2016 FALL: Fat Cats | Deicing Dangers | Nutritional Support for Ill Patients | EGC Monitoring | Meet criticalist Lisa Powell | Raking in the CE
Those Fat Cats
If you treat enough fat felines, you’ll eventually run across the extreme case of the 23 pounder who can’t seem to lose weight. These pets present so many difficulties that the cards seem stacked against them. Don’t lose heart – there may be techniques you haven’t tried yet, and you may yet get some pounds off of these cats.
- START the case by calculating the daily caloric intake. If this isn’t possible because the cat free feeds, fix that problem!
- Reduce the calories by 20%. It doesn’t matter how low this number is unless it’s below 140kcal daily. Cats can be 50% more or less hypometabolic than our calculated “typical” cat who theoretically maintains a normal weight on 250 kcal daily.
- Choose a high protein weight-loss food rather than restricting a maintenance diet. Avoid the ‘diabetes’ diets; they may be high in protein, but they may also be high in fat.
- Remind the owner that a kitchen measuring cup should be used.
- If multiple household members feed the cat(s), measure out the daily allotment into a sandwich bag. Ensure that the owners make clear to the rest of the family that when the bag is gone, feeding for the day is done!
- If the owner prefers dry food, divide it among meals and toys. A great toy can be made by burning 5-6 holes that are just barely bigger than kibble size out of a plastic water bottle. The acquisition of kibble then incorporates mental and physical energy for every piece. Every meal that is provided in a bowl is a missed opportunity for exercise!
- If the owner refuses to limit free feeding in a household of multiple cats, recommend Meow Space, which separates pets while they eat. Meow Space can be ordered from www.meowspace.biz or 855.636.9772.
- Weight loss can be rapid and simple if the owner allows switching from dry to canned food. Remember that canned food is about 70% water!
- Be aware that the metabolic rate of a cat does slow down as weight loss occurs, and that owners need to understand the looming danger of relapses. Be supportive when helping the owner to maintain weight loss.
- Schedule regular rechecks. Have a technician or receptionist assigned to call for follow-up.
Questions about nutrition? Contact our internal medicine team at either BluePearl in Blaine or BluePearl in Eden Prairie.
As we transition from summer to fall, winter still seems a long way off. But, as we all know, no one can predict that first snowfall, and it often comes long before we expect it. And with the snow, comes the need to deice.
When snow is on the ground, municipalities apply commercially prepared snow and ice melting products. Home and business owners also apply similar chemicals to sidewalks, porches and driveways. Most ice melting compounds contain salt products that can damage vegetation and hard surfaces and are toxic to people and their pets. A national survey shows that 60% of American households use rock salt and salt-based ice melt products, but only about 38% are aware of the hazards. During the winter season, part of our job as veterinary professionals is to educate our clients on the risk these products may pose to their pets.
What are the risks of the ice melting products to pets?
Many ice melting salt products contain sodium chloride. With exposure of the salt to water and low temperatures, an exothermic reaction occurs that causes melting with temperatures generated up to 175°F. This reaction can burn the pet’s foot pads and skin with contact and can burn the mouth and rest of the GI tract with ingestion. Dogs and cats can ingest the salt by licking snow or icy surfaces or by licking their paws after being outside and picking up the ice melting pellets between their toes.
Salt toxicity is also a risk with the salt-based ice melting products. Ingestion of salt can result in high blood sodium concentration leading to thirst, vomiting, lethargy, anorexia, renal damage and possible neurologic signs including seizures, coma and even death. It is difficult to know how much salt is a “toxic dose.” Even small amounts of pure salt can be dangerous to a pet, or even a child, if ingested.
A pet with clinical signs suspected of ingesting rock salt should be assessed by a veterinarian. Serum sodium level will be elevated and reestablishing normal fluid and electrolyte balance may be necessary with fluid support and in-hospital care with 24-hour observation. It is important if hypernatremia is documented that water replacement be managed carefully because rapid shifts in water and electrolytes from the CNS to the peripheral circulation can potentiate neurologic signs.
Are there alternative products that can be safely used?
