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Dr. Kramer On: Arterial Thromboembolism In Cats
By Dr. George A. Kramer, DACVIM (Cardiology)
Atlantic Coast Veterinary Specialists
Arterial thromboembolic (ATE) disease is a dramatic and potentially devastating condition in cats which results in the patient presenting in an emergent state. Prompt, accurate, and aggressive diagnosis and treatment of these patients when they present to an emergency hospital or critical care facility can have a dramatic effect on the outcome of the case.
All too often the patient is euthanized prematurely in this setting. It is the author's belief that this pattern of early euthanasia reinforces the perception in many clinicians' minds that arterial thromboembolic disease is an almost always fatal condition that should not be treated. This premise is completely incorrect; if treated properly, the patient hospital discharge rate and intermediate-term survival is no worse than that seen for many other critical care conditions (e.g. septic abdomen, pancreatitis, LSA, etc.) that are routinely treated by many of the same clinicians.
Arterial thromboembolic disease in cats is most commonly associated with underlying cardiac disease, but other conditions that predispose to a hypercoagulable state can be also be associated with the disease. In a retrospective review of non-cardiogenic cases of thromboembolic disease seen at necropsy, neoplasia, infectious disease, and inflammatory disease were the most common underlying conditions.
Most of the cats had multiple predisposing factors. Cardiovascular disease is by far the most common predisposing condition in cats with thromboemboli, but it is important not to overlook these other conditions in cats where there is no evidence of heart disease.
The remaining focus of this paper will be on...
You're
Invited: Lecture By Dr. Sikorski & Dinner
All veterinarians and their staff are cordially invited to attend a lecture by Lauren E. Sikorski, DVM, on "Canine Immune Mediated Hemolytic Anemia."
The lecture by Dr. Sikorski will take place on Tuesday, September 22 at 8 PM at Atlantic Coast Veterinary Specialists, 3250 Veterans Memorial Hwy., Bohemia, NY. It will be preceded by dinner
at 7 PM. The lecture is worth two CE credits with NYSVMS.
Kindly RSVP by Thursday, September 17 to 631-285-7780.
The evening is sponsored in part by Abbott Laboratories. |
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AVMA Rejects Policy Change On Ear Cropping
And Tail Docking
The American Veterinary Medical Association last month rejected a resolution that would have revised its policy on ear cropping and tail docking of dogs.
Submitted by the Utah Veterinary Medical Association, the resolution would have eased the AVMA policy which was adopted by the executive board in Nov., 2008 that opposes the procedures when done solely for cosmetic reasons.
The revision would have noted that the procedures, though offering limited or no therapeutic value, are condoned by the American Kennel Club and many members of society. Because of that acceptance, the policy would have stated that it is "imperative that the procedures be performed by trained, licensed, and caring veterinarians using the current standard of care" while continuing to support the elimination of those procedures from breed standards.
The November 2008 policy significantly altered the AVMA's position against the two procedures; previous policy recommended only that veterinarians discuss with clients the cosmetic nature of the procedures before performing them. A major reason for the resolution was to defend veterinarians willing to perform such procedures who might otherwise be ostracized by the profession for going against AVMA policy.
Orthopedic Breakthrough For Multi-Billion Dollar Veterinary Market
TR BioSurgical, LLC reports what it calls "highly encouraging results" using a new medical device -- a bioscaffold implant -- in canine patients with advanced osteoarthritis. Using a very simple procedure, the device is implanted in or near injured tissue and provides a structural matrix for existing repair cells, such as stem cells or fibroblasts, to infiltrate and heal tissue.
The company's veterinarians say they are highly encouraged by the implant's long-term performance, currently evaluated beyond 90 days after a single implant procedure.
The bioscaffold implant contains no drugs, cells, or growth factors. It serves as a structural scaffold for existing cells and provides an environment for physiological tissue repair. The implant is made from a proprietary, copolymerized collagen and is said to be sterile, cost-effective, and non-immunogenic.
Osteoarthritis is the leading cause of disability in dogs and is estimated to affect 25% of the dog population. It is estimated that owners spend over $1 billion each year in the United States just for canine orthopedic-related diseases.
Cardiac Research Shows Diseased Heart Valves
In Dogs Produce Serotonin
A significant part of the question of what causes mitral valve disease in dogs, giving scientists and medical experts clues into new possible ways to treat or prevent the disease, may have been solved by a Colorado State University veterinarian. The discovery refutes the current believe that mitral valve disease -- the top heart disease in dogs -- is inevitable as a part of aging in pets.
Dr. Chris Orton, a cardiac surgeon at Colorado State's Veterinary Teaching Hospital, has been investigating the role of serotonin in heart valve disease in dogs. It has been known for some time that drugs that enhance serotonin production in humans -- such as appetite suppressants, migraine medications, and antidepressants -- cause drug-induced heart valve disease. It turns out that naturally occurring heart valve disease, known as degenerative myxomatous heart valve disease, is virtually identical in dogs and humans.
