocardiography and on electrocardiography (ECG), with no clinical signs2. OccultVentricular premature complexes are seen on ECG (a common finding with early stage DCM in Dobermans)And/or Echocardiographic changes start to appear, e.g. left ventricular dilatation3. OvertClinical signs of heart failure, +/- arrhythmiasWess et al, 2011
When collagen is an optionIn veterinary medicine there is a growing trend to select ‘biological’ dressings that create a physiological interface between the wound surface and the environment. Collagen dressings, such as Cyprofil (Pioneer Vet Products) are therefore a real option in the management of hard to heal wounds in dogs and cats See Case study 3.A 5-year-old male Lhasa Apso presented to our specialist veterinary hospital with a 4 cm diameter soft tissue sarcoma on his caudal elbow that required surgical excision. The surgery was initially successful however the wound dehisced and open wound management was started using wet-to-dry dressings, changed on a twicedaily basis. Cultures of the wound revealed a profuse growth of Streptococcus canis, sensitive to amoxicillin clavulanate, so open wound management was continued in combination with oral antibiotics. The wound, located over the olecranon, was in a difficult area to allow primary closure using the adjacent skin due to tension. It was therefore important that a healthy and clean granulation bed of tissue was obtained to enable a thoracodorsal flap placement. A Cyprofil collagen dressing was selected following control of the infection because of the known effects on inflammatory mediators and the proliferation phase of wound healing in addition to the structural support that it provides to the wound bed. The dressing was cut to the size of the wound, facilitating multiple uses of one dressing and applied directly onto the wound bed. The dressing was then secured with a secondary and tertially dressing layer. The collagen dressing was changed every 3 days. The wound was not inspected between these changes to allow integration of the dressing with the wound surface.Eight days later the wound bed had a healthy bed of granulation tissue that was free of infection. Surgery was performed at this point and a thoracodorsal axial pattern flap was elevated to close the wound. This is the first report of the use of a collagen dressing to support a wound prior to the transfer of an axial pattern flap in the dog. The flap healed successfully and at the last re-examination, a year following surgery, the patient was clinically well with no evidence of tumour recurrence or wound problems.Collagen was selected in this wound once the infection had resolved, as the function of collagen in infected wounds is unknown. However once infection had been controlled the benefits of the collagen in this particular case were: the integration with the wound surface, the non toxic and non-irritant properties and the promotion of a viable and healthy bed of granulation tissue that was suitable for flap transfer. The low frequency of bandage changes was also beneficial as it allowed the maintenance of a moist wound environment while reducing the risk of exposure to further infection. In this case the dressing selected was collagen type 1 of fish origin (Cyprofil, Pioneer Vet Products), a licensed product in dogs.1.The soft tissue sarcoma.2.The infected wound just after dehiscence.3.Day 3 of the collagen dressing.4.Day 8 just prior to skin flap.5.Following the thoracodorsal skin flap.6.4 weeks after surgery.
There are a wide number of wound dressing products available on the veterinary market, with each dressing having a specific function in wound healing. In order to use these dressings appropriately, a sound understanding in the processes of wound healing is essential, and therefore which dressing is most suited to the different phase, in order to optimise wound healing. Wound debridement is also a key aspect of wound management, and again, knowledge of the different techniques, and materials, which can be utilised is essential, in order to select the most appropriate approach.