Salt-based ice melting products are the least expensive. There are other, more expensive formulations that contain potassium chloride, magnesium chloride, calcium carbonate or calcium magnesium acetate. The potassium and magnesium salts are less toxic if ingested but can still burn the foot pads. The calcium-based products do not create an exothermic reaction but still can be drying to the skin surface with exposure.
What advice should the veterinary staff give their clients to protect their pets from deicing products?
There are steps that the pet owner can take to minimize risk for the pet:
- Monitor/modify your pet’s behavior to minimize the risk of salt exposure.
- Use waterproof pet boots during winter walks with dogs.
- Wash off the pet’s feet, abdomen and chest after being outside with exposure to deicing salts.
- Use sand, crushed cinder or cat litter to provide traction on icy pavement being aware that these products will not melt the snow or ice.
- Immediately remove slush and dissolved deicing product after the snow and ice have melted enough.
- Seek veterinary care if you suspect food pad or skin burning from salt exposure or that your pet has ingested a significant amount of a salt product.
If you or any staff members have questions about the winter dangers associated with your patients, please call either our Blaine or Eden Prairie hospitals.
Nutritional Support of Ill Patients
Ill patients have a higher nutritional need than healthy animals. The presence of illness or trauma induces hormonal changes, which cause an increase in the pet’s metabolism. Additional calories are required to fuel the cells involved in healing and protecting the body. Should additional nutrition not be made available, the body will break down its own protein, carbohydrate and fat stores to provide the extra fuel.
Patients not receiving adequate nutrition to support their higher metabolic needs have been shown to develop infection more frequently and to be prone to wound dehiscence. Protein breakdown in the body for energy will adversely affect the functions of the heart, respiratory system and gastrointestinal tract. Compromise to the patient’s organ function further complicates the patient’s health. Studies demonstrate that patients receiving adequate nutritional support have more rapid and successful recoveries from episodes of illness, trauma, and surgery.
Technicians are in an advantageous position to identify patients who may not be receiving adequate nutrition. Within 3 to 5 days of a patient’s inappetance the protein and fat stores required to maintain the health of the patient start to become depleted. Weight loss, the absence of adequate food intake for more than 3 days, weakness and lethargy, low blood sugar levels, and low blood protein levels should all prompt a technician to inquire of the doctor whether additional nutritional support needs to be considered. The more severe the injury, the more compromised the patient’s health prior to the injury, and the chronicity of the injury also factor into the decision whether to pursue nutritional support.
How to Feed
A number of methods are available to feed patients who do not ingest an adequate amount of nutrition. Enteral feeding of patients, if possible, is recommended as it is less expensive and is more physiologic allowing the body to decide how many and which nutrients will be assimilated. Parenteral feeding is typically reserved for patients too debilitated to safely receive enteral feeding or those with nonfunctional gastrointestinal tracts.
The method of enteral feeding utilized in a particular patient varies with the pet’s underlying illness, the disposition and alertness of the pet, the type of feeding tube available, and the preferences of the veterinarian providing the patient’s healthcare. Each method of assisted feeding has its advantages and disadvantages. It is important that technicians overseeing the patient’s care understand the methods and risks associated with the feeding technique utilized.
Methods of Enteral Feeding
Many patients can be coaxed to eat by warming the food, providing a variety of diet types or spoon-feeding.
Appetite stimulants work best in cats with only mild illness. They appear to stimulate the appetite center of the brain. Appetite stimulants tend to be less effective in dogs.
Syringe feeding will work only in very cooperative patients. There is risk for the patient aspirating the food if the feedings are given too quickly.
Nasoesophageal tubes are most commonly used in smaller patients with lower caloric requirements. Limitations to the use of these tubes include the need for a liquid diet and the subsequent volume of food that can practically be administered by this technique. Nasoesophageal tubes are easy to place and require no anesthesia but can be irritating to the nose. Intermittent feedings or a continuous infusion of nutrition (pictured) can be provided by this method.