Dr. Orton's group has discovered that cells in diseased heart valves of both dogs and humans produce serotonin locally, and this may be driving the disease process.
Orton's group is working to discover what triggers the enzyme in the valve that makes serotonin, and he would like to launch a clinical trial on dogs to look at the impact of a drug that inhibits the enzyme that produces serotonin in the heart. More information.
Drug Companies See Opportunity In Pet Generics
Portland, Maine-based Putney Inc. has introduced its first generic drug approved for pets by the U.S. Food and Drug Administration. The painkiller is a generic version of caprofen, whose branded version, Rimadyl, is owned by Pfizer Inc. It is a non-steroidal, anti-inflammatory drug similar to ibuprofen that Putney bought from Northern Ireland's Norbrook Laboratories Ltd. after it was approved.
It's a first step toward the company's goal of developing its own generic drugs for approval by the FDA's Center for Veterinary Medicine. Fully 86% of drugs used for animals have no generic equivalent, so there is a huge potential market, company officials say.
Many of the patents on the drugs have long since expired, and an additional FDA review of a drug for use in pets is a relatively short pathway. For instance, it took three years to develop and gain approval for the painkiller marketed by Putney. Compare that with the 10 or more years it takes to develop a human drug from scratch.
Putney was launched in 2006, and has, until now, been marketing human drugs available to veterinarians, a very common practice. Company officials say they have 20 potential generic pet-drug targets of their own in the pipeline. More information in audio report.
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Funny Bones
Pooches That'll Make You Smile!
Here's a happy guy. We're guessing he's peeked at these
other photos. |
Events Calendar (Aug.-Oct.)
No LIVMA Monthly Meeting in August.
Click here for
other state, national, and global veterinary events in August.
Sept. 9-13
15th Annual Intl. Veterinary Emergency
& Critical Care Symposium
Hyatt Regency, Chicago
Thursday, Sept. 10
LIVMA monthly meeting
Tuesday, Sept. 22
Lauren E. Sikorski, DVM, on "Canine Immune Mediated Hemolytic Anemia"
Atlantic Coast Veterinary Specialists
[7 PM, dinner; 8 PM, lecture]
Click here for more information.
Click here for
other state, national, and global veterinary events in September.
Oct. 1-4
New York State Veterinary Conference
Cornell University College of
Veterinary Medicine
Ithaca, New York
Thursday, Oct. 8
LIVMA monthly meeting
Oct. 12-15
Atlantic Coast Veterinary Conference
Atlantic City Convention Center
Atlantic City, New Jersey
Click here for
other state, national, and global veterinary events in October. |
About Atlantic Coast
Veterinary Specialists
At Atlantic Coast Veterinary Specialists, our commitment is to provide you — the referring veterinarian — and your clients, the best and the latest in modern veterinary
medicine.
Whether it is through our mobile ultrasound service or through our referral and emergency services available, Atlantic Coast Veterinary Specialists is here to work with you as a
partner on those difficult and challenging cases. We look forward to hearing from you.
Please feel free to call any member
of our Board Certified staff for help and assistance.
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QUIZ: What’s Your Diagnosis?
Kira is a 9-year old F (s) Golden Retriever, presented to ACVS as an emergency case overnight due to anorexia, lethargy, two episodes of vomiting, and acute diarrhea of two days in duration.
Kira had a history of eating toys and recently got fed a couple of pieces of bacon. There was no exposure to toxins, drugs, or chemicals. She lives near the beach and is an indoor/outdoor
dog. On presentation, Kira seemed 5% dehydrated, weak, and painful upon palpation of cranial abdomen. Otherwise normal. Initial diagnostics included blood work, abdominal radiographs, and
cPL.
Blood work as follows:
Chemistry
ALT 568U/L (20-100)
ALP 759 U/L (10-90)
TBIL 14mg/dL (0.1-0.6)
ALB 4.5 g/dl (2.2-4.4)
BUN 35mg/dL
CREA 2.5mg/dL (0.3-2.1)
CBC: inflammatory leukogram
Abdominal radiographs were unremarkable and cPL was normal.
Kira was admitted to the hospital for supportive treatment, antibiotics, pain management, and kept NPO. The following morning, Kira was transferred to our internal medicine department and
an abdominal ultrasound was performed. Results included a diffusely mottled liver parenchyma and a very abnormal gall bladder (see images above). Gall bladder was described as severely distended
with a stellate pattern to the sludge. Patient was moderately painful upon examination of the same area. Other organs appeared normal grossly.
QUESTION: Based on these findings, WHAT IS YOUR DIAGNOSIS?
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