It is always nice to start the year with some good press! Check out “Electronic Consultation: A Tool To Increase Pets’ Standard Of Care” in this month’s Veterinary Practice News.
Cynthia Stubbs, DVM, DACVIM – Small Animal Internal Medicine
Dr. Cindy Stubbs received her DVM from North Carolina State University in 1995. She then went on to complete a one-year rotating Internship in Small Animal Medicine and Surgery at Texas A&M University, followed by a Residency in Small Animal Medicine at Colorado State University (CSU). Her research interest was feline infectious diseases. In 1999, she received a Master’s Degree in Clinical Sciences based on this research at CSU. Dr. Stubbs then worked for 2 years in a large, multi-doctor specialty hospital in Marietta, GA. From 2001-2008, Dr. Stubbs was the owner and internist for North Georgia Veterinary Specialty Care in Suwanee, GA. She currently provides internal medicine services at Triangle Veterinary Emergency Clinic in Durham, NC.
Her special interests in internal medicine include all things feline, especially infectious diseases. She speaks at local, state and national conferences about topics in feline medicine (systemic hypertension, diabetes mellitus, respiratory disease, renal disease, and geriatric care to name a few). She also enjoys working with canine patients, especially with their interesting endocrine concerns.
She currently lives in North Carilona with her husband, Paul Frank, their two young human children Jack and Lily, and their animal children (5 cats and 2 dogs). She enjoys reading and gardening in her “spare” time.
Lisa Cellio, DVM, Diplomate, ACVIM
Dr. Lisa Cellio is a Diplomate of the American College of Veterinary Internal Medicine. She completed her undergraduate education at the University of Notre Dame with a Bachelor’s Degree in biology in 1994. She then attended veterinary school at the Ohio State University College of Veterinary Medicine. She was awarded a Doctorate of Veterinary Medicine in 1998.
Dr. Cellio went on to further her veterinary education with a small animal rotating internship at Michigan Veterinary Specialists from 1998 to 1999. She spent the next three years as an emergency veterinarian in a busy emergency and referral institution. Dr. Cellio completed a three year residency program at Veterinary Specialty and Emergency Center in Overland Park, Kansas. In 2005, she became board-certified as a Diplomate to the American College of Veterinary Internal Medicine.
Dr. Cellio is married and has two young children. The family also includes two Cavalier King Charles Spaniels and one cat. Her hobbies include running, yoga and traveling.
FDA Suspends Temporary Emergency Permit for Evanger’s
Recently the FDA and USDA announced suspension of a permit for Evanger’s Dog and Cat Food Company.
In the statement the FDA reports that:
“Evanger’s, operating in Wheeling, Illinois, deviated from the prescribed process, equipment, product shipment, and recordkeeping requirements in the production of the company’s thermally processed low acid canned food (LACF) products. The deviations in their processes and documentation could result in under-processed pet foods, which can allow the survival and growth of Clostridium botulinum (C. botulinum), a bacterium that causes botulism in some animals as well as in humans.”
A recall has not been announced. But please do keep in mind the possibility of Clotridium botulinum infection in cases presenting with flaccid paralysis who have ingested Evanger’s canned foods.
Christal Pollock, DVM, DABVP (Avian)
Carpenter JW, Pollock CG, Koch DE, Hunter RP. Single- and multiple-dose pharmacokinetics of marbofloxacin after oral administration to rabbits. Am J Vet Res. 2009 Apr;70(4):522-6. PubMed PMID: 19335109.
Michael D. Willard, DVM, MS, DACVIM (Small Animal Internal Medicine)
Farnsworth CC, Herman JD, Osterstock JB, Porterpan BL, Willard MD, Hooper RN, Roussel AJ, Schmitz DG, Fogelberg K, Kochevar DT. Assessment of clinical reasoning skills in veterinary students prior to and after the clinical year of training. J Am Vet Med Assoc. 2008 Sep 15;233(6):879-82. PubMed PMID: 18795847.
Chelsea Greenberg, DVM, DACVIM (Oncology)
Greene SN, Lucroy MD, Greenberg CB, Bonney PL, Knapp DW. Evaluation of cisplatin administered with piroxicam in dogs with transitional cell carcinoma of the urinary bladder. J Am Vet Med Assoc. 2007 Oct 1;231(7):1056-60. PubMed PMID: 17916030.
Greenberg CB, Boria PA, Borgatti-Jeffreys A, Raskin RE, Lucroy MD. Phase II clinical trial of combination chemotherapy with dexamethasone for lymphoma in dogs. J Am Anim Hosp Assoc. 2007 Jan-Feb;43(1):27-32. PubMed PMID: 17209082.
This report is based on video evaluation and conversation with Dr. Smith regarding Fluffy Jones [regarding neurologic signs following ear cleaning].
