Veterinary Medicine - December 2007 - (Page 781)

or two times a day), good appetites, no weight loss, normal blood work results, and negative results on a fecal examination, treat for the stomach worm Physaloptera species before performing an endoscopic or a surgical gastroduodenal biopsy. Administer fenbendazole orally (75 mg/kg daily) for five days plus one day of pyrantel pamoate orally (7.5 mg/kg). Pyrantel can be given on the same day as fenbendazole. Repeat this treatment in three weeks. These doses are higher than the labeled doses, but I have found them to be successful after numerous treatment failures at the recommended doses. Think Addison’s disease! In my opinion, a serious problem in private practice today is not including sodium, potassium, and chloride concentrations in many in-house serum chemistry profiles. When you examine a young- to middle-aged female dog with a history of intermittent vomiting and lethargy or anorexia, polyuria and polydipsia, or possibly an acute episode of shock, bradycardia is a good indicator of hypoadrenocorticism. The bradycardia may be relative (i.e. a heart rate of 100 beats/min may not seem slow but is in a dog that presents in shock with 10% dehydration). So in these dogs, be sure to measure sodium, potassium, and chloride concentrations to further support the diagnosis, and perform an ACTH stimulation test to confirm it. CATS Suspect food allergy in cats #1 with intense head or neck pruritus. The degree of self-mutilation and excoriation that occurs in cats with food allergy can be dramatic. Other differential diagnoses include ear mites, atopy, otitis externa, and scabies. However, cats with these conditions typically do not demonstrate the same degree of self-mutilation. I recommend a strict novel antigen diet; most patients show dramatic improvement within a few days. Learn to place esophageal and gastric feeding tubes. Cats need feeding tubes in cases of hepatic lipidosis (any tube), esophageal disease such as doxycycline-induced esophageal stricture (gastrostomy tubes), chronic renal failure (any tube), or any other disease that doesn’t affect gastrointestinal function but suppresses a cat’s appetite. I like esophagostomy tubes because they don’t require special equipment and are easy to place. In cats with hepatic lipidosis, use a naso- and red rubber catheters are nonreactive. If you must leave a polypropylene catheter in, administer an antispasmodic such as prazosin from the beginning. All catheters should be attached to a closed, sterile collection system. Use prednisolone in cats, not prednisone. Sometimes cats fail to respond to prednisone because the diagnosis is wrong and they don’t have a corticosteroid-responsive disease. But sometimes they fail to respond because they can’t convert prednisone to the active form, prednisolone. Eliminate the potential for treatment failure based on poor hepatic conversion by giving prednisolone to all cats that require oral corticosteroid therapy from the start. #4 #2 #5 As an alternative to lactulose in cats with chronic constipation or hepatic encephalopathy, try milk or cream. Lactulose is effective because there is no enzyme to digest this disaccharide; thus, the disaccharide stimulates osmotic diarrhea. Most cats are lactose-intolerant and will have a similar #5 A heart rate of 100 beats/min is slow in a dog in shock with 10% dehydration. esophageal tube for a few days to feed and help stabilize these cats before administering anesthesia for esophageal or gastric feeding tube placement. Do not leave a polypropylene #3 urinary catheter in the urethra of an unblocked male cat. Replace it with a polyvinyl or red rubber catheter. Polypropylene (used in Tom cat catheters) tends to be irritating to urethral mucosa and can cause urethrospasm once the tube is removed, often resulting in a cycle of recatheterization and additional irritation. Polyvinyl (used in infant feeding tubes) response to milk. Cats frequently hate the taste of lactulose but love milk. Titrate the dose to soften stools. BONUS TIP A buccal mucosa bleeding time test is a simple way to evaluate predisposed breeds for von Willebrand’s disease before elective surgery. Since von Willebrand’s disease is common in Doberman pinschers, Chesapeake Bay retrievers, Scottish terriers, German wirehaired pointers, and Shetland sheepdogs, presurgical evaluation is prudent and can be inexpensively performed with a buccal mucosa bleeding time test. BONUS TIP Lime sulfur is still the most effective antifungal for treating dermatophytosis. Sure it stinks, but it’s safer than griseofulvin and cheaper than fluconazole or itraconazole. And it more effectively eliminates dermatophytosis than any of those products combined. O REFERENCE 1. Hale DE, Bennett MJ. Fatty acid oxidation disorders: a new class of metabolic diseases. J Pediatr 1992;121(1):1-11. VETERINARY MEDICINE December 2007 781

Table of Contents Feed for the Digital Edition of Veterinary Medicine - December 2007

Veterinary Medicine - December 2007 Contents Letters Editors' Guest Thanking Our Valued Reviewers The Veterinary Medicine Interview: Dr. Joseph Harari Clinical Exposures Idea Exchange Answers to Three Commonly Asked Questions About Lyme Disease Practical Ideas for Managing Common Internal Medicine Problems A Tip for Interpreting Leptospira Species Titers Investigating Proteinuric Kidney Disease Counseling New Puppy Owners: Normal Play vs. Aggressive Tendencies 11 Guidelines for Conservatively Treating Chronic Kidney Disease CE Form Product Preview Advertiser Index Marketplace/Classifieds Mind Over Miller Merial Insert

Veterinary Medicine - December 2007

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