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Dialysis

In recent years, the number of academic and private practices offering dialysis has grown exponentially.  The most concentrated region of dialysis centers in the United States is the Northeast.  In Manhattan alone there are now two hospitals that offer dialysis.  This presentation focuses on hemodialysis.  While peritoneal dialysis can be performed without specialized equipment, the procedure requires intensive management, is often accompanied by multiple complications that may hinder delivery of therapy, and is less efficient than hemodialysis. Furthermore, the expense of peritoneal dialysis can equal or exceed that of hemodialysis.  Therefore, the author prefers to utilize hemodialysis when it is available. Currently, in veterinary medicine acute kidney injury is the primary indication for hemodialysis. One of the hallmarks of acute kidney injury is the potential for at least partial recovery of renal function. Therefore, hemodialysis is employed as a means of achieving metabolic stability so that the patient may survive long enough for the kidneys to regain adequate function. When hemodialysis is initiated early in the course of disease (prior to the development of hyperkalemia, fluid overload, and severe acidemia) outcomes (i.e. survival and renal recovery) are far superior to when hemodialysis is utilized as a salvage procedure, long after conventional

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Dry Eye: Keratoconjunctivitis Sicca (KCS)

Keratoconjunctivitis sicca, or “dry eye,” is a condition affecting many cats and dogs, most often older dogs. Some dog breeds are more prone to developing KCS than others: American cocker spaniel, dachshund, English bulldog, Lhasa apso, miniature schnauzer, pug, shar-pei, shih tzu, West Highland white terrier, and the Yorkshire terrier. In cats, the condition is most commonly initiated by feline herpesvirus infection and is a result of decreased tear production and changes in the composition of the tear film. Functions of the tear film include providing oxygen and nutrition, removing waste products and debris, lubricating the eyelids, maintaining a smooth optical surface and providing antibacterial components. Causes There are a number of potential causes of KCS; in most pets the cause is not determined. In dogs, the disease is frequently inherited and presumed to be caused by an immune-mediated attack of the lacrimal (tear producing) gland, especially in those susceptible breeds mentioned earlier. Certain drugs, most notably the sulfa-containing medications, may cause KCS depending on the susceptibility of the pet. Neurologic conditions such as facial nerve damage can also result in KCS. Infection and inflammation of the lacrimal gland may cause it to be temporarily or permanently destroyed. Viral infections

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Feline Iris Melanosis

Iris melanosis is a feline-specific condition where the iris becomes pigmented. The pigment is a result of melanocytes, or pigmented cells, inappropriately replicating and spreading over the iris surface. Iris melanosis is benign, but it can transform into malignant cancer. It should therefore be monitored closely by your family veterinarian and veterinary ophthalmologist. In many cases the pigment first appears as a small, flat and benign nevus, or “freckle,” on the iris. Benign iris pigment is termed “iris melanosis,” which may stay benign for many years, but does have the potential to spread unpredictably. Spreading iris melanosis can lead to secondary ocular complications such as glaucoma and retinal detachments. More importantly, the spreading melanocytes can become so aggressive that they transform into cancerous cells called malignant. Malignant melanoma can spread to other organs such as the liver and lungs and is potentially fatal. Despite researchers’ best efforts, we do not yet have a way to definitively identify when benign iris melanosis is about to transform into malignant melanoma. Most ophthalmologists do, however, consider the following signs “clues” that the pigment is becoming dangerous: rapid pigment spread or thickening and pigment reaching the very outer edge of the iris. If these

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Cataract Surgery

The various surgical procedures for cataract removal are demanding and require meticulous and precise microsurgical techniques. Surgery is performed using an operating microscope and microsurgical instruments. Two techniques are currently used to remove cataracts from the eye. One method involves making a large incision into the eye and removing the entire lens.  The more common method (termed phacoemulsification) allows for a much smaller incision and is the preferred method for lens removal. This procedure involves placing a small ultrasonic instrument into the eye. This instrument generates about 40,000 tiny vibrations per second to fragment the cataract. The lens material is then aspirated out of the eye. Phacoemulsification is associated with a much higher success rate than older methods of cataract removal. Both techniques involve the removal of the damaged lens material. Artificial lenses can be positioned in the eye in place of the damaged lens before the completion of surgery. Pets usually benefit from cataract surgery with or without artificial lens implantation. The decision to place an intraocular lens in the eye should be discussed with your veterinary ophthalmologist and may be affected by factors at the time of surgery. Artificial Lenses Intraocular lenses are often recommended. An intraocular lens

