Friday, November 25, 2011
Hydrocephalus
Tuesday, September 20, 2011
When is a bladder not a bladder?
My patient, 10 y/o German Shepard Dog, came in with the complaint of incontinence. She was wetting her bed at night, something she had never done. With some extra questioning I found that she had been "off" for weeks with decreased appetite and weight loss. On exam I felt something large in her belly so I called for radiographs and saw this:
On the left side is a large round area that looks like a very large urinary bladder. I asked my technicians to walk her outside and let her pee and she did a lot. But after she came back from the yard a second view looked the same. What was going on? In this case Ultrasound gave me the answer. Sadly, this is a very large abdominal tumor leaning on her urinary bladder. That is what was making her urinate at night. Sometimes it takes multiple tests to get the right answer.
On the left side is a large round area that looks like a very large urinary bladder. I asked my technicians to walk her outside and let her pee and she did a lot. But after she came back from the yard a second view looked the same. What was going on? In this case Ultrasound gave me the answer. Sadly, this is a very large abdominal tumor leaning on her urinary bladder. That is what was making her urinate at night. Sometimes it takes multiple tests to get the right answer.
Friday, September 16, 2011
Diet cures feline hyperthyroidism
When I was still in veterinary school at Tenessee I remember the Internal Medicine folks announcing that C/D diet for cats was going to cure feline cystitis and, "You'll never see another P/U surgery again." It didn't quite work out that way though C/D, S/D and W/D have worked as more arrows in our sling against that troublesome disease. Lately though Hill's has taken it's aim against another killer of cats, Hyperthyroidism.
Standard Hyperthyroid treatments
Traditionally we have had three possible treatments for Hyperthyroid cats: surgery, Radioactive iodine treatment and oral methimazole (Tapzole). Of course the trouble with the three is the first is invasive and expensive, the second requires days away from home and is expensive, the last choice is, at least, inexpensive though it can cause vomiting in any number of cats and at least some fall to severe drug reactions or simply can't stomach it.
What hath Hill's wrought?
So now Hill's thinks that they have the fix for all of these troubles with Y/D (hYperthyroid diet), a severely iodine restricted diet and, by the way, a vegetarian diet. This is really an unusual move as the most recent research seemed to show low iodine levels actually causing hyperthyroidism1
What Hill's did was to put a group of cats with hyperthyroidism and put them on a severely restricted iodine diet. All cats had lower thyroid levels within three months, most were normal. They continued with the kitty's for two years and they all were apparently healthy and continued with normal thyroid levels throughout. So what's the catch? Well, first they can't eat anything else as other foods will have higher iodine levels and thus ruin the effect. Second, no one knows if this will work and be safe for all cats. Nine cats is not a large test group. In early commentary on this diet one board certified veterinary endocrinologist expressed some real concern about Y/D. The iodine restriction is so severe that the cats will be iodine deficient. Clearly this is not a safe food for a normal thyroid cat, is it safe for a hyperthyroid cat to eat for years? "Too many unknowns", he commented.2
So what cats should be on Y/D diet?
Certainly any cat that is too sick for surgery or radioactive iodine treatment and is allergic to methimazole is a candidate for Y/D diet. Perhaps some may be early adopters and want to try Y/D for their cat before even using any of the standard treatment but a long discussion the risks inherent in an untried diet will need to be part of the treatment plan.
1. http://www.ncbi.nlm.nih.gov/pubmed/20800208
2. VIN link
Standard Hyperthyroid treatments
Traditionally we have had three possible treatments for Hyperthyroid cats: surgery, Radioactive iodine treatment and oral methimazole (Tapzole). Of course the trouble with the three is the first is invasive and expensive, the second requires days away from home and is expensive, the last choice is, at least, inexpensive though it can cause vomiting in any number of cats and at least some fall to severe drug reactions or simply can't stomach it.
What hath Hill's wrought?
So now Hill's thinks that they have the fix for all of these troubles with Y/D (hYperthyroid diet), a severely iodine restricted diet and, by the way, a vegetarian diet. This is really an unusual move as the most recent research seemed to show low iodine levels actually causing hyperthyroidism1
What Hill's did was to put a group of cats with hyperthyroidism and put them on a severely restricted iodine diet. All cats had lower thyroid levels within three months, most were normal. They continued with the kitty's for two years and they all were apparently healthy and continued with normal thyroid levels throughout. So what's the catch? Well, first they can't eat anything else as other foods will have higher iodine levels and thus ruin the effect. Second, no one knows if this will work and be safe for all cats. Nine cats is not a large test group. In early commentary on this diet one board certified veterinary endocrinologist expressed some real concern about Y/D. The iodine restriction is so severe that the cats will be iodine deficient. Clearly this is not a safe food for a normal thyroid cat, is it safe for a hyperthyroid cat to eat for years? "Too many unknowns", he commented.2
So what cats should be on Y/D diet?
Certainly any cat that is too sick for surgery or radioactive iodine treatment and is allergic to methimazole is a candidate for Y/D diet. Perhaps some may be early adopters and want to try Y/D for their cat before even using any of the standard treatment but a long discussion the risks inherent in an untried diet will need to be part of the treatment plan.
1. http://www.ncbi.nlm.nih.gov/pubmed/20800208
2. VIN link
Key Benefits
Easy. Effective. Safe.
