Getting to the root of anesthesia-free dental care

64 Pages·2013·32.54 MB·English

The secret
language of
veterinarians
|
Obenski chronicles
the code words
doctors use in
their practices.
page 5
November 2013 | Volume 44 | Number 11 | dvm360.com
save world
Getting to
How veterinary medicine can
the
the root of
anesthesia-free
PART 3: SERVING THE PUBLIC
dental care
S
Natural disasters. Disease outbreaks. cott Mason found his passion in
More veterinarians are Terrorist bombings. When crisis hits, these the bombed-out shadow of the
Alfred P. Murrah Federal Build-
sanctioning cleanings sans veterinarians are on the scene. By John Lof in ing in Oklahoma City in 1995. Lorna
N anesthesia. Here’s what you Lanman heard her passion in the eerie
e
w need to know. By Sarah A. Moser silence of small family farms stripped
s bare of livestock by foot-and-mouth

| Despite the fact that the American Animal disease in northern England in 2001.

B Hospital Association (AAHA) calls pet Carrie McNeil found a way to harness
u
s dentistry without anesthesia “unac- her activist spirit through investigating
i
n ceptable and below the standard of care” and the everything from rabies to malnutrition
e
s American Veterinary Dental College (AVDC) with the Epidemiological Intelligence
s
has issued a position statement warning against Service (EIS), part of the U.S. Centers
|
M its use, the practice is gaining acceptance in the for Disease Control (CDC).
e veterinary community. T e result? A wide range Veterinarians all, Mason and
d
i of opinions and some strenuous objections. Lanman spend most of their time
c
in For one thing, as of Nov. 1, AAHA-accredited in private practice, seeing dogs and
e
practices that don’t comply with this standard cats, taking histories, treating disease

| won’t pass their evaluation. For another, the and behavior problems, working the

P
r AVDC objects altogether to the term “anesthesia- traditional front lines of veterinary
o
d free dentistry,” preferring to call it “nonprofes- medicine. McNeil has worked in
u
c sional dental scaling”—the word “dentistry” is a private practice but now does public
t
s misnomer, they say. But other doctors say some service work full time. When disaster
level of care without anesthesia is better than strikes, when public health is threat-
nothing, and it’s at least a step in the right direc- ened, they’re all three packed up and
tion. Before making your f nal call, read on to see ready to roll. But recently, between
what your colleagues have to say about this issue. crises and disasters, they had a
break—and time to talk with dvm360
It’s better than nothing—isn’t it? >>> Dr. Scott Mason (right) and two task force members about how public service had brought
work on an injured search-and-rescue dog during disaster
“I have clients who are completely unwilling a new passion into the trajectory of
aid operations after the Moore, Okla., tornado this year.
to put their pet under anesthesia either from their veterinary careers.
See page 12> See page 14>
N
o
v
e
m Hey, good lookin’! Swimming with From 3D client Perfecting your
b
e Dealing with a male the fi shes—and education to anal bone fracture
r

2 staffer’s unease starving to death gland supplements repair technique
0
1
3 page 24 page 28 page 30 page M1
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Inside | CONTENT
Volume 44, Issue 11
ON THE COVER
save world
How veterinary medicine can
the
PART 3: SERVING THE PUBLIC
Natural disasters. Disease outbreaks.
Terrorist bombings. When crisis hits,
these veterinarians are on the scene.
Cover, page 14
PLUS
Getting to the root of anesthesia-free
dental care
Cover, page 12
NEWS SPECIAL CONTRIBUTORS MEDICINE360
6 | Medical update 5 | Where did I go wrong? The small animal section begins after page 26.
Circovirus not considered T e secret language of veterinarians
main cause of mystery illness Michael Obenski, vmd M1 | Sugery STAT
Julie Scheidegger Tailor your bone fracture
24 | The dilemma repair technique
“Hey, good lookin’!”