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Brachycephalic Syndrome: Eye Symptoms

Brachycephalic, or short-headed dogs, are characterized by short muzzles, or noses. Common breeds include bulldogs, pugs and Boston terriers. Brachycephalic syndrome is a common condition in these breeds of dogs and can include both respiratory and ophthalmic symptoms. The symptoms associated with the eyes include Shallow orbits (or sockets), causing excessive exposure of the eyeballs and a predisposition to proptosis (when the eyeball is displaced from the eye socket) Excessive eyelid length Relatively poor blink reflex Medial canthal entropion (rolling inward of the eyelids) causing the eyelid hairs to inappropriately contact the cornea All of the above result in a predisposition to corneal ulcerations and pigmentary scarring of the cornea. These conditions can be surgically corrected by a procedure called canthoplasty, which removes a portion of the eyelid in the inner corner of the eye. By shortening the eyelid length, the entropion is corrected and the dog will normally be better able to blink. The net effect is better protection for the eye, decreased corneal exposure and irritation, and improved long-term corneal health. In both cases, the scarring is a result of 1) excessive exposure of the eyes, and 2)  hairs from the lower eyelid entropion constantly rubbing on the

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Cancer: Transitional Cell Carcinoma

Transitional cell carcinoma (TCC) is a cancerous tumor most commonly found in the urinary bladder and the urethra. It is most often seen in older small breed dogs such as Scottish terriers, West Highland white terriers, dachshunds, and Shetland sheepdogs and rarely identified in cats. There appears be a genetic component to the development of TCC, especially in Scottish terriers. Rare cases have been linked with the use of cyclophosphamide (a chemotherapy drug) and chronic exposure to hydrocarbons. Many times a cause is not determined. Symptoms A diagnosis of TCC is suspected when the following symptoms are exhibited: · Straining to urinate or urinating small amounts frequently · Blood in the urine · Inability to urinate (obstructed bladder) These symptoms are not specific for a bladder tumor. Animals with bladder infections or bladder stones may behave the same way. A bladder tumor or bladder stones may be suspected in animals with these symptoms if they have only temporary relief or no relief from antibiotic therapy. Diagnosis It is rare that a bladder tumor can be felt by palpating the belly, and most bladder tumors are not seen on abdominal radiographs (X-rays). Some tests your veterinarian may recommend if a bladder tumor is suspected

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Tracheal Collapse

Tracheal collapse occurs most often in middle-aged to older dogs. The diagnosis is suggested by a honking cough precipitated by activity, excitement or water drinking. Nonproductive coughing may occur without a stimulus. Tracheal collapse results when the windpipe (tracheal) cartilages soften. The trachea should resemble a relatively firm garden hose. Viewed on end, the windpipe is a U-shaped structure with a tight membrane covering the top. Where cartilage softens, it collapses and widens at the top. The membrane then drapes (collapses) loosely, blocking the inside of the trachea. Depending on where the collapse is most severe, this results in an inability to bring air into or out of the trachea and lungs during breathing. Complications of this disease include lung problems, heart disease or heart failure, enlarged liver and chronic kidney insufficiency. Dental infections, elongated soft palate, pneumonia, chronic bronchitis and obesity aggravate the disease. Symptoms Signs vary and include mild to severe panting, respiratory distress and bluish discoloration of the mucous membranes (cyanosis). Abdominal breathing efforts result in tense abdominal muscles. Dogs with tracheal collapse are frequently overweight but may be thin. A heart murmur associated with valvular heart disease is often encountered because both problems occur in aging

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Kidneys: Chronic Kidney Disease and Long-Term Renal Failure