Clinically proven nutrition to restore thyroid health
Improves thyroid health in 3 weeks* (when fed as the sole source of nutrition)
Complete daily nutrition with a taste your cat will loveAdditional Info
Additional benefits for overall health
Supports kidney health with controlled phosphorus and low sodium
Helps maintain bladder health with controlled mineral levels
Promotes heart health with essential nutrients like taurine and carnitine
Promotes healthy skin and a luxurious hair coat with high levels of omega-3 and -6 fatty acids
IMPORTANT
Because iodine intake from other food sources -- treats, another pet's food, etc. -- can compromise the effectiveness of low-iodine nutrition, it's critical that you follow your veterinarian's feeding instructions carefully and feed only y/d.
Monday, February 28, 2011
Laser Therapy
Below is a summary of my notes and comments from the VVMA meeting this last weekend. My final opinion is, if Laser therapy truly is effective then it should be clearly marked as a medical unit ( anyone can buy these on the internet) and further marked as "experimental" as it is clear to me that we have no clue what we are doing. If it really has effect then we shouldn't be randomly irradiating tissues, if it has no effect then it needs to be a door stop. Luckily, you have an in-house expert. :-)
Laser therapy is currently used to treat anything. Really, anything. As with any modality there's not a chance that it works for everything and Dr. Godeine does not claim it does though he is very insistent that it does work. He gave a case study of a dog with TCC that he had surgically removed, it returned with a vengeance and, additionally, the dog was in heart failure and renal failure. He discontinued all pharmaceuticals and started laser therapy with a LED belt type unit similar to this one Cold laser pad. The dog went back to eating and drinking and followup US showed regression of the tumor. The dog lived another year before being PTS.
LASER EQUIPMENT
The equipment available include:
Lasers:
SLD: (Super Luminous Diode)
LED:
Wow, talk about unclear. The definition: The use of light energy in the 600 to 1000nm range to promote homeostasis in damaged or diseased tissue resulting in tissue healing and pain modulation.
The theory is that light waves penetrating the skin activate Chromophores in mitochndria. The chromophores activate enzyme systems causing some biological effect. Proposed mechanisms would be:
Arndt-Schultz Law is another important factor in dosimetry.
Set the machine to a likely setting and run with it. Keep in mind the basic principle that pain relief requires higher doses and stimulating wound healing requires lower doses.
**Have a sick animal, hepatitis, renal failure, what not. Set the laser to the doses above and aim at large muscle masses. This should give general stimulation and encourage good health and better appetite .
Just for fun:
Try manual settings on the laser set to 8 Joule and use that as a nerve block for dentals. It takes effect in about 60 seconds and lasts for 48 hours. Dr. Godine has not tried this for declaws.
Laser therapy is currently used to treat anything. Really, anything. As with any modality there's not a chance that it works for everything and Dr. Godeine does not claim it does though he is very insistent that it does work. He gave a case study of a dog with TCC that he had surgically removed, it returned with a vengeance and, additionally, the dog was in heart failure and renal failure. He discontinued all pharmaceuticals and started laser therapy with a LED belt type unit similar to this one Cold laser pad. The dog went back to eating and drinking and followup US showed regression of the tumor. The dog lived another year before being PTS.
LASER EQUIPMENT
The equipment available include:
Lasers:
- Monochromatic and coherent light
- Narrow spectral width
SLD: (Super Luminous Diode)
- Monochromatic and less coherent
- Broad spectral width
LED:
- Monochromatic and incoherent
- Broadest spectral width
Laser light what does it do?
Wow, talk about unclear. The definition: The use of light energy in the 600 to 1000nm range to promote homeostasis in damaged or diseased tissue resulting in tissue healing and pain modulation.
The theory is that light waves penetrating the skin activate Chromophores in mitochndria. The chromophores activate enzyme systems causing some biological effect. Proposed mechanisms would be:
- COX inhibition
- Decreased cellular apoptosis.
- Stimulation of monocytes and macrophages
- INFRARED light penetrates the deepest into tissue and is best for musculoskeletal pathologies
- RED light is best for superficial lesions such as wounds.
- Blue and Green light have antibacterial properties.
Have your cake and eat it too.
Arndt-Schultz Law is another important factor in dosimetry.
- A weak stimulus will elicit a strong reaction.
- A medium stimulus causes a modest reaction
- A moderately strong stimulus usually inhibits the system slightly.
- A very strong stimulus can strongly inhibit the system.
Bottom line: What do I do?
Set the machine to a likely setting and run with it. Keep in mind the basic principle that pain relief requires higher doses and stimulating wound healing requires lower doses.
- Superficial wounds and general biostimulation@ target depth*: 2-4 J/cm² not to exceed 5 J/cm².SLD’s and LED’s work well.
- Subacute inflammation or chronic pain: 5-10 J/cm² at target depth*. Low Frequencies.
- Acute inflammation and pain: 12-36 J/cm² at target depth. 2500-5000 Hz for inflammation and 2-20 Hz for pain.
- Systemic immune stimulation of Blood: Red and Infrared 4J/cm2 and at 700-2500 Hz.**
**Have a sick animal, hepatitis, renal failure, what not. Set the laser to the doses above and aim at large muscle masses. This should give general stimulation and encourage good health and better appetite .
Just for fun:
Try manual settings on the laser set to 8 Joule and use that as a nerve block for dentals. It takes effect in about 60 seconds and lasts for 48 hours. Dr. Godine has not tried this for declaws.
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