8 | Veterinary headlines Karl C. Maritato, dvm, dacvs
Marc Rosenberg, vmd
Robbery gone wrong: Teen gets stuck
in veterinary hospital’s HVAC M5 | News
28 | Can we talk? Secret to human AIDS vaccine
10 | Dr. Pol captures record-setting Something is f shy about us may be found in feline peptide
Michael Paul, dvm
ratings in fourth season
M6 | Diagnotes
42 | Stampede
Canine urolith epidemiology:
Animal vaccine workers excepted Acting on the f y M1
1981-2012
from federal shutdown Bo Brock, dvm
Carl A. Osborne, dvm, phd,
27 | UF professor arrested for secretly READER SERVICES dacvim; Jody P. Lulich, dvm, phd, dacvim;
Eugene Nwaokorie, dvm, ms; and Vachira Hunprasit, dvm
recording female veterinary students 30 | Products360
Don’t miss the latest in
veterinary products
COMMUNITY
20 | Feedback 41 | Calendar EQUINE360
Letters to the editor Up-to-date info on conferences The equine section begins after page 26.
E1 | Gastroenterology
28
EPE: A growing concern in foals
Ed Kane, phd
E5 | Medical update
Equine veterinary medical news
Kristi Reimer
E6 | News
Infographic: Catastrophic wild
horse population growth ahead?
E1
3
COVER PHOTO COURTESY OF DR. SCOTT MASON dvm360 | November 2013 |
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WHERE DID I GO WRONG?
| Michael A. Obenski,
DVM

Mission
Through its extensive network of news sources,
dvm360 provides unbiased multimedia reporting on
all issues affecting the veterinary profession.
secret language
Neal Award Winner Neal Award Finalist
2006 2006-2012 The
2008-2012
Content Group of veterinarians
Editor/News Channel Director | Kristi Reimer
[phone], [email protected]
Content Manager | Adrienne Wagner
Senior Content Specialists Alison Fulton | Heather Biele, DVM
Associate Content Specialists Ashley Barforoush | Julie Scheidegger
Of all the crazy medical terms T is simply means that the Smiths’ cat, who happens
Assistant Content Specialists Andrea Hewitt | Victoria Biondi
to be suf ering from anemia, is urinating OK, but there
Medical Editor | Heather Lewellen, DVM out there, none are cooler than
are no stools in the litter pan. (We call anemic patients
Technical Editor | Jennifer Vossman, RVT the ones that we make up. Kool-Aids because I tell clients that their pet’s blood is
Editor, E-media | Jessica Zemler
supposed to look like tomato juice, but instead it more
Senior Web Developer | Ryan Kramer
I
’m always glad to hear from a colleague, and such was closely resembles Kool-Aid.)
Multimedia Contributor | Troy Van Horn
Art Director | Steph Bentz the case last week when a classmate of mine from “T at’s exactly the type of thing I’m talking about,” said
veterinary school called me up. I hadn’t seen him Vern. “We veterinarians have a language all our own. We
Advanstar Veterinary
since graduation. T is isn’t unusual, because my atten- should ask our colleagues to send in examples, and see
8033 Flint St., Lenexa, KS 66214 | [phone]
Vice President/General Manager | Becky Turner Chapman dance at class reunions and homecomings would have to what sort of clever responses we get.”
Group Content Director | Marnette Falley improve greatly just to be bad. I told him to consider it done and now I invite you to
Medical Director | Theresa Entriken, DVM At any rate, Vern Acular and I were pretty close at one send your veterinary clinic’s made-up terms and phrases
Director, Electronic Communications | Mark Eisler time, and I was anxious to hear what had prompted him to [email protected]. Vern’s call reminded
Director, The CVC Group | Peggy Shandy Lane to get in touch after all these years. me that it’s been a year since I told you that my friend,
“Mike,” he said. “It’s that silly column you write. T ere’s Arnie, was already working on a new veterinary medical
Sales Group
Sales Director | David Doherty a subject that you ought to address, but I just dictionary. Here are some recent additions:
[phone] | [email protected]
never seem to have time to get in touch. Mr. Clean: T is is a Q-Tip with no
Senior Account Manager Terry Reilly
Even today, we’re having a campout, cotton on the end. T ese are not
[phone] | [email protected]
Senior Account Manager Chris Larsen but I decided to call anyway.” commonly encountered unless
[phone] | [email protected] “Hold it, Vern. You lost me you have a nasty cat in one
Account Manager Angela Paulovcin already. What do you mean hand and your last avail-
[phone] | [email protected]
you’re having a campout?” able Q-Tip in the other. It
Senior Account Manager, Projects | Jed Bean
[phone] | [email protected] “Oh, that’s a term we use becomes problematic when
Sales and Projects Coordinator | Anne Belcher in my of ce, Mike. Rough you put a normal applicator
Books/resource guides Maureen Cannon | [phone] days are called campouts into some orif ce of the cat
List Rental Sales | Renée Schuster because they’re in tents.” and a Mr. Clean comes out.