Renal (kidney) failure occurs when the kidney function has deteriorated to such a degree that the kidneys can no longer perform their normal functions of eexcreting wastes, maintaining water and electrolyte balance, and producing hormones. Renal failure occurs in chronic and acute forms. Acute renal failure is of sudden onset and is potentially reversible, depending on the degree of damage to the kidneys. In contrast, chronic renal failure has been present for months to years and is irreversible. Dogs and cats with chronic renal failure cannot be cured, but their clinical signs may be managed to help maintain a reasonable quality of life. Kidneys are composed of many small functional units called nephrons. Dogs, cats and humans are normally born with such an abundance of nephrons that signs of kidney failure do not become apparent until more than two thirds of the nephrons have been damaged. This surplus of nephrons makes it more difficult to detect chronic kidney disease until it is well advanced. As a consequence, chronic kidney failure is often an insidious condition that remains unrecognized until it is severe. Because kidney disease is typically advanced at the time of initial diagnosis, the initiating cause of chronic kidney

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Epilepsy Diagnosis

Pets are diagnosed with epilepsy often only after they have a seizure. Because seizures can be caused by any process that alters the normal neurological function, a definitive diagnosis can be obtained only after the doctor conducts a physical examination, obtains a thorough history, and has the results of medical and/or advanced imaging (CT or MRI) diagnostics, if necessary. Once a diagnosis is determined, the doctor can create a plan to manage and treat the patient. Types of Epilepsy There are three types of epilepsy: Primary or idiopathic epilepsy. This form of epilepsy is one for which no underlying pathology or abnormality can be identified. Typically seen in dogs between one and five years of age, it is suspected that idiopathic epilepsies have a genetic basis. Breeds that are predisposed to idiopathic epilepsy include beagles, standard poodles, Labrador retrievers, German shepherds, German pointers, golden retrievers, keeshonds, Irish wolfhounds and the Belgian sheepdog family. Secondary or symptomatic epilepsy. In these cases, the epilepsy is secondary to a disease process such as a benign or malignant mass in the brain; congenital brain malformation such as hydrocephaly; infectious or non-infectious inflammation of the central nervous system (CNS); cerebrovascular disease; or cranial trauma. Causes

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BAER Test for Hearing Loss

Brainstem Auditory Evoked Response (Baer) Testing Brainstem auditory evoked response (BAER) testing is an electro-diagnostic test used to evaluate the hearing of dogs, cats and other domestic animals. It evaluates the components of the external ear canal, middle/inner ear cavities, cranial nerve and selected areas of the brainstem. It is a non-invasive procedure that takes 5 to 15 minutes to perform. In some circumstances, sedation is used. If the hearing threshold needs to be determined, more often in older patients, general anesthesia is recommended. From small subcutaneous electrodes and externally applied acoustic stimuli of different intensity, we record numerous waves, each of which represents composite neuronal activity. What are the uses of BAER testing? 1. Early diagnosis of hearing loss secondary to cochlear agenesis/degeneration. 2. Assessment of brainstem (caudal part of the brain) function. 3. Conductive hearing loss, which is the result of a dysfunction of the external ear canal and middle ear space. 4. Sensorineural hearing loss, which is the result of dysfunction of the cochlea, cochlear nerve or central auditory pathway. Hearing Loss in Puppies Most responsible breeders of dogs who are high risk for congenital deafness will test litters of puppies before selling them. Such breeds include

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Disk Disease

The spinal column is made up of a number of small bones called vertebrae that are lined up like building blocks. A hole in the center of each vertebra forms a tunnel in which the spinal cord lies. The spinal cord is extremely important because it carries the messages from the brain to the rest of the body. It is also extremely delicate, and the bony vertebrae help to protect it. Between each vertebrae, just underneath the spinal cord, is a little cushion, called an intervertebral disk, which cushions the vertebrae from one another and provides flexibility to the spine during movement. As a part of the normal aging process, these disks deteriorate, resulting in disk disease. Normally, each disk consists of an outer fibrous ring and an inner gelatinous center. (A good analogy would be a jelly donut). With age this “doughnut” changes in consistency; the outer fibrous ring becomes fragmented and the inner “jelly” center hardens to a consistency of hard cheese. The fragmented outer fibrous ring may no longer be able to hold this hard center in place, and movement of the vertebrae on either side may suddenly squeeze the disk out of its normal position. Unfortunately,