The video evaluation is as follows: Mentation: BAR, Gait: mild vestibular quality ataxia, occasional stumbling to the right and/or left side, no evidence of UMN involvement or paresis, CN’s: Horner’s syndrome OD-rest NSF and no evidence of spontaneous nystagmus. Postural responses and reflexes were not evaluated. A mild right head tilt was also evident and occasional wide head excursions noted. The patient appears extremely alert and responsive and there does not seem to be evidence of central vestibular disease. However, she is currently on prednisone which may mask some clinical abnormalities.
Denervation hypersensitivity testing should be performed using phenylephrine OU. To confirm that the Horner’s syndrome is indeed a third order Horner’s (i.e. a post ganglionic lesion typically seen with otitis media), phenylephrine drops are used OU and any ocular changes monitored every few minutes. If resolution or near-resolution of the Horner’s occurs in less than 20 minutes, then the lesion is post-ganglionic and would support our presumption that we are dealing with ear disease. If it is between 20-40 minutes, a second order Horner’s must be considered, such as is seen with diseases of the mediastinum. If it takes greater than 40 minutes for resolution, then disease within the cervical spinal cord or midbrain must be considered (which is highly unlikely in this cat).
Since no ototoxic drugs were used to my knowledge, clinical signs likely have resulted from irritation to the sympathetic innervation in the middle ear as well as the vestibulocochlear nerve in the inner ear during the ear cleaning. If so, clinical signs will likely resolve over time but it may take months for the Horner’s syndrome to fully disappear. However, since there is no indication for prednisone in this cat and since prednisone may very well be masking a possible central vestibular disorder, re-evaluation after tapering prednisone is indicated including a full neurologic exam. If signs recur or other signs arise, MRI scanning of the head may be indicated.
Georgina Barone, DVM, DACVIM (Neurology)
American Journal of Veterinary Research
January 2009, Vol. 70, No. 1, Pages 99-104
Hans D. Westermeyer, DVM, Sara M. Thomasy, DVM, PhD, Helen Kado-Fong, MS, David J. Maggs, BVSc
Objective—To detect feline herpesvirus type 1 (FHV-1) in blood of cats undergoing experimental primary herpetic disease or with spontaneous disease presumed to be caused by FHV-1 reactivation.
Animals—6 young specific-pathogen–free (SPF) cats and 34 adult cats from a shelter.
Procedures—Conjunctiva and nares of SPF cats were inoculated with FHV-1, and cats were monitored for 21 days. Periodically, blood was collected for CBC, serum biochemical analyses, and detection of FHV-1 DNA via PCR assay. For shelter cats, a conjunctival swab specimen was collected for FHV-1 PCR assay, and blood mononuclear cells were tested via virus isolation (with or without hydrocortisone) and FHV-1 PCR assay.
Results—All SPF cats developed clinical and clinicopathologic evidence of upper respiratory tract and ocular disease only. Via PCR assay, FHV-1 DNA was detected in blood of all SPF cats at least once between 2 and 15 days after inoculation. Feline herpesvirus type 1 DNA was detected in conjunctival swabs of 27 shelter cats; 25 had clinical signs of herpetic infection. However, virus was not isolated from mononuclear cell samples of any shelter cat regardless of passage number or whether hydrocortisone was present in the culture medium; FHV-1 DNA was not detected in any mononuclear cell sample collected from shelter cats.
Conclusions and Clinical Relevance—A brief period of viremia occurred in cats undergoing primary herpetic disease but not in cats undergoing presumed recrudescent herpetic disease. Viremia may be important in the pathogenesis of primary herpetic disease but seems unlikely to be associated with recrudescent disease.
American Journal of Veterinary Research
January 2009, Vol. 70, No. 1, Pages 16-22
D. M. Boothe, DVM, PhD, A. Boeckh, DVM, PhD, H. W. Boothe, DVM, MS
Objective—To determine the effect of WBC accumulation on the concentration of enrofloxacin in inflamed tissues in dogs.
Animals—6 adult Bloodhounds.
Procedures—Dogs were instrumented bilaterally with tissue chambers. Peripheral WBCs collected from each dog were exposed in vitro to radiolabeled enrofloxacin (14C-ENR). Inflammation was induced with carrageenan in 1 chamber. Ten hours later, treated cells were administered IV to each dog such that 14C-ENR was delivered at a mean ± SD dosage of 212 ± 43 μg. Samples of extracellular fluid from inflammation and control chambers and circulating blood were then collected before (baseline) and for 24 hours after WBCs were administered. Samples were centrifuged to separate WBCs from plasma (blood) or chamber fluid. Radiolabeled enrofloxacin was scintigraphically detected and pharmacokinetically analyzed. Comparisons were made between extra- and intracellular chamber fluids by use of a Student paired t test.
Results—14C-ENR was not detectable in plasma, peripheral WBCs, control chambers, or baseline samples from inflammation chambers. However, 14C-ENR was detected in extra- cellular fluid from inflammation chambers (mean ± SD maximum concentration, 2.3 ± 0.5 ng/mL) and WBCs (maximum concentration, 7.7 ± 1.9 ng/mL). Mean disappearance half-life of 14C-ENR from extracellular fluid and WBCs from inflammation chambers was 26 ± 10 hours and 17 ± 6 hours, respectively.