[phone] | [email protected]
“T ey’re intense? I get it, Can’ticillin: T is is the
Contributing Authors | Advisory Board Vern. You always did have small amount of antibiotic
Christopher J. Allen, DVM, JD | Kenneth L. Marcella, DVM
a way with words. What that’s too little to shake up
Brett Beckman, DVM, DAVDC, DAAPM | Michael A. Obenski, VMD
Jan Bellows, DVM, DAVDC | Carl A. Osborne, DVM, PhD, DACVIM is it that you want me to and draw from the bottle
Anthony Carr, DVM, DACVIM | Karen L. Overall, VMD, PhD, DACVB write about?” but too much to throw
Karyn Gavzer, MBA | Michael Paul, DVM
Marsha L. Heinke, DVM, CPA | Michael H. Riegger, DVM, DABVP “Like I was saying, Mike, away. As your practice
Alice M. Jeromin, DVM, DACVD | Gerald M. Snyder, VMD right in the middle of the becomes more successful, a
David M. Lane, DVM, MS | James F. Wilson, DVM, JD
campout, my reception- larger amount of can’ticillin
Reprints ist informed me that my next patient would be hard to disposal becomes acceptable.
877-652-5295 ext. 121/ [email protected]
handle—a real circus dog.” Kilimanjaro: T is is the large pucker of skin that oc-
Outside US, UK, direct dial: 281-419-5725. Ext. 121
“Stop the music again, Vern. You keep going too fast curs at the ends of large irregular incisions. If you cut the
Subscriber Services for me. What do you mean by circus dog?” extra skin away, the incision length quadruples.
Visit dvm360.com to request or change a subscription or
“T at’s another one of our hospital code words. It Hemastuff: T is is the blackish grunge that forms in
call our Customer Service Department toll-free at
[phone] or at [phone] means that the dog is vicious.” the little grooves of a hemostat. Just as the steam ster-
“I don’t get it.” ilization indicator tells you that proper autoclaving has
“T e pooch will go right for the juggler.” been accomplished, the presence of hemastuf indicates
“OK, Vern, I’m with you so far. Now, what would be that someone on your staf is getting lazy. In my practice,
Chief Executive Offi cer | Joe Loggia
important enough to tear you away from a circus dog it means that the technician was of the previous day,
Chief Executive Offi cer Fashion Group, Executive Vice-President | Tom Florio
at a campout and compel you to call me? If you had a and the doctor was supposed to clean the instruments.
Executive Vice-President, Chief Administrative Offi cer &
Chief Financial Offi cer | Tom Ehardt morsel of free time, I’d have thought that you’d use it to Yesterday, I called Arnie to ask if he had any more
Executive Vice-President | Georgiann DeCenzo make up silly new hospital terms.” veterinary terms for me.
Executive Vice-President | Chris DeMoulin
“T at’s just the point, Mike. Every hospital creates “I’m just too busy and tired to even think about that
Executive Vice-President, Business Systems | Rebecca Evangelou
their own in-house jargon. We should be sharing it. now, Mike,” he said. “I’m exhaustipated.”
Executive Vice-President, Human Resources | Julie Molleston
Sr Vice-President | Tracy Harris Don’t you have examples from your hospital?” T is is, of course, the term to use when you’re too
Vice-President, Media Operations | Francis Heid I had to admit that we often speak our own private tired to give a poop.