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Anticonvulsant Medications

Phenobarbital Phenobarbital is perhaps the most widely used anticonvulsant. It is administered two times per day. A patient on phenobarbital must have blood levels monitored periodically for therapeutic levels and to ensure the drug does not reach toxic levels in the bloodstream. Metabolism of the drug tends to vary widely on an individual basis; therefore, two dogs of the same weight may require vastly different dosages. In general, phenobarbital is considered a safe drug when levels and blood analysis (complete blood count and biochemistry) are performed regularly. Many owners report an increase in their pet’s appetite and thirst when initially placed on phenobarbital. Within the first three weeks of therapy, it is also normal to see mild to moderate sedation, which usually subsides after a few weeks. Liver disease and bone marrow suppression are sometimes seen. Care should be taken with the diets of such patients to help avoid obesity. Because phenobarbital is an addictive drug, it should never be decreased or withdrawn suddenly. Always consult with the doctor before adjusting medication dosages. Potassium Bromide (KBr) Potassium bromide is another frequently used anticonvulsant medication. It is administered by itself or in conjunction with phenobarbital. This is a chemical grade substance

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Cancer: Tumors of the Mouth and Oral Masses

Oral masses can range from benign extra gum tissue to oral cancers. Although sometimes the shape, size and location of oral masses can help predict the type of mass, benign and malignant oral masses can masquerade as each other and even look identical. Depending on the nature of the mass and previous tests performed, further diagnostics may be recommended. In some cases, we may recommend going directly to surgery. What can be done to treat the mass? Once the type of mass is determined, a treatment plan can be formulated. Often treatment will involve some type of surgery. Depending on the origin of the cells and tissue involved, some masses can be simply removed. However, some tumor types are known to project microscopic projections into the surrounding tissues. In these cases, we may recommend a wide, or “radical” excision, meaning we remove the mass with some of the normal neighboring tissue. At times this may mean removing part of the jaw, but these patients quickly adapt and return to their pre-surgical self within days to weeks and the changes in their physical appearance is surprisingly minimal in many cases. We will always submit the mass for microscopic (histopathologic) review to

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Malocclusion

A malocclusion can mean that your pet has a tooth (or teeth) out of place or that the pet’s upper and lower jaws do not line up properly. Malocclusions can affect any breed; however, some breeds, like the German shepherd, are prone to have a shorter lower jaw genetically, so their canine teeth hit the roof of their mouth. Other breeds, like boxers, are bred with a protruding chin to have an intentional malocclusion. Even if a breed is meant to have a malocclusion, there may still be pain associated with the imperfectly positioned teeth or jaw. Why does a malocclusion matter? A pet may appear to look normal but have a painful malocclusion hiding behind those closed lips. Malocclusions become concerning when imperfectly positioned teeth touch the roof of the mouth, another tooth or gum tissue. This traumatic contact can lead to holes in the roof of the mouth, abnormal wearing of teeth and ulcers where tissue is being damaged. The consequent chronic pain and infection can become a quality of life issue for your four-legged family member. Many families report that their pet does not show any signs of oral soreness and “is eating well.” It is important

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Jaw Fracture

Each jaw fracture is different, and consequently, each fracture may require a different treatment. However, prior to addressing a broken jaw, we must ensure your pet is otherwise stable. Sometimes we take X-rays of the chest or abdomen to look for bruising in the lungs or hidden bleeding. Depending on the cause of the fracture (being hit by a car or misjudging a stair height), it is not uncommon to provide supportive care (fluids, pain medications, etc.) for 12-48 hours prior to surgery. This allows your pet to recover somewhat from the trauma. Jaw fracture stabilization and repair is often performed with wire and acrylic splinting. These splints are minimally invasive, meaning we often do not have to make incisions or place pins to put the pieces back together. Often you cannot even see the appliance from the outside. Although your pet will need softened food and no access to chew toys, he or she can often continue to go for walks and partake in many of their usual activities while the splint is in place. And, most pets can eat the night of surgery. There will be some maintenance required to care for the splint (flushing, checking for cracks,

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Feline Stomatitis

Oral health is a very important factor in a pet’s quality of life and can affect overall health. You are making a wonderful commitment to your pet’s oral care. Please be aware that each patient is different; however, we will do our best to determine a treatment plan during your initial visit. Here’s what to expect when you come to visit us. What is stomatitis? Technically, the word stomatitis simply means inflammation (itis) of the cavity (stoma). In this case we are referring to the oral cavity (mouth), and in the case of cats, we are referring to a specific disease condition that leads to severe oral inflammation and pain. Stomatitis is a very complicated condition; however, we do know that it appears to be a hypersensitivity to plaque. For an unknown reason, the immune system over-reacts to the components of plaque or calculus (tartar) and creates significant inflammation, ulceration and pain wherever plaque is found, and in some cases, throughout the whole mouth. Imagine having canker sores throughout your whole mouth every day of your life! How can stomatitis be treated? Unfortunately, since stomatitis does not have a specific known cause, it is very difficult to treat. Many patients