Conclusions and Clinical Relevance—WBCs were responsible for the transport and release of 14C-ENR at sites of inflammation. Accumulation of drug by WBCs might increase the concentration of drug at the site of infection, thus facilitating therapeutic success.
Veterinary Patholology 46:63-70 (2009)
L. E. Craig, E. E. Hardam, D. M. Hertzke, B. Flatland, B. W. Rohrbach and R. R. Moore
A retrospective study of cases of a unique intramural inflammatory mass within the feline gastrointestinal tract was performed in order to describe and characterize the lesion. Twenty-five cases were identified from archival surgical and postmortem tissues. The lesion most often occurred as an ulcerated intramural mass at the pyloric sphincter (n = 12) or the ileocecocolic junction or colon (n = 9); the remaining cases were in the small intestine. Seven cases also had lymph node involvement. The lesions were characterized by eosinophilic inflammation, large reactive fibroblasts, and trabeculae of dense collagen. Intralesional bacteria were identified in 56% of the cases overall and all of the ileocecocolic junction and colon lesions. Fifty-eight percent of cats tested had peripheral eosinophilia. Cats treated with prednisone had a significantly longer survival time than those receiving other treatments. We propose that this is a unique fibroblastic response of the feline gastrointestinal tract to eosinophilic inflammation that in some cases is associated with bacteria. The lesion is often grossly and sometimes histologically mistaken for neoplasia.
Journal of Veterinary Internal Medicine
Volume 23 Issue 1, Pages 43 – 49
G. Le Traon 1 , S.F. Brennan 2 , S. Burgaud 1 , S. Daminet 3 , K. Gommeren 3 , L.J.I. Horspool 4 , D. Rosenberg 5 , and C.T. Mooney 2
Background: A liquid solution of levothyroxine (L-T4) is available for treatment of canine hypothyroidism.
Hypothesis: Once daily oral administration of a liquid L-T4 solution is effective and safe for controlling hypothyroidism in dogs.
Animals: Thirty-five dogs with naturally occurring hypothyroidism.
Methods: Dogs received L-T4 solution PO once daily at a starting dosage of 20 μg/kg body weight (BW). The dose was adjusted every 4 weeks, based on clinical signs and peak serum total T4 (tT4) concentrations. Target peak serum tT4 and thyroid stimulating hormone (TSH) concentrations, 4–6 hours posttreatment, were 35–95 nmol/L and < 0.68 ng/mL, respectively. Dogs were followed for up to 22 weeks after establishment of the maintenance dose.
Results: Clinical signs of hypothyroidism improved or resolved in 91% of dogs after 4 weeks of L-T4 treatment at 20 μg/kg once daily. The maintenance dose was established in 76, 94, and 100% of dogs after 4, 8, and 12 weeks of treatment, respectively. This was 20 μg L-T4/kg BW for 79% of the dogs, 30 μg/kg BW for 15%, and 10–15 μg/kg BW in the remaining 6%, once daily. Thereafter, median peak tT4 and TSH concentrations were 51 nmol/L and 0.18 ng/mL, respectively, and remained stable during the 22-week follow-up; clinical signs did not recur.
Conclusions and Clinical Importance: All of the hypothyroid dogs had rapid clinical and hormonal responses to supplementation with the PO-administered L-T4 solution. The starting dosage of 20 μg L-T4/kg BW once daily was suitable for 79% of dogs.
Journal of Small Animal Practice
Volume 50 Issue 1, Pages 9 – 14
Radiographic appearance of cardiogenic pulmonary oedema in 23 cats
L. Benigni, N. Morgan* C. R. Lamb
Objective: To describe the radiographic appearance of pulmonary oedema in cats with cardiac failure.
Methods: Thoracic radiographs of 23 cats presented to a first opinion practice with signs of cardiac failure were reviewed. All cats had tachypnoea and/or dyspnoea and enlarged left atrium on echocardiography.
Results: Pulmonary oedema was characterised radiographically by an increased opacity associated with a range of patterns and variable distribution. All cats had evidence of a reticular or granular interstitial pattern. This occurred in combination with alveolar pattern in 19 (83 per cent) cats, including six with air bronchograms, with increased diameter of pulmonary vessels in 16 (71 per cent) cats and with bronchial pattern in 14 (61 per cent) cats. The distribution of pulmonary oedema was considered to be diffuse/non-uniform in 14 (61 per cent) cats, diffuse/uniform in four (17 per cent) cats, multi-focal in four (17 per cent) cats and focal in the remaining one (4 per cent). Nine (39 per cent) cats were considered to have a regional distribution of oedema, including five (22 per cent) with a ventral distribution, three (13 per cent) with a caudal distribution and one (4 per cent) cat with a hilar distribution. The distribution of pulmonary opacities was bilaterally symmetrical in five (22 per cent) cats.
Clinical Significance: The variable appearance of feline pulmonary oedema is likely to complicate its radiographic diagnosis.