Vice-President, Legal | Michael Bernstein language in my of ce. For example, a technician might
Vice-President, Electronic Information Technology | J Vaughn come to me and say, “T e Smith Kool-Aid cat is at high Dr. Michael Obenski owns Allentown Clinic for
Executive Vice-President | Ron Wall tide, but there are no whales on the beach.” Cats in Allentown, Pa.
5
ILLUSTRATIONBYRYANOSTRANDER dvm360 | November 2013 |
mbcyyelaaallcgonkewnta ES337945_dvm1113_005.pgs 10.11.2013 22:15 ADV
NEWS | Medical update
Circovirus not considered
main cause of mystery illness
Tweet this
Scan the QR
code with your Researchers seek explanation for canine cases in Midwest. By Julie Scheidegger
mobile device to
share this article
on Twitter. Right now, researchers know Diseases paper are doing circovirus samples testing positive for circovirus
what the mystery illness isn’t. research. “We share our samples—we at the Diagnostic Center in Michigan
T e primary cause is not canine split them and share them—so that also tested positive for coinfection.
circovirus. However, that doesn’t rule everybody can be working on this to Matti Kiupel, section chief for the
out testing for circovirus and possible get a diagnosis as quickly as possible,” Diagnostic Center’s pathology labora-
coinfections in the hunt for a diagnosis. Forshey says. “We’re still uncertain of tory, encourages veterinarians to do a
T e April release of a paper fo- what the primary cause is.” full diagnostic workup on the samples
cused on canine circovirus published Presently, the only consistent clinical they submit—not just a circovirus test.
in Emerging Infectious Diseases and signs associated with the recent illness “In order to link circovirus to the cause
subsequent reports of an undiagnosed are vomiting and bloody diarrhea, of a disease process, a full diagnostic
illness in Ohio dogs possibly related to which could have a wide range of con- workup (including a postmortem in
tributing factors. Researchers are f rst the case of deceased animals) is essen-
working to rule out common causes. tial,” Kiupel says in a release. “T is also
Forshey says they’ve done that with allows diagnosticians and pathologists
the Ohio cases. “Not many gut lesions, to identify the full spectrum of infec-
intestinal tract lesions, just the bloody tions and/or diseases that are present
diarrhea,” he says of the af icted dogs. in a specif c case.”
“We don’t think there’s a lot of gut T e Diagnostic Center is currently
damage being done.” working on an in situ hybridization
It’s a primary cause that is elud- (ISH) technique. ISH is a method
ing them. “At this point in time we’re that uses DNA or RNA probes to
actually looking at the possibility—a detect virus in microscopic lesions.
very distinct possibility—that this is “What we’re looking for in some of the
a coinfection, not just one organism. lesions—is there something compa-
It may be viruses, it may be bacteria, rable?” Mullaney says. T ey are looking
those sorts of things, but one thing for evidence of vasculitis or evidence
that is unique is this vasculitis,” Forshey of necropsy or infection in lymph node
circo prompted the Diagnostic Center says. “For example, one of the dogs tissue, for example. T ey are looking
for Population and Animal Health at actually had serum oozing through the for any connection to porcine circo-
Michigan State University College of gum tissue. It was very severe damage virus. “Anything that looks like that
Veterinary Medicine in Lansing, Mich., to the vascular system. would be key for us,” he says.
to take steps to add canine circovirus “One of the other dogs also had skin In the meantime, he doesn’t want
to its testing catalog. While still in the loss along the top of the loin area along veterinarians to let pet owners panic.
very early stages of testing, T omas the thoracic vertebrae back into the “T e number one thing they really
Mullaney, MVB, MS, PhD, director of lumbar vertebrae due to lack of blood need to do is calm their clients,” he
the Diagnostic Center, says as of Oct. supply due to this vasculitis,” he con- says. Mullaney encourages veterinar-
7 canine circovirus has been found in tinues. However, some dogs have had ians to do a thorough environmental
two dogs in Michigan. vasculitis and some have not. and diagnostic workup on patients
But really, he says, a positive circo A spokesperson for the Ohio exhibiting clinical signs possibly linked
test tells investigators nothing. In the Department of Agriculture says that to the illness. “Investigate all of the
study published in Emerging Infectious despite present uncertainty around common causes—of which there are
Diseases, both healthy and ill dogs the illness, canine circovirus has been many—so you are not missing the
tested positive for circo. In fact, out of ruled out as the primary contributor common things,” he says.