Esophagostomy tubes are placed into the cervical esophagus through a small incision in the overlying skin. They are easy to place, although general anesthesia is required. Esophagostomy tubes are very safe and allow for the infusion of larger volumes of fluid-based nutrients than can be achieved using smaller nasogastric tubes.
Gastrostomy tubes require specialized equipment to be placed. A number of methods for placement have been described. Mushroom-tipped feeding tubes empty directly into the stomach. Gastrostomy tubes have the advantage of not interfering or causing discomfort around the patient’s neck region. They are especially useful in patients with disease affecting the mouth, throat or esophagus.
Jejunostomy tubes must be placed surgically through the side of the abdomen into the small intestines. They are typically placed when there are concerns for gastric disease, problems with vomiting, or upper GI motility problems. Special diets containing more elemental nutrients which require less digestion must be utilized. A pump is used to continuously infuse small volumes of liquid nutrition so as not to overwhelm the intestines with too much volume.
Feeding tubes should be clearly marked so as to minimize complications associated with their use. An
Elizabethan collar may be required to prevent the pet from bothering the tube.
If you have questions regarding critically ill patients and nutrition, please contact our critical care team at the Eden Prairie hospital at 952.942.8272.
Electrical impulses within the heart are responsible for the coordinated contraction of the cardiac chambers, i.e. the atria and the ventricles. The SA node, also known as the pacemaker of the heart, is responsible for initiating the electrical impulse. The electrical impulse travels along special nerves in the heart wall stimulating the right and left atrial chambers to contract. After a fraction of a second delay at a nerve bundle called the AV node, the electrical impulse then travels along additional nerve pathways into the walls of the ventricles stimulating the ventricular muscles to contract. This directed flow of electrical impulses through special nerve pathways causes a coordinated contraction of first the atria and then the ventricles pumping blood rhythmically out into the arteries of the body.
These electrical impulses also travel beyond the heart into the surrounding body in a predictable direction. Wired electrodes, attached to the body in predetermined locations, will detect the electrical impulses. An electrocardiograph (ECG) machine, to which the electrodes are attached, displays the strength and direction of the impulses on a monitor as they are produced. A printout of the tracing can also be produced by many machines.
Electrocardiography is an excellent means of monitoring the heart rhythm and rate in anesthetized patients. A change in the heart rate can alert technicians and clinicians to the depth of anesthesia or the adequacy of blood perfusion. The presence of abnormal tracings may reflect an underlying heart condition, electrolyte imbalances, or excessive neurologic tone. Many medications can also adversely alter the rate and rhythm of the heart. When observing a patient’s ECG, it is important to be cognizant of trends. The changes observed on an ECG monitor during an anesthetic procedure provide early visual clues that a problem may be developing.
It is important to realize that the electrocardiograph reading only reflects the electrical activity of the heart. It provides no information about the pumping ability of the heart. The effectiveness with which the heart is pumping blood through the body can better be assessed using other monitoring parameters such as blood pressure or pulse strength, oxygen saturation (pulse oximetry), and end tidal CO2 concentrations (capnography). That being said, an excessively low heart rate, excessively high heart rate, or asynchronous stimulation of the cardiac chambers, as noted by an abnormal heart rhythm on an ECG tracing, can interfere with the ability of the heart to efficiently pump blood through the body. Electrocardiography can identify when an abnormal heart rate or rhythm is contributing to poor perfusion.
How to connect an ECG:
Electrocardiograph electrodes are conventionally placed in a standard position on the patient so that abnormalities are easier to detect.
Red Electrode – Left hindlimb
Green Electrode – Right hindlimb
White Electrode – Right forelimb
Black Electrode – Left forelimb
Lead II is the most commonly used setting for evaluating the heart rate and rhythm. Lead II (which measures directional electrical impulses between the right forelimb and left hindlimb) correlates best with the direction of electrical impulse flow in the heart resulting in the best view of the P wave and QRS complex.
To reduce the loss of electrical signal as the electrical impulse travels between the skin and the electrodes, medical jelly is applied between the two surfaces.
|Normal ECG tracing|
Bradycardia: a heart rate less than 60 beats/minute
Sinus tachycardia: an excessively rapid heart rate with normal P-QRST complexes
Ventricular Premature Contractions: heart beats which originate in one of the ventricles. Abnormal nerve conduction through the ventricle causes the QRS complex to be wide and abnormal.