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Root Canal

Oral health is a very important factor in a pet’s quality of life and can affect overall health. You are making a wonderful commitment to your pet’s oral care. Please be aware that each patient is different; however, we will do our best to determine a treatment plan during your initial visit. Here’s what to expect when you come to visit us. What is a root canal? A root canal is a procedure designed to eliminate pain and remove infection from within the tooth (endodontics) and around the base of the tooth at its apex, which is deep within the bone. If you have ever had an abscessed tooth, you know how painful these infected teeth can be! The painful nerve fibers and infected material inside the tooth are carefully removed to create a clean, hollow space. The canal is filled with a sealant and a rubber-like material (gutta percha) in an effort to prevent any communication between the tooth and surrounding bone. The original fracture site (and/or any additional access points that we created) are then sealed, using the same materials a human dentist would use, to prevent any contamination from oral bacteria in saliva. The filling is polished

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Dental Extractions

Oral health is a very important factor in a pet’s quality of life and can affect overall health. You are making a wonderful commitment to your pet’s oral care. Please be aware that each patient is different; however, we will do our best to determine a treatment plan during your initial visit. Here’s what to expect when you come to visit us. Why would my pet need extractions? Extractions are necessary in cases of severe periodontal disease, unsalvageable tooth fracture and tooth resorption. Although we prefer to save teeth whenever possible, it is much better to have no tooth than a painful tooth. Our pets do very well with missing teeth, and often, they do better when the painful tooth is gone. Why can’t my veterinarian perform the extractions? It is important to know that there is no such thing as a “just pulling it” procedure when it comes to a dog or cat’s tooth. Our pet’s teeth are designed to stay in the mouth under extreme forces (think of a lioness taking down a zebra), so it can be very difficult to extract an animal’s tooth. Human dentists who have been asked to help in animal cases have said,

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Heart Medications

Amiodarone Amiodarone is an anti-arrhythmic medication, which may be used to control multiple types of arrhythmias. It has been shown to potentially convert atrial fibrillation back to a normal rhythm. It is only given once daily, after an initial loading period (higher dose for 5-7 days). Side effects include loss of appetite, vomiting, liver failure (which may be reversible if the drug is stopped) and destruction of platelets by the immune system. Angiotensin-converting enzyme (ACE) inhibitors These medications are used to prevent fluid retention. They also help to control some of the hormones that are elevated with significant heart disease and congestive heart failure, as well as prevent fibrosis (scarring) of the heart muscle. Side effects include increases in potassium and kidney values (BUN, creatinine). Either enalapril or benazepril may be used. Atenolol Atenolol is a beta blocker. It may be used to control multiple types of arrhythmias. It can also be used for patients with heart disease such as subaortic stenosis, pulmonic stenosis or hypertrophic obstructive cardiomyopathy to slow the heart rate and allow the heart more time to fill with blood. Side effects include lethargy, weakness and loss of appetite. This medication CANNOT be started or stopped abruptly,

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Pet Food Labels – How to Read Them

How do you choose an appropriate food for your pet? Your best source of nutritional information for your pet is your veterinarian or veterinary technician with knowledge of canine and feline nutrition. These individuals know your pet’s medical history and specific dietary needs. With all the different types and brands of commercial pet food available, choosing the right food for your pet can sometimes be overwhelming. Is there a difference between pet foods named “Beef Dinner” and “Beef Flavor”? How do you compare the “guaranteed analysis” on the label between diets? To help demystify the secrets of choosing the “best” pet food, it helps to understand how to read a pet food label. The Association of American Feed Control Officials (AAFCO) have issued specific rules and guidelines that pet food companies must follow when creating their pet food labels. These labels are comprised of two parts: the principal display panel and the information panel (see later in handout). Principal display panel The principal display panel is the part of a label most obvious to the consumer. It grabs your attention and allows you to identify the product as pet food. The principal display panel legally must contain a product identity,

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