Zoonotic element?
four ill dogs in Ohio, only one tested of the illness or as the cause of death in Mullaney and the Ohio Depart-
Lindsay Ruland, DVM, owner positive for circovirus. four dogs in the state. ment of Agriculture say there is no
of Emergency Veterinary Tony Forshey, DVM, state vet- Mullaney says all they can say about indication the illness is spreading. At
Hospital in Ann Arbor, Mich., is erinarian at the Ohio Department of the role of canine circovirus at this the same time, he acknowledges that
looking for proof the mystery Agriculture, said in a recent podcast point is that “it potentially might have what they know now may change in
illness she continues to see in that the original samples from infected been involved.” He says the bigger ques- the future. Mullaney is conf dent that
her clinic could be zoonotic. dogs in Ohio were being tested at the tion is, does circovirus play a role in the a diagnosis will be found soon. “My
dvm360.com/mystery.
University of California-Davis, where illness when circo-positive dogs also guess is we’ll get to the bottom of this
authors of the Emerging Infectious test positive for another infection? Both in a matter of weeks.”
6
| November 2013 | dvm360 GETTY IMAGES/HANNELE LAHTI
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NEWS |
Veterinary headlines
Robbery gone wrong: Teen gets
stuck in veterinary hospital’s HVAC
19-year-old spends 11 hours in ventilation system before employees
fi nd him stuck the next morning. By Andrea Hewitt On her day of , Sept. 16,
Barbara Clingman, practice
manager at Small Animal
Hospital in Milwaukee, was at her
house an hour away from the clinic
when she got a frantic call from her
employees. For the
f rst 40 minutes of
the staf ’s shift, they
had dismissed sounds
thought to be from
children playing across
Shane H. Ray
the street. T en one
employee went into the bathroom and
heard someone screaming, “Help!”
Ten employees searched for the
source of the sound to no avail, so they
called 911. T e police found 19-year-old
Shane H. Ray trapped in the recovery
unit of the building’s ventilation system.
T e f re department cut Ray out
of the ventilation unit. Trapped for
roughly 11 hours, he emerged naked
and bleeding. “He climbed on the roof
at 9 p.m. the night before, took his
clothes of and climbed in our ventila-
tion system to try to steal morphine
and ketamine,” Clingman says. “But he
got stuck and we found him in a three-
feet-by-two-feet space.”
Clingman says Ray headed one way,
but the shaft narrowed and he turned
FLEAS around. He then fell 10 feet through
the ventilation system to the ground
level in the recovery unit. “T ere’s a
halo of three-inch screws every four
BEWARE:
feet in the ventilation so he came out
with a lot of scratches,” Clingman says.
Ray inf icted quite a bit of damage to
the ventilation system, which Cling-
man estimated at more than $5,000.
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and tried to claw his way out with no
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gotten out.” She says Ray panicked “like
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�* 99% effi cacy for a full month2 Clingman says the experience was
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man says she’ll keep some controlled
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does break in—say a more successful
1Elanco study B6FUS120002 naked 19-year-old—the clinic won’t be
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| November 2013 | dvm360
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mbcyyelaaallcgonkewnta ES338749_DVM1113_009_FP.pgs 10.15.2013 21:57 ADV
NEWS |
Veterinary headlines
Dr. Pol
captures record-setting ratings
dvm360’s
Commenters on Facebook page rate ‘old-school’ veterinarian subpar.