What should you do if you note an abnormal rate or rhythm on the ECG of an anesthetized patient?
- Inform the veterinarian.
- Make sure that the airway is patent and oxygen flow is satisfactory. Adjust oxygen levels as deemed appropriate.
- Assess whether the patient is breathing (or being ventilated) adequately. Check end tidal CO2 (capnography).
- Check the patient’s circulatory status. Helpful monitoring parameters include evaluating the patient’s blood pressure, oxygen saturation (pulse oximetry), pulse strength, and alignment of pulse with the ECG heart beat.
- Consider treatments to reverse hypotension, if present.
- Consider the patient’s depth of anesthesia.
- Consider whether the surgeon is stimulating the vagal nerve.
- Consider medications that may be affecting the heart.
Many arrhythmias and alterations in heart rate will respond to adjustments made to improve oxygenation, ventilation and circulation. If an arrhythmia that is causing hemodynamic instability persists despite such therapy, then specific drug treatments may be required.
Note: It is beyond the scope of this article to describe all the abnormal heart rhythms that can occur in a patient, how to recognize them and what treatments should be considered. It is recommended that individuals responsible for ECG monitoring learn to recognize normal and abnormal ECG readings, so they can bring abnormal readings to the attention of the veterinarian.
For more information on ECGs, contact our internal medicine service.
FROM THE MEDICAL DIRECTOR
Meet Lisa Powell, DVM, DACVECC
Lisa Powell, DVM, DACVECC
“I have always wanted to be a veterinarian, ever since I told my dad when I was 7 years old. I’ve never wanted to be anything else! I love my job!”
Still as enthusiastic about veterinary medicine as that 7-year-old, Dr. Lisa Powell joins the BluePearl team in Eden Prairie after 15 years with the University of Minnesota where she was the intensive care unit director and a professor. After receiving her undergraduate and veterinary degrees from Texas A&M, she completed her internship with Animal Medical Center in New York City and her residency at Tufts University. Her clinical interests include trauma, toxicity and mechanical ventilation cases.
Get to know our newest criticalist…
What keeps you interested day after day?
I enjoy improving the quality of life for critically ill dogs and cats, so excellent patient care is most important to me. I also love working with other specialists to provide the most advanced and intensive care necessary to help our small animal patients. Working with a fabulous staff with great morale is important and keeps me excited about going to work every day!
Describe a patient or case that especially moved you.
When I was an intern, a young dog, the pet of an autistic boy, presented after an OHE, and she had chewed her stitches out. Her intestines had prolapsed, and she needed emergency surgery. She was very sick post-operatively, and it was the first septic abdomen case I managed. The dog did not survive, but the experience solidified my love and passion for emergency and critical care medicine. She was my inspiration, and I hope the pets I’ve helped since then honor her short life.
Describe how you like to interact with the primary care veterinarian.
Collaborating and working together with other veterinarians is one of the things I like most about my job. So, I always enjoy talking with primary care veterinarians to consult/answer any questions about emergency cases or critical patients that they are currently treating. When caring for one of their critical patients, I am a huge proponent of constant and efficient communication. I support daily updates, either with phone calls or treatment/diagnostic report updates that are emailed or faxed.
How do you spend your time away from the hospital?
I enjoy exercising, biking, swimming and hiking. Traveling is fun, especially if it’s to a beach!
Join us for
Our daylong event, October 22 from 8:00am to 2:30pm, at Crowne Plaza Minneapolis West, will feature CE for veterinarians, technicians and practice managers. Topics will include critical care, dermatology, internal medicine, pathology, radiology, surgery, leadership and best practices.
If you have any questions, contact Jackie Todd, firstname.lastname@example.org, or 763.754.5000.
Brought to you by the following sponsors:
AEVS, CareCredit, Elanco, Patterson, Pets Remembered Cremation Services, Zoetis
Please check our online calendar regularly for the most current information about others courses, dates and locations.