The fourth season of T e Incred- and ensure that his staf kept adequate
Informal Facebook poll on Pol
ible Dr. Pol premiered Aug. 17 on documentation of telephone calls, treat-
He and his show are an abomination and a blight
Nat Geo WILD and, according to ment records and recommendations to
on our profession. —Mike Paul
Nielsen Media ratings, the show contin- record an appropriate case history. He was
ues to be the cable channel’s No. 1 series. required to complete continued education The only time I would ever tune in would be to
see what NOT to do. —Kelly Czech Tarrido
And the episode that aired on Sept. 14 regarding small animal reproduction and
apparently set the highest rating in Nat ultrasound techniques and interpretation. That is not real life veterinary medicine. Patients
Geo WILD’s history. Grettenberger was also placed on proba- still awake for surgical procedures? Our patients
T e website TVbytheNumbers.com tion for the same incident. At the time of only receive the best care. Just like a human hos-
pital. This is 2013 … not 1983. I feel sorry for his
says the episode Pol’s suspension, three of the four veteri-
patients and their owners. —Laura Vezina Gayle
more than doubled narians at Pol Veterinary Services in Weid-
the network’s Sat- man, Mich., were on probation including I can’t watch. Misinformation, poor diagnostics,
urday night average Eric Gaw, DVM, (disciplined for a separate poor practices. Sets veterinary medicine back 40
delivery, with an incident) who does not appear on the real- years. —Brent Varriale
average of 776,000 ity show. All have since met the require- Though he may be out of date, I still fi nd the
viewers. Viewers ments of the state’s disciplinary actions. show highly entertaining. It is also refreshing to see
tuned in to watch Dr. Pol told dvm360 last year that he a veterinarian not really looking down on a fellow
Dr. Jan Pol Jan Pol, DVM, and plans to continue doing the show for the colleague and instead treating him with respect
while he offers his opinion. —Casey Curtis
his nonveterinarian son, Charles, deal foreseeable future. “You see how many
with an emergency calving with a heifer people love the show and learn from it, Dr. Pol seems like a nice enough guy but he
out in the pasture. Later in the episode, especially the children,” Pol said. needs to attend some continuing education
associate Brenda Grettenberger, DVM, But many veterinary health profes- classes! I watched a few episodes and, as a vet
treated piglets with pneumonia. sionals and animal welfare groups dislike who DOES attend CE, I could not believe some of
the stuff he does! —Susan Nelson
Never shown on the reality series was that Pol is seen as the televised face of
Pol’s 2012 probation involving a pregnant veterinary medicine. T ey have been Dr. Pol’s medical practices are subpar and barbar-
8-year-old German shorthair patient outspoken on blogs and other outlets ic. His license should be pulled. —Catherine Holly
in 2010. T e Michigan Department of about his approach to veterinary practice, There’s enough breeders and groomers that think
Licensing and Regulatory Af airs Bureau termed “old-school” by Nat Geo WILD. they know veterinary medicine more than the up-to-
of Health Professions Board of Veterinary Pol says as long as his patients are pleased date veterinarians. Let alone this HACK making mon-
Medicine found that Pol had failed to ac- with his work and that of his associates, ey on TV. Gives veterinary medicine a bad name …
curately read a canine ultrasound, appro- he doesn’t worry about his critics. “I let hate this show. —Jennifer Pihalja-Drescosky
priately treat the patient and to maintain them blow of ,” he says.
IN BRIEF |
News
Vaccine workers
excepted from
federal shutdown
The shutdown of the federal govern-
ment Oct. 1 held up animal vaccine ap-
proval and distribution for a short time.
The Center for Veterinary Biologics,
part of the U.S. Department of Agricul-
ture, is responsible for verifying animal
vaccines and releasing them into the
marketplace. The American Veterinary
Medical Association warned that a pro-
longed shutdown could endanger herd
health, food safety and public health.
Not long after, U.S. Rep. Kurt Schrader,
DVM, called Agriculture Secretary
Tom Vilsack. “I’d like to think me and
the AVMA pushed them to make a
common-sense decision,” Schrader told
dvm360. By Oct. 8, Sec. Vilsack deemed
CVB employees who approve vaccines
to be “excepted” from furlough.
10
| November 2013 | dvm360
mbcyyelaaallcgonkewnta ES338694_dvm1113_010.pgs 10.15.2013 20:46 ADV